they carry a chart around with me called the "failed assumptions chart." it shows the numerous times over the past 10 years where we made assumptions either about the war, projection, or structure and have been wrong. we have been wrong or 100% of the time. as the saying goes, expect the unexpected. we must also be prepared for a scenario due to an unforeseen contingency for ground forces, soldiers do not have the time they need to rest and recover. we will need to find ways to help them as well. take a look at this next chart. as i mentioned, the vast majority of our wounded warriors are suffering from post-traumatic stress or traumatic brain injury. yet most of us do not recognize these injuries. in fact the injuries we believe are most common, mainly amputations and burns, which only represent 10% and 2% of the population respectively. the truth is because we cannot see these injuries affecting the brain, they do not receive the same level of focus and attention as deputations, burns, shrapnel, and other visible ones. there is simply a body -- bias in the conscious or subconscious towards visible wounds and injuries towards those that are not visible. i would be careful in qualifying that bias. it exist everywhere, including in the medical community. part of it, i believe, is a problem -- lack of understanding of the physiology behind these injuries. they are, in fact, real injuries no different from bullet wounds, amputations, or severe burns. everywhere i go, i get a tanker's explanation of these injuries. i will spare you that today. a big part of the challenge is the validity of the symptoms. they may display symptoms including concentration problems, personality changes, and memory impairment. we need to better understand how to differentiate between them and, at -- and most effectively treat them. recognizing that it very well may make matters worse if the individual is misdiagnosed. the lack of improvement or the worsening of symptoms can be incredibly frustrating for the patient and for his family members. another challenge we are seeing with respect to injuries of the brain is the latency of symptoms. unlike a broken leg or a shrapnel wound that is immediate the jig immediately apparent and, in most instances, can be treated and he'll in a short period of time, the latency of symptoms that is common to brain injury often results in diagnosis and treatment. unfortunately, the time between when the injury is incurred and when it is actually diagnosed and treated properly can be fraught with related symptoms such as irritability, problems concentrating, anxiety, and depression. the onset of whatever the element, whatever the incident and it is the causes posttraumatic stress, it is 12 years before someone seeks their first treatment. a bunch of bad stuff happens in the 12-year interval. fortunately, many of our nation 's brightest men and women from academia, industry, and the medical industry, nonprofit organizations, and government as a whole are working tirelessly in this important area. together over the past decade we of made tremendous progress in what has been largely uncharted territory with the development of effective protocols, imaging methods, their peace, and protective devices. we have also made great strides within our own ranks. among our many and others, we have created a pain management task force and campaign planned to adopt best practices army- wide. we have issued much needed guidance in critical areas such as pharmacy management and pain management. our medical command recently changed several policies regarding the number of prescriptions, medications, and the duration for which a prescription may be considered talent -- valid. this has led to a decreased use of prescription medication, specifically narcotics and psychotropic medicine. at walter reed, for example, psychotic usage has decreased from over 80% to 8.5% in the last year and a half among our wounded warriors. this is a good news story. we are doing our best to replicate it at other army escalations. the problem is having people who are trained in alternative pain management who can work these reductions. this type of challenge will help us decrease the number of accidental overdoses, medication diversion, and drug abuse. these are important elements of the army's holistic medical campaign plan. over all we of that -- made great progress. although i could talk for hours about individual efforts, that is not to say there are problems where there is still significant room for improvement. the reality is we as a department and a nation will be dealing with the symptoms and effects of these injuries for decades to come. make no mistake, this is where your money will be spent. if you are one of those people that that is the only thing that turns you on, okay. this is where it is going to be spent. when you looked at those numbers, when you looked at 66% of my most severely wounded soldiers, that is where you are going to be spending your money. we have learned many lessons coming out of vietnam. we have all seen pictures of veterans penniless, homeless, living under bridges. that was and is unacceptable. the reality is, these are not new injuries or injuries unique to this war. they have been around since before the civil war. we know this from research that has been done on the topic of post-traumatic stress. for those of you who have not seen it, i highly encourage you to watch the hbo documentary "war-torn." it provides an amazing account of the impact of these injuries on individuals in past wars. there is a segment of film where a group of world war ii vets that is especially interesting, particularly for someone like me whose father fought in the war and never talked about his experience. i would like to show you a short clip of humorous -- of humor. it is part of a retained by the late comedian george carlin. >> i do not like words that conceal reality. i do not like euphemisms or euphemistic language. american english is loaded with euphemisms. americans have trouble dealing with reality. americans have trouble facing the truth so they invent a kind of soft language to protect themselves from it. it gets worse with every generation. i will give you an example. there is a condition in combat most people know about. it is when a fighting person's nervous system has been stretched to its absolute peak and cannot take any more input. it has either snapped or is about to snap. in the first world war, the condition was called "shellshocked." simple, honest, direct language. two syllables -- shellshocked. it almost sounds like the guns themselves. that was 70 years ago. then a whole generation went by and the second world war came along. the very same combat condition was called "battle fatigue at "four syllables. it takes a little longer to say. does not seem to hurt as much. fatigue is a nicer word in shock. shellshocked -- battle fatigue. then we get -- then we have the war in korea. my lesson -- madison avenue was riding high at that time. the very same combat condition was called "operational exhaustion." we are up to eight syllables now. the humanity has been squeezed completely of the phrase. it is totally sterile. operational exhaustion. the supply something that might happen to your car. then, of course, came the war in vietnam, which is only been over for 16 or 17 years. thanks to the lies and deceit surrounding that war, it is no surprise the very same condition was called "post-traumatic stress disorder." still eight syllables, but we have added a hyphen and the pain is buried under jargon. i bet a crystal calling it "shellshock," some of those vietnam veterans might have gotten the attention they needed at the time. >> the person who tried to educate america about battle fatigue after a war ii was none other than audie murphy. audie murphy got hooked on a sleeping pill and locked himself in a hotel room in denton, texas for over a week to get himself off of it. he went around to veterans groups talking about what was called "battle fatigue." he did not have a lot of success in raising awareness. to overcome the stigma that exists related to these and visible wounds and to avoid the same outcome on the other side of this war, we must continue to study and learn while raising awareness of programs and support services put in place to make sure the men and women who suffer from these are care -- cared for properly in the event they are injured or in need of help. this is particularly important as it pertains to our reserve component soldiers. the reality is we are able to more effectively influence those soldiers serving on active duty and help them mitigate the stressors affecting this. it is more debacle to do this in the case of individuals not serving on active duty. they are often geographically removed from a support network provided by military installations. they lack the ready camaraderie soldiers and daily oversight and hands-on assistance of members of the chain of command. in many cases, these soldiers have limited or reduced access to care and services. meanwhile, they are more vulnerable to the challenges of an adverse stock economy -- an adverse economy and a troubled labor market, especially for our young people. we are continuing to work this issue very, very hard. we are not going to rest until we learn how to bridge the divide in the reserve component. we are looking for further ways to expand the accessibility to programs that are positively impact in the lives of soldiers serving on active duty and their families. this is an absolute priority. that said, we recognize the best long-term solutions are at local level. with the citizens of our nation of the committees. towns, cities, support networks, colleges, universities, industry, and health care groups. there are private, public, updates based -- faith based whose sole desire is to care for veterans and their families. members of the fellow -- members of the military are limited by law, in what we can and cannot do with respect to supporting or promoting these organizations. we rely on others to help spread the word and rally around our soldiers, sailors, airmen, marines, and coastguardsman. so that when a young man or woman least the military and regret -- returns home, we can be certain they will be embraced by the committee and given the support needed to integrate back into the lives of those they left behind i will quickly mention one final topic and open it up for questions and discussion. as i mentioned, after nearly a decade of war, our soldiers are fighting the effects and many will be dealing with the injuries they sustained for decades to come. this clearly represents a readiness issue. consider cents january 2008, the number of of soldiers in the disability system has increased 169% to write around 20,000. the reality is that number is actually probably closer to double that factor if you figure in the number of soldiers who are not yet enrolled, but are, nevertheless, not deployable. some people are going to be given a p4, a prominent profile. they will have a profile for up to six months. they will enter back into that portion of the service we can deploy. others will not. they will remain in that population and finally enter the d.e.s. that is one of the effects of 10 years of war. that is what happens. 1% of the population fights a 10-year war. meanwhile the average time it takes to get an active-duty soldier through the disability evaluation system is 373 days. needless to say this is too long. the system is complex, disjointed, and confusing. dod is working closely with the department of veterans affairs along with the military services to make needed improvements. i will tell you that i am pleased and encouraged to see the level of collaboration to date. the new disability evaluation system is not perfect, however, it represents a step in the right direction as we work together to address these issues. all of them affect our readiness. we must address them accordingly, not as an army or department, but as a nation. we recognize it will be a requirement to reduce the size of our force in coming days as we work through forecast and budget cuts and the drawdown of forces in iraq and afghanistan. that said, we must make these reductions smartly. whatever the size of the army, it must remain trained and ready. we must not accept anything less. history has shown us to expect the unexpected. we must always be ready and prepared when called upon to meet our obligation to the american people and that is to fight and win our nation of three wars. i appreciate the opportunity to join you. thanks for what you do each and every day. i will be happy to answer any questions you might have. [applause] >> thank you. questions? >> in the panel before lunch we had a wounded warrior tell us they thought one of the things that needed to be done was for the services medical system to talk to one another, -- talk to one another. there has been a lot of the of the talking to a va. that has some ways to go, but what about the services talking to each other? >> and general amos is who i started with on this long journey. the protocols affect all services. general dunford is my partner today. i do not think the relationship between the ground forces has ever been any greater. the air force and the navy are, in fact, asking us and they have participated fully in the development and implementation of the protocols. like anything it takes time to do those things, but i think we are a lot further down the road in ensuring that as a joint force we recognize posttraumatic stress and brain injuries. we like to, beat up on ourselves. the problem is the things associated with this thing is civilian life. it is real. i am talking to 500 people in this room today. 400 of you really get it and really believe it. 100 of you are saying, not really. they are just plain the system. i know that is true because i briefed every formation that these in the united states army. it is like when you talk to the reserve components. no matter how wonderful the army is towards the reserve components, there will always be 10% that believe they are not getting what the active component guys do. on the other side, the research at the same problem in looking at the active component guys. it is just the way human nature works. the stigma associated with these is very difficult to get people to understand when you cannot see that injury. we can see with imaging techniques. we are starting, at least i am hearing in the research i am reading, that we can see images of the brain. the issues are huge. i am really thanked -- i really think we have come a long way with all the services looking at these, but that is not to say there are not still falls out there that just do not believe it is real. sir? >> sir, one of the things i am wondering is is there any thought of coming up with some special line items to cover these costs you are going to incur because they are born to be enormous relative to what they have been in past -- they are going to be enormous relative to what they have been in past wars. that line item, no one is going to insist that you reduce i would not think. >> you are exactly right. we are just beginning to understand the second and third order effects of 10 years of conflict. we are just beginning to understand the second and third order effects of fighting for 10 years. there have always been volunteers in our forces, but we've never done it with all volunteers. we have done it with all volunteers and we have at -- as opposed to do it multiple deployments. these are real costs that we are going to incur. i think the absolute think i would ask you to do is if you see anybody cutting back on brain research, you raise up like a phoenix and attack them. that is really the problem. get on google and find an article or the services are criticized for not taking proper care of folks to of lost an arm, leg, or limb grid all you'll find is the wonderful job we are doing with prostatic innovation. but every week there is an article on how we are uncaring critic comes to the care of prisoners -- post-traumatic stress and brain injuries. the problem is the science is so immature. there is no file marker for a concussion yet. we are about a year and a half away from having a file marker using a device not unlike what a diabetic use -- uses it to inject blood sugar. it will say definitively for us this individual as a concussion. do you know how to use that will be? that we know that they have a concussion? or do not have a concussion? what we need to do is continue to push for the research in this area and understand the brain. i believe that will help with a lot of our other problems. if you are familiar with what and the key is doing up in boston. she is looking at the mutation of protein at collection in the brain and people who go through significant contested events, like football players and sponsors. that has a tie to what she things -- i think she thinks. i do not want to put words in her mouth. could have a direct connection to alzheimer's. what happens to folks with alzheimer's? we need to be forcing everybody to continue all the research and good stuff that is being done to understand the brain. positron emission tomography and what that allows us to do at looking at concussions. put up the slide real quick. the first one about brains. this is a picture using positron emission tomography. three brains from three different in individuals. this shows us this is an injury. on the right is your normal brain. 20% of the energy created by your body. that is what it looks like when it is functionally normal. 15%-25% of the energy created by the body is burned in that brain. the brain in the center is an individual that hasn't comatose for five days. that is what their brain looks like. he a soldier is comatose on the battlefield, we are getting them to medical care. with two minutes in 42 such as much to go on a field 100 yards long -- somebody told me it is 55.79 yards or something. clusters the with 55. 55 yards wide with cameras and ankles and doctors and everybody who rush out and bring him in at halftime and say, "you are good to go. to apply the second half." he is stressing out that night. somebody comes up to him and says, "if you have any symptoms tomorrow morning, i want you to come to the emergency room. that was a pretty nasty hit you got." guess what? he went in. they went to the doctor and explain these systems. the ticket picture of his brain using positron emission tomography. that is what is brain looked like. that is the problem. at that individual goes out and receives a second concussion before the brain has returned to normal, the chances for cognitive impairment grow exponentially. we need to continue this kind of research so we understand this more. i would ask you all to force that point home. tied for one more question, i guess. you guys have to get back. the real food is out there now. >> my name is andrea sawyer. i am the wife of a medically retired soldier. he was 70% permit. my question to you is is there in the works in a system that would financially protect us when we are forced to be medically retired? for a lot of us, we are not getting put out of the military with our husbands on able to work. we are having to leave our jobs to take care of them and our financial futures are threatened. my husband was put out at 70% permanent. that is a $1,300 check. while we wait for that the a rating, we are burning through our lifetime savings waiting for something that has already been decided on one side of the house. we do not have any financial protections in that situation. we are in it -- at the mercy of a va system that says "wait for us." is there a look at reforming that wages for people who