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Veterans Affairs’ Shinseki Answers Hard Questions

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This is ALL THINGS CONSIDERED from NPR News. I'm Robert Siegel.

MICHELE NORRIS, host:

And I'm Michele Norris.

All this week, we've heard a series of reports on the new wave of veterans -men and women who have served in Iraq and Afghanistan. They have presented the Department of Veterans Affairs with new challenges: A bigger, younger clientele and more women than ever before. There are also more vets with brain trauma and more with post-traumatic stress.

Today, we'll hear from the man who's trying to reinvent his agency, so that it can meet the needs of these new vets, the secretary of the Department of Veterans Affairs.

SIEGEL: General Eric Shinseki brings impressive credentials to his office. He was Army chief of staff. He was the one who said we would need hundreds of thousands of troops in Iraq. Incidentally, he is the first American of Asian ancestry to achieve a four-star rank. His family is Japanese-American. And he's no stranger to the problems of veterans. In Vietnam, a land mine took off part of his foot.

I sat down with Secretary Shinseki earlier this week in his office to ask about his attempts to overhaul the VA.

General Shinseki, welcome to the program.

Secretary ERIC SHINSEKI (Veterans Affairs Department): Thank you. It's good to join you.

SIEGEL: And in addition to my questions, I want to put to you what some of the veterans have told our reporters with their stories this week in the series. For example, we'll begin with Brian Hawthorne, a veteran who's been waiting for two years for your agency to process his claim for PTSD. He told our reporter this.

Mr. BRIAN HAWTHORNE: They kind of all stem back to the same thing, which is just wait. So whether it's G.I. Bill or medical disability claim, you have this impression that the VA will get to it, and that is unfortunate because – and I say this all the time – we have to realize that, well, if the VA is not your friend, who is?

SIEGEL: How do you fix a culture of the Department of Veterans Affairs so that veterans like Brian Hawthorne just assume that the Department of Veterans Affairs is their friend?

Sec. SHINSEKI: Well, I would, you know, explain to Brian that it's more than just about friendship. This is an obligation that the nation owes those who have served. And by my responsibilities, I am the one charged with ensuring that those obligations are met. And we look at this as a relationship with clients, not just customers. Customers have an opportunity to shop around and decide which choices they want to, you know, exercise.

And relationship with a client is different. Clients have already invested in this relationship. Our obligation now is to fulfill that obligation. And so to Brian's concerns about how long it takes to process some of these things, my concerns as well. It's what we've been after for the past year. Some of this has built up over time, but we intend to do something about it.

SIEGEL: As our reporter John McChesney reported this week, the number of outstanding claims at the VA for service-related disabilities – injured limbs, PTSD, brain trauma – is around half a million, and nearly 40 percent of those have been waiting on the decision for over four months. How do you deal with the backlog? How do you break down that backlog?

Sec. SHINSEKI: Well, I'll accept those numbers. They seem to fall into the rough categories, I recall. I would tell you that last year we processed 977,000 claims, and then received about a million new claims in return. So this is not a case of, you know, case is sitting for extended periods of time. We do exceed the 125-day mark, and a number of those, but we move them as well.

SIEGEL: The figure that our listeners heard was about 40 percent exceed that four-month mark.

Sec. SHINSEKI: That's correct. This is a big numbers game. And so, we have to take a bold approach to this. In the past, our approach has been more claims, hire more people. You want to go faster, hire more people. Today, we have 11,400 persons adjudicating claims. Now, that's a significant number. We have just received authority to hire about 4,000 more people to help us in this area.

At some point, we have to get beyond just sort of the brute-force approach to this, and we have to get better business processes, automation in place. We have to change the relationship between VA and the veteran where they see us as advocates for them.

And so, the level of trust is better, because for every claim we adjudicate where the veteran feels there is a requirement to appeal the decision, well, it just compounds the numbers that we're dealing with.

SIEGEL: Our listeners heard this week that the first encounter, the beginning of that relationship, for the veteran with the VA is here's your 23-page application that you have to fill out and not a symbol of advocacy right there. More like, you know, what are you all about, fellow? Can you do anything about that? Or is it inevitable that your first encounter is a mound of paperwork?

Sec. SHINSEKI: Well, I'm one of those who went through that process, so I have firsthand knowledge about, you know, what that means. It's not a good welcome, and we intend to do something about that. We have to simplify the process and get our decisions down to what are the essential elements of information we need to adjudicate a claim at a high quality on behalf of the veteran.

SIEGEL: I want to play you something that we heard during this week's series. This is something about the burden of proof resting with the veteran. Vietnam veteran John Wood was an Army reconnaissance scout and says it took him from 1972 to 2006 for the VA to admit that he had a post-traumatic stress disorder. Here's what he said.

Mr. JOHN WOOD: I was, you know, having nightmares and flashbacks. I couldn't get along with people, a lot of anger issues. They were saying that I couldn't prove that I had any sort of combat status in Vietnam. And so, therefore, it couldn't possibly be post-traumatic stress disorder because I wasn't in combat, which I was.

SIEGEL: I know that you can't comment on Mr. Wood's case, but can the VA actually shift the burden of proof? Can it change that in any way?

Sec. SHINSEKI: Well, I think much of what I bring to this responsibility is I'm part of the same generation he is, and so I have a good number of friends who went through the process of trying to have some of their issues recognized.

PTSD was, at that time, not something that was recognized, so I think that was probably widespread. And yet throughout history, you know, whatever we want to call it, PTSD has always been part of what combat soldiers for sure, sailors, airmen, Marines, for sure, have dealt with. But as the environment of warfare has changed, there are no safe areas today as we describe them in Iraq and Afghanistan.

Well, those stresses apply to more than just the combat frontline soldiers. And that's part of the adjustment here, both to the fact that PTSD is a real issue and that many more are exposed to the level of stress that produces these outcomes.

SIEGEL: That if somebody served in a country where there could be an IED or a car bomb any place, stress is not just for those who are out on the – whatever we call, the frontline today.

Sec. SHINSEKI: Sure. In fact, we are putting in place recognition of the fact that under the current operation, service in the combat zone itself can be seen as a precursor for PTS.

SIEGEL: Our listeners this week also heard from Carolyn Schapper, who is an Iraq veteran, who told our reporter about asking a counselor at the Washington, D.C. VA hospital for a women's-only-counseling session. Here's what she said.

Ms. CAROLYN SCHAPPER: A young female veteran walking through the VA is very aware of herself because it's mostly Vietnam vets. All their heads turn, they're all watching you. And so, it's uncomfortable to walk to the back of the hospital to get to this clinic. Because if you have experienced military sexual trauma, that's the last thing you're going to want to do.

SIEGEL: And Schapper asked why not have a separate entrance for the women's clinic? This is a change in your clientele. You have now, I believe, 12 percent female veterans coming out of Iraq and Afghanistan.

Sec. SHINSEKI: Actually, it's a little higher, Robert. I think the active component is 14 percent and reserve component I believe she may be a reserve component soldier – as high as 17 percent. So, yes, the population is changing.

In 10 years, we're going to be probably 15 percent women. Today, we're about 5, maybe 6 percent, so pretty significant.

SIEGEL: It sounds like a huge change.

Sec. SHINSEKI: Oh, it is a change. And 10 years is not all that much time, so we are beginning this process. We have appointed women's program coordinators at 144 of our medical centers. They're important because they are the folks that are going to help us understand what programs we need to create and put into place in the next 10 years. And that's everything from integrating women's health care into primary clinic areas or creating a women's clinic, free-standing clinic that take care of women alone.

The reason I give you those two offers is because we've already started this discussion. And in some cases, you know, the women at one hospital want a clinic. In other cases, they choose not to, they'd rather be integrated into the primary care just like everybody else. And where that's their preference, that's what we try to do so that we're not coming up with a cookie-cutter approach to everything.

SIEGEL: In the last election, John McCain often proposed that veterans be given a card, which would give them portability, and they should take it to any medical center in the country and get treated. It seemed to be an alternative to saying how do we keep on building veterans facilities to accommodate this growing population.

And a lot of veterans didn't like that idea. They wanted their own system, a discrete system. What is the future of that idea? Do you assume that there will be always a discrete medical system for veterans? Or could there or should there just be a benefit you get, which gets you your health care for the rest of your life?

Sec. SHINSEKI: This is a good question. I would offer that there will still be major conflicts in the future of this country. It's not assured, but there is some opportunity for those kinds of concerns. And as long as we have that potential, I just think you need a health care system that's prepared to deal with the large-scale consequences of that and not find out after the fact that we've given up capabilities that, with good reason, were put into place after large conflicts like World War II, Korea and Vietnam.

This is about meeting the obligation, as I indicated, to the veterans. And it's also a business proposition. But the obligation is an important part of this.

SIEGEL: Well, General Eric Shinseki, secretary of the Department of Veterans Affairs, thank you very much for talking with us.

Sec. SHINSEKI: Thank you, great pleasure. Thank you, Robert.

SIEGEL: And you can hear the other stories in our series on Veterans Affairs at our website, npr.org.

(Soundbite of music)

MICHELE NORRIS, host:

This is NPR.

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