department of veterans affairs + + + + + veterans … - fpow...9from to start with. 10 so just...

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DEPARTMENT OF VETERANS AFFAIRS

+ + + + +

VETERANS BENEFITS, COMPENSATION, AND PENSION SERVICE

+ + + + +

FORMER PRISONERS OF WAR ADVISORY COMMITTEE

SPRING MEETING

+ + + + +

WEDNESDAY, MAY 17, 2017

+ + + + +

The Advisory Committee met in theSoutheast Louisiana VA Medical Center, Room1Q115, 2400 Canal Street, New Orleans, Louisiana,at 9:00 a.m., Robert Certain, Chairman,presiding.

PRESENT:

ROBERT CERTAIN, Chair LANE CARSON HARRY CORRE ROBERT HAIN SHOSHONA JOHNSON COLONEL HAL KUSHNER JEFFREY MOORE SHIRLEY QUARLES


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ALSO PRESENT:

LESLIE WILLIAMS, Designated Federal Officer DR. ERNEST SNEED DR. KIRK MARTIN STEPHANIE REPASKY COLONEL MURPHY NEAL JONES, USAF ANTHONY SMITH LA'TOYA PRIEUR ERIC ROBINSON MARILYN CORRE LISA COLE LUCINDA COLLINS KAREN JAMES

* via telephone


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T-A-B-L-E O-F C-O-N-T-E-N-T-S

PageOpening Remarks by Chairman Certain. . . . . . . . . . . . . 4

Introductions. . . . . . . . . . . . . . . . . . . 5

Administrative by Ms. Williams. . . . . . . . . . . . . . .18

Secretary Report by Dr. Repasky . . . . . . . . . . . . . . .25

Office of Advisory Committee Management by Ms. Burney. . . . . . . . . . . . . . . .84

Advisory Committee on Disability Compensation by Dr. Martin. . . . . . . . . . . . . . . .96

Benefits Assistance Service by Ms. Prieur. . . . . . . . . . . . . . . 145

New Orleans Regional Office Director by Mr. Bologna . . . . . . . . . . . . . . 172

State of Louisiana Department of Veterans Affairs by Mr. Peters and Mr. Holcombe . . . . . . 208


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1 P-R-O-C-E-E-D-I-N-G-S

2 (9:58 a.m.)

3 MR. CERTAIN: Being the kind of guy I

4 am, I'd like you all to stand and pledge

5 allegiance to the flag.

6 (Pledge of Allegiance)

7 MR. CERTAIN: All right. Welcome to

8 New Orleans. I want to thank Lane for yeoman's

9 work and working with the VA here to get things

10 scheduled and setup a few months in advance of

11 when we anticipated being here, and for those of

12 us who were able to get here.

13 As you know, when we left San Antonio,

14 we were planning on being in Washington at this

15 point, but that changed because of the cost.

16 This was less expensive than Washington, so our

17 plan is to allow -- so we're here now and our

18 plan is to go to San Francisco in August, and

19 we'll talk about that later in the agenda, and

20 then next year will be at central office,

21 probably in the spring of the year.

22 Maybe Dr. Shulkin will have his feet


5

1 on the ground by then and be able to meet with us

2 and report in. We have a pretty easy agenda this

3 time, including tomorrow. We'll go over to the

4 World War II museum and spend the afternoon over

5 there, and then have dinner together tomorrow

6 night.

7 We'll finish up before noon on Friday

8 so we can all go back to wherever it is we came

9 from to start with.

10 So just because we've got folks here

11 from the VA Medical Center, let's introduce

12 ourselves to them and then ask them to introduce

13 themselves to us. I'm Robert Certain. I'm the

14 Chairman of the committee. Been on the committee

15 for a few years and Vietnam is my prison

16 experience. Dr. Quarles.

17 MS. QUARLES: I'm Shirley Quarles.

18 I'm 28 years of Army service, a retired Colonel,

19 and I've been on this committee for, this is my

20 second year, so it's certainly an enjoyment to

21 work with these former prisoners of war. I am

22 not one.


6

1 COL. KUSHNER: I'm Harold Kushner. I

2 retired after 26 years in the Army. I was a POW

3 in Vietnam for five and a half years. I'm a

4 physician. I'm an ophthalmologist. I practice

5 in Dayton Beach, Florida. And I have been on

6 this committee, I think, four years, four or five

7 years.

8 DR. HAIN: Bob Hain. I'm a retired

9 Navy doctor. I spent 27 years in the Navy and

10 then had the pleasure of being a former Executive

11 Director of the Mitchell Center for POW studies

12 in Pensacola. Glad to be here.

13 MR. MOORE: I'm Jeff Moore. I'm a

14 retired Navy neuropsychologist. For the past 28

15 years, I've been associated with the Robert E.

16 Mitchell Center in Pensacola, Florida, and thanks

17 to Dr. Hain's retirement five years ago, I've

18 been privileged to be an Executive Director for

19 the past five years. I think that's why they sat

20 us so close.

21 MR. CARSON: Good morning. I'm Lane

22 Carson. I guess the only local amongst the


7

1 committee here. I was born and raised about 70

2 years ago right down Magazine Street, near the

3 hotel in the uptown part of our great city, and

4 certainly, we're so excited that all of you are

5 here and getting to see this wonderful hospital.

6 Certainly, the Director and his staff

7 have been working very, very hard to make this

8 conference for us and to give us a great tour

9 this afternoon. As the Chairman said, the D-Day

10 Museum is tomorrow afternoon, and hopefully some

11 good Cajun food and music may be following that,

12 if we can work that out, but I'm at least going

13 to be with you all, honor and a privilege as an

14 old Vietnam combat platoon leader, to be with you

15 great heroes.

16 And we may have Colonel Murphy Neal

17 Jones coming later, one our local POWs who was in

18 Hanoi for over seven years. He should be

19 attending later today, but glad to have you with

20 us. And two words of caution now, whatever you

21 do, don't lose all your money at the casino,

22 possibly in the hotel, and of course, if you're


8

1 down on Bourbon Street, as an old assistant

2 district attorney, call me up, I'll be glad to

3 help you any way I can, but thank you, Mr.

4 Chairman, for having us.

5 MR. CORRE: My name is Harry Corre.

6 Former POW for three and a half years in Bataan

7 and Corregidor. I'm presently working at the Los

8 Angeles Medical Center for the last 15 years.

9 And very happy to be joining this crowd. Thank

10 you very much.

11 MS. JOHNSON: Shoshona Johnson. Iraq

12 POW. I guess I'm a pediatric, as I was told last

13 week. It's been a long time since I heard that.

14 Retired Army and retired, retired. I ain't

15 working for nobody. I just volunteer my time as

16 much as possible to keep myself busy. And this

17 my last meeting.

18 MR. CERTAIN: No, you have one more.

19 MS. JOHNSON: Are you kidding me?

20 Isn't that what you all told me last time.

21 MR. CERTAIN: All rotations are

22 scheduled for 1 October each year.


9

1 MS. JOHNSON: They didn't tell me I

2 got one more.

3 MR. CERTAIN: It's like catch-22.

4 MS. JOHNSON: Okay. I guess not. I

5 guess you all stuck with me for another meeting.

6 MS. WILLIAMS: Well, good morning,

7 everyone. My name is Leslie Williams. I'm an

8 Air Force veteran, and I'm also your Designated

9 Federal Officer. Very happy to be here.

10 MR. CERTAIN: She is a much maligned

11 Designated Federal Officer and is working under

12 difficult circumstances, I think, because she's a

13 geographically separated marriage. Your

14 husband's a Marine?

15 MS. WILLIAMS: Yes.

16 MR. CERTAIN: And a wife. And the

17 kids are with him.

18 MS. WILLIAMS: Just one.

19 MR. CERTAIN: Just one.

20 MS. WILLIAMS: Yes. Single. One

21 child.

22 MR. CERTAIN: Single. The kid.


10


2 MR. CERTAIN: So periodically, she

3 actually goes to stay in Hawaii, which is a tough

4 thing, but somebody has to do that to keep the

5 marriage together, and then has to rely on other

6 people. Eric Robinson is still her backup and

7 then we'll get to him in a minute, but our

8 recorder over here, remember when you speak, say

9 your name first for his benefit so that the

10 minutes will be accurately reflected. Okay.

11 Yes, sir.

12 MR. CORRE: Mr. Chairman.

13 MR. CERTAIN: Mr. Corre.

14 MR. CORRE: I know that she's the

15 pediatric, but I'm the old man. I just turned 94

16 1st of May.

17 MR. CERTAIN: Okay. How about, Eric,

18 introducing yourself and then we'll get to the

19 staff here?

20 MR. ROBINSON: Okay. Good morning.

21 Well, my name is Eric Robinson. I'm an Army

22 veteran. I'm the Assistant DFO to Leslie for the


11

1 committee. Been on the committee for about three

2 years now, and I'm just glad to be here.

3 MR. CERTAIN: Okay.

4 DR. SNEED: Good morning, everyone.

5 My name is Dr. Ernest Sneed. I'm a staff

6 physician here at the New Orleans VA. Been on

7 staff for 40 years. I also have training.

8 Obviously, a chance to interact with World War II

9 POWs. We had a big outreach for that program as

10 well. Welcome to New Orleans. Did my undergrad

11 here.

12 Just a warning, following up on Mr.

13 Carson's comments, one of our Tulane alums made

14 it on the T.V. show Jerry Springer, got his idea

15 from Bourbon Street.

16 MS. BURNEY: Good morning, everyone.

17 I'm Jelessa Burney. I am out of the Office of

18 the Secretary by way of the Advisory Committee

19 Management Office, and I am actually the program

20 specialist that oversees your committee and work

21 alongside your DFO and your ADFO, and I will be

22 bringing greetings to you later on on the agenda.


12

1 MR. CERTAIN: So you work with Ms.

2 Moragne?

3 MS. BURNEY: Yes. That's my director.

4 MR. CERTAIN: Welcome from Washington.

5 Who are you and why are you here?

6 MR. STEVENSON: Fred Stevenson. I'm

7 the chief of plans and outreach for the New

8 Orleans VA Medical Center, and I'm part of the

9 council that scheduled this or put this operation

10 together.

11 MR. CERTAIN: Thank you for being

12 here. How about all those people up around the

13 podium? Oh, wait a minute. Over here.

14 MS. SCHLESINGER: I'm Annaliese

15 Schlesinger. I'm with the Senator Kennedy's

16 Office.

17 MR. CERTAIN: With whose?

18 MS. SCHLESINGER: Senator Kennedy.

19 MR. CERTAIN: Oh, okay. Good. Thank

20 you. Military aide or advisor, what's your

21 position with him?

22 MS. SCHLESINGER: I'm the regional


13

1 director.

2 MR. CERTAIN: Oh, okay. Good.

3 Thanks. Welcome.

4 MS. MERINO: I'm Anne Merino. I'm an

5 ER Medical PVT.

6 MS. COLE: Hi. I'm Lisa Cole. I'm a

7 28-year Army veteran, retired 1st Sergeant. I

8 work here in the ER office.

9 MS. COLLINS: Hi. I'm Lucinda

10 Collins. I'm Mr. Rivera's Executive Assistant.

11 Welcome to New Orleans, and Mr. Rivera sends his

12 regrets. He's actually in DC working on a new

13 initiative with the Secretary, and he really

14 wanted to be here, but when duty calls, you got

15 to go, so he's in DC. Thank you for being here.

16 MS. JAMES: I'm Karen James. I am the

17 Equal Employment Opportunity Program Manager. I

18 am a Air Force retiree and I am very happy for

19 you all to be here.

20 MR. CERTAIN: Thank you. And, Harry,

21 do you want to introduce your bride? Or shall

22 she introduce yourself?


14

1 MR. CORRE: This is my wife, Marilyn.

2 MS. CORRE: How do you do, everybody?

3 MR. CORRE: Three and a half years in

4 prison camp, 30 years here.

5 MR. CERTAIN: You've all had a chance

6 to review the agenda? Have any questions about

7 it? I encourage you to look under Tab 2, review

8 your own bio. You might want to correct some

9 errors, like, it says I was in the Army. That

10 has to be correct, doesn't it? And bios of the

11 folks sitting around the table are under Tab 3.

12 Four has to do with who we are as a committee.

13 The committee members, the handbook

14 that we've seen before is in here again, and the

15 various slides we'll be reviewing. Leslie.

16 MS. WILLIAMS: Yes. Good morning,

17 everyone. So first I want to welcome everyone to

18 Advisory Committee meeting. I am super excited

19 to see everyone. I apologize for the technical

20 difficulties that we've been having. So if the

21 phone blows up and just starts beeping, ignore

22 it. We're trying to get it under control.


15

1 So I'm excited because we're going to

2 try something new at this committee meeting,

3 something we've never done before. So

4 originally, I came up with the idea for us to

5 play bingo. However, due to some schedule

6 changes, my briefing has actually been bumped to

7 the last day, so I redesigned it so it's going to

8 be bingo with a twist.

9 So I'm going to give everyone in this

10 room a card. Throughout the meeting, you're

11 going to hear several presentations, so it's very

12 important that you pay attention, and you're

13 actually going to mark the squares, based off the

14 presentations, and on the last day, who has the

15 most squares get a prize.

16 MR. CERTAIN: We have even more people

17 coming in.

18 MS. WILLIAMS: So that is Mr. Joe

19 Sincero. He is the FPOW partner. So you will be

20 hearing from him a little later on in the

21 meeting, I believe tomorrow, and then this is

22 La'Toya Prieur. You'll be hearing from her later


16

1 on today.

2 MS. QUARLES: How do we mark this?

3 Every time we hear something?

4 MS. WILLIAMS: Yes. I have little

5 squares. I'm so sorry, so if you're not a

6 committee member, you can't sit at the table.

7 I'm so sorry. So that's what the chairs around

8 the room are for.

9 Okay. So for everyone else, I'm just

10 going to pass this around and you can take a

11 square. And so I have one last thing. I want to

12 give a special thanks to Mr. Carson. He was

13 very, very instrumental in helping me plan this

14 meeting. So on behalf of the committee, we have

15 this for you, Mr. Carson. It is something to

16 thank you for everything that you've done for us

17 and in making this, which will be, probably, the

18 best committee meeting ever.

19 MR. CARSON: I know that, Ms. Leslie.

20 Thank you so much, and how was Dooky Chase's last

21 night?

22 MS. WILLIAMS: It was closed. Yes.


17

1 So for those of you all who don't know. I am a

2 Louisiana native. I grew up in Baton Rouge, went

3 to college here at UNO, so it's my alma mater.

4 So last night I was trying to treat my director,

5 or my chief, to a traditional Southern cuisine at

6 this restaurant called Dooky Chase, we got there,

7 it was closed. Yes.

8 And so the most fascinating thing

9 about this restaurant is the cook, she's 93 years

10 old, and she's still cooking, which is why a lot

11 of people like to eat there. The food is very

12 good, but also the fact that she's 93 and still

13 cooking. So did anyone have any questions for me

14 before I yield the floor back to the Chairman?

15 MS. JOHNSON: You got Dooky Chase

16 beat. You 94. You 94 and still working. You

17 good.

18 MS. WILLIAMS: And just as an

19 announcement, so for anyone who just came in, if

20 you can please sign in right there. And for the

21 speakers, I will give you your binders. If

22 there's nothing for me, I yield the floor back to


18

1 the Chairman.

2 MR. CERTAIN: Well, goodie. Stephanie

3 Repasky is on the agenda next. Is that person

4 here? Okay. She's not due until, like, 10

5 o'clock, so we're running a little bit. So move

6 ahead with the agenda kind of quickly, if she can

7 come in, or what do you want to do?

8 MS. WILLIAMS: So I believe her staff

9 is going to get her. I guess, in the meantime,

10 while we waiting for Dr. Repasky to come, we can

11 take care of some administrative business. Yay,

12 everyone loves administrative.

13 So the photos that I gave you,

14 everyone earlier, as I said, those will actually

15 be something that you will go through when, we'll

16 probably use her briefing, however, at this time,

17 if you can sign the first document and just give

18 it to me, and this is what I'm going to use for

19 the honorarium.

20 MR. CERTAIN: You want the whole

21 Social Security number or just put the last four.

22 MS. WILLIAMS: No, just put your last


19

1 four.

2 MR. CARSON: Mr. Chairman?

3 MR. CERTAIN: Yes.

4 MR. CARSON: If I may, I just noticed

5 a neighbor of mine that just walked in the door,

6 and this fellow is well-respected. Let me tell

7 you that. He's not only Mr. POW here in

8 Louisiana, but he's our guy who knows all POWs.

9 If anybody's been here, he spent seven years in

10 Hanoi Hil, and if anybody knows that when you

11 help POWs, that's Colonel Neal.

12 COL. JONES: Murphy Neal Jones.

13 MR. CARSON: Murphy Neal Jones, yes,

14 and his wife.

15 COL. JONES: And my wife Linda.

16 MR. CARSON: Good to see you. The

17 Chairman invited you all to come, and the

18 Director, to be with us today, and we just

19 started our meeting. Mr. Chairman, would you

20 fill in?

21 MR. CERTAIN: We look forward to

22 getting to know you in November.


20

1 MS. WILLIAMS: So one of the things I

2 did want to announce is, Mr. Milligan is going to

3 be joining us via Microsoft Lync, and so he's

4 going to dial-in, but he did want me to pass on

5 to the committee his apologies for not being able

6 to attend in person.

7 MR. CERTAIN: He's having his roof

8 replaced and it was -- he had been waiting for

9 some months and they showed up with the roofing

10 materials last -- end of last week, was that when

11 it was?


13 MR. CERTAIN: And so he decided he

14 needed to be there when it was happening, so he's

15 at home and has access to phone and computer, but

16 didn't feel comfortable leaving his house alone.

17 So we'll count him present when he calls in.


19 MR. CERTAIN: Leslie, do you have any

20 part of your briefing you want to go over since

21 we have a few dead minutes?

22 MS. WILLIAMS: It's going to take a


21

1 little bit longer.


3 MS. WILLIAMS: Because I'm giving the

4 VBA 101 briefing, but I do have something I would

5 like to put forth in front of the committee. I

6 was doing to discuss this on the last day, but I

7 can just squeeze it in now.

8 So as everyone knows, we have a few

9 members who are going to be rolling out within

10 the next year or so, so I would like, at this

11 time, to solicit, if you know anyone who's

12 interested in participating on this committee, if

13 you can please send me their contact information,

14 because I'd really like to start the process now

15 and fill those -- find those individuals.

16 MR. CERTAIN: And we need to keep

17 about five people in the pipeline. The rotation

18 schedule, we moved everybody -- so all the

19 rotations will occur as of the beginning of a

20 fiscal year, and then in order to set it up so

21 there's an even -- the same number of people

22 every year rotating off and on to the committee,


22

1 or out for reappointment, and then to cover

2 things like members dying, or resigning, so we

3 need a couple extra people in the pipeline.

4 So if you have nominations, please get

5 them to Leslie, we'll discuss them, get them in,

6 start the process to get through the VA for the

7 appointments. We also have to post it, I guess,

8 in the --

9 MS. WILLIAMS: The Federal Register.

10 MR. CERTAIN: -- Federal Register --


12 MR. CERTAIN: -- for volunteers and

13 nominations from other than us. That's how we

14 got Lane and Shirley on to the committee, and

15 then other committees, folks that are -- as you

16 know, if they're rotating off of one committee,

17 they can come on to another one for one term, and

18 so if there's interest, then those folks have to

19 be considered as well.

20 So two, please keep thinking about

21 your peer group as well as folks that you know

22 who have a deep and abiding interest in the well-


23

1 being of former prisoners of war so that we can

2 have a vital and active committee working on

3 until there's only one of us left.

4 MS. WILLIAMS: Did you have anything

5 you wanted to tell?

6 MR. CERTAIN: Now too, as for Tom

7 McNish, as you know, he was the Chair for the

8 crowded two decades, rotated off a year or so

9 ago, and was made a special consultant to the

10 committee for a period that was undefined period,

11 and he and I talked last, couple, three months

12 ago, about I think for a place where you can fly

13 solo, now that I've moved to San Antonio, he's a

14 local phone call away, and so we can continue to

15 consult about the history of the place.

16 But to ask him to step away from his

17 business and to take time off to come here, I

18 thought, was no longer a necessary thing to look

19 over our shoulder and make sure that we weren't

20 undoing everything he worked so diligently to do,

21 which we're not.

22 Our agendas, because we are an aging


24

1 population, have shifted. We're still very much

2 focused on things like outreach to the community,

3 particularly those of our groups who are -- never

4 come into the VA, or hold the VA at arm's length,

5 those who are not particularly, once you get to

6 past about 70, which is where most of us are, if

7 they're not at 100 percent, to encourage them to

8 come for a review of their protocols and new

9 protocol physical to see if they're qualified for

10 additional benefits.

11 And with the our goal of trying to get

12 everybody up to the 100 percent level, and where

13 appropriate, to the individual unemployable

14 level, and that, of course, benefits not only the

15 former POW during our lifetime, but assuming we

16 pre-decease our spouses, they benefit the spouse

17 on our demise.

18 So outreach to the spouses is

19 important too so they can beat us over the head

20 and shoulders to get us in to do what we need to

21 be doing. So that's where we are on this. Tom

22 has been a very good friend for a very long time,


25

1 not only to the committee, but to me personally,

2 and to the population of -- starting with non-

3 POWs, but then to all the POW communities from

4 both POWs from World War II, Korea, Vietnam, and

5 Desert Shield/Desert Storm, Iraqi Freedom,

6 wherever we actually get living POWs now.

7 So there we are, and you are Dr.

8 Repasky?

9 DR. REPASKY: Good morning, sir.

10 MR. CERTAIN: Hi. Welcome.

11 DR. REPASKY: Hi. Thank you. How are

12 you today?

13 MR. CERTAIN: Thank you for zooming in

14 so quickly.

15 DR. REPASKY: Absolutely. It's a

16 pleasure. So are you ready for --

17 MR. CERTAIN: We're ready.

18 DR. REPASKY: Well, good morning,

19 everyone. My name is Stephanie Repasky. I'm an

20 Associate Director here and the Acting Deputy

21 Director, and here on behalf of Mr. Fernando

22 Rivera, our Director, who was called to DC, and


26

1 so he sends his regrets for not being here

2 personally.

3 This is a true honor and privilege for

4 us to host you and to have you here, and it's

5 nice to see friends that helped us with this

6 project and to help put our healthcare system

7 back up and running again, so just wanted to give

8 you a brief overview of some of the information

9 and, of course, answer any questions that you may

10 have along the way. Anything before we get

11 started?

12 So first, I'm not sure if you're

13 familiar or not, but Secretary Shulkin has put

14 together a ten-point plan that he is pushing

15 forward across all of VA. These are some key

16 highlighted points. His focus has been usually

17 on accountability at every level of the

18 organization and trying to make it easier for

19 people to be held accountable, and really,

20 reinforcing the importance of doing that.

21 As well as looking at choice

22 legislation, the original legislation was set to


27

1 expire in August, so that is being extended, and

2 then also looking at modifications that may be

3 needed that will make it easier for veterans to

4 choose where they get their healthcare, and those

5 are all in the works.

6 The other thing that he's looking at,

7 he really wants to make VA, understandably, the

8 provider of choice for veterans, so how do we

9 enhance the programs that we do have and make

10 sure that the services that we have are meeting

11 the needs of our veterans, and that we have the

12 infrastructure in place, and that we're

13 coordinating with DoD.

14 We really would like there to be that

15 seamless transition. And there's some things

16 that we can do to improve that coordination, so

17 that's high on his radar as well.

18 You may have also heard about the

19 electronic medical record, CPRS, which is our

20 current medical record. It's certainly state of

21 the art, or has been, and allows us to do a lot

22 of tracking for patients and making sure that


28

1 we're getting exams done on time, that we're

2 following up on things, but we need to continue

3 to advance that platform and making sure that

4 it's keeping up with community standards.

5 He has put forth a zero suicide as a

6 goal. And this, in '16, has actually been a

7 little bit ahead of the curve on this. Our

8 network director, a few years ago, actually set

9 that as a goal as well, and actually went out and

10 did a standardized training for all VISN 16

11 facilities, and he did reduce suicide with that.

12 And so we've implemented some things

13 that they're looking at for the national level as

14 well, but again, zero suicide is one of his

15 goals.

16 And then improving VBA, both how

17 timely we process appeals, but also, the process,

18 making it easier for our veterans to do that.

19 This here is our current VISN. You

20 can see our network, VISN 16, and then in the

21 State of Louisiana, trying to see if I have --

22 yes, so New Orleans serves 23 parishes in the


29

1 Southeast Louisiana Region, however, with our new

2 hospital opening, we will become a regional

3 referral center.

4 And that actually was our mission

5 prior to Hurricane Katrina, when we were a fully

6 functioning hospital as well, and so we will be

7 able to take referrals for high-end specialty

8 care all the way from the Florida-Texas line,

9 into the pan handle of Florida, so really, that

10 whole I-10 corridor, looking at specialized high-

11 end care of such -- ultimately, it would be

12 heart, neurology, neurosurgery, and ultimately,

13 transplants, as we continue to build those

14 programs back.

15 So in 2017, we really have three main

16 focus areas. First and foremost is access.

17 That, of course, is a priority of ours, making

18 sure that we can get veterans in timely, making

19 sure that we're getting our services to them.

20 You can see on the bottom here, some of the

21 numbers in terms of our active number of

22 patients, and also, significant growth.


30

1 And we do healthcare in many, many

2 ways. So yes, it's good to have the face-to-face

3 opportunities, and we need that, but we also want

4 to make it easy for our veterans, particularly

5 those in rural areas, to be able to do

6 telehealth, and also, secure messaging with

7 providers, so if there's a quick question, and

8 they can actually email their provider and get a

9 response back so that they may not necessarily

10 have to come in, or say, no, we need to see you

11 now.

12 So really, we're looking at

13 healthcare, how do we reach everyone in multiple

14 different ways with that.

15 Then activation. I'll talk a little

16 bit more about the medical center, but just this

17 week, we've added urgent care and radiology, so

18 we're still continuing to expand services. We

19 brought up all of our outpatient services in

20 December and January, so we moved all outpatients

21 over, and then we opened urgent care and

22 radiology Monday, sorry, on Monday, and then


31

1 we'll be moving to our inpatient care, and again,

2 I'll provide a little bit more information about

3 that to you as we go forward.

4 And then our workforce. So buildings

5 are beautiful, but we need people to bring the

6 healthcare alive to really take care of our

7 veterans. And with the number of people that

8 we're hiring, going from a system of outpatient

9 clinics back to a 24/7 facility, we need to be

10 able to recruit the best talent that there is.

11 And making sure that we're training

12 them and making the selections for the services

13 that we need, so you can see some of the numbers

14 there. We work very closely with our academic

15 affiliate to recruit, and there's what's called

16 the trifecta in healthcare, in health.

17 So you attract the best clinicians

18 when you let them do healthcare, you let them

19 teach, and do research, and we have that all

20 here. Building a new research building,

21 expanding our research program, and really

22 working with others to recruit our staff.


32

1 So a little bit about the healthcare

2 system and our numbers. So you can see, we have

3 been growing every year in the number of veterans

4 that we treat. At one point, there was a

5 question of rebuilding and the need for services

6 here. What I think is interesting is, at the

7 time of Hurricane Katrina, we were at 40,000

8 unique veterans treated, but that included all

9 the veterans that we received from other VA

10 medical centers for that high-end acute referral.

11 So we're actually treating more

12 patients now than ever before, whole person, and

13 this will only continue to grow. It said on that

14 earlier slide, 6.8 percent growth rate, so we're

15 one of the larger growing facilities here in

16 bringing patients back.

17 And then also, with our veterans, we

18 take in our population that we like to look at as

19 well, you can see that number's growing. Just

20 last week we did what was called a ladies' night,

21 featuring -- we had over 200 females show up for

22 that to really highlight and emphasize, we did


33

1 that associated with Mother's Day as well, and

2 that has already been picked up and highlighted

3 on the national news as an event and a best

4 practice.

5 So activation of our new facility. I

6 mentioned in December we started moving over all

7 of our outpatient clinics. Those moved over in

8 December and January, the last two moved over on

9 January 13th, so all outpatient has been

10 consolidated here. There is a small contingency

11 of mental health in the community that will stay

12 in the community, because they're largely

13 community-based programs.

14 So now we're moving on to Phase 2.

15 With Phase 2, we're looking at moving over our

16 ambulatory procedures unit, so same-day

17 procedures, which we currently do, but offsite.

18 We're looking to bring that over in July/August

19 timeline. As I mentioned, we just opened

20 radiology on Monday. We moved over our urgent

21 care on Monday as well.

22 We'll be opening our emergency


34

1 department and our phase activation of inpatient

2 care, really, that next level, starting in July.

3 So first it's outpatient, then we're moving over

4 our operating rooms, procedures, basic level

5 inpatient care, and we will have some of all of

6 our beds open by September of this year.

7 So our plan is to start with inpatient

8 mental health, then add med surge and ICU, and

9 then add our community living center, which is

10 largely for hospice rehab, palliative care, 90-

11 day or less stays.

12 And then in Phase 3, is really, once

13 we get those basic services up, how do we grow

14 and expand in complexity? So how do you start

15 doing those many -- much more complex procedures,

16 including transplants, open heart, neurosurgery

17 cases that we, again, taking referrals from other

18 VAs for those services.

19 Some of our upcoming milestone dates,

20 I mentioned about admission. So again, starting

21 in inpatient mental health, then our ED,

22 eMedicine, and surgery, ICU, and community living


35

1 center in September.

2 We did have our ribbon cutting on

3 November 18th of last year. It was a wonderful

4 event. Really celebrated where we were going and

5 how far we've come, and the speed that we've

6 moving at with that. Over 1500 people attended

7 that event. As well, Secretary, himself, did

8 come as well as the Mayor, and the Governor, and

9 several Congressional Members.

10 And then this is an overview. I know

11 we'll be taking a tour later today. I look

12 forward to showing that to you, but to orient

13 you, so this is the building that you're at now.

14 It's an administrative building. Training rooms

15 on the 1st floor, all administrative on the 2nd,

16 3rd, 4th, and 5th floors here.

17 Not sure how many people are familiar,

18 but this is Canal Street. So we have a streetcar

19 running here, which then allows pedestrian

20 entrance right here off of that streetcar line.

21 We did a lot of focus groups with design.

22 So before we did design it, we


36

1 actually did over 100 -- met with over 100

2 veterans, including their caregivers, and asked

3 them, what is it that you're concerned about?

4 You know, and what are your hopes and your

5 dreams? What do you want this to be? We really

6 wanted to make sure that we took into account

7 what our patients were telling us.

8 And one of the biggest concerns was,

9 they said, don't let us get lost. It's a big

10 campus, we don't want to be wandering around. So

11 we took that and we designed it very much like an

12 airport. So there is a concourse that goes the

13 entire length of the building, and then every

14 building plugs into that.

15 So starting up here, the

16 administrative building actually connects, and

17 you've got your inpatient care here, this is

18 diagnostic and treatment, so that's all of your

19 ORs, your emergency department, your lab, your

20 kitchen, radiology. We put outpatient services

21 here, directly next to the patient parking

22 garage, because that is the most visited location


37

1 whenever our patients come here.

2 Transitional living and rehab is our

3 community living center. And then we're building

4 a research building. This has not yet been

5 turned over, but it's scheduled for later this

6 year, and then our central energy plant and

7 warehouse.

8 So when you come in, you literally use

9 the concourse to deploy or move down to the

10 building that you'd like to go into, and then

11 enter that building, and move from there. So

12 we'll be walking around to that. Any questions

13 or comments?

14 COL. MURPHY: Well, we're a bunch of

15 old folks that come to this facility. Do you

16 have any plans to do one of these walkways that

17 you see at airports?

18 DR. REPASKY: We actually looked at

19 that during design, and the amount of space that

20 you need to allow people to get on and off was

21 not really conducive with it, and the other thing

22 that came up is that, actually, for older, or


38

1 elderly, people who have difficulty moving, or

2 ambulating, they can actually be dangerous

3 getting on and off.

4 So how we've mitigated that is a

5 couple ways. We put the patient parking garage

6 right next to the outpatient building, which is

7 where most people go. This here is drop-off as

8 well, and we will have valet parking there, so

9 you can either drop-off or have valet, and we've

10 increased the number of escorts and guides that

11 we have to make sure that as soon as you come in,

12 actually, to the garage, we can assess and ask if

13 you need help.

14 There's a greeter at every entrance,

15 a live person, so that if you need help, they can

16 call, and we can have somebody come and help

17 transport you. That's how we mitigated. We

18 looked at doing it, but the safety and the space

19 did not allow it to happen. So those are some of

20 those things.

21 One of the things our focus group said

22 is, they wanted, love this, three things at every


39

1 entrance, so they wanted somebody to talk to, to

2 get directions, get help, get transportation,

3 they wanted bathrooms front of house because

4 people are driving here from distances and they

5 didn't want to have to worry about that, and the

6 other is, that they wanted a place to get

7 something to eat or drink.

8 So at every entrance we have what's

9 called a hub, and we'll see them on the tour this

10 afternoon, so there's a desk where you have a

11 live person, front of house bathrooms, and

12 actually, in the outpatient building, there's

13 bathrooms on every single floor of the garage, so

14 a lot of people going out to their car may want

15 to stop and use that, and then we have cafes at

16 every entrance as well. Yes, sir.

17 MR. CARSON: That third category,

18 speaking of drinking, you said, of all the

19 services at the hospital, the one that all the

20 veterans talk to me about is, when will the Dixie

21 Brewery be opened up?

22 DR. REPASKY: Yes. So Dixie Brewery


40

1 is our research building here. It is currently

2 scheduled to be finished in February of '18. We

3 call it the research building. The 1st floor,

4 because I don't want to miss this, is actually

5 some of our outpatient mental health services and

6 some of our new programs with our community

7 rehab, and then that upper floors are our

8 research programs.

9 I'm going to just keep moving around.

10 Yes, sir.

11 MR. CORRE: One of the biggest

12 problems that we have with L.A. is telephone

13 access. That is one of the -- we've been

14 fighting for a number of years and still haven't

15 found a cure for it, but the biggest problem that

16 veterans have is trying to get in to talk to

17 their primary care doctors, or the nurses, and

18 even to get access for appointments, et cetera.

19 And complain about waiting, getting

20 cutoff, wrong information, so one of the biggest

21 things that they're working on is education of

22 the people doing the telephone operations.


41

1 DR. REPASKY: Yes. I completely agree

2 with you and we talk about that every single

3 morning, actually. So we have -- and it's

4 something that we have to work on, literally, on

5 a daily basis, and so in full disclosure. So a

6 couple things that we've done, just locally here,

7 as well as from the national, so nationally,

8 they've standardized the telephone tree so that

9 every VA, when you call in, it's the same exact

10 script.

11 So it doesn't matter whether you're

12 calling this VA or another VA, the options and

13 press 1 for this, is the exact same. So they've

14 standardized the national script. Now, what we

15 have done here locally is published an updated

16 directory, because we have a lot of people

17 moving, as you can imagine with trying to

18 activate this space, and so we actually have our

19 service sheets personally certify them.

20 We've updated our contact information

21 on the directory, that it's correct, and we're

22 doing that every three months, actually making --


42

1 so that we have a site built into that.

2 The other, for the answer times then,

3 is what's called ACD, or automated call

4 distribution, so very much, particularly for our

5 operators, and then each of our clinics, our

6 telephone call center and our appointment center,

7 so a call comes in, people login, so let's say

8 we're all together in that, and then it goes to

9 the first person that's available.

10 We look at our wait times and the

11 abandonment rate on a daily basis. So how

12 quickly are we answering and how many people are

13 just hanging up because they'd rather just hang

14 up than get their answers, which is very

15 difficult. So we look at that daily and we're

16 actually, right now, in the process of adding

17 that to all of our outpatient clinics.

18 So we're adding more of that to be

19 able to monitor, how well are we doing in

20 telephone responsiveness, because it doesn't

21 matter what we can offer if people can't get to

22 us.


43

1 MR. CORRE: One other thing.

2 DR. REPASKY: Yes.

3 MR. CORRE: So you mentioned

4 directories, which is very important, because

5 I've worked in the patient advocate office,

6 updating for connection to doctors is very, very

7 important.

8 DR. REPASKY: Yes.

9 MR. CORRE: And changes, they need to

10 be almost on a daily basis.

11 DR. REPASKY: Yes. What we've tried

12 to do with that is actually list a number that

13 the doctor himself, or herself, is not answering,

14 because our doctors are treating patients. So

15 they're not really able to necessarily answer the

16 phones, but if we can get them to, like, the

17 clerk that's supporting them or the

18 administrative staff supporting them, that way

19 they can get the message, they talk to a live

20 person, we're not depending on voicemail and then

21 somebody picking it up, that that's the system

22 that we're trying to -- our goal is that phones


44

1 are answered by people as much as possible,

2 because if it's an emergency, then they can go in

3 and interrupt, you know, or if the doctor's out,

4 they can make sure that the person covering is

5 getting it, or they can get to the nurse and make

6 sure that we can get that addressed.

7 MR. CORRE: One thing that they tried

8 that's new, so the last six months, and isn't

9 working is, they've put all the doctors, et

10 cetera, nurse's departments, on a central thing.

11 All the calls go to central and then from there

12 out. It doesn't work.

13 DR. REPASKY: Yes.

14 MR. CORRE: It doesn't work at all and

15 it gets worse. So we have to go around to the

16 different departments and get the extensions of

17 the various people in order to get faster

18 service.

19 DR. REPASKY: Yes. That's something

20 that --

21 MR. CORRE: You might take that into

22 consideration.


45

1 DR. REPASKY: No, I appreciate that

2 very much. We just, two weeks ago, published --

3 so we have an online directory where you can

4 search by name, but that doesn't really help if

5 you're trying to reach the cardiology clinic, you

6 know? So we've actually just published a

7 secondary document that's not by name, but by

8 specific clinics or a specific doctor's team, but

9 you are absolutely correct.

10 This is something that I mentioned we

11 have to work on on a daily basis, and we're

12 constantly making changes to try and improve

13 that. So, yes, thank you. Can I come back to

14 you or?

15 MR. CORRE: Yes. Come back to me.

16 DR. REPASKY: Okay.

17 MR. CORRE: Go to somebody else.

18 DR. REPASKY: Did you have a question

19 too earlier?

20 MS. JOHNSON: He asked it, about

21 getting around the medical center, because that

22 is a huge place and it is -- look, I may be the


46

1 pediatric, but there are days when I don't get

2 around so well.

3 DR. REPASKY: We're calling it our

4 wellness program.

5 MS. JOHNSON: That's an exercise just

6 walking to their appointment.

7 DR. REPASKY: It's not uncommon to be

8 walking by and hear somebody go, I got 5000

9 steps.

10 MS. JOHNSON: But you answered it

11 already. Thank you.

12 DR. REPASKY: Thank you. Yes, ma'am.

13 MS. QUARLES: Shirley Quarles. Mental

14 health has been a challenge for most VAs

15 throughout the country, and so knowing that your

16 VA mental health inpatient service doesn't start

17 until July, what have been some of your

18 challenges for taking care of mental health

19 patients, both outpatient and inpatient, and in

20 particular -- please.

21 DR. REPASKY: So topic near and dear

22 to my heart. I am actually a psychologist by


47

1 training and I came here for a one-year position

2 for my internship as a psychologist, and 18 years

3 later, here I am, so I love this organization,

4 but I started inpatient and outpatient mental

5 health specialty in post-traumatic stress

6 disorder as well, so certainly, a topic near and

7 dear.

8 I think one of our biggest challenges,

9 and that still remains, is that inpatient care is

10 still pretty limited in the community, and

11 there's a really high turnover rate because the

12 vets are limited.

13 And so what we've found is community

14 hospitals may not necessarily keep patients as

15 long as we would, nor do they have the expertise

16 that our providers have for certain events that

17 may be contributing to admissions, particularly

18 with combat-related or post-traumatic stress

19 disorder.

20 So we worked with our other VA

21 facilities, particularly Biloxi, Alexandria, and

22 Shreveport, to have patients admitted to VAs


48

1 because of that expertise. The challenge with

2 that is, getting the ambulance to transport

3 someone multiple hours, and then the ambulance is

4 not necessarily close.

5 So sometimes it's really a tradeoff

6 and our clinicians are involved and make that

7 decision, so that's a clinical decision, whether

8 we admit in the community or whether we send

9 someone to another VA, and that's where that's

10 case-specific with that.

11 And then the other that we've tried to

12 do is work very, very closely with our community

13 facilities to do education to their providers as

14 well about veterans and our special populations

15 with that as well, so it's not uncommon for -- I

16 know Dr. Robinson was going to be -- did he --

17 oh, tomorrow. Okay.

18 So Dr. Robinson, who's our chief of

19 psychiatry, has been working on this for a number

20 of years. It's not uncommon for him to actually

21 go to our community facilities and talk with

22 them, or to work with them on discharge planning


49

1 to make sure that we're integrating them back

2 into our outpatient care.

3 So we will be very glad when we open

4 our own unit Friday. Yes.

5 COL. MURPHY: I live in the local

6 area, so I'm familiar with your hospital here,

7 but I've used a couple of your satellite offices,

8 Slidell, Hammond.

9 DR. REPASKY: Yes.

10 COL. MURPHY: It's confusing when you

11 call up to get an appointment. Who do you call

12 to get the appointment? I guess it all comes

13 through here?

14 DR. REPASKY: So what they've done

15 now, probably within the past, I think, eight

16 months, is, they've said, all calls will go to a

17 centralized telephone appointment center, and

18 that center can schedule and reach out to the

19 providers if they need to.

20 COL. MURPHY: Need to make that very

21 clear to the veterans because I just got hearing

22 aids out of Hammond, they did a marvelous job,


50

1 but it's confusing on who you're talking to --


3 COL. MURPHY: -- where your

4 appointment is, is it going to be here, is it

5 going to be at Hammond, et cetera, et cetera.


7 COL. MURPHY: So just --

8 DR. REPASKY: No, thank you for that

9 feedback. I can understand that.

10 COL. MURPHY: I got another question.

11 I'll raise it -- I'll wait.

12 DR. REPASKY: Are you sure?

13 COL. MURPHY: Yes.

14 DR. REPASKY: Yes, sir.

15 DR. HAIN: Bob Hain. Colonel Certain

16 and I were talking this morning about the ongoing

17 problem which some of us really think is plaguing

18 the VA in general as well as the whole population

19 of our facilities, and that's the issue of

20 polypharmacy.


22 DR. HAIN: And I would have to assume


51

1 you're implementing some program to coordinate

2 that or somehow get a handle on that, because

3 some of us have seen in other facilities, it's

4 very easy to just pass out psychotropic

5 medications and then you wind up with a suicide.

6 DR. REPASKY: No, a huge issue.

7 DR. HAIN: And the funniest thing to

8 me, and Bob Certain and I were talking about

9 this, watching T.V. for an ad for some medication

10 and it says, ask your doctor if this is right for

11 you. And speaking as a physician, the doctors

12 don't know that. All the directions and all

13 that, and there has to be something to let the

14 providers know. And this is so critical in

15 mental health.

16 DR. REPASKY: Absolutely. Dr. Sneed.

17 DR. SNEED: I can answer your

18 question. Yes, I can answer your question. I'm

19 going to do primary care, ambulatory, basically,

20 ground zero --

21 DR. REPASKY: He also, I will just

22 interrupt briefly, because I'm not gotten to him,


52

1 but Dr. Sneed is actually our provider for our

2 former prisoner of war team with this as well.

3 DR. SNEED: One of the things we have,

4 when we're used to that position, is, we have

5 clinical function is integrated with our primary

6 care team. We currently have two and then we

7 hired about four more. And so then that clinical

8 pharmacist, same day with that pharmacist or

9 that, you know, if they scheduled an appointment,

10 so that whole issue about the polypharmacy,

11 because you're correct. It's enough just to keep

12 with everything, and that is a big addition that

13 we've started and soon be expanding.

14 DR. REPASKY: You're absolutely

15 correct. We also have a team that's been looking

16 at this and looking at patient's individual

17 records, looking at patients who are on a high

18 number of medications, not just even specific

19 types of classes, but just a high number.

20 So I think for us, it's a little bit

21 of a challenge too because of the community care

22 and the coordinating of the community care,


53

1 mental health, and otherwise, that you have

2 multiple providers, and how do you make sure that

3 you're capturing all of what a patient is on and

4 that there's no drug-drug interactions with that,

5 so yes.

6 COL. MURPHY: The other thing --

7 DR. REPASKY: Yes, sir.

8 COL. MURPHY: -- I take a lot of

9 medications. I get most of mine, all of mine,

10 through Express Scrips, which I have to have a

11 co-pay for. It would be a lot cheaper if I came

12 through the VA. How does a vet get his

13 prescriptions that go to Express Scripts over to

14 the VA so I could get my prescriptions mailed to

15 me from there?

16 DR. REPASKY: Okay. So it would have

17 to be written by a VA provider, and that's one

18 thing that comes in, so what we can't do, for

19 many reasons, largely patient safety, is, I mean,

20 we've had some patients who've tried to do this,

21 understandably, is, they've seen a non-VA

22 provider, gotten a script, come in, and said,


54

1 here, I'd like you to fill it.

2 But we can only fill from people from

3 our providers who have written the script,

4 because there's an assessment done with that, and

5 there's liability as well as patient safety, so

6 that's one thing that we would have to work on.

7 COL. MURPHY: You know, a good

8 newsletter going out to tell people, if they want

9 to switch over or try to get it changed to save

10 them some money, I think it would be a good idea

11 to do that.


13 COL. MURPHY: All right. Because I

14 don't know what we pay, but I take a bunch every

15 day, it's just a handful of stuff, and my

16 caretaker here, puts it all together for me.

17 Another thing that --

18 DR. REPASKY: Add that to some of our

19 town halls.

20 COL. MURPHY: -- several years ago, I

21 was on a committee here, at the old VA hospital,

22 to look at ways to improve the care and helping


55

1 the veteran get the services they need. One

2 thing that was a pet peeve of mine, I needed new

3 eyeglasses, so I called up to get a prescription.

4 It took me two months to get an

5 appointment, I come in, and I hope it's not this

6 way anymore, and there's a whole room of people

7 waiting. They call out ten of us at a time,

8 walked out in the hall, they had an eye chart at

9 the end of the hallway, and we went out there,

10 and we took an initial eye exam there, went back

11 in, and sit down for a while.

12 Then they call the ten of us out, or

13 individually, and I had a good exam by a Tulane

14 doctor who's working for the VA, and when he

15 finished the eye exam, I said, can you also give

16 me a prescription, so I want to buy sunglasses,

17 which were not going to be covered by the VA,

18 because I did all the task mission and I couldn't

19 -- I said so I can go get some sunglasses made

20 with a prescription? He said, oh, we won't give

21 you a prescription here. I said, what do you

22 mean you won't give me a prescription? You just


56

1 gave me an eye exam. He said, no, we will give

2 you this letter and it listed several providers

3 of optometrists here in the New Orleans area, you

4 will have to go there and get another eye exam,

5 and then they will fit you for the eyeglasses.

6 It took me five months to get a pair

7 of eyeglasses. That is totally ridiculous.

8 DR. REPASKY: Agreed.

9 COL. MURPHY: All right. So what are

10 we doing --

11 DR. REPASKY: And how now are we doing

12 that here?

13 COL. MURPHY: -- to get rid of some of

14 that bureaucracy?

15 DR. REPASKY: So we are bringing an

16 optical shop back in-house.

17 COL. MURPHY: Wonderful.

18 DR. REPASKY: We will show it to you

19 today. It is not yet open, but will be shortly,

20 but they actually do have, in the eye clinic --

21 so what we did is, we actually brought in a

22 vendor in to the actual eye clinic, so our eye


57

1 clinic is an outpatient tower, that person has a

2 small office there, so if you want to see them

3 with a limited range in the community, you can.

4 COL. MURPHY: So they'll make the

5 glasses there for you?

6 DR. REPASKY: Yes, and you can pick

7 them up from there.

8 COL. MURPHY: All right. What about

9 dental? Right now, you got to have a crown done,

10 they send it to Dallas. I think it goes to

11 Dallas. Takes forever to get it back. Are you

12 going to --

13 DR. REPASKY: We are starting to bring

14 those back in-house.

15 COL. MURPHY: Okay. All right.

16 DR. REPASKY: Yes. That's part of

17 some of what we're having to continue to expand

18 with our services, but yes, that's all of what we

19 lost when we lost our hospital.

20 COL. MURPHY: It was even before you

21 lost the hospital. Okay. This was well before

22 Katrina, okay?


58

1 DR. REPASKY: Oh, well, we started

2 bringing things back in and there's some things

3 that we can do in-house, there are some things

4 that we were willing to ship out because of the

5 expertise with it, but I do know that they've

6 added a dental lab here and they're able to --

7 they're doing the final certifications on the

8 equipment, and then we will be able to do more

9 things in-house than we could before.

10 COL. MURPHY: All right. I'm going to

11 bring up one other thing.

12 DR. REPASKY: Certainly. Please.

13 COL. MURPHY: And, Bob, he may back me

14 up on this, I may be talking out of school here,

15 because I know there are other avenues that are

16 being pursued, fake POWs. All right. And I've

17 already talked to the Director over there about

18 this.


20 COL. MURPHY: I'll give you an

21 example, during Desert Storm, there were 21

22 prisoners, and one died in prison, the VA is


59

1 carrying 87 POWs from that war. All right.

2 We've got 400 and some odd that we know of that

3 are being cared from the Vietnam War. There are

4 only 400 and some of us left, and we're dying

5 like flies.

6 There is an easy track to do it, and

7 we gave it to Lucinda and Mr. Rivera. There's a

8 Web site that you can go to, if you ever have a

9 question on a phony POW, and I've uncovered four

10 here in the local area, one guy was asked by the

11 VA to come sit here for a POW meeting at the

12 other hospital, and two gentlemen from the

13 American Ex-POWs of Baton Rouge came up, and I

14 was there, we had three of us to talk to folks,

15 there was a guy over there in a pair of black

16 trousers, combat boots, a brown sweatshirt,

17 stormtrooper-looking hat, and I said, who's that

18 guy?

19 And the American Ex-POW said, well, he

20 said he was a Vietnam POW. I don't think so. I

21 go over and I asked him what his name was, and he

22 told me, I said, where were you a prisoner? He


60

1 said, in Vietnam. I said, how long were you

2 there? He said, ten years. Oh, yes, they all

3 have a covert mission, and I, pardon my

4 insinuation here, I said, you are a friggin'

5 liar, and I'm going to put you in jail.

6 When I reached down, he whipped out

7 his VA I.D. card that had POW stamped on it.

8 Now, how in the world does that happen? It takes

9 five minutes on the webpage to lookup a guy's

10 name, and if he were a prisoner for one hour, it

11 is going to show this.

12 MR. CERTAIN: It's an issue we've

13 discussed multiple times in the community and

14 what's happened just in the last two years, is

15 that the VA central office is doing a number of

16 things. One is, they've got those Web sites and

17 they're working those. The other is that, part

18 of the VA system is that regional computer

19 systems were not the same.

20 And they're old and they're falling

21 apart, and maintaining them is very expensive,

22 and so when I moved from San Bernardino, to


61

1 Atlanta, to someplace else, if my name is

2 registered as Robert one place, and Bob at

3 another, and Robert G. is another, then I'm three

4 people.

5 COL. MURPHY: Yes.

6 MR. CERTAIN: And so they scrubbed the

7 system down about a year and a half ago to

8 eliminate the duplications, which cut the number

9 of former POWs in the system down substantially

10 to a more accurate number, and then we've given

11 them the same -- the Web site you're talking

12 about, and part of our ongoing recommendations

13 have been to compare the VA list against the DoD

14 list to make sure there are no names on the VA

15 list that do not also appear on the DoD list, or

16 to figure out why they're there.

17 So that's an in-process thing. I'm

18 like you, I found a phony in San Bernardino some

19 years ago, and I turned Brad loose on him, and --

20 COL. MURPHY: Mike's obviously is

21 good.

22 MR. CERTAIN: And so we do that, and


62

1 we expose these guys. Unfortunately, what

2 happens, you know, out in the community is, they

3 can go to Medals of America and get all the

4 medals and uniforms they want, and claim to be

5 something, and then the court struck down the

6 Stolen Valor Act, getting that reinstituted has

7 been a bit of a challenge for the Congress.

8 And so we're still struggling with

9 that and we still -- every elite organization has

10 their own junkyard dogs to root them out. I

11 think Dr. Hain told me one time there was posters

12 for the control group --

13 MR. MOORE: Me. Jeff Moore. I'm the

14 DoD representative here. We have a comparison

15 group at the Mitchell Center and we even had a

16 couple of wannabes in the comparison group, but

17 quite frequently. I mean, there is an official

18 DoD list and quite frequently, we get contacts

19 that even want to come to the Mitchell Center for

20 an annual exam, and they're not on the list. We

21 just have to --

22 COL. MURPHY: You're down at


63

1 Pensacola?

2 MR. MOORE: Yes, I am.

3 COL. MURPHY: Boy, that's a great,

4 great service they've given to us down there, and

5 I tell you what, the psychiatric department here

6 probably ought to take a look at some of the

7 studies you guys have done down there on how we

8 survive versus some of the other cases. I think

9 you'll find it very, very interesting.

10 MR. CERTAIN: Well, thanks. Let's

11 move on. Do you have additional information for

12 the committee?

13 DR. REPASKY: Yes. Actually, just a

14 good transition, so I did want to just highlight

15 for us, we have a dedicated PAC team for our

16 former prisoners of war with Dr. Ernest Sneed,

17 who spoke earlier, as our primary care physician,

18 and also, Anthony Smith.

19 And a couple things that we're doing,

20 so we're doing a lot more posting on social media

21 and outreach events for this group and to try and

22 promote that. We've reached out to our VSOs to


64

1 help identify people, on flagging them in the

2 system, creating some educational brochures that

3 would go in our clinics, and then have --

4 including Mr. Rivera's direct contact

5 information, that is his cellphone, as well.

6 He accepts calls, and all the time, he

7 keeps that on him, and we give that out to all of

8 our patients at every town hall meeting as well.

9 I'm assuming we'll make that information as well.

10 Dr. Sneed, anything -- I wanted to

11 make sure that you saw there. Put names with

12 faces as well. Any other questions for me?

13 MR. CERTAIN: No. Thank you for that

14 information. I'm looking forward to seeing this

15 nearly empty facility.

16 DR. REPASKY: It's getting pretty

17 full. It's getting full.

18 MR. CERTAIN: Sounded like you weren't

19 very well open yet, so it's still a work in

20 progress.

21 DR. REPASKY: Actually, so the entire

22 outpatient tower, all seven floors, is open.


65

1 That's our busiest. So that's a seven-story

2 building that's fully open. The 1st floor of our

3 community living center, which is our rehab and

4 prosthetics, is fully activated. The top two

5 floors are inpatient.

6 And then our inpatient building, of

7 course, is not activated, but then in diagnostic

8 and treatment, that larger building, the whole

9 1st floor, half of the 2nd floor, are fully

10 operational, and we have staff moved into the 4th

11 floor as well, so it's filling up.

12 It's really inpatient services, which

13 is that inpatient building, and then our 3rd

14 floor, the diagnostic and treatment, where our

15 ORs are, that we have left to go.

16 MR. CERTAIN: Is this a replacement

17 for our hospital destroyed in Katrina?

18 DR. REPASKY: Yes, it is, sir.

19 COL. KUSHNER: I have two questions,

20 actually, how many FTEs, full-time employees, do

21 you have?

22 DR. REPASKY: We'll end up with about


66

1 2800, once we have all of our inpatient services

2 going. We're about 1800, 1900 right now. We

3 just brought on 26 more this week.

4 COL. KUSHNER: And how many beds?

5 DR. REPASKY: Two-hundred.

6 COL. KUSHNER: Two-hundred.

7 DR. REPASKY: Hundred and twenty med

8 surg, ICU, sixty transitional living, or

9 community living center, and twenty inpatient

10 mental health.

11 COL. KUSHNER: Do you have a dental

12 plan?

13 DR. REPASKY: We do.

14 MR. CERTAIN: Very good. Thank you.

15 DR. REPASKY: Thank you.

16 COL. MURPHY: Bob, one last question.

17 I brought this up to Mr. Rivera also, we're

18 having a POW reunion --

19 MR. CERTAIN: Yes, we are.

20 COL. MURPHY: -- from the Vietnam

21 period in November, and Mr. Rivera was very kind

22 to offer a tour to our group, well, I come to the


67

1 hotel to give a briefing, and I just wanted to

2 pass that information along to Bob Barnett, who's

3 our reunion coordinator, and so we don't know

4 what's going to happen. They're looking at the

5 schedule of how they can fit it in, et cetera.

6 MR. CERTAIN: Thank you.

7 MS. JOHNSON: I have one question.

8 MR. CERTAIN: Smith?

9 MR. CERTAIN: Shoshona, a question?

10 MS. JOHNSON: It's a quick question.


12 MS. JOHNSON: Shoshona Johnson. You

13 showed the area that your hospital covers, but

14 you're very unique. Is there any other hospital

15 like this in the country? I mean, I've never

16 seen anyone this size and to have as many

17 different departments, and stuff like that,

18 before.

19 DR. REPASKY: You know, most of them

20 -- so we're what's called a Level 1 facility, so

21 Level 3s make, pretty much, your basic community

22 care, Level 2 will have some specialized, and


68

1 then we'll be what's called a Level 1 facility,

2 of which there is 26 in the country. And that's

3 those that have the high-end acute care.

4 How we're built may be a little bit

5 different. Orlando is actually similar, in terms

6 of, they have a concourse, and Denver, the newer

7 hospitals, because that's been more of the newer

8 design concepts. Primarily for way finding.

9 But probably closest to us, really,

10 would be Houston.

11 MS. JOHNSON: Really? Because I live

12 in Texas and --

13 DR. REPASKY: Tremendous. They have

14 over 5500 employees at their facility.

15 MS. JOHNSON: Wow.

16 DR. REPASKY: And they have a lot of

17 support, national programs that they support.

18 They're a very large referral center for the

19 whole country, including a lot of the open heart

20 and high-end complex care, some of which will

21 come back here.

22 MS. JOHNSON: Okay.


69

1 DR. REPASKY: They picked it up

2 whenever our hospital closed.

3 MS. JOHNSON: Oh, okay.

4 DR. REPASKY: But we're bringing it

5 back home. Thank you again.

6 MR. CERTAIN: Thank you. Anthony

7 Smith is the POW advocate here.

8 MR. SMITH: Yes, for the VA. Good

9 morning. How you all doing this morning? You've

10 already met Dr. Sneed, who's our provider. And

11 we do want to focus here, one of the things, to

12 answer the question about telephones, my

13 cellphone number is actually on the brochure and

14 on the card, so we should use this card.

15 So that's a temporary thing. When you

16 call, they just pick up the phone, since somebody

17 mentioned they're calling right back. That's the

18 one solution. That's how they get that worked

19 out, so POWs will be able to contact me.

20 We have a nurse, we have Pierre, who

21 is a social worker with PSA, so that team

22 dedicated. One of the other questions was about


70

1 prescriptions. If, indeed, we can get the POWs

2 to come to the VA, see the VA doctors, it'll make

3 everything much quicker.

4 When you have a primary care provider,

5 you can put in that consult to get your

6 eyeglasses done, we're giving it everything it's

7 supposed to. There being a lot of guys who get

8 it on the outside. So what happens, you bring

9 the prescription in, and now it's going back

10 through a whole new process.

11 DR. SNEED: Yes, I can answer that, to

12 answer your question. One of the things we do in

13 primary care, when you're leaving for the day,

14 you know, you checkout, at that same time, we

15 will work with you to set an appointment date and

16 time that's convenient for you, both for an eye

17 and for audiology.

18 And for my fellow physicians in the

19 audience, you know, for the outside

20 prescriptions, obviously we have to review the

21 record. I always joke with my patients, either

22 for good or bad, I tell them, I don't know your


71

1 outside doctor from a guy who's wearing a Mickey

2 Mouse costume at Disney World. I need to see the

3 records to go through, because, yes, it is a big

4 patient safety issue.

5 And like physicians would know, you

6 know, our whole issue is reducing medical errors

7 nationwide. Every day, the number of patients,

8 not just veterans, but patients in general, that

9 die due to errors would account for almost two

10 aircrafts falling from the sky.

11 So yes, we really, really concentrate

12 on looking at those records of that private

13 doctor, making sure they're giving quality care,

14 and, you know, the decisions, why and how they

15 made that decision regarding the medications.

16 MR. CERTAIN: What's the wait time for

17 somebody to get an appointment here at this

18 hospital?

19 DR. SNEED: That's a good question

20 from the standpoint of -- you're talking

21 about somebody that's new trying to get in or

22 someone who's already in?


72

1 MR. CERTAIN: Either way.

2 DR. SNEED: If they're linked into, if

3 they're already linked into the system, they know

4 their physician and nurse, their PSAs and

5 everything, so that is not a problem. Also, we

6 have the software that might help us get into

7 your email system.

8 One of the things alert veterans to

9 that sometimes they don't know is, once you get

10 linked into that system, not only do you have

11 email access to your primary care, you also have

12 access to any doctor in the VA system, and we

13 have to answer that email within 48 hours or

14 someone comes and yells at us.

15 Now, new patients, I don't know that

16 off the top of my head. That's a question that

17 somebody else may be able to answer for you.

18 MR. CERTAIN: So if you're doing

19 outreach to get people to use VA as their primary

20 provider so that they can get medications

21 coordinated and filled through the VA pharmacy,

22 how difficult is it to actually get them in and -


73

1 -

2 DR. SNEED: Once you know who they

3 are, it's not difficult at all because with

4 providers, we keep a tracking of who has

5 accessibility, also, we have a same-day walk-in,

6 if necessary, at least to get them started. You

7 know, like I said, with the fellow physicians, I

8 have to know the reasoning behind those

9 medications because, you know, and what the

10 problems are that patients for something that I,

11 along with that other doctor, may be a medical

12 error.

13 MR. CERTAIN: All right. And do you

14 have a problem with people gaming the system by

15 getting doubled-up prescriptions on certain meds

16 by going to a civilian provider and then coming

17 in or is the, in the Web out there, some way to

18 pick up on it?

19 DR. SNEED: Well, I believe the

20 question is, particularly regarding, and that's a

21 whole other topic regarding pain meds and stuff,

22 we have a doctor that actually has a state


74

1 monitoring system where he can access that. And

2 as far as other meds, one, you're just relying on

3 the honesty of the patient, and two, I mean --

4 and it'd be interesting to see which medicines

5 you need to kind of really game the system,

6 because there's not much pocket value for a lot

7 of the meds, because we use mostly high-quality

8 meds that don't cost much, so why would you even

9 go and spend money for the meds?

10 MR. CERTAIN: You are the primary care

11 provider, right?

12 DR. SNEED: Yes, sir.

13 MR. CERTAIN: And you had the -- have

14 you had face-to-face training for this?

15 DR. SNEED: I had face-to-face

16 training with World War II veterans. They had a

17 session in San Diego a couple years ago, and it

18 was like a four-day conference, with not only

19 medical, but psychological and social support

20 groups that you need to be aware of. Basically,

21 it just comes down to really taking time,

22 listening to the veteran, and really, not only


75

1 knowing them medically, but also, the social

2 environment in which they operate.

3 Because once you know that, what

4 ancillary services you need, you can request

5 that.

6 MR. CERTAIN: Yes, and the conditions

7 in which they were held.

8 DR. SNEED: Right.

9 MR. CERTAIN: Which leads to later

10 issues.

11 DR. SNEED: Yes.

12 MR. CERTAIN: Mr. Smith, you were

13 trained as a care provider in the care and

14 benefits team?

15 MR. SMITH: I've worked along with

16 VBA, Mr. Phil Simpson. We both attended the last

17 training in San Antonio, where they went in-depth

18 into doing interviews, making sure that POWs

19 don't have to be examined three, four, five

20 times. Here, they get it documented, because

21 that was one of the things the POWs, documenting

22 issue, brought up, was that, they were coming in


76

1 to, let's say, New Orleans, they would be seen.

2 They relocate to San Antonio, and they

3 have to go through this whole process all over

4 again, as opposed to just having that information

5 in CPRS and transferring over.

6 MR. CERTAIN: And how long do you get

7 to stay in this position? How long have you been

8 --

9 DR. SNEED: Seven years now.

10 MR. CERTAIN: Seven years now?

11 DR. SNEED: But we're pretty active

12 lately. Now that we have a full standing

13 hospital, we'll be putting a team together to

14 address the POWs.

15 MR. CERTAIN: So when the hospital

16 went down in Katrina, everybody got dispersed

17 around --

18 DR. SNEED: The vast majority of our

19 veterans went to Alexandria.

20 MR. CERTAIN: So you had to rebuild

21 the whole staff here. It's not a matter of

22 having them deployed into clinics around, it's --


77

1 DR. SNEED: It's just, now I'm putting

2 it all together in one team.

3 MR. CERTAIN: It's a little bit of a

4 challenge.

5 DR. SNEED: We'll get there. Actually

6 leading the POWs was kind of heartbreaking in

7 other ways, when you hear their stories, and one

8 of the things about people faking the system, and

9 all those, it is frustrating. It has to be.

10 You've been a POW. Somebody that's just walking

11 in the room with some cockamamie story, or

12 something.

13 MR. CERTAIN: Yes, there's very few of

14 us out there. We all get heartburn.

15 DR. SNEED: And they all say the same

16 thing, that I have no orders, no paperwork, mine

17 was top secret, I was -- everybody knows the

18 military sends you somewhere, you get orders.

19 You go anywhere in the military, you're going to

20 get orders.

21 MR. CERTAIN: Okay. So thank you.

22 DR. SNEED: All right. Thank you.


78

1 MS. QUARLES: I'm just piggybacking

2 off of Dr. Certain's question. This is Dr.

3 Quarles. Since you're the PCP for POWs, and

4 considering that that population is getting

5 older, and smaller in number, from your

6 professional standpoint, how often do you see

7 former POWs in your area?

8 DR. SNEED: In my area, here in New

9 Orleans, what I'd rather do, based on their

10 physical needs or mental needs, is, at a minimum,

11 I like to see my guys, at a minimum, every six

12 months. I tell them I like to see them at least

13 once before and once after, just to say, hi, bye,

14 leave me alone, and as you create histories and

15 everything, when everybody else comes up, you may

16 have to have them integrated with mental health,

17 or you may have to have social work as well.

18 Just depends on what issue arises or

19 what needs that veteran would like to have

20 addressed.

21 MR. CERTAIN: And with the non-POW

22 population here in the area, have you ever had


79

1 access to the Mitchell Center records to make

2 comparison and make sure we can?

3 DR. SNEED: No, I haven't had access

4 to those records.

5 MR. CERTAIN: That's one thing we've

6 been trying to work on for a few years too.

7 MR. MOORE: Dr. Moore. In that

8 regards, do we currently have a national list of

9 former POW teams throughout the country at all

10 the different facilities?

11 DR. SNEED: Each facility, I know,

12 would have at least one doctor, with some

13 support, designated as a POW provider. We don't

14 have, like, a national, like, network going where

15 we have, like, an email of subscribers, but each

16 facility has one doctor.

17 MR. CERTAIN: Jeff, one of the things

18 we asked for last time was to get the rosters.

19 Okay. Good.

20 MS. WILLIAMS: So Leslie Williams, so

21 just to expound on your question, for the last

22 committee meeting, that question was posed, so as


80

1 part of the recommendations, one of the requests

2 from VHA was to come up with a list at each

3 facility and to provide it to VBA, and we'll do

4 the same. They agreed to that.

5 And so that information is going to be

6 housed by an external webpage. So we're in the

7 process of working on it. We already have the

8 webpage. VBA, we already have our list, we're

9 just waiting for VHA to give us that information,

10 and then it'll be in one centralized location.

11 MR. CERTAIN: POW coordinator at the

12 regional office is in the medical centers, the

13 POW advocate's in the care teams, and to get all

14 that together so that when we locate, then we can

15 go to the Web site and find out who we need to

16 talk to in the local area --

17 MR. MOORE: That'll be very helpful.

18 MR. CERTAIN: And every time it gets

19 updated, I'm not sure whether you're a rare breed

20 or just fortunate, or somebody forgot you, but to

21 be in the position seven years seems like a

22 really long and good tenure.


81

1 DR. SNEED: It's been helpful, but by

2 taking it back over after the storm, it's really

3 been helpful to have that background moving

4 forward, but Mr. Carson and Ms. Lucinda Williams

5 have really been doing the groundwork as far as

6 getting the numbers up, finding information out -

7 -

8 MR. CERTAIN: Mr. Carson.

9 MR. CARSON: Yes, Mr. Chairman, just

10 wanted to ask one question. Anthony, I know you

11 all been working -- well, Dr. Sneed in getting

12 the POW committee together, and working towards

13 establishing the clinic, and using the San

14 Antonio model a lot, because we all know that's

15 one of the best in the country.

16 We talked a little bit about outreach,

17 because we know that in San Antonio, too, that

18 about 1/3, this is rough figures, but 1/3 of the

19 POWs in the area were in the program, the other

20 2/3 were not. And I find our numbers are very

21 comparable here in the Southeast, particularly

22 the Southeast Louisiana area.


82

1 We talked a little bit about ways to

2 outreach to them. And with the data that Leslie

3 and the group is going to get together for us,

4 can you give us some ideas on how we can outreach

5 and try to bring the other 2/3 in as quickly as

6 possible?

7 DR. SNEED: Get the information, send

8 it out, circulars, information in the mail,

9 brochures, and also, with their numbers to

10 contact them, but also, use the social media as

11 far as, like, the wives, grandkids, kids, of them

12 to reach them to let them know that we're here or

13 available for them.

14 MR. CARSON: Like a direct mail piece?

15 DR. SNEED: Direct mail. Right.

16 MR. CARSON: From, like, the Director

17 and I think even our State Director of Veterans

18 Affairs offered to join in because they have

19 service offices in every county throughout the

20 state. Sometimes they're aware of POWs that we

21 may not be aware of, so working together through

22 direct mail and then follow-up with phone calls,


83

1 perhaps?

2 DR. SNEED: Yes, sir.

3 MR. CARSON: Maybe personal visits, if

4 the time and staff allots for it.

5 DR. SNEED: Yes, sir. You could be

6 doing all of that. And one of the things that --

7 Hal Kushner will pick up Social Security numbers.

8 Primarily, you'll get Louisiana Social Security

9 numbers when you get your attachment. Or really,

10 what it is, we're getting the DoD information

11 where you get a bigger picture, and you see more,

12 because everybody may not have gotten a Social

13 Security card in Louisiana if you join the

14 military here.

15 So sometimes their information is in

16 the database, but they changed from New Orleans

17 to New York, whatever, so that can be a problem

18 also.

19 MR. CARSON: Thank you.

20 DR. SNEED: Anymore questions?

21 MR. CERTAIN: Anything else?

22 DR. SNEED: Thank you, all.


84

1 MR. SMITH: You're welcome.

2 MR. CERTAIN: Just a few minutes ahead

3 of time. We have Burney? We're ready for you.

4 MS. BURNEY: Good morning, everyone,

5 again. As I indicated earlier, I'm Jelessa

6 Burney out of the Office of the Secretary with

7 the Advisory Committee Management Office, and on

8 behalf of the Secretary, the Honorable David A.

9 Shulkin, I welcome you to today's meeting.

10 Usually in the absence of the

11 Secretary, or the Deputy Secretary, or the Chief

12 of Staff, my supervisor, or Director, for the

13 office would be here to attend the meeting and

14 provide a briefing to your committee. I believe

15 Boomer met with you all in San Antonio, where he

16 provided some information with regards to FACA

17 101, did the briefing, talked to you all about

18 smart recommendations, provided a template, and

19 additional information.

20 Well, since I was going to be in the

21 area anyway, because I am from New Orleans, I

22 started by VA career here at the VA regional


85

1 office, and as a claims examiner, Boomer thought

2 it would be best if I stopped by and chatted with

3 you all. I'm excited to be here. Had the

4 opportunity to spend Mother's Day with my mom.

5 Haven't done that in the 11 years since I've been

6 gone.

7 After Katrina, I relocated to

8 Washington, D.C. area, married myself a veteran.

9 I'm not a veteran, but I married a veteran. My

10 husband is an Air Force retiree, and I do come

11 from a long line of veterans in my family. We

12 have a lot of Air Force retirees, so I must say,

13 Go Blue.

14 We have some Army vets, we have some

15 Navy retirees, and a few sprinklings of Marines.

16 We'll ask for forgiveness for those. The ones in

17 my family are pretty, kind of, crazy, but, you

18 know -- anyway. I am happy to be here.

19 As Dr. Repasky pointed out, the

20 Secretary does have a lot of different

21 initiatives that he is focusing on. Five of his

22 top priorities are -- one of them is the Greater


86

1 Choice, the second one is Modernized Systems,

2 Focus Resources is a third one, the fourth one is

3 Improved Timeliness, which is always a big thing

4 with VA, and it has been, so we're looking

5 forward to doing that, as well as suicide

6 prevention. That's another hot topic for us.

7 What I have here is a list of those

8 five priorities and when I'm done speaking, I'll

9 provide this list to Leslie, your DFO, so that

10 she can give each one of the committee members a

11 copy of this, and it has a little one or two

12 statements as to what each of the priorities is

13 about.

14 As we look forward to hearing from the

15 Secretary as he moves his -- moves forward with

16 the initiatives, via news releases or just this

17 town hall meetings, we hope to get a lot of

18 information with regards to the top five

19 priorities.

20 Additional things that we're doing

21 here at the VA is, in our office, the Office of

22 the Advisory Committee Management, we are looking


87

1 forward to making history as we standup five new

2 additional advisory committees. Currently, VA

3 has 25 advisory committees, and so we're going to

4 increase that number to 30 advisory committees.

5 Yes.

6 Five of the committees -- three of

7 them are what we would call the discretionary

8 committees, and these discretionary committees

9 are established at the behest of the Secretary.

10 And two of the other committees are what we

11 consider mandated, or statutory committees,

12 because they're mandated by law, or by Congress.

13 The first of the discretionary

14 committees is called the Veterans Family

15 Caregiver and Survivor Advisory Committee, and

16 this committee is going to focus on issues

17 related to veterans, their families, their

18 survivors, across the generations, looking at the

19 relationship and the veteran's status for each

20 one of the veteran family members, caregivers,

21 and survivors.

22 The second of the discretionary


88

1 committees is going to be the VA Prevention of

2 Fraud, Waste, and Abuse Advisory Committee, and

3 it's going to focus on ways to identify and

4 leverage cutting edge fraud, waste, and abuse

5 detection, and reporting activities across VA

6 through one single office.

7 And the third is the Veterans Suicide

8 Prevention Advisory Committee. As I mentioned

9 earlier on, one of the top five priorities for

10 the Secretary is suicide because the suicide

11 prevention, on a daily basis, there are about 20

12 veterans that commit suicide daily, and of that

13 20, 6 of them, VA have been able to identify, and

14 that's because those veterans have been linked

15 through VA and they've received care through VA

16 in terms of mental healthcare.

17 The other 14 or so veterans, either

18 did not have the information needed to link up

19 with VA or they just simply refused to get the

20 help that they needed through VA. So that is one

21 of the initiatives that we're looking at. And

22 this committee will implement ways to implement a


89

1 best health model for veterans to ensure that

2 critical and early intervention is established

3 and to reduce the need of -- to reduce the number

4 of suicides among our veterans.

5 The next two committees are mandated,

6 again, by law, so they are statutory, and one of

7 them is the Presidential Commission. And the

8 acronym for it is the COVER Commission, and COVER

9 stands for Creating Options for Veterans

10 Expedited Recovery.

11 And this particular committee is going

12 to focus on the Choice Act, and do a study on the

13 opioid crisis, because that is another major

14 thing that's happening with the veterans; this

15 opioid crisis.

16 Secondly, we have a statutory

17 committee called the West L.A. Veteran and

18 Oversight and Engagement Board, long words, and

19 this particular committee is going to focus on

20 how to manage the West L.A. campus.

21 So as I indicated, 25 committees,

22 we're going to increase to 30 committees, 15 of


90

1 those committees currently are statutory. We're

2 going to increase that number to 17, 10 of them

3 are discretionary, we're going to increase that

4 number to 13.

5 Generally, the General Services

6 Administration, or GSA, allots for an agency to

7 have a certain number of discretionary

8 committees, and so right now, our VA is right at

9 the number, which is 13, and so we're actually

10 going to them now to get special approval in the

11 event the Secretary sees the need to standup

12 additional committees.

13 All of the committees right now,

14 whether it's mandated by law or by Congress, or

15 at the behest of the Secretary, are all receiving

16 the Secretary's priority to move forward with

17 establishment, so we're all excited about that.

18 And lastly, in our office, we're

19 excited because we're gearing up for our second

20 annual, or second, should I say, Secretary Chair

21 Summit. In May of 2015, we held the very first

22 Secretary Chair Summit, where the Chairs of each


91

1 committee received an invitation from the

2 Secretary at the time, which was Secretary

3 McDonald.

4 He invited them all to come in and

5 share some of his vision that he had for

6 transforming VA, additionally, he received some

7 feedback from the Chairs on how we could

8 transform VA together.

9 It was an excellent meeting. We

10 initially scheduled the meeting for an hour and a

11 half. An hour for the Chairs to hear from the

12 Secretary, however, he spoke beyond that. We

13 actually had him for two hours because he was

14 excited. He ignited an excitement within all of

15 the Chairs as well. We got a lot of great

16 feedback, not only from the Chairs, but also from

17 the Secretary, so we're hoping to do the same

18 thing with our new Secretary, in transforming VA

19 or continuing to do so.

20 The only feedback that we got that was

21 not as great was that we should have had our

22 Designated Federal Officers, such as Leslie, in


92

1 the room so that they too can get the real-time

2 information, as the Chairs did, so that they too

3 can be a part of the unfolding of transforming

4 VA.

5 So this time around, we plan to have

6 the Secretary invite the Chairs and the DFO to

7 attend that meeting. Planning is underway.

8 Initially, we were looking at an early June

9 timeframe, or mid August, but because the

10 Secretary's calendar is filling up, he's quite

11 busy with getting around, and advocating, and

12 partnering with different agencies, and community

13 providers, we may have to slip back to September

14 timeframe.

15 However, we will keep you all in touch

16 through your Designated Federal Officer once we

17 get a date pinned down. That's all I have.


19 MS. JOHNSON: I have a question.

20 MS. BURNEY: Yes, ma'am.

21 MS. JOHNSON: What was that last

22 committee again?


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1 MS. BURNEY: Suicide Prevention.

2 Veterans Suicide Prevention.

3 MS. JOHNSON: No.

4 MS. BURNEY: Yes, West L.A. campus.

5 So it's called the Veteran and Community

6 Oversight and Engagement Board. So West L.A.

7 campus, I believe, have a lot of land there, and

8 so that committee is going to determine how to

9 manage that land and do some other things.

10 (Off-microphone comments.)

11 MS. BURNEY: I do not. Not at this

12 time. I don't have any other additional

13 information. There'll be more information to

14 come once the -- actually, the package to

15 establish this committee is sitting with the

16 Office of General Counsel, and once -- we're

17 hoping to move it to the Secretary, either by

18 Friday or Monday, so that he can sign-off on it,

19 we can file it, and then the program team can

20 make an announcement, a news release, and we can

21 move forward with getting members and having the

22 first meeting, so that we can get some awesome


94

1 advice and recommendations to the Secretary and

2 on to Congress, so more to come.

3 Okay. Thank you. Any questions for

4 ACMO?

5 MS. QUARLES: Well, actually, Bob, I

6 have one for you, related to the committees,

7 well, we would love to hear from your experience,

8 the meeting with the Secretary, as a Chair.

9 MR. CERTAIN: I wasn't the Chair when

10 the meeting was held.

11 MS. BURNEY: And so only the Chair and

12 the DFO, well, this time around, the Chair and

13 the DFO. I know that there are some committees

14 that actually have a Chair and an Acting Chair,

15 but only one is invited to the meetings.

16 MS. QUARLES: But yours is coming up,

17 Bob.

18 MR. CERTAIN: Well, yes. It's

19 important to get that -- those dates bracketed

20 for the Chairs because we actually have lives.

21 Secretary McDonald was very accessible, and so

22 we've had teleconferences, Dr. Kushner and I had


95

1 a couple teleconferences with him, and he

2 responded to emails within minutes, usually, when

3 he was the Secretary. I don't have the new

4 Secretary's email address.

5 I take his out rather regularly and

6 responded well, so very quickly, to inquiries

7 about what was going on and concerns we had. So

8 I'm hoping that we will establish that same kind

9 of relationship with Secretary Shulkin.

10 MS. QUARLES: Well, thank you.

11 MS. BURNEY: You're welcome.

12 MR. CERTAIN: Anything else? Then

13 it's time for what's called a networking break,

14 whatever that means, that the networking is

15 across the hall. So let's be back in here on the

16 hour.

17 (Whereupon, the above-entitled matter

18 went off the record at 11:33 a.m. and resumed at

19 11:39 a.m.)

20 MR. CERTAIN: As you may recall in the

21 last couple meetings, Mr. Moragne had suggested

22 that we do some cross-fertilization with other


96

1 advisory committees that have similar concerns

2 with the populations they represent, and so

3 today, Kirk Martin is the Chair of the Advisory

4 Committee on Disability Compensation, which is

5 one of our concerns.

6 And then what the idea is that if we

7 have similar recommendations that we're planning

8 to put forward, we would coordinate the wording

9 and refer to the other committee as being

10 interested in the same subject, so that as it

11 works its way through the system, it works as a

12 foot stomper, and if the wording is the same,

13 then it makes it a lot easier to get approval,

14 so, Mr. Martin, you're on.

15 DR. MARTIN: Good morning. Thank you

16 very much for the opportunity to be here.

17 Speaking with the Former Prisoners of War

18 Advisory Committee is an honor and it's humbling.

19 What you sacrificed for your country and for the

20 veterans is awe-inspiring, and I'm happy to be

21 here and share a few thoughts for the advisory

22 committee on disability compensation with you.


97

1 I'll tell you just a quick snapshot

2 about my history. I am retired U.S. Air Force,

3 and also, kind of run a parallel life in the

4 civilian life as a Mayo Clinic surgeon. I did

5 surgical oncology in pancreatic cancer surgery

6 for 28-1/2 years. At the same time, I was a

7 reservist, a Guardsmen, and period of active duty

8 interspersed, the last four years spent at the

9 Pentagon as one surgeon for the National Guard,

10 and the assistant for the Air Force Surgeon

11 General.

12 So had a good chance to see military

13 medicine, civilian medicine, and now, VA

14 medicine, and it's a been a good, kind of,

15 stepping stone to compare the civilian sector

16 with the military sector, and what we bring to

17 care for our veterans.

18 Our advisory committee, like this

19 advisory committee, is Congressionally mandated.

20 And is basically run by Statute 38 USC and the

21 Management Committee Advisory Office. Jeff

22 Moragne visited us and talked to our committee


98

1 about a year ago, and talked about this cross-

2 linking, or cross-pollination, between advisory

3 committees, and I'm happy to have a chance to

4 visit with you.

5 I had to laugh this morning at

6 breakfast, I looked down, and I'm just literally

7 covered with this powdered sugar from beignets.

8 And I'm thinking, you know, this could be the

9 pollen and I'm in perfect position to cross-

10 pollinate with the former prisoners of war.

11 The Advisory Committee on Disability

12 Compensation was established in 2009 by Secretary

13 Shinseki and we have, basically, setup in the

14 bylaws that we will advise the Secretary and

15 subsequently, the House and Senate Committees on

16 VA Affairs biannually, with a former report on

17 the status of disability compensation for

18 veterans.

19 The committee has now finished their

20 fourth biannual reports, which we submitted last

21 October, October 16, and in addition, our charter

22 allows us to provide reports as deemed necessary,


99

1 and therefore, we've had three interim reports in

2 the history of our committee.

3 I began service on the Advisory

4 Committee on Disability Compensation in 2013,

5 became Chairman in 2016, last year, following Lt.

6 Gen. Chevy Scott, which some of you may know. He

7 was from Texas.

8 We have no termination date for the

9 committee, which I guess is a good thing. We

10 don't have any barcodes or best used by dates,

11 but our committee does rotate, like all the

12 advisory committees now, and basically, on a

13 three-year cycle, usually no more than two

14 consecutive terms will be granted.

15 Now, our committee is setup to have a

16 maximum of 18 members. We have never had that

17 many members. We have had 12. One of committee

18 members, a representative from one of the VSOs,

19 died last year and so we have been at 11 members

20 since that.

21 This spring, we had advertised in the

22 Federal Register for nominations for committee.


100

1 We're looking to add another VSO representative

2 back to the committee. We're also looking to add

3 another economist, and some other qualified

4 individuals. I suspect this iteration, we

5 probably will get at least, maybe two, more

6 members to our advisory committee. We have a

7 couple members rotating off at the end of this

8 year.

9 So currently, our committee

10 composition is made up of a mix of population.

11 We have five physicians, we have four retired

12 General officers, two Air Force, two Army, keep

13 things equal. We have one attorney, on PhD

14 economist, and had enough questions that come up

15 about the economic implications of various things

16 that we deal with that it makes sense to add

17 another economist.

18 The economist we have is an academic

19 economist and brings a lot of insight to the

20 committee, particularly in the earnings/loss kind

21 of data and studies like that.

22 We have one retired VBA employee, Tom


101

1 Pamperin, we have retired insurance executive,

2 two healthcare executives, and we had two DFOs,

3 we've recently had one of our DFOs rotate off the

4 committee, and so we're back to one DFO.

5 MR. CERTAIN: What's a DFO?

6 DR. MARTIN: Designated Federal

7 Officer.


9 DR. MARTIN: They're the ones that

10 actually kind of make us legitimate and if we

11 don't follow the orders --

12 MR. CERTAIN: You can't have an

13 official meeting of an advisory committee without

14 the presence of a DFO.

15 DR. MARTIN: And like this advisory

16 committee, all the advisory committee meetings

17 are advertised in the Federal Register as to time

18 and place. We make a time for public comments at

19 each of our meetings, and people, if they show

20 up, and we also don't speak for the VA, we

21 simply, kind of, assimilate data and provide the

22 Secretary of the VA reports, but the VA speaks


102

1 for itself and we don't intend to speak for them.

2 Just like today, I come as an

3 individual speaking for the advisory committee

4 and for myself, not representing what the

5 Secretary thinks or the VA.

6 This is our committee back in 2015.

7 This is General Scott. And he set down to the

8 committee, rotated off, the rest of the

9 committee, pretty much, is the same.

10 Now, what I wanted to do in the time

11 that I have today is try to cover, sort of, a

12 broad brush of what we have been involved with

13 over the last, at least, two or four years. The

14 big-ticket items that we've been concerned about

15 and the things that we've brought to the

16 attention of the Secretary and the VA, where we

17 thought we could contribute by pointing out some

18 of the things that make the process not work or

19 some of the things that could make the process

20 work better.

21 So I'd like to cover a couple of

22 these. They may be very familiar to you, they


103

1 may be not familiar, please stop me if you have

2 questions, and I'll try to go through these

3 fairly quickly so that we don't get bogged down,

4 but I did want to at least make you aware of the

5 kind of things that we deal with.

6 Unlike you, all of our meetings are

7 held around the Beltway and the VA buildings in

8 D.C. We haven't been offsite in quite a while,

9 so we usually meet either at Vermont Avenue, in

10 the main building, or on G Street at the federal

11 VA building right down in the capitol.

12 Probably the main thing, and one of

13 the things that's actually in our charter to look

14 at, is the VA rating for disabilities, the

15 Schedule for Rating Disabilities. And this is

16 kind of the basic framework that talks about the

17 medical and the environmental, the administrative

18 environmental, aspects of granting disabilities,

19 and is that disability current, does it meet the

20 current standards for compensating veterans for

21 whatever injury they have, and is it timely?

22 Now, this schedule had really not been


104

1 revised in decades. It had been updated here and

2 there, but as far as front to back renovation, or

3 scrubbing of it, it really hadn't been. So we,

4 back in 2009, the project began to look at every

5 single rating in the Schedule for Disability

6 Ratings, bring it up to date, current medical

7 technology, current medical therapy, current

8 thoughts about the illness and the disease, and

9 then to try and make sure that the compensation

10 was on parity with the earnings loss they

11 suffered because of this disability from military

12 service.

13 Notice I said 2007, or 2009, even if

14 we take the 2009 date, '09, and it's now '17,

15 that's a lot of years since this started, and

16 unfortunately, that process is not done yet, and

17 won't be done, probably, until late 2018. We'll

18 talk about that more in detail.

19 Individual unemployability has been a

20 really thorny issue that we have wrestled with.

21 It basically is a compensation, additional

22 compensation, to bring veterans who are not rated


105

1 at 100 percent because of their disability, but

2 are unable to gain and maintain employment,

3 compensation to bring them up to the 100 percent

4 level.

5 That's had some problems over the

6 years, not the least of which, it has exploded in

7 the number of people in this program. Now, we're

8 hopeful that that will partially be fixed by the

9 rating schedule, which will adjust them up from

10 where they probably should have started. We'll

11 talk about that in two minutes.

12 The appeals process, if any of you

13 have been involved with appeals of disability

14 ratings, you know it's a long process. The

15 average appeal takes 3.1 years for a decision.

16 If that is remanded, that is if the veteran

17 brings in new evidence, if you add something else

18 to it, the process starts over, and even if it's

19 remanded once, the average time for the appeal is

20 now double; 6.2 years.

21 So this is a huge issue, so we'll talk

22 about that in a little bit. Guard and Reserve


106

1 issues, as you know, the Guard and Reserve have

2 been part of a war for at least the last 20

3 years, probably, certainly the last decade, very

4 involved.

5 Yet, the Guard and Reserve rotate on

6 and off active duty, and capturing those periods

7 of duty can be difficult. For instance, a

8 veteran that goes to a combat theater with the

9 Air Force Reserve or with the Guard, and serves

10 for three weeks, doing whatever they do, flying

11 combat missions, or support services, or

12 whatever, and goes home, that combat action does

13 not generate a DD214 because it's less than 31

14 days.

15 And so that period in combat doesn't

16 show up on any records, military or VA. So

17 that's something we have been working on hard to

18 fix, and we're still working that issue. That's

19 one of the things the committee's worried about.

20 Separation health exams, Guard and

21 Reserve, you don't have the same rules as active

22 duty for separation health exams, separation


107

1 assessments, so we don't know exactly what the

2 status of the Guardsman or Reservist is when they

3 come off of their Guard and Reserve tours, even

4 if they've bene deployed for half of their

5 career.

6 The good -- you can say, wow, is there

7 anything good you're going to talk about? Yes,

8 there are a few things that are really going to

9 make you feel good, and one of them is the VA

10 Live, VBA Live Manual. That basically, is

11 computerizing the rating schedule and the updates

12 that go out from a book that's many times as big

13 as your binder, that has pages pasted in every

14 day, they go in, take out the bad stuff, put in

15 the good stuff, or paste things over it, fix it

16 up. That's no longer working.

17 Now it's all online and that's

18 happened over a relatively short period of time

19 so that the latest, most current information is

20 available to every rater across the system at

21 every computer terminal. And you don't have to

22 depend on somebody to update their giant binders


108

1 and go through and fix them.

2 The National Work Queue is another bit

3 of good news. The National Work Queue is

4 basically taking all the ratings claims

5 throughout and if one center, one regional

6 office, is just flooded with claims and they're

7 way behind schedule, the National Work Queue can

8 centrally, from Washington, D.C., reroute those

9 claims to any of the regional offices across the

10 country now. And that is up and running.

11 And it has shortened the time for

12 claims from forever to a reasonable smaller

13 number of the days waiting. We'll talk

14 about that.

15 Women's veteran issues have become a

16 very important piece of data for our committee

17 and we are looking at that on a regular basis.

18 The number of women veterans is growing and their

19 missions in and out of theater have exponentially

20 expanded.

21 The C&P exams, the compensation and

22 pension exams, for the exams, you must see a


109

1 provider to get during the course of your

2 disability claim, have become easier to get now

3 because of the use of contract physicians as

4 opposed to the finite number of VA physicians.

5 They can now send these claims out to other

6 physicians to have the exams done faster and

7 using the VA standards.

8 And you're going to hear more about

9 that in the future. Veteran homelessness, as you

10 know, that was a priority for the VA for a long

11 time, zero veteran homeless by 2015, when I first

12 came to this committee, it's still a very high

13 visibility issue, very important issue, for all

14 the Secretaries, including Dr. Shulkin, I

15 believe.

16 Other issues we talk about is Agent

17 Orange and Gulf War Illness. That's a huge issue

18 with a lot of presumptive diagnoses that have

19 been granted, but some still in the flow still

20 being worked, and we're looking at all of those.

21 In the last two meetings, we've had three, four

22 hours of discussion on Gulf War Illness and Agent


110

1 Orange.

2 Presumptive diagnoses, mainly to do

3 with Agent Orange and Gulf War Illness, and also,

4 things like burn pits, things like water

5 pollution, Camp Lejeune, things like that, that

6 we also get into.

7 Claims backlog, that's another bit of

8 good news. The Secretary McDonald had a 12

9 breakthrough priority scheme, and a lot of the

10 things you'll see, you may see relating to one of

11 those, or more of those, priority items. I

12 haven't seen Dr. Shulkin's priorities yet, we

13 asked him to our meeting in March,

14 understandably, he was very busy at that time,

15 hopefully he'll be able to make the one in June,

16 but we're waiting to deploy those with the

17 previous priorities.

18 Okay. And our reports, what happens

19 to them? What happens to your reports? Probably

20 about the same thing. They go to the Secretary

21 through a list of VA offices first, they get to

22 the Secretary's office, the recommendations are


111

1 examined very carefully, the VA then responds to

2 the committee, in some manner, about how they're

3 received, or what they plan to do about the

4 recommendations.

5 And just for your information, in the

6 2014 report, they concurred in 9 issues, they

7 concurred, in principle, in 14 issues. Now, the

8 difference in this verbiage, concur usually means

9 there's a plan to implement the recommendation,

10 concur in principle means, yes, we agree with

11 that, but we don't have a recommendation or we

12 can't make a recommendation at this point, so

13 that's kind of what the VA did for the last

14 report.

15 Our biannual report, submitted last

16 year, is still in process and has not been

17 reviewed to come back to us yet.

18 The VA uses the GAO, just as your

19 committee does, the General Accounting Office, to

20 estimate costs and burden on the federal health

21 dollars for everything, so most everything we

22 have goes through the GAO, including the


112

1 earnings/loss statement for individual

2 unemployability, and other items.

3 The Schedule for Rating Disabilities

4 makes its way through the GAO for their approval

5 as one of the last steps. Now, here's the VASRD,

6 the VA Schedule for Rating Disabilities. This is

7 the big 15-body system rework that's been in

8 progress for some years now.

9 And the idea was to review every body

10 system and then institute a re-look every ten

11 years, when this started, so that no system is

12 more than ten years old. The terminology, the

13 medical knowledge, the treatment, things like

14 that, changes over time. It gets better over

15 time, other treatments are developed, other

16 medicines come out, and new diseases are named

17 and implemented here on the ratings schedule.

18 So we have to have some kind of a fix

19 where every certain length of time they're

20 reviewed. The first thought was, let's do it

21 every ten years, realistically, that's come down

22 to every five years now because things change


113

1 more rapidly than every decade.

2 The intent is to assure that the

3 rating schedule is applying current medical

4 science and incorporates new and current

5 earnings/loss statement. The earnings/loss

6 statement that we have been using is almost a

7 decade old and so we're looking for new data, and

8 it's part of our mission.

9 So where do we stand with this big

10 update of medical knowledge? And, kind of, the

11 interesting thing is, you say medical

12 terminology, that hasn't changed too much. Well,

13 actually, it has. And if you look at the old VA

14 rating schedules, they talk about things like

15 paralysis agitans, and unless people went to

16 medical school a long time ago, like I did, you

17 might not know what that is. They'd scratch

18 their head and say, what is that?

19 But, you know, that kind of

20 terminology needs to be updated so that people

21 are conversant with it, say, oh, yes, now I know

22 what it is, and it makes more sense.


114

1 So in addition to the update, we added

2 new medical conditions, we clarified the existing

3 evaluation criteria to be sure that the

4 evaluations suit the complexity of the disease,

5 diabetes being a very complex disease with a lot

6 of facets.

7 Those of you who have dealt with this

8 know that even the work-up for diabetes usually

9 encompasses about four or five other DBQs, the

10 Disease-Based Questionnaires, like hypertension,

11 like cardiovascular disease, vision, the number

12 of things that are linked to diabetes and they're

13 all part of the disease, which, you've kind of

14 got to look at everything to make some kind of

15 judgement about the disability a particular

16 veteran has.

17 And then after this is all done, it

18 has to be approved, and I'll show you the easy

19 little cycle it goes through, and after it's

20 approved, then it's got to be transcribed and put

21 into the VBA Live so it's available for raters to

22 use, and to let veterans understand what the


115

1 changes are and any impact they may have.

2 The idea here is not to go back and

3 change the ratings that have been granted. The

4 idea is to be sure that the new ratings are based

5 on the current medical science and current

6 disability understanding in compensation, and

7 that the veterans understand the difference.

8 We're not going to go back and -- the

9 intent is not to take the veteran's benefits

10 away, but rather, to compensate them more

11 equitably based on the current data.

12 Okay. So each one of these body

13 systems goes through a working phase group, a

14 developmental phase group, where they take a

15 draft of the changes, and then a concurrence

16 phase, where they send it through all the

17 different offices in the VA. And here is that

18 easy to understand schedule that this goes

19 through. I'm being a little facetious, because

20 this is a very long and laborious process.

21 And the thing is, if this just went

22 through this office, to this office, to this


116

1 office, to this office, in the space of a day, or

2 two weeks, or a month, it might be easier to

3 understand. But sometimes it goes and it has no

4 timeline. In fact, most times, right now, it

5 goes and has no timeline.

6 So it could go to the JAGs, and it

7 could sit on the JA Office of the Judicial Office

8 for years, and it may need that length of time to

9 get through it, but it stays in there a very long

10 time.

11 And so our committee, last year, in

12 the biannual report, one of our wide items was

13 that the Secretary establish some kind of a

14 timeframe for these various offices, within the

15 VA particularly, that they need to look at it,

16 respond to it, and get it on, so hopefully this

17 system is going to be faster than the ten years

18 it's been going on now.

19 The other thing is, some of these

20 offices are outside the VA system and once it's

21 outside the VA system, like at GAO, and public

22 comments, things like that, there is a timeframe,


117

1 but within the VA system, the timeframe wasn't

2 very well specified, and so we're working to see

3 if that can be tightened up a little bit.

4 Where do we stand right now? Zero of

5 fifteen final rules published. There are six

6 body systems for the final rules at present, two

7 have been proposed, ten have been cycled for

8 concurrence, and at the time I drafted this in

9 early March, we were looking at November 2017,

10 but now it's been pushed back to 2018.

11 So hopefully in 2018, we'll get these

12 final rules published for the new rating system.

13 And then the review cycle, as I mentioned is

14 going to be every five years.

15 Okay. So switch gears to individual

16 unemployability. Now, this has been around for

17 quite a while. 38 USC authorizes the rating

18 schedule to provide the ratings bases, as far as

19 practicable, upon an average impairment in

20 earning capacity. And that, as far as practical

21 language, is what's really used to authorize

22 these individual unemployability benefits.


118

1 Again, the committee is a little

2 concerned that the name is not an accurate

3 description of what's happening, because as

4 you'll see, many of these veterans are over 65,

5 many are over 75, when they first receive

6 individual unemployability.

7 And layperson could look at this and

8 go, holy cow, they couldn't work in the civilian

9 sector at age 75. They probably would have

10 trouble finding a job at that age. And the

11 Social Security recognized retirement age is 67

12 now, so the name is probably not helping this

13 issue.

14 The individual unemployability, kind

15 of, came to light in 1945, as a segment for

16 rating disabilities, and they said at that time

17 that age may not be considered as a factor in

18 evaluating service-connected disability, and

19 that's still true, and service-connected

20 unemployability could not be based on advancing

21 age.

22 So that's why, initially, a veteran


119

1 who was 80 years old, can be awarded individual

2 unemployability. But again, bear in mind that,

3 as far as the committee can see, this is really

4 an adjustment in the rating schedule to get

5 people who are not at 100 percent because of a

6 disability, yet, they have disabilities

7 consistent with somebody who is totally disabled,

8 to that 100 percent level.

9 So it's kind of being used to get the

10 disability right, but unfortunately, it's tied to

11 unemployability. Now, this isn't unemployed,

12 this is unemployable, so it's not that if they

13 had a job, they could do it, they just simply

14 aren't able to do it because of their

15 disabilities.

16 I don't want to get too far in the

17 weeds because it gets very tedious, but the GAO,

18 in 2015, it did a study on earnings loss for

19 individual unemployability, and they came back

20 with seven options for revising this TDIU, total

21 disability individual unemployability, including

22 discontinue benefits beyond retirement age,


120

1 consider rehab, and if they get rehabbed, to drop

2 the benefits, increase the earnings limit that

3 people can have to be qualified for TDIU, lower

4 the disability rating criteria, add new

5 unemployability claims criteria, and use patient-

6 centered work disability measures, and gradually

7 reduce the benefit payments.

8 None of that has been accepted. That

9 is a GAO proposal. We currently have asked the

10 VA to do another earnings loss study, current

11 earnings loss study, and that is being contracted

12 as we speak. The bids are out for that.

13 So hopefully that earnings loss study

14 will provide a more realistic picture of what the

15 earnings loss of these veterans is, what it

16 should be to get them up to the level of

17 uninjured people. And then to make that

18 adjustment within this TDIU. That's what's going

19 on right now.

20 The studies we were previously using

21 were from 2007, 2008, and 2012, and then the GAO

22 study of 2015 I just mentioned to you. These


121

1 studies all made suggestions within them, the CNA

2 study, increase comp for mental issues, the Econ

3 Systems study, that's with functional impairment,

4 and income is 7 percent higher, and then adjust

5 down for tendinitis, arthritis, and move IU at

6 age 65 to 66, found for both for rehabbed and

7 deny IU, that was there recommendation.

8 The RAND study, physical disability

9 increases in comparity and mental disability

10 decreases that. And so this is what I was

11 mentioning to you earlier, 19 percent were over

12 75 years of age when they received TDIU; when

13 they first received it. But at that age, only 1

14 of 14 were able to work, 1 of 14 in the general

15 population were able to work at age 75.

16 And here's what I had mentioned to you

17 about the IU, kind of, expanding. Between 1996

18 and 2005, it increased from 71,000 to 220,000.

19 In 2012, over 300,000. The most common primary

20 disability in FY13 was PTSD, in nearly half.

21 Right now, upfront income verification, between

22 SSA, Social Security, IRS, and VA happens to just


122

1 serve as a check on the veterans who were

2 receiving TDIU.

3 What we think is going to happen is,

4 next year and ongoing, that this Econ -- I mean,

5 this economics loss data, the earnings loss data,

6 will come out of the VA study, probably, within

7 the next year in the VA, so we'll look at this in

8 a smarter light and more current light.

9 Let me just say a couple words about

10 appeals, and I mentioned the long duration of

11 appeals within the system. If you look at the

12 number of veterans who filed appeals, only 4 to 5

13 percent of all those who filed appeals choose to

14 file a formal appeal to the board. That means

15 only about 5 percent of all the veterans actually

16 appear before or case is heard by the Board of

17 Appeals.

18 The others are, kind of, waited before

19 they get to that board level or the veteran

20 withdraws it, or other information comes in and

21 it kind of goes back into the cycle.

22 The filed appeals, 1.4 million claims,


123

1 within that, 6.35 medical issues per claim. The

2 notice of disagreement, between 10 to 12 percent,

3 when 4 to 5 percent actually get to the Board of

4 Veterans Appeals.

5 This program also is exploding.

6 Between 2012 and 2015, veteran appeals increased

7 35 percent, and 438,000 appeals as of January,

8 the end of January of this year, and the VA

9 projects that appeals will increase to more than

10 2.2 million by the end of 2027 without reform.

11 Now, what's being done to fix that?

12 Here's the lifecycle of the appeal. Remember,

13 when we looked at the lifecycle of the VASRD

14 appeal process, this is the lifecycle of the

15 appeal. I don't expect you to read this. If you

16 can, then you probably don't need glasses. This

17 is a check.

18 Okay. Good. This is the whole cycle

19 and at any point in this, the way the system is

20 setup now, if I add additional elements, I've got

21 a new medical examination, I've got another

22 physician's opinion, I've got a new problem that


124

1 comes up, my appeals might be over here, goes

2 back to here and starts over.

3 So it's non-linear, multi-staged, and

4 maintains a local record, the jurisdiction is

5 split between VBA and the Board of Appeals, the

6 panels can produce new evidence at any time

7 without limitation, and to transform this, it's

8 going to require a legislative change, which is

9 way beyond our committee, and increased

10 resources.

11 We can recommend more resources, which

12 we've done, and in response to that, the VA's

13 hired several hundred more attorneys for the

14 Board of Veterans Appeals and other spots,

15 including at the regional offices, particularly

16 in the structure with who can look at the appeals

17 that regional office does.

18 How's this going to be fixed? Well,

19 even this year, the VA has presented a new --

20 remember the fully developed claims where you

21 present everything for a rating decision and

22 should expedite it, and has, actually, they're


125

1 going to be fully developed appeals where you

2 have everything in a package, you send it

3 through, and get an appeal much faster.

4 And that's because then you don't add

5 new evidence, you don't go back and start over

6 again. So this new simplified appeals process

7 lets veterans choose three lanes to go, higher

8 level review at the regional office, closed

9 record, no duty to assist, no new evidence,

10 that's fast because it's decided at the regional

11 office.

12 The supplemental claim level at VBA,

13 and then finally, the appeals lane, it goes to

14 the board. And the veteran can choose one of

15 these three lanes. If your appeal is all good or

16 it's relatively succinct, it's pretty simple,

17 it's a yes/no decision, then you probably want to

18 go to the higher level of review at the regional

19 office, or supplemental claim level.

20 Even at this level, there is a duty

21 for VA to assist. So I think that that is

22 probably going to help this immense backlog in


126

1 the veterans appeals, but it's going to be a work

2 in progress.

3 Okay. A couple of good things for

4 review, feeling better, and there's usually acid

5 in your stomach about now. The National Work

6 Queue is this centralized office for the work of

7 looking at bases and arriving at a decision on an

8 appeal -- on a disability claim, can be made in

9 more rapid fashion.

10 You remember the pictures, I talked to

11 somebody earlier, and, Dr. Hain, maybe it was you

12 and I that talked about it, the pictures of the

13 stacks of records in the VA offices, and you open

14 the door, and you just see this towering stack of

15 record on tables.

16 Fortunately, those records have mostly

17 all been digitized over the last, about, four or

18 five years. The Undersecretary of Benefits was

19 kind of leading the charge for digitization of

20 many of these records, and that's actually

21 changed a lot in the VA so that if I'm in North

22 Carolina, and I'm in a regional office there, and


127

1 one of my constituents comes in, files an appeal,

2 and they can't see this appeal, the National Work

3 Queue can send it to a regional office in another

4 state, another area, and that has the capacity to

5 look at it and make a decision more quickly.

6 And that kind of thing has really

7 improved the workflow of the civilian ratings

8 process. The transition began in March 2015, so

9 it's really not that old, and not too long ago

10 did they start this.

11 They implemented the test phase and

12 then Phase 2 to more regional offices in June of

13 2015, after March opening. They're looking at

14 new capacity for computerized assistance for the

15 raters when you look at this. Since May 2016,

16 distributing workload to all 56 regional offices

17 is occurring on a daily basis.

18 The decision cycle has been reduced 14

19 days or less, which is a tremendous gain from

20 what it used to be on the little paper records.

21 The average date to complete claims in 2016 was

22 122 days, in 2017, they're going to add appeals,


128

1 probably later this year, the appeals process, to

2 try and farm those out to where they can be seen

3 more quickly, and that'll help with the appeals.

4 Since December 2016, work claims are

5 seen within five days. Now, here's the other bit

6 of good news. Usually, a process like this would

7 take 27 new buildings, 50,000 employees, and a

8 bunch of equipment. The National Work Queue has

9 24 employees in D.C., and they said they're full

10 staffed.

11 The committee asked them, do you need

12 more assistance in this function? No, we're

13 good. So 24 employees are revolutionizing the

14 claims handling across the United States, and

15 actually, overseas.

16 So this has been really good news, the

17 National Work Queue, NWQ. It's a very good

18 process.

19 By March 2014, claims backlog had

20 dropped from 611,000 to 345,000, that's about a

21 42 percent drop, and between '13 and '14, the

22 claims that were over two years old, 99 percent


129

1 of them had been done, claims that were greater

2 than a year old, 98 percent of those had been

3 done, and the 127,000 current claims were 77

4 percent done, an average of, what, 300 a day, so

5 this is the backlog that you've all heard about,

6 the waiting in line, the backlog, for claims to

7 process. It's getting better too.

8 Why did that drop happen? Why did the

9 turnaround occur? Well, part of it was the

10 automation. It happened over a nine-month

11 period, 1.3 million in 2014, paper to complete

12 automation, the fully developed claims, we're

13 talking about having things ready in a package

14 ready to go, they had medical supporting

15 evidence, they had the other things that they

16 needed to meet the criteria for the claim, the

17 turnaround goal is 75 days, but by September 17th

18 it had dropped to an actual 30 days.

19 And service treatment records, those

20 pesky things that the veterans used to have to go

21 and knock on doors at the military to get at

22 Denver or one of the other repositories for


130

1 military records, that, by DoD standards, had to

2 be submitted within 45 days of a separation, and

3 that happened back in December of '13.

4 I was at the Pentagon when that

5 happened and that was a huge change, but it also

6 allowed these records to be captured and sent to

7 the VA at the time of separation, so that they

8 didn't have to put it on the veteran to go find

9 you medical record. It should be there. It

10 should be there.

11 The other two things that helped were

12 the VBA Live Manual, and that project was

13 completed in just nine months, changing from the

14 big binders to online, currently updated rating

15 schedules, and claims processing by the National

16 Work Queue, which dropped the turnaround time to

17 less than three days since 2015.

18 So those are all good news things that

19 you can take home and feel good about. We've

20 been concerned with a lot of things with the

21 committee. We meet quarterly. We generally have

22 a pretty good turnout. We want more than 75


131

1 percent of the committee there and generally we

2 have that despite the busy schedules and the

3 dispersed geographic distribution of our

4 committee across the states.

5 I think everybody on the committee

6 feels very dedicated to the fact that we were

7 hoping to do something to help veterans,

8 particularly disabled veterans, you know, be

9 compensated for their service-connected

10 disabilities.

11 So it's meaningful for all of us, just

12 like it is for you. Can we cross-link with any

13 of these things in your agendas? I suspect we

14 probably do and I'm sure that a lot of the issues

15 that we have here, you visited these --

16 MR. CERTAIN: A couple of things that

17 we've heard over time is that veterans with any

18 disability rating at all, there's concern about

19 going in for a review because they're afraid

20 they'll lose what they have. And so that makes

21 it more difficult for the VA to invite them in.

22 And then consequently, as we heard


132

1 this morning, here in this area, only about 1/3

2 of the prisoner of war population in the

3 catchment area are part of the system, and that

4 seems awfully low, which raises a huge outreach

5 issue for the coordinator, or the advocate, in

6 this region.

7 And all of that has to do with making

8 sure that compensation is properly done and not

9 fearing that you'll lose your 30 percent if you

10 go in and try to move to a higher rating.

11 DR. MARTIN: The raters that we have

12 that work with the doctors, share a lot of very

13 interesting insight in the decision, the rating

14 decision, and things that go on in the VA. And

15 we always have at least one former VA rater on

16 the committee. Tom Pamperin is the person who's

17 there now. Tom's spent his career at the VA, not

18 only in rating, but other things as well.

19 And one of the things he told the

20 committee, that I found very interesting was, the

21 VA basically goes in with the idea that once a

22 veteran is rated for a disability and receives


133

1 compensation, that compensation is not going to

2 be taken away. It's kind of going in goal.

3 It does become tough, and medically

4 it's hard because you've got diseases now that we

5 can actually, if not cure, at least turn into

6 long-term survival and remission. Things like

7 prostate cancer, things like sleep apnea. What

8 happens when you put on a CPAP at night and your

9 symptoms completely go away?

10 So that basically, you could say, has

11 eliminated the disease. What happens to the

12 hearing loss that's treated with devices, hearing

13 aids? What happens to people that have

14 infectious disease and get better?

15 A lot of things can happen that you

16 kind of scratch your head and go, I don't really

17 understand that. But the going in philosophy,

18 and I think, at least from our committee's

19 standpoint, is that we're not looking to take

20 veteran's benefits away, we're looking to make

21 the ones that are granted more accurate and more

22 equitable.


134

1 So I understand exactly what you're

2 saying, and I understand the fears veterans have,

3 but I don't think within the VA there's a big

4 camp saying, we've got to save money by taking

5 away benefits. I don't sense that at all.

6 MR. CERTAIN: But getting that across

7 to the veterans is a challenge, and getting word

8 out for presumptives into the community of

9 veterans to say, okay, if you've got -- if you've

10 served in Vietnam and you have X that's been

11 determined to be an Agent Orange result, then you

12 need to come in and let us evaluate that for

13 service connection.

14 DR. MARTIN: Yes.

15 MR. CERTAIN: It's basically with the

16 presumptives and that's a big issue for that

17 proportion. So part of what I've been

18 encouraging and recommending is that we need much

19 more proactive kinds of outreach to invite

20 veterans in to review their current conditions

21 against presumptives that may, if they served in

22 certain theaters.


135

1 DR. MARTIN: Yes.

2 MR. CERTAIN: Now, we just had one, I

3 know, that I got involved with with a fighter

4 pilot who had been based in Thailand and

5 developed one of the various Agent Orange-related

6 diseases, and yet, was out of a different

7 regional office than this one, and they turned

8 him down several times because the rule in

9 Thailand was that you had to live within 50-feet

10 of an area that had been treated with Agent

11 Orange or be in a work area that was close

12 enough.

13 And so, you know, pilots taxi with the

14 canopies open right past all those areas, and so

15 there was -- it finally took an attorney to get

16 involved in it to get the lower ranking reviewer

17 to see the light of day, and so that's a

18 frustration that I think is -- it reminds me of

19 the book Rainmaker, John Grisham's novel about if

20 you turn down the claim long enough, the person

21 will die and you won't have to worry about it.

22 And I rather hate for the VA to be


136

1 seen as that kind of an operation as that

2 insurance company was in that novel.

3 DR. MARTIN: One of the things that

4 has happened, the VA claims for Gulf War Illness

5 or Agent Orange is, they have channeled this,

6 basically, to a single point. Jim Sampsel, who

7 many of you may have heard of or know, is kind of

8 a guru within the VA on Agent Orange.

9 And he knows it backward and forward.

10 He's visited with our committee many times

11 before, but in the last two months, or in the

12 last two meetings, or at each meeting, and he

13 basically looks and reviews all the Agent Orange

14 claims, and the presumptives, he knows the areas,

15 he knows pretty much everything there is to know

16 about the VA and Agent Orange.

17 And so that has helped to at least

18 streamline things through a single point. I

19 don't think it's slowing down claims because

20 there are not that many claims at all involved,

21 but it's kind of made it better; more equitable.

22 Yes, sir.


137

1 MR. CARSON: Mr. Chairman. Lane

2 Carson. Our FPOW coordinators at benefits and

3 the hospital side are working together to find,

4 you know, more POWs out there. We know that's

5 one of their goals. But we're also, of course,

6 trying to get the existing ones up to 100

7 percent. And it sounds like unemployability is

8 harder and harder to get there, the little bit

9 I've been picking up with all the new studies

10 coming out.

11 And so a two-prong question, one, from

12 the perspective of trying to get 100 percent

13 rating for an FPOW, is there any one particular

14 way they -- we need to encourage our local FPOW

15 committee members to attempt to identify to try

16 to bring that veteran up to that 100 percent?

17 And then of course, secondarily, DIC,

18 you didn't touch too much on DIC, but that's what

19 most of us older veterans are trying to make sure

20 our spouses would be ready to receive in the

21 event we pass on. Secretary McDonald talked last

22 summer about transcribing the DIC, and he wasn't


138

1 even getting into, like, long weekends or trying

2 to get it done in a two or three-day period,

3 which is a nice goal, but the second part of my

4 question is, how to fast track the DIC claims,

5 more particularly, they're centralized now, I

6 believe, in the pension office.

7 MR. CERTAIN: National Work Queue.

8 MR. CARSON: Right. And then our

9 suggestion was to try to bring the DICs back to

10 each regional office, but that's not the way it

11 is, and there were some issues about that, so

12 would you touch a little bit on how to get our

13 POWs up to 100 percent and then two, how do we

14 fast track the DIC to the spouses when they pass

15 on?

16 DR. MARTIN: Okay. I'll take those in

17 reverse order, but the DIC, they are trying to

18 approach with regional experts, with people that

19 are kind of focal points for DIC claims in the

20 regional offices, and how well that's working, I

21 can't tell you right now because we haven't heard

22 from them, probably, in the last year.


139

1 So I can't really give you a current

2 update on that. I believe it was what you're

3 talking about, and I agree that's very important,

4 but I can't really tell you much from our

5 committee's standpoint.

6 MR. CARSON: Well, no, no, they mark

7 the file, they're fast tracking it, best they can

8 --

9 MR. CERTAIN: But those went into

10 their work queue, and so they go to the next

11 available review.

12 DR. MARTIN: Well, within those

13 regional offices, they have specialty buckets

14 where they go in.

15 MR. CERTAIN: So I don't think they

16 necessarily get handled at the regional office

17 and the concern with the POW community, this

18 committee in particular, is that, the

19 coordinators tend to develop relationships with

20 their former POWs and their spouses. And in

21 places where that, when the POW dies, that

22 coordinator has, in some places, been able to


140

1 turnaround the claim within 24 hours.

2 And the concern is that, given the age

3 of our spouses, that every 24 hours of lost time

4 is critical when it comes to compensation. And

5 so that's why this committee has recommended a

6 number of times, since the work queue was

7 established, that for POW spouses, surviving

8 spouses, that the turnaround be kept within the

9 local regional office, and that's been rejected

10 twice.

11 And so we haven't found a way to word

12 it in a way that it'd get accepted yet, so we

13 laid off on it this past year, this past set of

14 recommendations, there's no point in beating a

15 dead horse.

16 And if, in fact, it turns out that the

17 work queue means that those things can be turned

18 around in 24 to 48 hours, then we don't have a

19 problem, but back when General Hickey was

20 automating the initial claims process, there was

21 a good bit of pushback, you know, within the

22 regional offices, in the claims departments,


141

1 because they don't like the idea of change, and

2 digitization, and all that.

3 But it seems to have worked out in the

4 benefit of the veteran since that's happened in

5 the initial claims process, is that appeals

6 process that hasn't been digitized yet, and the

7 reason why it takes 3.1 years to get that

8 adjudicated, to me, is sort of mind-boggling. I

9 don't get that anymore.

10 But it's partially because it's still

11 on paper? Is that right?

12 DR. MARTIN: I think it may be a

13 little part of that, but I think the majority of

14 the time is just the time to get through that

15 giant lifecycle that I told you and the adding

16 evidence, and things like that, and the

17 availability of the VBA attorneys.

18 MR. CERTAIN: Well, attorneys tend to

19 slow everything down no matter where we go, and

20 so, quite frankly, when the answer's to hire more

21 of them, it just strikes me as not necessarily

22 the best thing we could be doing.


142

1 DR. MARTIN: Yes. We've been through

2 two cycles of actually hiring more. Let me just

3 mention one other -- I lost, actually -- I will

4 ask, Lane Carson, in the VBA office about the DIC

5 claims and spouse benefits. The second part of

6 it, I don't want to leave with the impression

7 that TDIU is being constricted or that the claims

8 are being awarded less frequently. That's not

9 the case at all.

10 There are actually more claims being

11 awarded --

12 MR. CARSON: That's a good route to go

13 then to get them up.

14 DR. MARTIN: It's still a good route

15 to go. Yes. The question, and the thing I was

16 dealing with is, how you manage that for years,

17 future years, and so it's a lot of future looking

18 at it and the size of the program, the

19 exponential growth, but it's still a valid way to

20 compensate people.

21 MR. CERTAIN: So we are at the noon

22 hour, and lunch is ready for us in the next room,


143

1 and so we pick up and bring it back in here to

2 lunch, so we can continue informal conversations

3 while over eating, but don't talk with your mouth

4 full.

5 MS. WILLIAMS: Sorry, I don't mean to

6 interrupt your questioning, but there are a few

7 things that I need to clarify from the briefing,

8 so I'll leave it to the committee. Once we get

9 your lunch and come back in here, I can get the

10 clarification or I can just do it later. That's

11 the committee's discretion, but there's a list of

12 things that I think that you all may need to get

13 more information on so things can be more clear.

14 DR. MARTIN: So please tell the

15 committee members, feel free to email me. I'll

16 send them forward to the DFO or to other people

17 who can answer the questions.

18 MR. CERTAIN: Is your email address on

19 your --

20 DR. MARTIN: I'm not sure if it is,

21 but it's [email protected]. Feel free to

22 reach out to me.


144

1 MR. CERTAIN: Okay. Dr. Martin, thank

2 you for your time today. I understand you're

3 heading back to Jacksonville.

4 DR. MARTIN: Yes, sir.

5 MR. CERTAIN: So --

6 DR. MARTIN: Actually, we're scheduled

7 for a meeting in June, so I'll bring this issue

8 up with them there.

9 MR. CERTAIN: Okay. Good. Thank you.


11 went off the record at 12:37 p.m. and resumed at

12 1:27 p.m.)

13 MR. CERTAIN: Again, when our

14 speaker's up here, if you're -- if you want to

15 ask a question, always state your name so our

16 reporter can get the minutes correctly.

17 Remember, all the microphones are live so please

18 do not have side conversations by voice. If you

19 need to pass notes, that's okay, but we need to

20 keep it as quiet as possible so that those of us

21 with hearing deficiencies can actually hear, and

22 those of us with soft voices can actually be


145

1 heard, and those of us who are easily distracted

2 -- oh, look, a squirrel, easily distracted now,

3 don't get distracted, so just be considerate of

4 each other. That's a good thing to be.

5 And this afternoon, we start with

6 La'Toya Prieur of Washington, DC, the Chief of

7 Benefits Assistance Services at VBA.

8 MS. PRIEUR: Thank you. La'Toya

9 Prieur. I am the Chief of Military and Veteran

10 Outreach with VBA Benefits Assistance Service.

11 The first time I had an opportunity to address

12 this committee was in August of last year and I'd

13 been on the job for four months.

14 Since then, I've had an opportunity to

15 get an in-depth look at the more than 30 programs

16 my office is responsible for administering, to

17 include FPOW. Our job is to provide education

18 and access on each of VBA's six business lines,

19 which are disability compensation, education,

20 insurance, vocational rehabilitation and

21 employment, loan guarantee, and did I say

22 education? Pension and fiduciary. Thank you.


146

1 I'm proud to say that I am an Army

2 veteran who, my father was a Vietnam veteran, my

3 maternal grandfather was a Korean War veteran and

4 my paternal grandfather was a World War II

5 veteran. Having said all of that, I am

6 embarrassed to say that until I began my career

7 with VA in 2007, we were largely unaware of the

8 benefits and services that we were entitled to.

9 And our ignorance of the benefits and

10 services that we were entitled to contributed to

11 my father's death in 2004, and I'd like to share

12 a personal story with you, if I may.

13 My career history, I purposely left

14 out that before I started with VA, I worked as a

15 police officer in Dayton, Ohio and Detroit,

16 Michigan for about eight years. And I did that

17 when I came off of active duty in the Army,

18 because my dad was a police officer, and so was

19 my aunt, so I wanted a job where I could drive

20 fast, shoot guns, and arrest people, make a good

21 salary, and that's what I had an opportunity to

22 do.


147

1 So I started working as a police

2 officer in 2001. And we had cellphones back

3 then, I have two now, I hate them, because people

4 are always able to access me, but at this time, I

5 had a cellphone, and because I was a young

6 officer, I worked midnight shift or evening

7 shifts a lot of the time because I didn't have

8 seniority.

9 So I was ending my shift one evening

10 about 11 o'clock at night, heading into the

11 police station, and something told me, grab your

12 cellphone on your way upstairs to write your

13 report. And I generally didn't take my cellphone

14 everywhere with me because nobody's awake at 11

15 o'clock, midnight, 1:00, 2:00 in the morning,

16 except the other officers that I work with, so I

17 knew they could reach me on the radio.

18 But something told me, take your

19 cellphone, La'Toya, so I did. Get upstairs to

20 write an arrest report, and about ten minutes

21 later, my sister, who lives in Los Angeles and

22 was finishing her undergrad degree, calls me


148

1 frantic. She lives with my dad, who's the

2 Vietnam veteran, and she's like, something is

3 wrong. Dad is going crazy. He's barricaded me

4 inside the house. He's threatening to blow the

5 house up and kill both of us.

6 So I was like, get out. Climb out of

7 a window. I don't care what you have to do. Get

8 out. And she was like, I can't. I can't go

9 anywhere. I said, have you called 9-1-1? She

10 said, no, I called you. So I know a number of

11 the men and women in this room are veterans, and

12 you know that when a fellow brother or sister

13 calls you for help, that you come running.

14 I will say, when I called the Los

15 Angeles County Police Department, they came

16 running. I identified myself, and I told them, I

17 don't care what you have to do, get my sister out

18 of the house. They sent in a SWAT team, they

19 came in with what we call the ghetto bird, the

20 helicopter with the spotlight, and knocked down

21 the doors, were able to extract my sister and my

22 father safely.


149

1 One of the officers that came in

2 noticed that something was not physically right

3 with my father and they had a squad standing by.

4 When they checked his blood sugar, I later

5 learned that a blood sugar of 350 is quite high,

6 his blood sugar was over 600. His organs started

7 shutting down and he passed away the next day.

8 This was in 2004. A number of you

9 have heard of Nehmer, which was decided in 2007,

10 diabetes is now a presumptive condition related

11 to Agent Orange and some of the chemicals that

12 were used in Vietnam.

13 Because my family and I were ignorant,

14 my dad didn't know he had diabetes. He had no

15 knowledge of the Nehmer case that was going on.

16 We had no idea that he was sick. So that drives

17 what I do today with myself and with my team when

18 it comes to outreach.

19 We have to make sure that we have the

20 right people, at the right place, with the right

21 equipment to educate veterans, like myself, like

22 my dad, and family members, like my sisters, to


150

1 recognize the signs of when something is wrong;

2 when a veteran needs help, when they are in

3 mental distress, and physical distress, and any

4 type of distress.

5 Educate them to know what VA is here

6 for and that we are able to assist, and what

7 benefits and services we provide. So when I came

8 onboard a year ago, I had a finance background, I

9 worked for the CFO for five years, and I noticed

10 that the 12 analysts on the team were extremely

11 busy.

12 They would run all over the country.

13 Whenever somebody said, can you come and do an

14 outreach event, they said, yes. So I pulled data

15 that was specific to the FPOW community for the

16 past two years. In 2015, we attended a total of

17 72 events, 153 man-hours were spent on FPOW.

18 There were a total of 205 veterans in attendance,

19 330 other attendees, these can be family members,

20 beneficiaries, caretakers, we received six claims

21 at these events for FPOWs, and we did not sign

22 anyone up for eBenefits registration.


151

1 So I said, something is wrong with

2 this picture. Because when I look at the events

3 that we are accepting, someone might say, hey,

4 can you come two hours away and give us a VBA 101

5 briefing? And everyone would always say, yes.

6 Well, how many attendees are going to be there?

7 They'd say, ten. Two to five would show up.

8 So we sent someone two hours away to

9 give a briefing to two to five people, when, in

10 fact, we could have gotten the information for

11 the ten attendees, I can then assign that to the

12 analyst on my staff, or reach out for assistance

13 from one of the regional offices, and we can make

14 contact with that person one-on-one, find out

15 what their needs and interests are, and in 20

16 minutes, be finished, instead of wasting dollars

17 on travel, hotel, time, and one to two people

18 being out of the office each day.

19 So some of the improvements that we

20 made last year, we did reduce the total number of

21 events that we physically travel to, however, the

22 total hours, near 2000, we had increased veteran


152

1 attendance, we went from 330 other attendees to

2 nearly 3000, because we are educating family

3 members, wives, children, caretakers, things of

4 that nature.

5 The claims that we received went up as

6 well from FPOWs, to 29, and we were able to teach

7 people about eBenefits and say, hey, you want to

8 check the status of your claim? You want to get

9 your certificate of enrollment for a home loan?

10 Let me show you how to do this online. It'll

11 take five minutes. Instead of calling the 800

12 number or traveling an hour to a regional office

13 to find out what's going on, let me show you how

14 to do this from the comfort of your home.

15 So those are some of the improvements

16 that we have made. Again, I'm looking at return

17 on investment and where we can get the most bang

18 for our buck when we do go out and travel. So

19 these are a list of 2017 conferences that my

20 staff will be attending.

21 If you notice, I have Veterans of

22 Foreign Wars, Disabled American Veterans, and


153

1 Vietnam Veterans of America highlighted, and, Mr.

2 Carson, this is for you, all of these conferences

3 are in New Orleans this summer.

4 MR. CARSON: I see that. I don't know

5 why, but that's good.

6 MS. PRIEUR: All of these are in New

7 Orleans and with the help of Mr. Bologna and our

8 Deputy Under Secretary, Mr. James Manker, who I

9 previously worked for, I said, Jamie, I need some

10 money for overtime.

11 All three of these conferences, we

12 will have claims clinics there, and if you're not

13 familiar with a claims clinic, veterans can come

14 in, they can find the status of their claim, they

15 can speak face-to-face with someone who works in

16 our veterans service center, and tell them what

17 the process is to start a disability compensation

18 claim, what the process is to put in a pension

19 claim, and we can show them that this is the

20 evidence that is needed, and this is what the

21 rules say.

22 In addition to this, we're going to


154

1 have rate in a day capability for these claims

2 clinics. So if a veteran comes in with their

3 DBQs, everything is ready to rate, their claim

4 needs no further development, then we will be

5 able to rate that claim that day.

6 Now, if they need further development,

7 if they need to be seen by a specialist of that

8 nature, then we can assist with that, but if

9 everything is good to go, we'll be able to rate

10 in a day, so thank you, Mr. Bologna for providing

11 the personnel for those three claims clinics.

12 Also, the American Legion has

13 requested a claims clinic at their conference in

14 Reno, Nevada, so I will be working with the

15 Director of that regional office to see if we can

16 offer the same thing for the veterans in those

17 areas.

18 The last --

19 MR. CERTAIN: La'Toya?

20 MS. PRIEUR: Yes, sir.

21 MR. CERTAIN: The one that's not on

22 there, is happening in New Orleans, is the Nam


155

1 POW, the Vietnam POW, reunion.

2 MS. PRIEUR: When is that?

3 MR. CERTAIN: Middle of November.

4 MS. PRIEUR: Okay. I haven't started

5 projecting out for FY2018 yet, but I can

6 definitely add that to our list.

7 MR. CERTAIN: It's just one week over.


9 MR. CERTAIN: I'll give you the dates

10 if I can.

11 MR. BOLOGNA: I'll talk when I get up

12 about -- we cover a lot of events that people

13 don't realize, lots of reunions, lots of big and

14 small. We've already done seven events this year

15 in New Orleans.


17 MR. BOLOGNA: So we're well-equipped.

18 MS. PRIEUR: So I'll continue with a

19 few general outreach updates. One thing that

20 we've done this year, on March 15th, the final

21 rule came out about the Camp Lejeune water

22 contamination. BAS partnered with compensation


156

1 service to get letters out and make everyone

2 aware of the eight presumptive conditions that

3 are linked to water contamination at Camp

4 Lejeune.

5 We've done media blasts, information

6 on social media, we've done print mailings. I

7 also presented this information to the Casualty

8 Advisory Board in Germany last month, so now DoD

9 has also linked this information to their Web

10 site, so veterans and service members are aware

11 of the final rule of Camp Lejeune water

12 contamination, and they know what they need to do

13 to get a claim started, to seek care, anything of

14 that nature.

15 We've also been partnering with

16 National Cemetery Administration with their pre-

17 need burial. This allows veterans to fill out

18 the majority of the paperwork of where they would

19 like their final resting place to be now, so it

20 takes some of the burden off of the family member

21 when their time comes.

22 Servicemembers Group Life Insurance


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1 Online Enrollment System, modernization is one of

2 the things our new Secretary is pushing. So

3 SOES, as we call it for short, puts our insurance

4 line of business more in line with private

5 industry practices.

6 The Navy was the first to go online in

7 April of this year. Air Force will go online in

8 July. What it does, instead of making changes,

9 updates, increases, or decreases to the SGLI

10 insurance, previously, you had to take a piece of

11 paper and give it to your HR representative, so

12 if you have a good HR representative, they'll

13 process it right away.

14 If you have a bad one, it might sit on

15 their desk for a few weeks, it might get lost in

16 the shredder, may not get processed. With SOES,

17 servicemembers are able to go online and make

18 these changes. And one thing that I do not have

19 up here, the Secretary has also made suicide

20 prevention one of his priorities.

21 So in Benefits Assistance Service, one

22 of the things that we came up with this year, my


158

1 team wrote a distressed veteran SOP, and it

2 focuses on five areas of the stress. The first

3 one is special emphasis, those are homeless

4 veterans and elderly veterans, veterans over the

5 age of 65, then we have financial distress, we

6 have mental distress, which focuses on suicide

7 awareness, and we have different routes for those

8 who deal with veterans in person and on the

9 phone.

10 There's training that must be

11 completed by every single employee in Veterans

12 Benefits Administration and it lets you know, if

13 I call you on the phone, and I am suicidal, what

14 needs to be done? I need to get your name, I

15 need to find out where you are, I need to get

16 your callback number, I need to do a warm handoff

17 to the crisis line, and not just say, hey,

18 suicidal veteran, why don't you call this number,

19 and hang up.

20 I actually need to transfer them on

21 the phone and make sure they get the assistance

22 they need. If they hang up on me, that's fine,


159

1 because then I have to call the crisis line on

2 that veteran we have, and provide their contact

3 information so a counselor can then reach back

4 out to them, and try to assist them by telephone.

5 If we have a veteran in mental

6 distress that comes into one of our regional

7 offices, then it is the responsibility of the VA

8 employee to actually do a warm handoff. So if we

9 are co-located with a VA medical center, we will

10 physically walk that veteran over and make sure

11 they receive the medical assistance they need.

12 If we are not co-located, then we will

13 arrange for transportation for them as well.

14 Those are all the outreach updates I have to

15 provide. May I answer questions for the

16 committee at this time? Yes, Mr. Carson.

17 MR. CARSON: Direct mail, and in

18 trying to go after the existing list, we're

19 always talking about the DoD list, we're talking

20 about someone else had a list that was floating

21 around here, has any region done an organized

22 direct mail to all the POWs who aren't in the


160

1 system now, which is quite a huge percent?

2 MS. PRIEUR: Not to my knowledge. We

3 have not.

4 MR. CARSON: Okay. So each region, on

5 its own, if they took that up as a goal, could do

6 that. The head of the VAMC, the head of the RO,

7 could jointly put a publication together, send

8 out an invitation, and try to bring them in, and

9 then work with them, right? I mean, we could do

10 that, couldn't we? It sounds so simple to me,

11 and for some reason we don't seem to be doing

12 that.

13 MR. BOLOGNA: Yes, so I'll jump up

14 with you, if that's okay. So I'm Mark Bologna.

15 Thank you for having me, Mr. Chairman. Thank

16 you. I am the Director of the regional office,

17 but to answer Secretary Carson's question, yes,

18 you could. I would argue, having spent eight

19 years in Washington, and now a bunch of years

20 back out in the field, the better coordinated way

21 is to do it with BAS from headquarters, so you

22 get the consistent messaging and you get the --


161

1 now, obviously, once you identify any population,

2 including former POWs, you generally want to

3 bring them together locally.

4 But I would argue what you don't want

5 to do is have every -- I wish Mr. Rivera were

6 here, he and I have a great relationship. We do

7 a ton of outreach together. But on something

8 like this, where we want all veterans in a

9 population to get the same idea, that's why we

10 have Benefits Assistance Service, is to do a very

11 coordinated outreach effort.

12 So I would personally not be in favor

13 of going grassroots. I would do a coordinated

14 campaign, right, that is then supported from the

15 field. That would just be my initial reaction to

16 it.

17 MR. CARSON: Well, what about a trial

18 run in one region of the country where we would,

19 maybe, do that joint communication between you

20 and Fernando to the existing POWs.

21 MR. BOLOGNA: You could. Again, my

22 response would be, it's pretty easy to do it from


162

1 headquarters, I think, I mean, I'm saying that,

2 but having spent eight years, because what you

3 would want to do, for instance, is mine the data

4 on the VHA side, right?

5 On our side, on the benefit side, as

6 you know, we're essentially limited to, we don't

7 really know about a veteran until he or she files

8 a claim. On the hospital side, of course, Mr.

9 Rivera, as do other hospital directors, beat the

10 bush about, enroll with us, right? Enroll even

11 if you don't think you're eligible. Enroll even

12 if you don't need us, because it helps create the

13 list, right, that we can then reach out to.

14 And I think having run the data shop

15 for VBA at headquarters years ago, I think the

16 right way to do it is to get it from headquarters

17 and be, again, rollout with the support of local.

18 So could you do it? Absolutely you could. I

19 think you would see more benefit if we did it

20 strategically from headquarters, because you'd

21 have to coordinate with VHA nationally to get

22 their list. That's one --


163

1 MR. SMITH: One of things you're

2 saying about it, when you're not enrolled. I

3 went through this past week about -- for every

4 POW, name, and address, and the only thing that's

5 consistent is, where the money goes, but I have

6 people who have moved four or five times, so if

7 their address is -- if they're not enrolled in

8 our system, it's just about an impossible task

9 trying to find them.

10 So that's the first thing, if you're

11 enrolled and you're registered, we've got a

12 current address or phone number on you, we can do

13 that, but without that information, it's just a

14 hunt. It's just going out and about, and if the

15 phone numbers are no good. The only that's

16 consistent is where the money's going. The

17 banking institutions. Everything else has

18 changed.

19 And since Katrina, most of our

20 veterans just have dispersed everywhere, and I

21 think -- I found eight of them were Phoenix, I

22 had four, five in Alexandria, it was just all


164

1 over the place. So trying to find a good address

2 if you're not registered, is almost an impossible

3 task.

4 MR. BOLOGNA: Without listening to

5 you, Mr. Secretary, one idea that comes to mind,

6 and again, I'm sorry, I should have -- I can go

7 back and explain who I am, but one of the things

8 that might be useful -- I'll speak for Louisiana,

9 because obviously, that's where I am. We have

10 three hospitals, as you know, in the state. Mr.

11 Rivera here at Southeastern Veterans Louisiana

12 Health System, he and I go out monthly and do

13 town halls throughout the geography that we

14 collectively cover.

15 And one of the things that, as I was

16 listening to La'Toya speak, we've continually

17 tried to do is give the information out in those

18 forums even if the population we want to hit may

19 not be there, because they know people, right?

20 And as I hear you speaking, maybe one

21 of the things that we do need to think about

22 across the country is, when you do any kind of


165

1 outreach, any kind of public event, putting some

2 information about, do you know a former prisoner

3 of war? Do you know, you know, somebody in your

4 family?

5 So that we start to get at the

6 grassroots too, because part of the problem is,

7 if we don't know that you exist, we don't know

8 that you exist, but if you're already going into

9 the veteran community, then those veterans are

10 more likely to know those folks.

11 So just reflecting on hearing you,

12 that might be something we have to start to do at

13 a grassroots level.

14 MR. CERTAIN: Yes, what we had

15 recommended from our San Antonio meeting in

16 January was, so that the VA start using -- go to

17 other resources for names. The DoD has a

18 complete register. Now, they may or may not have

19 good addresses either, unless they're on pension,

20 and then they can know where at least the bank

21 is, to POW organizations, which are American Ex-

22 POWs, and the Nam POW, and the Desert


166

1 Storm/Desert Shield has a small organization.

2 Korea has disbanded. So unless

3 they're in American Ex-POWs, but those

4 organizations do have address lists and contact

5 information, and then cross-referencing their

6 list against the VA list to find out who's not in

7 the VA list.

8 MR. BOLOGNA: Right.

9 MR. CERTAIN: And that's one of our

10 concerns is that, those folks who are not in the

11 list, that are not being served by the VA, be

12 approached with an invitation to come in --

13 MR. BOLOGNA: Sure.

14 MR. CERTAIN: -- and become part of

15 the system. And then to start reviewing, through

16 VBA, the level of disability compensation, if

17 any, and then if it seems low, to invite those

18 veterans for a thorough protocol physical.


20 MR. CERTAIN: And that's our

21 recommendation from January.

22 MR. BOLOGNA: Sure. And I think,


167

1 again -- so let me backup half a step to give a

2 bit of context. So my name is Mark Bologna. I'm

3 the Director of the VBA Regional Office. As an

4 aside, I was born and raised in New Orleans. I

5 am not a veteran, but I have spent my entire

6 adult life in the service of those you who have.

7 I take that very seriously. I come from a long

8 family line of veterans, and I've dedicated my

9 career to you.

10 I spent 15 years wandering around the

11 country in the service of VA, where I was asked,

12 and including eight years in Washington, and I

13 came back five years ago with, at the time, ten-

14 week-old twin girls, who are now five and a half,

15 to raise them as New Orleanians, and at the time,

16 to come back, it was something I really believed

17 in and I wanted to serve veterans in my home

18 state.

19 But I was working with Secretary

20 Shinseki at the time on the paperless claims

21 processing system. But I spent eight years in

22 VBA headquarters and one of the reasons that BAS


168

1 was created, frankly, was to do exactly what you

2 were describing, to take a national approach

3 rather than, I do something really great over

4 here and somebody three states doesn't know about

5 it, or they do it a little different, and exactly

6 what you're saying, the national organizations.

7 That's what BAS does and does well.

8 Now, in this instance, I think it's one level up,

9 even, that you have to take the VHA side and the

10 VBA side, and work together to be able to reach

11 out to those, you know, organizations that you

12 described. They're easy to get to and they're

13 not big.

14 MR. CERTAIN: And the DoD side too.

15 MR. BOLOGNA: Yes. Again, you don't

16 want to try to do that from an RO, from a field

17 level, you want to do that from the Secretary's

18 Office, to DoD, to those organizations, with the

19 communication structures in VHA, or VBA. I only

20 say that based on my experience in headquarters,

21 right?

22 Now, once you identify the population,


169

1 then I do believe the right spot, then, for the

2 field to come in is to be able to personalize it

3 and say, hey, we welcome you, and let us come out

4 and visit with you, and work through, even one-

5 one-one sometimes, but what's the unique thing

6 that we need to help you and our your family

7 member?

8 I think that's the structure that I

9 would suggest works well. You don't want

10 individual offices trying to go find the list and

11 coordinate. That's my opinion.

12 MS. PRIEUR: So one thing that I can

13 offer is, perhaps, to make a recommendation to do

14 a national outreach campaign for FPOWs, because

15 that will give me the personnel and the time, and

16 authority, to go out and get the list from the

17 different organizations that you all are

18 mentioning, and put together a consolidated list,

19 and then get with the three administrations and

20 determine what is the best way to go out and

21 reach these people.

22 If it's through print, T.V. ads,


170

1 newspaper, radio, and then perhaps we can do

2 something together like that.

3 MR. BOLOGNA: And I think, again, just

4 reacting to you, Mr. Secretary, I think this

5 idea, and this is something we could do locally,

6 is start to incorporate some information in every

7 one of our public briefings, so that, while we

8 may not have any former POWs in the room, by

9 definition, we're in a room with veterans and

10 their families, you know, and that helps get the

11 word out, because something you and I talked

12 about when you were Secretary, as well as we talk

13 about all the time, you can never do enough

14 outreach.

15 And you think you were talking about

16 your dad, you think that you've done so much, and

17 then somebody walks in and they say, well, I had

18 no idea. And you think, well, gosh, we did all

19 of this outreach, and I think the lesson for me

20 as a leader has been, it's never enough and

21 there's never enough modes; never enough

22 modalities, never enough rooms to be in, that you


171

1 should constantly, because no matter how well you

2 think you're doing, you know, you didn't hit the

3 right person at the right time. Yes, sir.

4 MALE PARTICIPANT: I'm just wondering,

5 was there any way we can include survivors of the

6 FPOW as well? Because, you know, when dependents

7 are --

8 MS. PRIEUR: We have a survivors

9 program as well. Yes.

10 MALE PARTICIPANT: Because it's easier

11 to locate the POW, but, you know, you got so many

12 spouses out there, dependents of POWs, that'd be

13 entitled to VBA benefits as well.

14 MS. PRIEUR: Correct.

15 MALE PARTICIPANT: Unless their filing

16 a burial claim or some type of DIC benefit, we

17 don't know if they're veteran, if they are a POW.

18 MS. PRIEUR: Absolutely.

19 MALE PARTICIPANT: We need to include

20 them in our outreach as well. I mean, even if

21 you're not talking to a POW, the dependents are

22 just as important as a POW.


172

1 MS. PRIEUR: Thank you for mentioning

2 that. I am way over my time, and I am into

3 yours, so are there any last questions that I can

4 answer for the committee? No? Thank you.

5 MR. BOLOGNA: So I don't have a formal

6 presentation because I figure you get lots of

7 PowerPoint, and I intentionally wanted to come

8 after La'Toya to be able to -- Mr. Carson and I,

9 Secretary Carson and I, had exchanged some

10 messages ahead of time, and what I thought I

11 would do is just give you a little bit of an

12 overview of, sort of, from the field perspective,

13 what we do in terms of outreach, and what we do

14 in general.

15 And certainly, be able to answer

16 questions or reflect against ideas, again, from

17 the field perspective, to help inform your

18 decisions and your recommendations to the

19 Secretary, if that's okay.

20 Again, so you know, I think we have

21 regional offices in most states. We have a

22 couple of offices in a couple of states. On the


173

1 ground, we do a couple things, here in New

2 Orleans, we primarily process disability claims

3 compensation. As you know, pension, and

4 education, and insurance, and loan guarantee are

5 consolidated, depending on which business we're

6 talking about, into a couple of offices.

7 Our secondary, but no less important

8 mission in New Orleans, is vocational

9 rehabilitation and employment, but those are the

10 two services that we primarily offer directly out

11 of the office just down the street, about a mile

12 down the street, from here.

13 One of the things that we have really

14 done a lot of over the last three years, really,

15 under Mr. Rivera's leadership here at the

16 hospital, is outreach. We did outreach. We did

17 a fair amount of outreach, but when he got back

18 to New Orleans, and like me, he grew up in New

19 Orleans, started his VA career at the VA Medical

20 Center downtown.

21 We really started doing this in a

22 coordinated way and going out throughout the


174

1 catchment area, and really rotating so that the

2 community knew that not only were we out in your

3 community, but that we would be back.

4 And I'm sure you will remember, the

5 first time we go out to a community, people would

6 say, this is great, we'll never see you again,

7 and so we showed up again, right? And it was

8 about building that trust and we've learned a

9 lot.

10 So when La'Toya talked about claims

11 clinics, and I was kind of smiling when you were

12 talking about the event in November, it's

13 wonderful that we're going to have these big

14 events, and we're going to cover them, but we do

15 that all the time.

16 Because it's New Orleans, we're a

17 pretty popular place, we get reunion, reunions

18 come in all the time, whether it's a unit, or a

19 platoon, we've seen all sizes, and all sorts of

20 shapes and flavors of why a particular group of

21 veterans chooses to come together. Again, it

22 might be a ship or it might be -- you know, and


175

1 they'll call.

2 We did one, you remember, I can't

3 think of the hotel, it was on Canal Street, it

4 was -- was it a Native-American Indian? I'm

5 putting you on the spot. It was in a group.

6 They called us and they thought they would have

7 75 people. They ended up having ten. Joe went,

8 I went, and we were able to help that group, and

9 really give them the attention, and their

10 spouses, they needed, and it was a mile from us.

11 And that was worth doing because we

12 were able to take some claims, and we were also

13 able to help educate those people so that when

14 they went back to their communities, they had a

15 resource and new people, they might in fact --

16 maybe don't serve people where they live. They

17 had a personal connection into VA.

18 And so we do a lot of those -- that,

19 while we report them to headquarters, they may

20 not realize, right? Obviously, DoD's national

21 convention is going to get a lot of attention,

22 but the idea of a claims clinic, we do,


176

1 essentially, that every month, some of them are

2 partners from the Louisiana Department of

3 Veterans Affairs are in the room.

4 And we go out into these communities

5 and we just did one, two weeks ago? Franklin,

6 which is about 120 miles west of New Orleans,

7 down the bayou, and we had 14 people there to

8 take claims, and to answer questions about

9 claims, and to educate people, beyond the talking

10 head, right, me up in the front of the room

11 giving general information.

12 People want to come in and be able to

13 talk about my situation or we had one lady came

14 up to me and said, my husband has severe PTSD, he

15 had a traumatic brain injury, he was with her,

16 but he could speak, but he didn't -- he couldn't

17 speak very clearly and very well, and she said,

18 who can I talk to with my husband? And we were

19 able to bring them right over to someone and talk

20 about their own specific situation.

21 In other cases, when we've done that

22 outreach, we've had people come up to us, we've


177

1 had veterans come to us and say, I have a

2 neighbor who won't leave his or her house.

3 Here's the information. Could you come out and

4 visit with them? And we're able to do that.

5 And again, as I think about your

6 suggestion, I think the outreach we already do is

7 a great way to get information. We have not, or

8 certainly, I have not, talked consistently or

9 provided information to that audience about, is

10 anyone a former POW, do you know any former POWs,

11 do you know the spouse or the widow of a former

12 POW?

13 And that certainly makes sense to me,

14 that we should start to add that to our

15 messaging, because, while I think it's important

16 to target the groups, this shotgun approach into

17 the community so that other veterans may reach

18 out to somebody who's not there, or that's sort

19 of off our radar, I think, could be really

20 powerful.

21 We've done a ton of outreach here, to

22 the degree that we sort of ran out of money


178

1 because we didn't budget for the success of it,

2 but what we've found is we now can't not do it.

3 We've earned this trust, we've earned the

4 expectation, now people are used to -- in

5 Madisonville, where Dr. Carson lives, we're going

6 to be out there June 6th, I think. It's not the

7 first time.

8 And so people now, we've gone from,

9 oh, yes, you guys will never be here again and

10 we've never seen you, to, there's a real trust

11 and a bond, and a willingness to say, this is

12 what you're doing well, and here's some problems,

13 but the dynamic of it is different, because they

14 trust us and we know them.

15 One of the other things I'd like to

16 share with you that we've done in partnership is

17 that, we try really hard to bring the outreach

18 and the service to where the veteran is. And on

19 the VBA side, we completely ripped that off from

20 VHA. As we started to do these outreach efforts

21 in partnership, we realized that, for years now,

22 there's been this community-based approach,


179

1 right? The clinics and getting out into the

2 community.

3 But in VBA, at least in my office, our

4 answer to serving you was, you can call the toll-

5 free number or you can come to visit me in my

6 space.

7 My space is at 1250 Poydras, so about

8 a mile from here, on the corner of two busy

9 streets, Poydras and Loyola. It was the best

10 space we could get post-Katrina, frankly, but as

11 you know, having been there, Mr. Carson, it's not

12 the easiest space for veterans to get to.

13 If you come in, they come up an

14 escalator, then go past security, then you come

15 into my space, and you all but get strip-searched

16 to come in. It's not the most welcoming, even

17 though the employees are welcoming, you know,

18 when you're greeted with magnetometer and told to

19 take off everything metal, you know, 2 feet, it's

20 just not the best.

21 But when we partner with the CBOCs,

22 with the clinics, then you're already going for


180

1 service, and you're going in your community, and

2 now we're there to serve you where you are. And

3 while I love New Orleans, I do, as hard as it is

4 for me to believe, there are people in Louisiana

5 that don't love New Orleans. And that line seems

6 to be about 50 miles away.

7 You only want to come in to go to the

8 Saints game once a year. And the further away

9 you get, and I'm sure that's true in other

10 states, the less you want to necessarily go to

11 the hub. And so we have been able to -- Joe

12 Simpson, Joe and I have actually worked together

13 my entire career. Joe was one of the people that

14 was one of my very first instructors 24 years

15 ago.

16 We're starting to have folks like Joe

17 go out to the clinics on a regular basis so we

18 can serve the veteran population where they are.

19 And we're seeing, it's improved the

20 relationships, it's improved the trust, and it

21 gets our folks out into the world where we can

22 really listen, you know, and hear, boy, you guys


181

1 are doing this well, but you're not doing this

2 well, you know, and it's just a different feel

3 then when you come to my office.

4 You know, I think there's something

5 about coming to where you are, seeing you in the

6 way that helps you or your family. And we learn

7 about that. We learn about the neighbor or we

8 learn about -- and so I'm intrigued by that

9 approach in terms of trying to find former POWs.

10 I think the lists are great, I think

11 we should do that, but I also think it's, we need

12 to make that part of our presentation, part of

13 outreach, even when we're not talking. Any

14 questions or comments or things I can answer?

15 Yes.

16 MS. JOHNSON: Shoshona Johnson. I

17 definitely think that you -- incorporating your

18 outreach directly towards former prisoners of war

19 is needed, but I don't think you should wait for

20 higher up to give you a guideline. That takes

21 too much time and they're dying. Plain and

22 simple. They're dying at a rate that is


182

1 ridiculous, and they shouldn't -- they need their

2 benefits now.

3 So if you wait for that, you know, so

4 many are going to be gone and that's one of the

5 things that really bothers me. Sometimes you

6 just have to take the lead and do what's

7 necessary, especially when you think about the

8 Korean War prisoners of war who have -- a lot of

9 them have just been, basically, forgotten from

10 history, and then the Vietnam prisoners of war,

11 who came home and were treated so horribly.

12 Some of them, if you're just randomly

13 saying, oh, if you're a prisoner of war, they

14 don't want to hear that crap. They've already

15 been treated badly. You need to speak to them

16 specifically on a certain level.

17 I know a prisoner of war from -- lives

18 in El Paso, and he wants nothing to do with the

19 damn VA. He is so angry, so, so angry. I talked

20 to him about joining the community and he just

21 blew. So when you think about just talking to a

22 group of veterans and throwing out the POW, you


183

1 know, oh, also, POW, that's not going to gain you

2 any cheers. It's going to piss some of them off

3 even worse, because of the way they've been --

4 felt they've been dealt with for so many years.

5 So I think that individual reach out

6 is very necessary in order to smooth-out ruffled

7 feathers, and get them into the office so they

8 can know what they're entitled to. They've

9 already earned this. They gave so much already.

10 Twenty-two days is all I did and it was friggin'

11 hell.

12 So for the guys that did so much more

13 before me, we need to do better. And I'm waiting

14 to, you know, the man at the top to put his stuff

15 together and really -- we can't wait for that.

16 MR. BOLOGNA: Sure. Look, maybe I

17 didn't phrase it correctly. I don't disagree

18 with you. What I am saying is, it's not that

19 hard from headquarters to run the list. I don't

20 think -- and maybe I'm wrong, maybe you guys

21 disagree, and I certainly respect that, it's

22 finding, how can I say this, running the list to


184

1 get the starter list isn't that hard, but I don't

2 think you want 50 offices trying to reach the

3 organization, maybe you do, and that's okay.

4 MS. JOHNSON: Well, it would be easier

5 for them, but they haven't done it. They've been

6 asking from way before I came on this committee

7 about that, and they haven't done it. So if

8 we're going to keep on waiting for that to

9 happen, Hell's going to freeze over and the devil

10 going to be ice skating before we get it.

11 So you might as well just go ahead and

12 do it yourself.

13 MR. BOLOGNA: I appreciate that.

14 MR. CARSON: Stop beating up the dead

15 horse of outreach for a second, change to another

16 topic a little bit, upgrading ratings to 100

17 percent, and the Former POW committee, working

18 together, benefits and the House are supposed to

19 review some of these POW members and attempt to

20 try to get them up to a higher rating, right?

21 That's our goal, right?

22 So I was just curious how that works


185

1 and just -- how does that work? How does the Ex-

2 POW committee, I know we're getting it setup

3 here.


5 MR. CARSON: We have our new hospital

6 and we're getting it online, but how would all

7 you all come together from the doctors beginning

8 evaluation to seeing their current diagnosis and

9 problems, and saying he's at 60 percent now, but

10 he's got this, you know, diabetes issue now that

11 could get him up to 100.


13 MR. CARSON: Does the system work

14 together so that it's filed and he requests to go

15 up to 100, that we're getting there some kind of

16 a way?

17 MR. BOLOGNA: Yes, so, you know, from

18 the field level, I think, essentially, you just

19 hit it, right? So Anthony helps coordinate on

20 the hospital side and to your point, I think that

21 however we become aware, and we should try as

22 many different ways as we can, but in your


186

1 example, I'll use, maybe, two examples, so the

2 hospital becomes aware of a veteran, say a former

3 POW, that they're serving.

4 Then what happens is they would reach

5 out -- if Anthony was the first one to recognize

6 it, they would reach out to us and then at that

7 moment, on the benefits side, then we tackle that

8 case and do all the things you just described.

9 Let's first take a look and see what the

10 situation is.

11 If the veteran has a claim or has a

12 running award, what's already there? We would

13 put a DRO, or senior person, a senior examiner,

14 to go through that case to see, is it not

15 something there already and look to see what can

16 be done to raise it and/or what other evidence

17 might be needed, right? Another opinion, another

18 exam, so that's the case if you already have

19 somebody that we've got, right?

20 MR. CARSON: Okay. So that's how the

21 system works and comes together, and as we get

22 the clinic setup and established, and we -- the


187

1 POWs come to it, and we start more formally

2 treating them, that's how it will occur, right?


4 MR. CARSON: Right. The Chairman of

5 the Disability Committee was here earlier today,

6 talked a little bit about UI.

7 MS. WILLIAMS: IU.

8 MR. CARSON: IU. Okay.

9 MR. BOLOGNA: Okay. IU.

10 MR. CARSON: Individual

11 unemployability, right.

12 MR. BOLOGNA: Yes, sir.

13 MR. CARSON: What's the best way to

14 get a typical FPOW rated individual who's at 60

15 or 70, or whatever percentage he's at, getting

16 him to 100? Trying to go through UI or just

17 trying to get it through the presumptions?

18 MR. BOLOGNA: The right answer is to

19 case manage it, right? Is to have an expert go

20 in and look at that person's case and say, what

21 is the right answer for that man or woman?

22 That's the right answer. It needs to be this


188

1 immediate, sort of, focus. So in our case, we

2 get cases, they may or may not be former POWs,

3 but we'll get what I'll call special interest

4 cases that'll come to us, for whatever reason.

5 It's putting a senior -- a qualified

6 person to look at it and say, what's this

7 situation, and what's everything that this person

8 could possibly be entitled to? Sometimes it is -

9 - sometimes it's very obvious, you know, the

10 conditions or the injuries that they may have,

11 other cases, it's not.

12 So it's not a one-size-fits-all, but

13 I do think it's a, to answer your question, focus

14 on that specific person and their experience.

15 MR. CARSON: Got you. So once we get

16 them to 100, the Chairman and the committee's

17 already expressed that desire to fast track the

18 DIC claim, so your office and I talked a little

19 bit about that in the past, and, you know, our

20 recommendation initially was, transfer the DIC

21 claim to the regional office, which, I know

22 they're centralized now and at the pension


189

1 office.


3 MR. CARSON: So what about that and

4 then, how do you fast track them now under the

5 present system or try to get that spouse or DIC

6 as quickly as you can?

7 MR. BOLOGNA: Sure. So if I could

8 step back half a step from that first. Have you

9 guys heard about the National Work Queue? Do you

10 know what --

11 MR. CERTAIN: Yes.

12 MR. BOLOGNA: So I think there's a lot

13 of efficiencies about the work queue. One of the

14 things that we need to be very mindful of in the

15 field is that we not give up on our

16 responsibility, just as you were talking about,

17 to deal with individuals as individuals and that

18 sometimes, it doesn't matter if there's a work

19 queue, we need to take action on this person, and

20 if it's because you happen to know them and they

21 happen to be in my state, then regardless of

22 where it would be assigned, I need to grab it out


190

1 of the queue and case manage that. Treat it,

2 right?

3 That's one of the things that we do do

4 in the field. So in your example, as soon as we

5 become aware of a case, and I'll give you an

6 example, sometimes you'll have a split, so a

7 veteran or a spouse may have a claim pending, and

8 then have another kind of claim pending.

9 Well, the way the system works is, it

10 can push both pieces out separately. And the

11 idea was to take advantage of resources wherever

12 they may be. But on sensitive cases, and

13 sensitive, again, I'm using that word, but it

14 could be for any reason, right? It could be

15 someone who's homeless, it could someone who's at

16 risk, it could be a former POW, it could be loads

17 of them.

18 The point is, when we identify that

19 there's a person that needs extra help, or

20 quicker help, then what we do in the field is

21 pull all those disparate parts together.

22 If I have the expertise to work both


191

1 pieces, then we will do it, if we don't, then we

2 get on the horn with, say, Milwaukee, and say, we

3 need you to work this piece today because we're

4 working this piece, so that we provide the

5 veteran, or the spouse, more of an answer, but

6 that's where no computer can -- it has to be

7 human interaction.

8 So what we have done, to circle back,

9 is to do that. As soon as we know, we get on the

10 phone with another station if we can't take it

11 all. Pension, and I have many people here that

12 can work pension and do more, but I would get on

13 the phone there and say, okay, we need to be

14 latched up hourly so that we know what we're

15 doing, so that that veteran or their family

16 member gets one answer, and they get one person

17 to then callback.

18 And I agree with you completely about

19 DIC, for instance, right, how do you -- so you

20 asked, how do you fast track it. Today, in the

21 National Work Queue, I can see my piece, I can't

22 see the whole country, but in headquarters, they


192

1 can see the whole country.

2 So when I sent you the message last

3 week that said, hey, what's on your mind? One of

4 the things you sent back was DIC and claims of

5 former POWs that are in process. I mean, the

6 idea of having to find folks is important, but

7 then how do we do once you're in.

8 So you send me a message, I sent a

9 text to the person that runs the National Work

10 Queue, because he wasn't in the office, and I

11 knew that, and I said, how many former POW claims

12 do we have pending right now? Where are they?

13 Meaning, are they in the queue or are they

14 dispersed to the field, and how long have they

15 been out?

16 And in four minutes, he wrote me back

17 and said, the answer's 122, at the moment -- no,

18 61, pending an average of 122 days. That's

19 clearly not acceptable. A list was sent out

20 within the hour, because I got one as a Director,

21 of the list, right, so that you could see it.

22 And so then what that person, Ron


193

1 Burke and I talked about is, we need to make this

2 part of the daily report that goes out. We need

3 to put this on everyone's radar, because it's

4 easy enough to see it, and that clearly should be

5 my highest priority.

6 The day that that went out, I had one,

7 it had been with us two days, we worked it that

8 day. But everyone needs to have that focus, and

9 it's not hard, for them to run that report. I

10 tell you that because that's the good and the bad

11 in the National Work Queue.

12 The bad, if you will, is if pieces of

13 get separated, human beings need to come in and

14 say, what's the right thing for this person and

15 solve it. The good is, literally, you and I were

16 talking by email and I was sending this guy a

17 text, and within an hour, we had made a shift

18 nationally to, you know, how we got to there, we

19 could say, this is important, we need to go get

20 this, and we could do it instantly.

21 And that's the power of it, and we

22 need to do it, obviously. So I do think it's not


194

1 hard to prioritize the DIC, it's not hard to keep

2 a national and a local focus. We changed that on

3 our report that day, locally, so every morning I

4 can see, do we have a POW claim pending?

5 And does it get to the point of

6 finding folks, but once they're in our system, we

7 obviously have an obligation to serve them very,

8 very quickly and well. Yes, sir.

9 MR. CERTAIN: Did I hear you say DIC

10 was 120 days?

11 MR. BOLOGNA: No. The claims that

12 were pending that moment across the country, they

13 could have been anything, but were for either a

14 former -- or what I asked was, claims pending

15 from former POWs at that moment, so they weren't

16 necessarily DIC, and now that I say that,

17 probably none of them were DIC, it was just a

18 claim pending, and they were pending 122 days on

19 average, which is way too long.

20 So, you know, in some cases -- and

21 they've since changed the daily report so

22 everyone sees it, and that's why when I was


195

1 reacting to you, and maybe I was poor -- that

2 kind of stuff is very quick in the system today.

3 We saw it, because you sent me an

4 email, we found the problem and said, whoa, whoa,

5 we also got to fix the systemic problem, right?

6 If nobody asks you again for two months, we've

7 got to go back, well, now it's on the daily

8 radar.

9 It doesn't excuse the -- they

10 shouldn't have been waiting 122 days, but now we

11 can fix it going forward.

12 MR. CERTAIN: Because I thought, and

13 I'm certain again, in San Antonio, we were told

14 that POW claims were flagged for expediting

15 activity.

16 MR. BOLOGNA: They are.

17 MR. CERTAIN: But you're saying, that

18 was not happening?

19 MR. BOLOGNA: No, it was --

20 MR. CERTAIN: Because 122 days doesn't

21 seem expedited.

22 MR. BOLOGNA: No, I think the issue


196

1 was that, at least in some -- I looked at a

2 couple of them. I think in some cases we request

3 an exam, let's say, right?

4 MR. CERTAIN: Yes.

5 MR. BOLOGNA: And so there's no more

6 -- once we request the exam, today, there's no

7 more action I could take. I need to wait for the

8 exam, but we need to have a national focus so

9 that the moment that exam is ready, let's say

10 it's next week, right, you go for your exam, then

11 that day, it needs to come back and we need to

12 make sure we grab it that day and work it that

13 day.

14 So it's really about total time and

15 actionable time, and so when it comes to the

16 station, that's the case that it should get

17 worked today, next.

18 MR. CERTAIN: So where it says, exam,

19 is that VBA or VHA?

20 MR. BOLOGNA: So we work in

21 partnership, VHA does the exam, but we ask them

22 for the exam. And it kind of gets back to this


197

1 point of everybody coalescing around the veteran.

2 So to your point about the clinic, right? The

3 way that that's going to work, I think, is, VHA

4 identifies the person as a former POW and

5 everyone comes together to do their part in as

6 near real time as possible.

7 So I can see, for instance, here, at

8 this medical center, former POW comes in, her or

9 she gets evaluated, right? Gets their exams

10 expedited, so possibly even while they're there

11 that day, you have my folks right there to be

12 able to evaluate, probably not with the person

13 sitting there, but evaluate it, turn to a doctor

14 if they need a medical opinion or clarification,

15 and be able to make a decision right then.

16 We have that ability today to do that,

17 so that's what I see. That's one of the things I

18 see as a benefit of the clinic. You can get, it

19 not same day, very, very, very fast service. And

20 with everybody together so that you're

21 considering all sides of it. Again, you don't

22 want my person making a decision in a vacuum, you


198

1 want him or her to be able to turn and get the

2 clarification.

3 And have the eyeballs saying, have we

4 done everything we can for this person? Have we

5 gotten every benefit that they have earned as

6 seamlessly as possible for them, and I think

7 that's what the clinic -- that's what we're going

8 to see. It's what we should see. Anything else

9 I can answer for you?

10 MR. CORRE: Harry Corre.


12 MR. CORRE: You weren't here and I

13 mentioned it before, this is not necessarily for

14 the FPOWs, but on outside QTC, do you have an

15 outside on QTC? The reason I mention it, not to

16 reflect on the doctors here, but as a service

17 officer, I get a lot of reports back that they're

18 not examined. They go into an office, within

19 five minutes, they're out, and the doctor says

20 he's done this report.


22 MR. CORRE: And I just wondered if you


199

1 considered it an oversight on the QTC doctors?

2 MR. BOLOGNA: Sure. So in New

3 Orleans, on the benefits sides, we've had very

4 little experience with QTC. We've been very

5 fortunate that the three hospitals that we work

6 with in the state have been able to do the work,

7 so we haven't had much direct experience with

8 QTC.

9 You do hear that complaint from time

10 to time, not only by QTC, but in general, and the

11 new Secretary and Secretary Shulkin talked about

12 that three weeks ago, about, part of that is

13 framing up -- you get an appointment card saying,

14 you need to come in for an exam, in your mind,

15 you have a -- we all associate it, if I say

16 you're going in for a medical exam, that conjures

17 up something, right?

18 But the process of what we need isn't

19 the typical exam, and so some of that may be

20 changing what we're saying and what we're

21 actually doing, right? If I tell you you're

22 going in for your exam, you're thinking physical,


200

1 right?

2 But it could be that what we need to

3 do is say, we need a medical report that might

4 not even need you there, or maybe it's by phone

5 call, we need to change that verbiage, so that we

6 clearly are articulating to you what you can

7 expect, because you do get this disconnect.

8 You come in, you say, the guy didn't

9 even touch me. He filled out ten questions and

10 ran out of the room. And I think some of that is

11 -- in some cases, to your point, I think that

12 examiners could do a better job. In other cases,

13 it's about explaining clearly what we need from

14 this process, but I don't have a lot of firsthand

15 experience with QTC. It just hasn't been what

16 we've done.

17 COL. KUSHNER: What does QTC stand

18 for? Exposing my ignorance again.

19 MR. BOLOGNA: It's the name of a

20 company, QTC, Inc. I can't remember what QTC

21 stands for. In headquarters, there's an

22 oversight function over QTC and the other


201

1 contractors, but Dr. Shulkin, and he was much

2 more articulate than I am being about this, about

3 -- and he, of course, is a practitioner, medical

4 practitioner, talked about, we sort of set

5 ourselves up for this problem because we don't

6 clearly articulate what it is that you're going

7 to experience.

8 I had never heard it quite presented

9 that way and that made a lot of sense, that we're

10 creating a problem because we aren't --

11 MR. CORRE: Well, in most of these

12 cases, there was an association with claims,

13 where they send them to an outside doctor rather

14 than inside, and one of the theories that I heard

15 about it was that because of the association of

16 the primary care doctors with the patient over

17 the years, they send them to an outside doctor so

18 that there is no conflict of interest.

19 MR. BOLOGNA: And that is true,

20 historically, on a claims processing side. VA,

21 we, VBA, we're not getting -- let's say you were

22 seen by -- your primary care physician is a VA


202

1 doctor. Generally, we wouldn't go to that

2 primary care physician for the information, we

3 would go to a C&P, Compensation and Pension

4 Service, within the hospital, which is separate

5 from the docs that are doing primary care.

6 And I think the legacy of that, I'm

7 not positive, was that idea of separation and it

8 feels like, as a society, we're moving away from

9 that, you know, because now we do DBQs,

10 disability benefits questionnaires, when you can

11 have your -- let's say you get care outside the

12 VA, you can have your doctor complete the DBQ.

13 And so often, that doctor's going to

14 be someone you probably have had a long

15 relationship, so it feels like, to me, that just,

16 the culture of that has changed, but that was the

17 history on that. Anything else I can answer?

18 MS. JOHNSON: I got one.

19 MR. BOLOGNA: Yes, ma'am.

20 MS. JOHNSON: Okay. Earlier, I forgot

21 who said it, oh, Shoshona Johnson, they were

22 talking about appeals, and let's say you have an


203

1 appeal that takes three years, what if the

2 veteran dies during the appeal? What happens?

3 MR. BOLOGNA: So if the veteran dies

4 during an appeal, the appeal is closed.

5 MS. JOHNSON: Are you kidding me?

6 MR. BOLOGNA: That's the way it works

7 right now. That is part of -- you know, one of

8 the Secretary's major priorities is appeals

9 modernization. There was a lot of work done last

10 year with Congress, with the White House, with

11 the service organizations to put forth a package

12 to get -- basically, to change the appeals

13 process; overhaul the appeals process.

14 The Secretary, again, three weeks ago

15 at the senior meeting, was hopeful that the

16 legislation's going to get through this year. It

17 needs to. There are fundamental changes that

18 need to happen in appeals. Being careful not to

19 take away benefits or rights from people who are

20 already in the system, but make it faster and

21 more streamlined as we put new appeals in.

22 In many cases, and again, I have


204

1 partnerships with the service organizations,

2 there are things that go down the appeals track

3 that shouldn't go down the appeals track. If it

4 comes back to us very quickly and it's a claim

5 for increase or it's a, hey, we made a mistake,

6 or we -- we don't need to do that through an

7 appeal. We can take care of that very, very

8 quickly, but people don't know.

9 They don't know any different, so they

10 go down the path they've gone down, and now

11 you're in this sort of lengthy --

12 MR. PETERS: Mark.

13 MR. BOLOGNA: Yes.

14 MR. PETERS: That is the old way of

15 doing claims. The appeals were automatically

16 canceled if the veteran died. Now, there's such

17 a thing as a substitution claim.

18 MR. BOLOGNA: Yes.

19 MR. PETERS: Where a spouse can

20 substitute for the veteran to carry on that

21 appeal.

22 MR. BOLOGNA: So this is Elmo Peters,


205

1 who works with the Louisiana Department of

2 Veterans Affairs. But there are loads of things

3 that need to be changed and the Secretary clearly

4 recognizes this is a priority. At the rate -- we

5 are processing more and more claims and you will

6 hear people say, oh, well, and they'll just be an

7 all first tour appeals.

8 Statistically, the percentage of

9 people that file an appeal has been constant for,

10 well, 11 years when I ran our data shop, it's

11 still the same, but of course, we're producing

12 more claims, so if the percentage stays the same,

13 fundamentally, the process is broken.

14 MS. JOHNSON: And if you die while

15 you're --

16 MR. BOLOGNA: QTC, Quality Timeliness

17 Customer.

18 MS. JOHNSON: And if they die while

19 you're putting in their claim?

20 MR. BOLOGNA: On the front end?

21 MS. JOHNSON: Yes.

22 MR. BOLOGNA: So --


206

1 MS. JOHNSON: Oh, okay. Because if

2 you find some former prisoners of war, they ain't

3 young. I mean, I'm not young, and they call me

4 the pediatric, like I said. So even if you start

5 their claim, there's a chance they may die before

6 it's taken care of.

7 MR. CERTAIN: La'Toya called the rest

8 of us elderly.

9 MR. BOLOGNA: You know, that same

10 challenge La'Toya was saying about her story, I

11 am married to the daughter of a Vietnam veteran

12 who died of non-Hodgkin's lymphoma in a VA

13 hospital, and had he jumped forward, he would

14 have fallen under one of the service connections.

15 He was a grunt in Vietnam, did 18 months, it was

16 very straightforward.

17 His claim was in process when he was

18 in a VA hospital in the early 1980s and it was

19 canceled, right, because he died. That was the

20 process if he dies. I come along, years later, I

21 never met my father-in-law, my mother-in-law had

22 such a bad memory of this, she would never file.


207

1 And I said, I'm an executive in the

2 VA, this is how you do it, and I'll get you a

3 counsel who will walk you through this. I had to

4 date her daughter, now my wife, for nine years

5 before she came in and applied. Today, and for

6 the last 11 years, she's gotten benefits. Now

7 she's angry, but she -- I told her, I was like,

8 it took me nine years to convince you, and that's

9 exactly my point.

10 You get, like, one crack at it, and if

11 you don't get it right, it just takes --

12 MR. CERTAIN: It's a difficult thing

13 to bring people back in once they've been

14 offended and especially this population. I can

15 think especially this population. And I really

16 appreciate your enthusiasm for this population,

17 your enthusiasm for your hometown, that kind of

18 shows, and thanks for spending so much time with

19 us today. I hope to see you again.

20 MR. BOLOGNA: I know you got to move

21 along, but I'm happy to be a resource for you

22 guys.


208

1 MR. CERTAIN: Well, these two guys

2 over here came in. They're waiting to get up.

3 MR. BOLOGNA: I'm happy to be a

4 resource and I do think, ultimately, success is

5 often person-to-person, right? And we can't lose

6 sight --

7 MR. CERTAIN: Well, see, I have a

8 brother who was in Vietnam. He's got non-

9 Hodgkin's lymphoma and diabetes, and he won't go

10 to the VA, because he just won't go to the VA.

11 MR. BOLOGNA: Now, my mother-in-law's

12 may not have had nothing to do with this. Thank

13 you. And, yes, enjoy our city, spend some money,

14 get out, have fun.

15 MR. CERTAIN: Colonel Strickland is

16 not going to be able to make it, so he sent two

17 people to take his place, so from the Louisiana

18 Office of Veterans Affairs we have these guys.

19 Whoever they are.

20 MR. PETERS: I'm Elmo Peters. I'm the

21 Manager of the Claims Office.

22 MR. CERTAIN: You're local, aren't


209

1 you?

2 MR. PETERS: Right in -- wherever you

3 went, it's Mark Bologna's office, and this is

4 Dave Holcombe. He's the Manager of the Southeast

5 Region. He's in one of these offices with 14

6 people, if you figure that out. But he asked us

7 to talk about DIC.

8 MR. HOLCOMBE: We weren't able to talk

9 about DIC, but some of the things I've been

10 listening to, I've been doing this 18-1/2 years,

11 just almost 19 now, and about 16 years ago, well,

12 I still didn't know very much, there was an

13 initiative in Louisiana started by a fellow named

14 Sam Jarvis, and somebody at our agency, but I

15 can't remember, to identify all the POWs in this

16 state, and get them 100 percent.

17 And after three years, I was told that

18 we did every one of them, at that time, except

19 one gentleman like the one you described, I ain't

20 coming to you. The hell with you.

21 Now, there's nothing new in this

22 business, yes, new laws, but nothing's new


210

1 because everything goes around full circle. The

2 same chickens come home to roost. And what I

3 mean that, training. And what I see is, people

4 who do these claims, what we did was very easy,

5 it was a lot less computer than it is now, but we

6 would write on top of the claim, POW, and use

7 this wonderful thing called a highlighter, and

8 that claim would get done in a day.

9 Now we got to go to D.C. You all

10 figure it out. You're paid much more than I am

11 for that. It worked. It worked. What we didn't

12 find out is, there were tools available, and I'm

13 going to get to DIC, but there were tools

14 available that were put into law to make it

15 easier to get POW claims through, that I don't

16 see them using.

17 There's a presumption list from POW

18 diseases, just like the Agent Orange list, just

19 like the Camp Lejeune water list. You don't hear

20 of anybody using it and you don't hear of people

21 knowing what to claim, and I've seen that on both

22 sides of the street, in my house, DA side too.


211

1 People don't know that that's on a

2 presumption list. They'll go back and look at

3 his record, if he didn't have it diagnosed in the

4 service, or he died. But there's a list as long

5 as my arm of POW-related diseases, a lot of them

6 do with starvation, which all POWs starved at one

7 time or another, depending on how you identify

8 starvation.

9 None of us probably could identify it,

10 but they could. Look at DIC. DIC went through

11 smooth as glass before the Milwaukee patient

12 center. It went through just like that. And I

13 had three claims that I personally worked on DIC,

14 that all got denied because the people in

15 Milwaukee didn't know that a surviving spouse has

16 only got to be one for one year before it's an

17 automatic grant. Did all you all know that?

18 But everybody doesn't. Like, you

19 know, the ten-year rule for a regular spouse?

20 It's one for a POW. There are people who don't

21 know that. There are people who don't know that

22 on my side of the house, there are people who


212

1 don't know that on his side of the house, and

2 claims get denied for it that shouldn't be.

3 The presumption list, but this was all

4 done in state. You get them 100 percent, and all

5 they got to do is live a year and their wife's

6 taken care of forever, automatically. It

7 shouldn't be as hard as it sounds like it is to

8 get it done, because the way Book 3 of the

9 adjudication manual is written, the VA

10 specifically gave more presumptions and more

11 leniencies toward approving claims for POWs than

12 they did combat vets.

13 I won't discuss whether that's right

14 or wrong, they ought to both be about the same,

15 but a POW claim that's put together right, it

16 should go out of service office right, it should

17 go to adjudication, and if they're done right,

18 they can be done in a day.

19 And I'm thinking that there's not the

20 right training on either side of the fence on

21 that, and all it is, is, we learn, we do, we live

22 through this, and the same chickens come home to


213

1 roost. It's in a cycle. Every 10 or 12 years,

2 what you fixed 10 or 12 years ago, will come back

3 at you in about 10 or 12 years. Any questions?

4 MR. MOORE: I got one for you. Mr.

5 Chairman, the whole idea of having Department of

6 Veterans Affairs all across our country in every

7 state, like Louisiana, it's a tremendous resource

8 available to VA and they partner, of course, well

9 together. I think the focus should be, how can

10 we partner better in the future?

11 And of course, what do we do now to

12 help each other? How can we improve our method

13 down the road? Your office is across the way

14 from Mark's, right? So if you mentioned Mark

15 about anything, unnecessary appeal, or something,

16 I'm not sure where that would be coming from,

17 that's something if we had good communication

18 between, and I know you all do, you could tell

19 them, hey, make sure no appeal's filed until we

20 clean it up, or something.

21 MR. BOLOGNA: So to your point, so

22 randomly, this was not on purpose, we meet


214

1 monthly with the service officers, that happened

2 to be this morning, so Elmo was with two hours

3 ago, three hours ago, but those are the kind of

4 things we talk about. In fact, we were talking

5 about some challenges this morning about that

6 exact issue.

7 It's not hard, it's -- I mean,

8 communication, I guess, is hard, but it's not

9 that, it's, what are you seeing? And we will

10 push back on service officers, just like Dave's

11 saying. They push on us, and they should, if

12 we're not doing something quite right, but we

13 also push back and say, if you're filing an

14 appeal and nothing's changed, what did you miss

15 or what did you not help us catch in real time so

16 we wouldn't even be at this point?

17 And, you know, there's some education.

18 There's some learning, as you mentioned, but

19 absolutely, when we get up in public, we say, you

20 don't have to use a service officer. We're here

21 to serve you, but I don't know why we wouldn't,

22 because it's another set of eyes that's there for


215

1 you. You're paying them by virtue of your taxes,

2 and it's also another set of eyes for us.

3 I'd rather see every veteran

4 represented because there's no harm and there's a

5 real benefit for us.

6 MR. HOLCOMBE: We never had problems

7 getting them, any POW or DIC claim, through New

8 Orleans. I'll tell you that. As long what I

9 said, a highlighter did wonders. The worst thing

10 ever happened to DIC claims was Milwaukee,

11 Wisconsin.

12 MR. BOLOGNA: I don't know that I

13 agree with that.

14 MR. HOLCOMBE: Don't have to.

15 MR. MOORE: We're looking for a way to

16 find POWs out there, kind of hint around, let's

17 face it, the country's in ruins.

18 MR. CERTAIN: Yes.

19 MR. MOORE: The service officers

20 around the country, you all come into contact

21 with many of them, particularly in the rural

22 area.


216

1 MR. HOLCOMBE: They don't leave our

2 office without a claim being filed unless they

3 show me 100 percent RA.

4 MR. MOORE: Right. So my point being

5 though, David, if we take full advantage of only

6 the service officers around the country who come

7 into contact with POWs, then that's a good way to

8 get them in the system, their jobs always pick up

9 in the big cities, you know, which we all posted

10 was coming.

11 MR. CERTAIN: The issue, of course,

12 service officers aren't going to see them unless

13 they've gone in to investigate the system, so

14 they've already identified themselves when they

15 show up at a service officer's desk.

16 MR. PETERS: And that's the problem

17 that we're seeing. They don't know about a

18 service officer.

19 MR. CERTAIN: Right.

20 MR. PETERS: And also, they will never

21 see them.

22 MR. CERTAIN: Yes, the law of


217

1 unintended consequences is out there to always

2 come back and bite us in the butt. Making the

3 claims online so that a veteran can do it himself

4 is probably a nice idea, but not one that's going

5 to work very well, even for the Gen X guys and

6 the Millennials, and stuff that don't get done if

7 it's not online, because unless you can read in-

8 between --

9 MR. HOLCOMBE: If they're 70 years

10 old, sir, and they haven't learned a computer,

11 they're not going to do.

12 MR. CERTAIN: No.

13 MR. HOLCOMBE: If they're 70 years old

14 and they haven't learned a computer, most of them

15 aren't going to at that point.

16 MR. CERTAIN: No. So the POW

17 community is elderly.

18 MS. PRIEUR: I see you in the back.

19 MR. HOLCOMBE: Usually it's their

20 families who bring them in.

21 MR. CERTAIN: Yes, and that's the

22 other concern. Okay. Let's keep the


218

1 conversation down. The obvious to the spouses

2 and other family members for this community is

3 probably key to getting this in, because we are

4 stubborn, and we're told, probably at every

5 meeting, that our DFOs and others who come in,

6 that unless you're listening carefully you're not

7 going to hear us because the two things that we

8 almost always say is, I'm doing just fine, and

9 that's based upon our bottom-line, not yours, not

10 the doctor's, you know, our reference point, then

11 the other one is, other people had it much worse.

12 And a lot of us stay away from the VA

13 because we don't want to take up time from

14 somebody who had it much worse, and that's why --

15 one reason we don't go in is altruistic;

16 altruistic motivation.

17 So I know this not an easy --

18 MR. HOLCOMBE: POWs are very selfless

19 and they don't think anybody owes them anything.

20 MR. CERTAIN: Yes, that's largely the

21 case.

22 MR. HOLCOMBE: You don't see


219

1 selfishness or you don't see that kind of

2 nobility in this kind of population.

3 MR. CERTAIN: We do not go in easy.

4 Dr. Kushner, had to arm wrestle him to get him

5 in.

6 COL. KUSHNER: Bob won.

7 MR. CERTAIN: So this is a difficult

8 population and so we're asking you to take on a

9 difficult task saying to ask the DA to do it,

10 because it's the right thing to do, for one

11 thing, and it's the right thing to do for our

12 survivors.

13 MR. PETERS: I tell veterans, when I

14 meet with them the first time, and they get to

15 see POW waiting, don't go in there and when a

16 doctor asked you how you're doing, I'm feeling

17 great, because that's going to go in your notes.

18 MR. HOLCOMBE: Usually it means that

19 it's over.

20 MR. CERTAIN: Last time I went in for

21 C&P, they wouldn't see me unless my wife was in

22 the room.


220

1 MR. MOORE: Answer the questions

2 correctly?

3 MR. CERTAIN: Just any questions

4 correctly, apparently.

5 MR. HOLCOMBE: Do you all have any

6 further questions for me?

7 MR. CERTAIN: Anything else for the

8 State of Louisiana Department of Veterans

9 Affairs? I think every state has those and we

10 appreciate what you're doing in a vacuum. All

11 right. The next thing is the tour. Lunch after

12 the network and we'll be back in here in, let's

13 say, 15 minutes? Will that work? And then we'll

14 take a tour of the hospital.


16 went off the record at 2:43 p.m.)

17

18

19

20

21

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Aa.m 1:13 4:2 95:18

95:19abandonment

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40:15,20 47:8Biloxi 47:21binder 107:13binders 17:21

107:22 130:14bingo 15:5,8bio 14:8bios 14:10bird 148:19bit 18:5 21:1 28:7

30:16 31:2 32:152:20 62:7 68:477:3 81:16 82:1105:22 108:2110:7 117:3 128:5137:8 138:12140:21 167:2172:11 184:16187:6 188:19

bite 217:2black 59:15blasts 156:5blew 182:21blood 149:4,5,6blow 148:4blows 14:21Blue 85:13board 89:18 93:6

122:14,16,19123:3 124:5,14125:14 156:8

Bob 6:8 50:15 51:858:13 61:2 66:1667:2 94:5,17219:6

body 112:9 115:12117:6

bogged 103:3Bologna 3:14 153:7

154:10 155:11,17160:13,14 161:21164:4 166:8,13,19166:22 167:2168:15 170:3172:5 183:16184:13 185:4,12185:17 187:3,9,12187:18 189:2,7,12194:11 195:16,19195:22 196:5,20198:11,21 199:2200:19 201:19202:19 203:3,6204:13,18,22205:16,20,22206:9 207:20208:3,11 213:21215:12

Bologna's 209:3bond 178:11book 107:12 135:19

212:8Boomer 84:15 85:1boots 59:16born 7:1 167:4bothers 182:5bottom 29:20bottom-line 218:9Bourbon 8:1 11:15boy 63:3 180:22bracketed 94:19Brad 61:19brain 176:15break 95:13breakfast 98:6breakthrough

110:9breed 80:19Brewery 39:21,22bride 13:21brief 26:8briefing 15:6 18:16

20:20 21:4 67:184:14,17 143:7151:5,9

briefings 170:7briefly 51:22

bring 31:5 33:1857:13 58:11 70:882:5 97:16 104:6104:22 105:3137:16 138:9143:1 144:7 160:8161:3 176:19178:17 207:13217:20

bringing 11:2232:16 56:15 58:269:4

brings 100:19105:17

broad 102:12brochure 69:13brochures 64:2

82:9broken 205:13brother 148:12

208:8brought 30:19

56:21 66:3,1775:22 102:15

brown 59:16brush 102:12buck 152:18buckets 139:13budget 178:1build 29:13building 31:20,20

35:13,14 36:13,1436:16 37:3,4,1037:11 38:6 39:1240:1,3 65:2,6,8,13103:10,11 174:8

buildings 31:4103:7 128:7

built 42:1 68:4bumped 15:6bunch 37:14 54:14

128:8 160:19burden 111:20

156:20bureaucracy 56:14burial 156:17

171:16Burke 193:1

burn 110:4Burney 3:9 11:16

11:17 12:3 84:3,484:6 92:20 93:1,493:11 94:11 95:11

bush 162:10busiest 65:1business 18:11

23:17 145:18157:4 173:5209:22

busy 8:16 92:11110:14 131:2150:11 179:8

butt 217:2buy 55:16bye 78:13bylaws 98:14

CC-O-N-T-E-N-T-S

3:1C&P 108:21 202:3

219:21cafes 39:15Cajun 7:11calendar 92:10call 8:2 23:14 38:16

40:3 41:9 42:3,6,749:11,11 55:7,1269:16 87:7 148:19157:3 158:13,18159:1 175:1 179:4188:3 200:5 206:3

callback 158:16191:17

called 17:6 25:2231:15 32:20 39:942:3 55:3 67:2068:1 87:14 89:1793:5 95:13 148:9148:10,14 175:6206:7 210:7

calling 41:12 46:369:17 152:11

calls 13:14 20:1744:11 49:16 64:682:22 147:22


225

148:13camp 14:4 110:5

134:4 155:21156:3,11 210:19

campaign 161:14169:14

campus 36:1089:20 93:4,7

Canal 1:12 35:18175:3

canceled 204:16206:19

cancer 97:5 133:7canopies 135:14capability 154:1capacity 117:20

127:4,14capitol 103:11captured 130:6capturing 53:3

106:6car 39:14card 15:10 60:7

69:14,14 83:13199:13

cardiology 45:5cardiovascular

114:11care 18:11 29:8,11

30:17,21 31:1,633:21 34:2,5,1036:17 40:17 46:1847:9 49:2 51:1952:6,21,22 54:2263:17 67:22 68:368:20 70:4,1371:13 72:11 74:1075:13,13 80:1388:15 97:17 148:7148:17 156:13201:16,22 202:2,5202:11 204:7206:6 212:6

cared 59:3career 84:22 107:5

132:17 146:6,13167:9 173:19180:13

careful 203:18carefully 111:1

218:6Caregiver 87:15caregivers 36:2

87:20caretaker 54:16caretakers 150:20

152:3Carolina 126:22carry 204:20carrying 59:1Carson 1:16 6:21

6:22 16:12,15,1919:2,4,13,1639:17 81:4,8,982:14,16 83:3,19137:1,2 138:8139:6 142:4,12153:2,4 159:16,17160:4 161:17172:8,9 178:5179:11 184:14185:5,13 186:20187:4,8,10,13188:15 189:3

Carson's 11:13160:17

case 122:16 142:9149:15 186:8,14186:18 187:19,20188:1 190:1,5196:16 218:21

case-specific 48:10cases 34:17 63:8

176:21 188:2,4,11190:12 194:20196:2 200:11,12201:12 203:22

casino 7:21Casualty 156:7catch 214:15catch-22 9:3catchment 132:3

174:1category 39:17caution 7:20CBOCs 179:21

celebrated 35:4cellphone 64:5

69:13 147:5,12,13147:19

cellphones 147:2Cemetery 156:16center 1:12 5:11

6:11,16 8:8 12:829:3 30:16 34:935:1 37:3 42:6,645:21 49:17,1862:15,19 65:366:9 68:18 79:1108:5 153:16159:9 173:20197:8 211:12

centered 120:6centers 32:10

80:12central 4:20 37:6

44:10,11 60:15centralized 49:17

80:10 126:6 138:5188:22

centrally 108:8certain 1:13,16 3:3

4:3,7 5:13 8:18,219:3,10,16,19,2210:2,13,17 11:312:1,4,11,17,1913:2,20 14:515:16 18:2,2019:3,21 20:7,1320:19 21:2,1622:10,12 23:625:10,13,17 47:1650:15 51:8 60:1261:6,22 63:1064:13,18 65:1666:14,19 67:6,8,969:6 71:16 72:172:18 73:13,1574:10,13 75:6,975:12 76:6,10,1576:20 77:3,13,2178:21 79:5,1780:11,18 81:883:21 84:2 90:7

92:18 94:9,1895:12,20 101:5,8101:12 112:19131:16 134:6,15134:22 135:2138:7 139:9,15141:18 142:21143:18 144:1,5,9144:13 154:19,21155:3,7,9,16165:14 166:9,14166:20 168:14182:16 189:11194:9 195:12,13195:17,20 196:4196:18 206:7207:12 208:1,7,15208:22 215:18216:11,19,22217:12,16,21218:20 219:3,7,20220:3,7

Certain's 78:2certainly 5:20 7:4,6

27:20 47:6 58:12106:3 172:15177:8,13 183:21

certificate 152:9certifications 58:7certify 41:19cetera 40:18 44:10

50:5,5 67:5CFO 150:9Chair 1:16 23:7

90:20,22 94:8,994:11,12,14,1496:3

Chairman 1:13 3:35:14 7:9 8:4 10:1217:14 18:1 19:219:17,19 81:999:5 137:1 160:15187:4 188:16213:5

chairs 16:7 90:2291:7,11,15,1692:2,6 94:20

challenge 46:14


226

48:1 52:21 62:777:4 134:7 206:10

challenges 46:1847:8 214:5

chance 11:8 14:597:12 98:3 206:5

change 112:22115:3 124:8 130:5141:1 184:15200:5 203:12

changed 4:15 54:983:16 113:12126:21 163:18194:2,21 202:16205:3 214:14

changes 15:6 43:945:12 112:14115:1,15 157:8,18203:17

changing 130:13199:20

channeled 136:5charge 126:19chart 55:8charter 98:21

103:13Chase 17:6,15Chase's 16:20chatted 85:2cheaper 53:11check 122:1 123:17

152:8checked 149:4checkout 70:14cheers 183:2chemicals 149:11Chevy 99:6chickens 210:2

212:22chief 12:7 17:5

48:18 84:11 145:6145:9

child 9:21children 152:3choice 26:21 27:8

86:1 89:12choose 27:4 122:13

125:7,14

chooses 174:21circle 191:8 210:1circulars 82:8circumstances

9:12cities 216:9city 7:3 208:13civilian 73:16 97:4

97:13,15 118:8127:7

claim 62:4 109:2123:1 125:12,19126:8 129:16135:20 140:1152:8 153:14,18153:19 154:3,5156:13 162:8171:16 186:11188:18,21 190:7,8194:4,18 204:4,17205:19 206:5,17210:6,8,21 212:15215:7 216:2

claims 85:1 108:4,6108:9,12 109:5110:7 120:5122:22 124:20127:21 128:4,14128:19,22 129:1,3129:6,12 130:15136:4,14,19,20138:4,19 140:20140:22 141:5142:5,7,10 150:20152:5 153:12,13154:1,11,13167:20 173:2174:10 175:12,22176:8,9 192:4,11194:11,14 195:14201:12,20 204:15205:5,12 208:21210:4,15 211:13212:2,11 215:10217:3

clarification 143:10197:14 198:2

clarified 114:2

clarify 143:7classes 52:19clean 213:20clear 49:21 143:13clearly 176:17

192:19 193:4200:6,13 201:6205:3

clerk 43:17Climb 148:6clinic 45:5 56:20,22

57:1 81:13 97:4153:13 154:13175:22 186:22197:2,18 198:7

clinical 48:7 52:5,7clinicians 31:17

48:6clinics 31:9 33:7

42:5,17 45:8 64:376:22 153:12154:2,11 174:11179:1,22 180:17

close 6:20 48:4135:11

closed 16:22 17:769:2 125:8 203:4

closely 31:14 48:12closest 68:9CNA 121:1co-located 159:9

159:12co-pay 53:11coalescing 197:1cockamamie 77:11COL 6:1 19:12,15

37:14 49:5,10,2050:3,7,10,13 53:653:8 54:7,13,2056:9,13,17 57:4,857:15,20 58:10,1358:20 61:5,2062:22 63:3 65:1966:4,6,11,16,20200:17 219:6

Cole 2:6 13:6,6collectively 164:14college 17:3

Collins 2:7 13:9,10Colonel 1:18 2:4

5:18 7:16 19:1150:15 208:15

combat 7:14 59:16106:8,11,12,15212:12

combat-related47:18

come 18:7,10 19:1722:17 23:17 24:424:8 30:10 35:5,837:1,8,15 38:1138:16 45:13,1553:22 55:5 59:1162:19 66:22 68:2170:2 80:2 85:1091:4 93:14 94:2100:14 102:2107:3 111:17112:16,21 122:6134:12 143:9148:13 150:13151:4 153:13166:12 167:7,16169:2,3 172:7174:18,21 176:12176:22 177:1,3179:5,13,13,14,16180:7 181:3 185:7187:1 188:4193:13 196:11199:14 200:8206:20 210:2212:22 213:2215:20 216:6217:2 218:5

comes 42:7 49:1253:18 72:14 74:2178:15 122:20124:1 127:1 140:4149:18 154:2156:21 159:6164:5 186:21196:15 197:5,8204:4

comfort 152:14comfortable 20:16


227

coming 7:17 15:1773:16 75:22 94:16137:10 181:5209:20 213:16216:10

comments 11:1337:13 93:10101:18 116:22181:14

Commission 89:7,8commit 88:12committee 1:5,11

3:8,10 5:14,14,196:6 7:1 11:1,1,1811:20 14:12,13,1815:2 16:6,14,1820:5 21:5,12,2222:14,16 23:2,1025:1 54:21 63:1279:22 81:12 84:784:14 86:10,2287:15,16 88:2,888:22 89:11,17,1991:1 92:22 93:893:15 96:4,9,1896:22 97:18,19,2197:22 98:11,1999:2,4,9,11,15,1799:22 100:2,6,9100:20 101:4,13101:16,16 102:3,6102:8,9 108:16109:12 111:2,19116:11 118:1119:3 124:9128:11 130:21131:1,4,5 132:16132:20 136:10137:15 139:18140:5 143:8,15145:12 159:16172:4 184:6,17185:2 187:5

committee's106:19 133:18139:5 143:11188:16

committees 22:15

87:2,3,4,6,8,8,1087:11,14 88:189:5,21,22 90:1,890:12,13 94:6,1396:1 98:3,1599:12

common 121:19communication

161:19 168:19213:17 214:8

communities 25:3175:14 176:4

community 24:228:4 33:11,1234:9,22 37:3 40:647:10,13 48:8,1248:21 52:21,2257:3 60:13 62:265:3 66:9 67:2192:12 93:5 134:8139:17 150:15165:9 174:2,3,5177:17 179:2180:1 182:20217:17 218:2

community-based33:13 178:22

comp 121:2company 136:2

200:20comparable 81:21compare 61:13

97:15comparison 62:14

62:16 79:2comparity 121:9compensate

115:10 142:20compensated

131:9compensating

103:20compensation 1:3

3:10 96:4,2298:12,17 99:4104:9,21,22 105:3108:21 115:6132:8 133:1,1

140:4 145:19153:17 155:22166:16 173:3202:3

complain 40:19complaint 199:9complete 127:21

129:11 165:18202:12

completed 130:13158:11

completely 41:1133:9 178:19191:18

complex 34:1568:20 114:5

complexity 34:14114:4

composition100:10

computer 20:1560:18 107:21191:6 210:5217:10,14

computerized127:14

computerizing107:11

concentrate 71:11concepts 68:8concern 131:18

139:17 140:2217:22

concerned 36:3102:14 118:2130:20

concerns 36:8 95:796:1,5 166:10

concourse 36:1237:9 68:6

concur 111:8,10concurred 111:6,7concurrence

115:15 117:8condition 149:10conditions 75:6

114:2 134:20156:2 188:10

conducive 37:21conference 7:8

74:18 154:13conferences

152:19 153:2,11conflict 201:18confusing 49:10

50:1Congress 62:7

87:12 90:14 94:2203:10

Congressional35:9

Congressionally97:19

conjures 199:16connection 43:6

134:13 175:17connections

206:14connects 36:16consecutive 99:14consequences

217:1consequently

131:22consider 87:11

120:1considerate 145:3consideration

44:22considered 22:19

118:17 199:1considering 78:4

197:21consistent 119:7

160:22 163:5,16consistently 177:8consolidated 33:10

169:18 173:5constant 205:9constantly 45:12

171:1constituents 127:1constricted 142:7consult 23:15 70:5consultant 23:9contact 21:13


228

41:20 64:4 69:1982:10 151:14159:2 166:4215:20 216:7

contacts 62:18contamination

155:22 156:3,12context 167:2contingency 33:10continually 164:16continue 23:14

28:2 29:13 32:1357:17 143:2155:18

continuing 30:1891:19

contract 109:3contracted 120:11contractors 201:1contribute 102:17contributed 146:10contributing 47:17control 14:22 62:12convenient 70:16convention 175:21conversant 113:21conversation 218:1conversations

143:2 144:18convince 207:8cook 17:9cooking 17:10,13coordinate 51:1

96:8 162:21169:11 185:19

coordinated 72:21160:20 161:11,13173:22

coordinating 27:1352:22

coordination 27:16coordinator 67:3

80:11 132:5139:22

coordinators 137:2139:19

copy 86:11corner 179:8

Corre 1:17 2:6 8:5,510:12,13,14 14:114:2,3 40:11 43:143:3,9 44:7,14,2145:15,17 198:10198:10,12,22201:11

correct 14:8,1041:21 45:9 52:1152:15 171:14

correctly 144:16183:17 220:2,4

Corregidor 8:7corridor 29:10cost 4:15 74:8costs 111:20costume 71:2council 12:9counsel 93:16

207:3counselor 159:3count 20:17country 46:15

67:15 68:2,1979:9 81:15 96:19108:10 150:12161:18 164:22167:11 191:22192:1 194:12213:6 215:20216:6

country's 215:17county 82:19

148:15couple 22:3 23:11

38:5 41:6 49:762:16 63:19 74:1795:1,21 100:7102:21 122:9126:3 131:16172:22,22 173:1,6196:2

course 7:22 24:1426:9 29:17 65:7109:1 137:5,17162:8 201:3205:11 213:8,11216:11

court 62:5cover 22:1 89:8,8

102:11,21 155:12164:14 174:14

covered 55:17 98:7covering 44:4covers 67:13covert 60:3cow 118:8CPAP 133:8CPRS 27:19 76:5crack 207:10crap 182:14crazy 85:17 148:3create 78:14 162:12created 168:1creating 64:2 89:9

201:10crisis 89:13,15

158:17 159:1criteria 114:3 120:4

120:5 129:16critical 51:14 89:2

140:4cross- 98:1,9cross-fertilization

95:22cross-link 131:12cross-pollination

98:2cross-referencing

166:5crowd 8:9crowded 23:8crown 57:9cuisine 17:5culture 202:16cure 40:15 133:5curious 184:22current 27:20 28:19

103:19,20 104:6,7104:7 107:19113:3,4 115:5,5115:11 120:10122:8 129:3134:20 139:1163:12 185:8

currently 33:17

40:1 52:6 79:887:2 90:1 100:9120:9 130:14

curve 28:7Customer 205:17cut 61:8cutoff 40:20cutting 35:2 88:4cycle 99:13 114:19

117:13 122:21123:18 127:18213:1

cycled 117:7cycles 142:2

DD-Day 7:9D.C 85:8 103:8

108:8 128:9 210:9DA 210:22 219:9dad 146:18 148:1,3

149:14,22 170:16daily 41:5 42:11,15

43:10 45:11 88:1188:12 127:17193:2 194:21195:7

Dallas 57:10,11damn 182:19dangerous 38:2data 82:2 100:21

101:21 108:16113:7 115:11122:5,5 150:14162:3,14 205:10

database 83:16date 70:15 92:17

99:8 104:6,14127:21 207:4

dates 34:19 94:1999:10 155:9

daughter 206:11207:4

Dave 209:4Dave's 214:10David 84:8 216:5day 15:7,14 21:6

33:1 34:11 52:8


229

54:15 70:13 71:785:4 107:14 116:1129:4 135:17149:7 151:18154:1,5,10 193:6193:8 194:3196:11,12,13197:11,19 210:8212:18

days 46:1 106:14108:13 127:19,22128:5 129:17,18130:2,17 183:10192:18 193:7194:10,18 195:10195:20

Dayton 6:5 146:15DBQ 202:12DBQs 114:9 154:3

202:9DC 13:12,15 25:22

145:6DD214 106:13dead 20:21 140:15

184:14deal 100:16 103:5

158:8 189:17dealing 142:16dealt 114:7 183:4dear 46:21 47:7death 146:11decade 106:3 113:1

113:7decades 23:8 104:1December 30:20

33:6,8 128:4130:3

decided 20:13125:10 149:9

decision 48:7,771:15 105:15124:21 125:17126:7 127:5,18132:13,14 197:15197:22

decisions 71:14172:18

decreases 121:10

157:9dedicated 63:15

69:22 131:6 167:8deemed 98:22deep 22:22deficiencies 144:21definitely 155:6

181:17definition 170:9degree 147:22

177:22demise 24:17denied 211:14

212:2dental 57:9 58:6

66:11Denver 68:6 129:22deny 121:7department 1:1

3:15 34:1 36:1963:5 148:15 176:2205:1 213:5 220:8

departments 44:1044:16 67:17140:22

depend 107:22dependents 171:6

171:12,21depending 43:20

173:5 211:7depends 78:18deploy 37:9 110:16deployed 76:22

107:4Deputy 25:20 84:11

153:8described 168:12

186:8 209:19describing 168:2description 118:3Desert 25:5 58:21

165:22design 35:21,22

37:19 68:8designated 2:2 9:8

9:11 79:13 91:2292:16 101:6

designed 36:11

desire 188:17desk 39:10 157:15

216:15despite 131:2destroyed 65:17detail 104:18detection 88:5determine 93:8

169:20determined 134:11Detroit 146:15develop 139:19developed 112:15

124:20 125:1129:12 135:5

development 154:4154:6

developmental115:14

devices 133:12devil 184:9DFO 10:22 11:21

86:9 92:6 94:1294:13 101:4,5,14143:16

DFOs 101:2,3 218:5diabetes 114:5,8,12

149:10,14 185:10208:9

diagnosed 211:3diagnoses 109:18

110:2diagnosis 185:8diagnostic 36:18

65:7,14dial-in 20:4DIC 137:17,18,22

138:4,14,17,19142:4 171:16188:18,20 189:5191:19 192:4194:1,9,16,17209:7,9 210:13211:10,10,13215:7,10

DICs 138:9die 71:9 135:21

205:14,18 206:5

died 58:22 99:19204:16 206:12,19211:4

Diego 74:17dies 139:21 203:2,3

206:20difference 111:8

115:7different 30:14

44:16 67:17 68:579:10 85:20 92:12115:17 135:6158:7 168:5169:17 178:13181:2 185:22204:9

difficult 9:12 42:1572:22 73:3 106:7131:21 207:12219:7,9

difficulties 14:20difficulty 38:1digitization 126:19

141:2digitized 126:17

141:6diligently 23:20dinner 5:5direct 64:4 82:14

82:15,22 159:17159:22 199:7

directions 39:251:12

directly 36:21173:10 181:18

director 3:13 6:116:18 7:6 12:3 13:117:4 19:18 25:2025:21,22 28:858:17 82:16,1784:12 154:15160:16 167:3192:20

directories 43:4directors 162:9directory 41:16,21

45:3disabilities 103:14


230

103:15,18 112:3,6118:16 119:6,15131:10

disability 3:10 96:496:22 98:11,1799:4 103:19 104:5104:11 105:1,13109:2 114:15115:6 118:18119:6,10,21 120:4120:6 121:8,9,20126:8 131:18132:22 145:19153:17 166:16173:2 187:5202:10

disabled 119:7131:8 152:22

disagree 183:17,21disagreement

123:2disbanded 166:2discharge 48:22disclosure 41:5disconnect 200:7discontinue 119:22discretion 143:11discretionary 87:7

87:8,13,22 90:3,7discuss 21:6 22:5

212:13discussed 60:13discussion 109:22disease 104:8

114:4,5,11,13133:11,14

Disease-Based114:10

diseases 112:16133:4 135:6210:18 211:5

Disney 71:2disorder 47:6,19disparate 190:21dispersed 76:16

131:3 163:20192:14

distances 39:4

distracted 145:1,2145:3

distress 150:3,3,4158:5,6 159:6

distressed 158:1distributing 127:16distribution 42:4

131:3district 8:2Dixie 39:20,22docs 202:5doctor 6:9 43:13

51:10 55:14 71:171:13 72:12 73:1173:22 79:12,16197:13 198:19201:13,17 202:1202:12 219:16

doctor's 44:3 45:8202:13 218:10

doctors 40:17 43:643:14 44:9 51:1170:2 132:12 185:7198:16 199:1201:16

document 18:1745:7

documented 75:20documenting 75:21DoD 27:13 61:13,15

62:14,18 83:10130:1 156:8159:19 165:17168:14,18

DoD's 175:20dogs 62:10doing 21:6 24:21

26:20 34:15 38:1840:22 41:22 42:1956:10,11 58:760:15 63:19,2069:9 72:18 75:1881:5 83:6 86:5,20106:10 141:22160:11 171:2173:21 175:11178:12 181:1,1191:15 199:21

202:5 204:15209:10 214:12218:8 219:16220:10

dollars 111:21151:16

Dooky 16:20 17:617:15

door 19:5 126:14doors 129:21

148:21double 105:20doubled-up 73:15downtown 173:20Dr 2:2,3 3:7,11 4:22

5:16 6:8,17 11:4,518:10 25:7,9,1125:15,18 37:1839:22 41:1 43:2,843:11 44:13,1945:1,16,18 46:3,746:12,21 48:16,1849:9,14 50:2,6,850:12,14,15,21,2251:6,7,16,16,1751:21 52:1,3,1453:7,16 54:12,1856:8,11,15,1857:6,13,16 58:158:12,19 62:1163:13,16 64:10,1664:21 65:18,2266:5,7,13,1567:11,19 68:13,1669:1,4,10 70:1171:19 72:2 73:273:19 74:12,1575:8,11 76:9,1176:18 77:1,5,1577:22 78:2,2,879:3,7,11 81:1,1182:7,15 83:2,5,2083:22 85:19 94:2296:15 101:6,9,15109:14 110:12126:11 132:11134:14 135:1136:3 138:16

139:12 141:12142:1,14 143:14143:20 144:1,4,6178:5 201:1 219:4

draft 115:15drafted 117:8dreams 36:5drink 39:7drinking 39:18drive 146:19drives 149:16driving 39:4DRO 186:13drop 120:1 128:21

129:8drop-off 38:7,9dropped 128:20

129:18 130:16drug-drug 53:4due 15:5 18:4 71:9duplications 61:8duration 122:10duty 13:14 97:7

106:6,7,22 125:9125:20 146:17

dying 22:2 59:4181:21,22

dynamic 178:13

EE 6:15earlier 18:14 32:14

45:19 63:17 84:588:9 121:11126:11 187:5202:20

early 89:2 92:8117:9 206:18

earned 178:3,3183:9 198:5

earning 117:20earnings 104:10

119:18 120:2,10120:11,13,15122:5

earnings/loss100:20 112:1113:5,5


231

easier 26:18 27:328:18 96:13 109:2116:2 171:10184:4 210:15

easiest 179:12easily 145:1,2easy 5:2 30:4 51:4

59:6 114:18115:18 161:22168:12 193:4210:4 218:17219:3

eat 17:11 39:7eating 143:3eBenefits 150:22

152:7Econ 121:2 122:4economic 100:15economics 122:5economist 100:3

100:14,17,18,19ED 34:21edge 88:4educate 149:21

150:5 175:13176:9

educating 152:2education 40:21

48:13 145:17,19145:22 173:4214:17

educational 64:2efficiencies 189:13effort 161:11efforts 178:20eight 49:15 146:16

156:2 160:18162:2 163:21167:12,21

either 38:9 70:2172:1 88:17 93:17103:9 165:19194:13 212:20

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eligible 162:11eliminate 61:8eliminated 133:11elite 62:9Elmo 204:22

208:20 214:2email 30:8 72:7,11

72:13 79:15 95:4143:15,18 193:16195:4

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36:19 44:2emphasis 158:3emphasize 32:22employee 100:22

158:11 159:8employees 65:20

68:14 128:7,9,13179:17

employment 13:17105:2 145:21173:9

empty 64:15encompasses

114:9encourage 14:7

24:7 137:14encouraging

134:18ended 175:7energy 37:6Engagement 89:18

93:6enhance 27:9enjoy 208:13enjoyment 5:20enroll 162:10,10,11enrolled 163:2,7,11enrollment 152:9

157:1ensure 89:1enter 37:11enthusiasm 207:16

207:17entire 36:13 64:21

167:5 180:13entitled 146:8,10

171:13 183:8188:8

entrance 35:2038:14 39:1,8,16

environment 75:2environmental

103:17,18equal 13:17 100:13equipment 58:8

128:8 149:21equitable 133:22

136:21equitably 115:11ER 13:5,8Eric 2:5 10:6,17,21Ernest 2:2 11:5

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176:1 185:18establish 93:15

95:8 116:13established 87:9

89:2 98:12 140:7186:22

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197:12,13evaluated 197:9evaluating 118:18evaluation 114:3

185:8evaluations 114:4evening 147:6,9event 33:3 35:4,7

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events 47:16 63:21150:17,21 151:2151:21 155:12,14174:14

everybody14:221:18 24:12 76:1677:17 78:15 83:12131:5 197:1,20211:18

everyone's 193:3evidence 105:17

124:6 125:5,9129:15 141:16153:20 186:16

Ex- 165:21 185:1Ex-POW 59:19Ex-POWs 59:13

166:3exact 41:9,13 214:6exactly 107:1 134:1

168:1,5 207:9exam 55:10,13,15

56:1,4 62:20186:18 196:3,6,8196:9,10,18,21,22199:14,16,19,22

examination123:21

examined 75:19111:1 198:18

examiner 85:1186:13

examiners 200:12example 58:21

186:1 190:4,6examples 186:1exams 28:1 106:20

106:22 108:21,22108:22 109:6197:9

excellent 91:9exchanged 172:9excited 7:4 14:18

15:1 85:3 90:1790:19 91:14

excitement 91:14


232

excuse 195:9executive 6:10,18

13:10 101:1 207:1executives 101:2exercise 46:5exist 165:7,8existing 114:2

137:6 159:18161:20

expand 30:18 34:1457:17

expanded 108:20expanding 31:21

52:13 121:17expect 123:15

200:7expectation 178:4expedite 124:22expedited 89:10

195:21 197:10expediting 195:14expensive 4:16

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94:7 168:20188:14 199:4,7200:15 201:7

expert 187:19expertise 47:15

48:1 58:5 190:22experts 138:18expire 27:1explain 164:7explaining 200:13exploded 105:6exploding 123:5exponential 142:19exponentially

108:19expose 62:1Exposing 200:18expound 79:21Express 53:10,13expressed 188:17extended 27:1extensions 44:16external 80:6extra 22:3 190:19

extract 148:21extremely 150:10eye 55:8,10,15 56:1

56:4,20,22,2270:16

eyeballs 198:3eyeglasses 55:3

56:5,7 70:6eyes 214:22 215:2

FFACA 84:16face 215:17face-to-face 30:2

74:14,15 153:15faces 64:12facetious 115:19facets 114:6facilities 28:11

32:15 47:21 48:1348:21 50:19 51:379:10

facility 31:9 33:537:15 64:15 67:2068:1,14 79:11,1680:3

fact 17:12 116:4131:6 140:16151:10 175:15214:4

factor 118:17fair 173:17fairly 103:3fake 58:16faking 77:8fallen 206:14falling 60:20 71:10familiar 26:13

35:17 49:6 102:22103:1 153:13

families 87:17170:10 217:20

family 85:11,1787:14,20 149:13149:22 150:19152:2 156:20165:4 167:8 169:6181:6 191:15

218:2far 35:5 74:2 81:5

82:11 104:2117:18,20 119:3119:16

farm 128:2fascinating 17:8fashion 126:9fast 125:10 138:4

138:14 139:7146:20 188:17189:4 191:20197:19

faster 44:17 109:6116:17 125:3203:20

father 146:2 148:22149:3

father's 146:11father-in-law

206:21favor 161:12fearing 132:9fears 134:2feathers 183:7featuring 32:21February 40:2federal 2:2 9:9,11

22:9,10 91:2292:16 99:22 101:6101:17 103:10111:20

feedback 50:9 91:791:16,20

feel 20:16 107:9130:19 143:15,21181:2

feeling 126:4219:16

feels 131:6 202:8202:15

feet 4:22 179:19fellow 19:6 70:18

73:7 148:12209:13

felt 183:4females 32:21fence 212:20

Fernando 25:21161:20

fiduciary 145:22field 160:20 161:15

168:16 169:2172:12,17 185:18189:15 190:4,20192:14

fifteen 117:5fighter 135:3fighting 40:14figure 61:16 172:6

209:6 210:10figures 81:18file 93:19 122:14

139:7 205:9206:22

filed 122:12,13,22185:14 213:19216:2

files 127:1 162:7filing 171:15 214:13fill 19:20 21:15 54:1

54:2 156:17filled 72:21 200:9filling 65:11 92:10final 58:7 117:5,6

117:12 155:20156:11,19

finally 125:13135:15

finance 150:8financial 158:5find 21:15 63:9

80:15 81:20 130:8137:3 151:14152:13 153:14158:15 163:9164:1 166:6169:10 181:9192:6 206:2210:12 215:16

finding 68:8 81:6118:10 183:22194:6

fine 158:22 218:8finish 5:7finished 40:2 55:15


233

98:19 151:16finishing 147:22finite 109:4first 10:9 14:17

18:17 26:12 29:1634:3 42:9 87:1390:21 93:22109:11 110:21112:20 118:5121:13 145:11157:6 158:2163:10 174:5178:7 180:14186:5,9 189:8205:7 219:14

firsthand 200:14fiscal 21:20fit 56:5 67:5five 6:3,6,17,19

21:17 56:6 60:975:19 85:21 86:886:18 87:1,6 88:9100:11 112:22114:9 117:14126:18 128:5150:9 151:7,9152:11 158:2163:6,22 167:13167:14 198:19

fix 106:18 107:15108:1 112:18123:11 195:5,11

fixed 105:8 124:18213:2

flag 4:5flagged 195:14flagging 64:1flavors 174:20flies 59:5floating 159:20flooded 108:6floor 17:14,22

35:15 39:13 40:365:2,9,9,11,14

floors 35:16 40:764:22 65:5

Florida 6:5,16 29:9Florida-Texas 29:8

flow 109:19fly 23:12flying 106:10focal 138:19focus 26:16 29:16

35:21 38:21 69:1186:2 87:16 88:389:12,19 188:1,13193:8 194:2 196:8213:9

focused 24:2focuses 158:2,6focusing 85:21folks 5:10 14:11

22:15,18,21 37:1559:14 165:10166:10 180:16,21192:6 194:6197:11

follow 101:11follow-up 82:22following 7:11

11:12 28:2 99:5food 7:11 17:11foot 96:12Force 9:8 13:18

85:10,12 97:2,10100:12 106:9157:7

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108:12 212:6forgiveness 85:16forgot 80:20 202:20forgotten 182:9formal 122:14

172:5formally 187:1former 1:5 5:21

6:10 8:6 23:124:15 52:2 61:963:16 78:7 79:996:17 98:10,16132:15 139:20161:2 165:2 170:8177:10,10,11181:9,18 184:17

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found 40:15 47:1361:18 121:6132:20 140:11163:21 178:2195:4

four 6:6,6 14:1218:21 19:1 52:759:9 75:19 97:8100:11 102:13109:21 114:9126:17 145:13163:6,22 192:16

four-day 74:18fourth 86:2 98:20FPOW 15:19 137:2

137:13,14 145:17150:15,17 171:6187:14

FPOWs 150:21152:6 169:14198:14

framework 103:16framing 199:13Francisco 4:18Franklin 176:5frankly 141:20

168:1 179:10frantic 148:1fraud 88:2,4Fred 12:6free 143:15,21

179:5Freedom 25:5freeze 184:9frequently 62:17,18

142:8Friday 5:7 49:4

93:18friend 24:22friends 26:5friggin' 60:4 183:10front 21:5 39:3,11

104:2 176:10205:20

frustrating 77:9frustration 135:18FTEs 65:20full 41:5 64:17,17

76:12 128:9 143:4210:1 216:5

full-time 65:20fully 29:5 65:2,4,9

124:20 125:1129:12

fun 208:14function 52:5

128:12 200:22functional 121:3functioning 29:6fundamental

203:17fundamentally

205:13funniest 51:7further 154:4,6

180:8 220:6future 109:9 142:17

142:17 213:10FY13 121:20FY2018 155:5

GG 61:3 103:10gain 105:2 127:19

183:1game 74:5 180:8gaming 73:14GAO 111:18,22

112:4 116:21


234

119:17 120:9,21garage 36:22 38:5

38:12 39:13gearing 90:19gears 117:15Gen 99:6 217:5general 50:18 71:8

90:5 93:16 97:11100:12 102:7111:19 121:14140:19 155:19172:14 176:11199:10

generally 90:5130:21 131:1147:13 161:2202:1

generate 106:13generations 87:18gentleman 209:19gentlemen 59:12geographic 131:3geographically

9:13geography 164:13Germany 156:8getting 7:5 19:22

28:1 29:19 38:340:19 44:5 45:2148:2 62:6 64:1664:17 73:15 78:481:6,11 83:1092:11 93:21 129:7134:6,7 138:1179:1 185:2,6,15187:15 201:21215:7 218:3

ghetto 148:19giant 107:22 141:15girls 167:14give 7:8 15:9 16:12

17:21 18:17 26:755:15,20,22 56:158:20 64:7 67:180:9 82:4 86:10139:1 151:4,9155:9 157:11164:17 167:1

169:15 172:11175:9 181:20189:15 190:5

given 61:10 63:4140:2

giving 21:3 70:671:13 176:11

glad 6:12 7:19 8:211:2 49:3

glass 211:11glasses 57:5

123:16go 4:18 5:3,8 13:15

18:15 20:20 31:337:10 38:7 44:244:11,15 45:1746:8 48:21 49:1653:13 55:19 56:459:8,21 62:3 64:365:15 71:3 74:976:3 77:19 80:1585:13 103:2107:12,14 108:1110:20 115:2,8116:6 118:8 125:5125:7,18 129:14129:20 130:8132:10,14 133:9133:16 139:10,14141:19 142:12,15148:8 152:18154:9 157:6,7,17159:18 164:6,12165:16 169:10,16169:20 174:5176:4 179:14180:7,10,17184:11 185:14186:14 187:16,19193:19 195:7196:10 198:18202:1,3 204:2,3204:10 208:9,10210:9 211:2212:16,17 218:15219:3,15,17

goal 24:11 28:6,943:22 129:17

133:2 138:3 160:5184:21

goals 28:15 137:5goes 10:3 36:12

42:8 57:10 106:8106:12 111:22114:19 115:13,18116:3,5 122:21124:1 125:13132:21 163:5193:2 210:1

going 7:12 15:1,7,915:11,13 16:1018:9,18 20:2,4,2221:9 31:8 35:439:14 40:9 48:1650:4,5 51:19 54:855:17 57:12 58:1060:5,11 66:2 67:470:9 73:16 77:1979:14 80:5 82:384:20 87:3,1688:1,3 89:11,1989:22 90:2,3,1093:8 95:7 107:7,8109:8 115:8116:17,18 117:14120:18 122:3124:8,18 125:1,22126:1 127:22131:19 133:1,2,17148:3 149:15151:6 152:13153:22 161:13163:14,16 165:8173:22 174:13,14175:21 178:5179:22 180:1182:4 183:1,2184:8,9,10 195:11197:3 198:7199:16,22 201:6202:13 203:16208:16 210:13216:12 217:4,11217:15 218:7219:17

good 6:21 7:11 9:6

10:20 11:4,1612:19 13:2 14:1617:12,17 19:1624:22 25:9,1830:2 54:7,1055:13 61:21 63:1466:14 69:8 70:2271:19 79:19 80:2284:4 96:15 97:1297:14 99:9 107:6107:7,9,15 108:3110:8 123:18125:15 126:3128:6,13,16,17130:18,19,22140:21 142:12,14144:9 145:4146:20 153:5154:9 157:12163:15 164:1165:19 193:10,15213:17 216:7

goodie 18:2gosh 170:18gotten 51:22 53:22

83:12 151:10198:5 207:6

Governor 35:8grab 147:11 189:22

196:12gradually 120:6grandfather 146:3

146:4grandkids 82:11grant 211:17granted 99:14

109:19 115:3133:21

granting 103:18grassroots 161:13

165:6,13great 7:3,8,15 63:3

63:4 91:15,21161:6 168:3 174:6177:7 181:10219:17

greater 85:22 129:1greeted 179:18


235

greeter 38:14greetings 11:22grew 17:2 173:18Grisham's 135:19ground 5:1 51:20

173:1groundwork 81:5group 22:21 38:21

62:12,15,16 63:2166:22 82:3 115:13115:14 156:22174:20 175:5,8182:22

groups 24:3 35:2174:20 177:16

grow 32:13 34:13growing 32:3,15,19

108:18growth 29:22 32:14

142:19grunt 206:15GSA 90:6guarantee 145:21

173:4Guard 97:9 105:22

106:1,5,9,20107:3

Guardsman 107:2Guardsmen 97:7guess 6:22 8:12 9:4

9:5 18:9 22:749:12 99:9 214:8

guideline 181:20guides 38:10Gulf 109:17,22

110:3 136:4guns 146:20guru 136:8guy 4:3 19:8 59:10

59:15,18 71:1193:16 200:8

guy's 60:9guys 62:1 63:7 70:7

78:11 178:9180:22 183:12,20189:9 207:22208:1,18 217:5

HHain 1:17 6:8,8

50:15,15,22 51:762:11 126:11

Hain's 6:17Hal 1:18 83:7half 6:3 8:6 14:3

61:7 65:9 91:11107:4 121:20167:1,14 189:8

hall 55:8 64:8 86:1795:15

halls 54:19 164:13hallway 55:9Hammond 49:8,22

50:5handbook 14:13handful 54:15handle 29:9 51:2handled 139:16handling 128:14handoff 158:16

159:8hang 42:13 158:19

158:22hanging 42:13Hanoi 7:18 19:10happen 38:19 60:8

67:4 122:3 129:8133:15 184:9189:20,21 203:18

happened 60:14107:18 129:10130:3,5 136:4141:4 214:1215:10

happening 20:1489:14 118:3154:22 195:18

happens 62:2 70:8110:18,19 121:22133:8,11,13 186:4203:2

happy 8:9 9:9 13:1885:18 96:20 98:3207:21 208:3

hard 7:7 106:17133:4 178:17

180:3 183:19184:1 193:9 194:1194:1 212:7 214:7214:8

harder 137:8,8harm 215:4Harold 6:1Harry 1:17 8:5

13:20 198:10hat 59:17hate 135:22 147:3Hawaii 10:3he'll 110:15head 24:19 72:16

113:18 133:16160:6,6 176:10

heading 144:3147:10

headquarters160:21 162:1,15162:16,20 167:22168:20 175:19183:19 191:22200:21

health 31:16 33:1134:8,21 40:546:14,16,18 47:551:15 53:1 66:1078:16 89:1 106:20106:22 111:20164:12

healthcare 26:627:4 30:1,13 31:631:16,18 32:188:16 101:2

hear 15:11 16:346:8 77:7 91:1194:7 109:8 144:21164:20 180:22182:14 194:9199:9 205:6210:19,20 218:7

heard 8:13 27:18122:16 129:5131:17,22 136:7138:21 145:1149:9 189:9 201:8201:14

hearing 15:20,2249:21 86:14133:12,12 144:21165:11

heart 29:12 34:1646:22 68:19

heartbreaking 77:6heartburn 77:14held 26:19 75:7

90:21 94:10 103:7helicopter 148:20hell 183:11 209:20Hell's 184:9help 8:3 19:11 26:6

38:13,15,16 39:245:4 64:1 72:688:20 125:22128:3 131:7148:13 150:2153:7 169:6172:17 175:8,13190:19,20 213:12214:15

helped 26:5 130:11136:17

helpful 80:17 81:181:3

helping 16:1354:22 118:12

helps 162:12170:10 181:6185:19

heroes 7:15hey 151:3 152:7

158:17 169:3192:3 204:5213:19

hi 13:6,9 25:10,1178:13

Hickey 140:19high 27:17 47:11

52:17,19 109:12149:5

high- 29:10high-end 29:7

32:10 68:3,20high-quality 74:7higher 121:4 125:7


236

125:18 132:10181:20 184:20

highest 193:5highlight 32:22

63:14highlighted 26:16

33:2 153:1highlighter 210:7

215:9Hil 19:10hint 215:16hire 141:20hired 52:7 124:13hiring 31:8 142:2historically 201:20histories 78:14history 23:15 87:1

97:2 99:2 146:13182:10 202:17

hit 164:18 171:2185:19

Hodgkin's 208:9Holcombe 3:16

209:4,8 215:6,14216:1 217:9,13,19218:18,22 219:18220:5

hold 24:4holy 118:8home 20:15 69:5

106:12 130:19152:9,14 167:17182:11 210:2212:22

homeless 109:11158:3 190:15

homelessness109:9

hometown 207:17honesty 74:3honor 7:13 26:3

96:18Honorable 84:8honorarium 18:19hope 55:5 86:17

207:19hopeful 105:8

203:15

hopefully 7:10110:15 116:16117:11 120:13

hopes 36:4hoping 91:17 93:17

95:8 131:7horn 191:2horribly 182:11horse 140:15

184:15hospice 34:10hospital 7:5 29:2,6

39:19 49:6 54:2157:19,21 59:1265:17 67:13,1469:2 71:18 76:1376:15 137:3 162:8162:9 173:16185:5,20 186:2202:4 206:13,18220:14

hospitals 47:1468:7 164:10 199:5

host 26:4hot 86:6hotel 7:3,22 67:1

151:17 175:3hour 60:10 91:10

91:11 95:16142:22 152:12192:20 193:17

hourly 191:14hours 48:3 72:13

91:13 109:22140:1,3,18 151:4151:8,22 214:2,3

house 20:16 39:339:11 98:15 148:4148:5,18 177:2184:18 203:10210:22 211:22212:1

housed 80:6Houston 68:10How's 124:18HR 157:11,12hub 39:9 180:11huge 45:22 51:6

105:21 109:17130:5 132:4 160:1

human 191:7193:13

humbling 96:18hundred 66:7

124:13hunt 163:14Hurricane 29:5

32:7husband 85:10

176:14,18husband's 9:14hypertension

114:10

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54:10 96:6 112:9115:2,4 132:21141:1 149:16161:9 164:5 170:5170:18 175:22190:11 192:6202:7 213:5 217:4

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241

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77:18,19 83:1497:12,16 104:11106:16 129:21130:1 145:9

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242

196:7,8,11 197:14199:14,18 200:2,3200:4,5,13 203:18204:6 205:3

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154:16 169:13173:10

offered 82:18office 3:8,13 4:20

11:17,19 12:1613:8 43:5 57:260:15 80:12 84:684:7,13 85:186:21,21 88:690:18 93:16 97:21108:6 110:22111:19 115:22,22116:1,1,7,7124:17 125:8,11125:19 126:6,22127:3 135:7 138:6138:10 139:16140:9 142:4145:16 151:18152:12 154:15160:16 167:3168:18 173:11179:3 181:3 183:7188:18,21 189:1192:10 198:18208:18,21 209:3212:16 213:13216:2

officer 2:2 9:9,1192:16 101:7146:15,18 147:2,6198:17 214:20216:18

officer's 216:15officers 91:22

100:12 147:16149:1 214:1,10215:19 216:6,12

offices 49:7 82:19108:9 110:21115:17 116:14,20124:15 126:13127:12,16 138:20139:13 140:22151:13 159:7169:10 172:21,22173:6 184:2 209:5

official 62:17


243

101:13offsite 33:17 103:8oh 12:13,19 13:2

48:17 55:20 58:160:2 69:3 113:21145:2 178:9182:13 183:1202:21 205:6206:1

Ohio 146:15okay 9:4 10:10,17

10:20 11:3 12:1913:2 16:9 18:421:2 45:16 48:1750:2,6,21 53:1654:12 57:15,21,2268:22 69:3 77:2179:19 94:3 110:18115:12 117:15123:18 126:3134:9 138:16144:1,9,19 155:4155:16 160:4,14172:19 184:3186:20 187:8,9191:13 202:20206:1 217:22

old 7:14 8:1 10:1517:10 37:15 54:2160:20 112:12113:7,13 119:1127:9 128:22129:2 204:14217:10,13

older 37:22 78:5137:19

onboard 150:8once 24:5 34:12

66:1 72:9 73:275:3 78:13,1392:16 93:14,16105:19 116:20132:21 143:8161:1 168:22180:8 188:15192:7 194:6 196:6207:13

oncology 97:5

one- 169:4one-on-one 151:14one-one 169:5one-size-fits-all

188:12one-year 47:1ones 85:16 101:9

133:21 137:6ongoing 50:16

61:12 122:4online 45:3 107:17

130:14 152:10157:1,6,7,17185:6 217:3,7

open 34:6,16 49:356:19 64:19,2265:2 68:19 126:13135:14

opened 30:2133:19 39:21

opening 3:3 29:233:22 127:13

operate 75:2operating 34:4operation 12:9

136:1operational 65:10operations 40:22operators 42:5ophthalmologist

6:4opinion 123:22

169:11 186:17197:14

opioid 89:13,15opportunities 30:3opportunity 13:17

85:4 96:16 145:11145:14 146:21

opposed 76:4109:4

optical 56:16options 41:12 89:9

119:20optometrists 56:3Orange 109:17

110:1,3 134:11135:11 136:5,8,13

136:16 149:11210:18

Orange-related135:5

order 21:20 44:17138:17 183:6

orders 77:16,18,20101:11

organization 26:1847:3 62:9 166:1184:3

organizations165:21 166:4168:6,11,18169:17 203:11204:1

organized 159:21organs 149:6orient 35:12original 26:22originally 15:4Orlando 68:5Orleanians 167:15Orleans 1:12 3:13

4:8 11:6,10 12:813:11 28:22 56:376:1 78:9 83:1684:21 153:3,7154:22 155:15167:4 173:2,8,18173:19 174:16176:6 180:3,5199:3 215:8

ORs 36:19 65:15ought 63:6 212:14outpatient 30:19

31:8 33:7,9 34:336:20 38:6 39:1240:5 42:17 46:1947:4 49:2 57:164:22

outpatients 30:20outreach 11:9 12:7

24:2,18 63:2172:19 81:16 82:282:4 132:4 134:19145:10 149:18150:14 155:19

159:14 161:7,11165:1 169:14170:14,19 171:20172:13 173:16,16173:17 176:22177:6,21 178:17178:20 181:13,18184:15

outside 70:8,1971:1 116:20,21198:14,15 201:13201:17 202:11

overhaul 203:13overseas 128:15oversees 11:20oversight 89:18

93:6 199:1 200:22overtime 153:10overview 26:8

35:10 172:12owes 218:19

PP-R-O-C-E-E-D-I-...

4:1p.m 144:11,12

220:16PAC 63:15package 93:14

125:2 129:13203:11

Page 3:2pages 107:13paid 210:10pain 73:21pair 56:6 59:15palliative 34:10Pamperin 101:1

132:16pan 29:9pancreatic 97:5panels 124:6paper 127:20

129:11 141:11157:11

paperless 167:20paperwork 77:16

156:18


244

parallel 97:3paralysis 113:15pardon 60:3parishes 28:22parity 104:10parking 36:21 38:5

38:8part 7:3 12:8 20:20

57:16 60:17 61:1280:1 92:3 106:2113:8 114:13129:9 132:3134:17 138:3141:13 142:5165:6 166:14181:12,12 193:2197:5 199:12203:7

partially 105:8141:10

PARTICIPANT171:4,10,15,19

participating 21:12particular 46:20

89:11,19 114:15137:13 139:18174:20

particularly 24:3,530:4 42:4 47:1747:21 73:20 81:21100:20 116:15124:15 131:8138:5 215:21

partner 15:19179:21 213:8,10

partnered 155:22partnering 92:12

156:15partners 176:2partnership 178:16

178:21 196:21partnerships 204:1parts 190:21Paso 182:18pass 16:10 20:4

51:4 67:2 137:21138:14 144:19

passed 149:7

paste 107:15pasted 107:13paternal 146:4path 204:10patient 36:21 38:5

43:5 53:3,19 54:571:4 74:3 201:16211:11

patient's 52:16patient- 120:5patients 27:22

29:22 32:12,1636:7 37:1 43:1446:19 47:14,2252:17 53:20 64:870:21 71:7,872:15 73:10

pay 15:12 54:14paying 215:1payments 120:7PCP 78:3pedestrian 35:19pediatric 8:12

10:15 46:1 206:4peer 22:21peeve 55:2pending 190:7,8

192:12,18 194:4194:12,14,18,18

Pensacola 6:12,1663:1

pension 1:3 108:22138:6 145:22153:18 165:19173:3 188:22191:11,12 202:3

Pentagon 97:9130:4

people 10:6 12:1215:16 17:11 21:1721:21 22:3 26:1931:5,7 35:6,1737:20 38:1,7 39:439:14 40:22 41:1642:7,12,21 44:144:17 54:2,8 55:661:4 64:1 72:1973:14 77:8 101:19

105:7 113:15,20119:5 120:3,17133:13 138:18142:20 143:16146:20 147:3149:20 151:9,17152:7 155:12163:6 164:19169:21 174:5175:7,13,15,16176:7,9,12,22178:4,8 180:4,13191:11 203:19204:8 205:6,9207:13 208:17209:6 210:3,20211:1,14,20,21,22218:11

percent 24:7,1232:14 105:1,3119:5,8 121:4,11122:13,15 123:2,3123:7 128:21,22129:2,4 131:1132:9 137:7,12,16138:13 160:1184:17 185:9209:16 212:4216:3

percentage 187:15205:8,12

perfect 98:9period 23:10,10

66:21 97:7 106:15107:18 129:11138:2

periodically 10:2periods 106:6person 18:3 20:6

32:12 38:15 39:1142:9 43:20 44:457:1 132:16135:20 151:14158:8 171:3186:13 188:6,7,14189:19 190:19191:16 192:9,22193:14 197:4,12

197:22 198:4person's 187:20person-to-person

208:5personal 83:3

146:12 175:17personalize 169:2personally 25:1

26:2 41:19 161:12211:13

personnel 154:11169:15

perspective 137:12172:12,17

pesky 129:20pet 55:2Peters 3:16 204:12

204:14,19,22208:20,20 209:2216:16,20 219:13

pharmacist 52:8,8pharmacy 72:21phase 33:14,15

34:1,12 115:13,14115:16 127:11,12

PhD 100:13Phil 75:16philosophy 133:17Phoenix 163:21phone 14:21 20:15

23:14 69:16 82:22158:9,13,21163:12,15 191:10191:13 200:4

phones 43:16,22phony 59:9 61:18photos 18:13phrase 183:17physical 24:9 78:10

121:8 150:3166:18 199:22

physically149:2151:21 159:10

physician 6:4 11:651:11 63:17 72:4201:22 202:2

physician's 123:22physicians 70:18


245

71:5 73:7 100:11109:3,4,6

pick 57:6 69:1673:18 83:7 143:1216:8

picked 33:2 69:1picking 43:21 137:9picture 83:11

120:14 151:2pictures 126:10,12piece 82:14 108:16

157:10 191:3,4,21pieces 190:10

191:1 193:12Pierre 69:20piggybacking 78:1pilot 135:4pilots 135:13pinned 92:17pipeline 21:17 22:3piss 183:2pits 110:4place 23:12,15

27:12 39:6 45:2261:2 101:18149:20 156:19164:1 174:17208:17

places 139:21,22plaguing 50:17Plain 181:21plan 4:17,18 16:13

26:14 34:7 66:1292:5 111:3,9

planning 4:1448:22 92:7 96:7

plans 12:7 37:16plant 37:6platform 28:3platoon 7:14

174:19play 15:5please 17:20 21:13

22:4,20 46:2058:12 103:1143:14 144:17

pleasure 6:1025:16

pledge 4:4,6plugs 36:14pocket 74:6podium 12:13point 4:15 32:4

111:12 123:19136:6,18 140:14185:20 190:18194:5 197:1,2200:11 207:9213:21 214:16216:4 217:15218:10

pointed 85:19pointing 102:17points 26:16

138:19police 146:15,18

147:1,11 148:15pollen 98:9pollinate 98:10pollution 110:5polypharmacy

50:20 52:10poor 195:1popular 174:17population 24:1

25:2 32:18 50:1878:4,22 100:10121:15 132:2161:1,9 164:18168:22 180:18207:14,15,16219:2,8

populations 48:1496:2

posed 79:22position 12:21 47:1

52:4 76:7 80:2198:9

positive 202:7possible 8:16 44:1

82:6 144:20 197:6198:6

possibly 7:22 188:8197:10

post 22:7post-Katrina

179:10post-traumatic

47:5,18posted 216:9posters 62:11posting 63:20POW 6:2,11 8:6,12

19:7 24:15 25:359:9,11,20 60:766:18 69:7 77:1079:9,13 80:11,1381:12 139:17,21140:7 155:1,1163:4 165:21,22171:11,17,21,22177:10,12 182:22183:1 184:17,19185:2 186:3190:16 192:11194:4 195:14197:4,8 210:6,15210:17 211:20212:15 215:7217:16 219:15

POW-related 211:5powdered 98:7power 193:21powerful 177:20PowerPoint 172:7POWs 7:17 11:9

19:8,11 25:3,4,658:16 59:1 61:969:19 70:1 75:1875:21 76:14 77:678:3,7 81:1982:20 137:4138:13 139:20159:22 161:2,20165:22 170:8171:12 177:10181:9 187:1 188:2192:5 194:15209:15 211:6212:11 215:16216:7 218:18

Poydras 179:7,9practicable 117:19practical 117:20

practice 6:4 33:4practices 157:5practitioner 201:3

201:4pre- 156:16pre-decease 24:16prescription 55:3

55:16,20,21,2270:9

prescriptions53:13,14 70:1,2073:15

presence 101:14present 1:15 2:1

20:17 117:6124:21 189:5

presentation 172:6181:12

presentations15:11,14

presented 124:19156:7 201:8

presently 8:7Presidential 89:7presiding 1:13press 41:13presumption

210:17 211:2212:3

presumptions187:17 212:10

presumptive109:18 110:2149:10 156:2

presumptives134:8,16,21136:14

pretty 5:2 47:1064:16 67:21 76:1185:17 102:9125:16 130:22136:15 161:22174:17

prevention 86:688:1,8,11 93:1,2157:20

previous 110:17previously 120:20


246

153:9 157:10Prieur 2:5 3:12

15:22 145:6,8,9153:6 154:20155:2,4,8,18160:2 169:12171:8,14,18 172:1217:18

primarily 68:8 83:8173:2,10

primary 40:1751:19 52:5 63:1770:4,13 72:11,1974:10 121:19201:16,22 202:2,5

principle 111:7,10print 156:6 169:22prior 29:5priorities 85:22

86:8,12,19 88:9110:12,17 157:20203:8

prioritize 194:1priority 29:17 90:16

109:10 110:9,11193:5 205:4

prison 5:15 14:458:22

prisoner 52:2 59:2260:10 132:2 165:2182:13,17

prisoners 1:5 5:2123:1 58:22 63:1696:17 98:10181:18 182:8,10206:2

private 71:12 157:4privilege 7:13 26:3privileged 6:18prize 15:15proactive 134:19probably 4:21

16:17 18:16 49:1563:6 68:9 100:5103:12 104:17105:10 106:3110:19 118:9,12122:6 123:16

125:17,22 128:1131:14 138:22194:17 197:12202:14 211:9217:4 218:3,4

problem 40:1550:17 72:5 73:1483:17 123:22140:19 165:6195:4,5 201:5,10216:16

problems 40:1273:10 105:5178:12 185:9215:6

procedures 33:1633:17 34:4,15

process 21:14 22:628:17,17 42:1670:10 76:3 80:7102:18,19 104:16105:12,14,18111:16 115:20123:14 125:6127:8 128:1,6,18129:7 140:20141:5,6 153:17,18157:13 173:2192:5 199:18200:14 203:13,13205:13 206:17,20

processed 157:16processing 130:15

167:21 201:20205:5

produce 124:6producing 205:11professional 78:6program 11:9,19

13:17 31:21 46:451:1 81:19 93:19105:7 123:5142:18 171:9

programs 27:929:14 33:13 40:640:8 68:17 145:15

progress 64:20112:8 126:2

project 26:6 104:4130:12

projecting 155:5projects 123:9promote 63:22properly 132:8proportion 134:17proposal 120:9proposed 117:7prostate 133:7prosthetics 65:4protocol 24:9

166:18protocols 24:8proud 146:1provide 31:2 80:3

84:14 86:9 98:22101:21 117:18120:14 145:17150:7 159:2,15191:4

provided 84:16,18177:9

provider 27:8 30:852:1 53:17,2269:10 70:4 72:2073:16 74:11 75:1379:13 109:1

providers 30:747:16 48:13 49:1951:14 53:2 54:356:2 73:4 92:13

providing 154:10PSA 69:21PSAs 72:4psychiatric 63:5psychiatry48:19psychological

74:19psychologist 46:22

47:2psychotropic 51:4PTSD 121:20

176:14public 101:18

116:21 165:1170:7 214:19

publication 160:7

published 41:1545:2,6 117:5,12

pull 190:21pulled 150:14purpose 213:22purposely 146:13pursued 58:16push 190:10 214:10

214:11,13pushback 140:21pushed 117:10pushing 26:14

157:2put 12:9 18:21,22

21:5 26:6,13 28:536:20 38:5 44:960:5 64:11 70:596:8 107:14114:20 130:8133:8 153:18160:7 169:18183:14 186:13193:3 203:11,21210:14 212:15

puts 54:16 157:3putting 76:13 77:1

165:1 175:5 188:5205:19

PVT 13:5

QQTC 198:14,15

199:1,4,8,10200:15,17,20,20200:22 205:16

qualified 24:9100:3 120:3 188:5

quality 71:13205:16

Quarles 1:19 5:165:17,17 16:246:13,13 78:1,394:5,16 95:10

quarterly 130:21question 30:7 32:5

45:18 50:10 51:1851:18 59:9 66:1667:7,9,10 69:12


247

70:12 71:19 72:1673:20 78:2 79:2179:22 81:10 92:19137:11 138:4142:15 144:15160:17 188:13

questioning 143:6questionnaires

114:10 202:10questions 14:6

17:13 26:9 37:1264:12 65:19 69:2283:20 94:3 100:14103:2 143:17159:15 172:3,16176:8 181:14200:9 213:3 220:1220:3,6

queue 108:2,3,7126:6 127:3 128:8128:17 130:16138:7 139:10140:6,17 189:9,13189:19 190:1191:21 192:10,13193:11

quick 30:7 67:1097:1 195:2

quicker 70:3190:20

quickly 18:6 25:1442:12 82:5 95:6103:3 127:5 128:3189:6 194:8 204:4204:8

quiet 144:20quite 62:17,18

92:10 103:8117:17 141:20149:5 160:1 201:8214:12

RRA 216:3radar 27:17 177:19

193:3 195:8radio 147:17 170:1radiology 30:17,22

33:20 36:20Rainmaker 135:19raise 50:11 167:15

186:16raised 7:1 167:4raises 132:4ran 177:22 200:10

205:10RAND 121:8randomly 182:12

213:22range 57:3ranking 135:16rapid 126:9rapidly 113:1rare 80:19rate 32:14 42:11

47:11 154:1,3,5,9181:22 205:4

rated 104:22132:22 187:14

rater 107:20 132:15raters 114:21

127:15 132:11rating 103:14,15

104:5 105:9107:11 112:3,6113:3,14 117:12117:17 118:16119:4 120:4124:21 130:14131:18 132:10,13132:18 137:13184:20

ratings 104:6105:14 108:4112:17 115:3,4117:18 127:7184:16

re-look 112:10reach 30:13 45:5

49:18 82:12143:22 147:17151:12 159:3162:13 168:10169:21 177:17183:5 184:2 186:4186:6

reached 60:6 63:22reacting 170:4

195:1reaction 161:15read 123:15 217:7ready 25:16,17 84:3

129:13,14 137:20142:22 154:3196:9

real 178:10 197:6214:15 215:5

real-time 92:1realistic 120:14realistically 112:21realize 155:13

175:20realized 178:21really 13:13 21:14

26:19 27:7,1429:9,15 30:1231:6,21 32:2234:2,12 35:4 36:537:21 43:15 45:447:11 48:5 50:1765:12 68:9,1171:11,11 74:5,2174:22 80:22 81:281:5 83:9 103:22104:3,20 107:8117:21 119:3127:6,9 128:16133:16 139:1,4162:7 167:16168:3 173:13,14173:21 174:1175:9 177:19178:17 180:22182:5 183:15196:14 207:15

reappointment22:1

reason 141:7160:11 188:4190:14 198:15218:15

reasonable 108:12reasoning 73:8reasons 53:19

167:22rebuild 76:20rebuilding 32:5recall 95:20receive 118:5

137:20 159:11received 32:9 88:15

91:1,6 111:3121:12,13 150:20152:5

receives 132:22receiving 90:15

122:2recognize 150:1

186:5recognized 118:11recognizes 205:4recommend 124:11recommendation

111:9,11,12 121:7166:21 169:13188:20

recommendations61:12 80:1 84:1894:1 96:7 110:22111:4 140:14172:18

recommended140:5 165:15

recommending134:18

record 27:19,2070:21 95:18 124:4125:9 126:15130:9 144:11211:3 220:16

recorder 10:8records 52:17 71:3

71:12 79:1,4106:16 126:13,16126:20 127:20129:19 130:1,6

Recovery 89:10recruit 31:10,15,22redesigned 15:7reduce 28:11 89:3

89:3 120:7 151:20reduced 127:18


248

reducing 71:6refer 96:9reference 218:10referral 29:3 32:10

68:18referrals 29:7 34:17reflect 172:16

198:16reflected 10:10reflecting 165:11reform 123:10refused 88:19regarding 71:15

73:20,21regardless 189:21regards 79:8 84:16

86:18region 29:1 132:6

159:21 160:4161:18 209:5

regional 3:13 12:2229:2 60:18 80:1284:22 108:5,9124:15,17 125:8125:10,18 126:22127:3,12,16 135:7138:10,18,20139:13,16 140:9140:22 151:13152:12 154:15159:6 160:16167:3 172:21188:21

register 22:9,1099:22 101:17165:18

registered 61:2163:11 164:2

registration 150:22regrets 13:12 26:1regular 108:17

180:17 211:19regularly 95:5rehab 34:10 37:2

40:7 65:3 120:1rehabbed 120:1

121:6rehabilitation

145:20 173:9reinforcing 26:20reinstituted 62:6rejected 140:9related 87:17 94:6

149:10relating 110:10relationship 87:19

95:9 161:6 202:15relationships

139:19 180:20relatively 107:18

125:16release 93:20releases 86:16relocate 76:2relocated 85:7rely 10:5relying 74:2remains 47:9remanded 105:16

105:19Remarks 3:3remember 10:8

123:12 124:20126:10 144:17174:4 175:2200:20 209:15

reminds 135:18remission 133:6Reno 154:14renovation 104:2Repasky 2:3 3:7

18:3,10 25:8,9,1125:15,18,19 37:1839:22 41:1 43:2,843:11 44:13,1945:1,16,18 46:3,746:12,21 49:9,1450:2,6,8,12,14,2151:6,16,21 52:1453:7,16 54:12,1856:8,11,15,1857:6,13,16 58:158:12,19 63:1364:16,21 65:18,2266:5,7,13,1567:11,19 68:13,16

69:1,4 85:19replaced 20:8replacement 65:16report 3:7 5:2 98:16

111:6,14,15116:12 147:13,20175:19 193:2,9194:3,21 198:20200:3

reporter 144:16reporting 88:5reports 98:20,22

99:1 101:22110:18,19 198:17

repositories 129:22represent 96:2representative

62:14 99:18 100:1157:11,12

represented 215:4representing 102:4request 75:4 196:2

196:6requested 154:13requests 80:1

185:14require 124:8reroute 108:8research 31:19,20

31:21 37:4 40:1,340:8

Reserve 105:22106:1,5,9,21107:3

reservist 97:7107:2

resigning 22:2resource 175:15

207:21 208:4213:7

resources 86:2124:10,11 165:17190:11

respect 183:21respond 116:16responded 95:2,6responds 111:1response 30:9

124:12 161:22responsibility

159:7 189:16responsible 145:16responsiveness

42:20rest 102:8 206:7restaurant 17:6,9resting 156:19result 134:11resumed 95:18

144:11retired 5:18 6:2,8

6:14 8:14,14,1413:7 97:2 100:11100:22 101:1

retiree 13:18 85:10retirees 85:12,15retirement 6:17

118:11 119:22return 152:16reunion 66:18 67:3

155:1 174:17reunions 155:13

174:17reverse 138:17review 14:6,7 24:8

70:20 112:9117:13 125:8,18126:4 131:19134:20 139:11184:19

reviewed 111:17112:20

reviewer 135:16reviewing 14:15

166:15reviews 136:13revised 104:1revising 119:20revolutionizing

128:13rework 112:7ribbon 35:2rid 56:13ridiculous 56:7

182:1right 4:7 7:2 17:20


249

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Ssacrificed 96:19

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schedules 113:14130:15 131:2

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115:5Scott 99:6 102:7

scratch 113:17133:16

Scrips 53:10script 41:10,14

53:22 54:3Scripts 53:13scrubbed 61:6scrubbing 104:3seamless 27:15seamlessly 198:6search 45:4second 5:20 86:1

87:22 90:19,20138:3 142:5184:15

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173:7Secondly 89:16secret 77:17Secretaries 109:14Secretary 3:7 11:18

13:13 26:13 35:784:6,8,11,1185:20 86:15 87:988:10 90:11,15,2090:22 91:2,2,1291:17,18 92:693:17 94:1,8,2195:3,9 98:12,14101:22 102:5,16110:8,20 116:13137:21 153:8157:2,19 160:17164:5 167:19170:4,12 172:9,19199:11,11 203:14205:3

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sector 97:15,16118:9

secure 30:6security 18:21 83:7

83:8,13 118:11121:22 179:14

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250

24:9 26:5 28:2028:21 29:20 30:1031:13 32:2,1937:17 39:9 57:270:2 71:2 74:478:6,11,12 83:1197:12 108:22110:10,10 117:2118:4 119:3126:14 127:2135:17 153:4154:15 162:19174:6 186:9,14,15191:21,22 192:1192:21 193:4194:4 197:7,17,18198:8,8 207:19208:7 210:3,16215:3 216:12,21217:18 218:22219:1,15,21

seeing 64:14180:19 181:5185:8 214:9216:17

seek 156:13seen 14:14 51:3

53:21 67:16 76:1110:12 128:2,5136:1 154:7174:19 178:10201:22 210:21

sees 90:11 194:22segment 118:15selections 31:12selfishness 219:1selfless 218:18Senate 98:15Senator 12:15,18send 21:13 48:8

57:10 82:7 109:5115:16 125:2127:3 143:16160:7 192:8201:13,17

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106:22,22 130:2,7202:7

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Sergeant 13:7seriously 167:7serve 122:1 167:17

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served 134:10,21166:11

serves 28:22 106:9service 1:3 3:12

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servicemembers156:22 157:17

services 27:1029:19 30:18,1931:12 32:5 34:1334:18 36:20 39:1940:5 55:1 57:1865:12 66:1 75:490:5 106:11 145:7146:8,10 150:7173:10

serving 179:4186:3

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setup 4:10 98:1399:15 123:20185:2 186:22

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167:20ship 58:4 174:22Shirley 1:19 5:17

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56:18 60:11101:19 106:16114:18 151:7152:10,13 153:19216:3,15

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sides 197:21 199:3210:22

sight 208:6sign 17:20 18:17

150:21sign-off 93:18significant 29:22signs 150:1similar 68:5 96:1,7simple 125:16

160:10 181:22simplified 125:6simply 88:19

101:21 119:13Simpson 75:16

180:12Sincero 15:19single 9:20,22

39:13 41:2 88:6


251

104:5 136:6,18158:11

sir 10:11 25:9 39:1640:10 50:14 53:765:18 74:12 83:283:5 136:22 144:4154:20 155:8171:3 187:12194:8 198:11,21217:10

sister 147:21148:12,17,21

sisters 149:22sit 16:6 55:11 59:11

116:7 157:14site 42:1 59:8 61:11

80:15 156:10sites 60:16sitting 14:11 93:15

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sounds 137:7160:10 212:7

Southeast 1:1229:1 81:21,22209:4

Southeastern164:11

Southern 17:5space 37:19 38:18

41:18 116:1 179:6179:7,10,12,15

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specialized 29:1067:22

specialty 29:7 47:5139:13

specific 45:8,852:18 150:15176:20 188:14

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specified 117:2speed 35:5spend 5:4 74:9 85:4

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Springer 11:14sprinklings 85:15squad 149:3square 16:11squares 15:13,15

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stands 89:9 200:21standup 87:1 90:11start 5:9 21:14 22:6

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252

166:15 170:6177:14 187:1206:4

started 19:19 26:1133:6 47:4 52:1358:1 73:6 84:22104:15 105:10112:11 146:14147:1 149:6 155:4156:13 173:19,21178:20 209:13

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107:2 152:8153:14

Statute 97:20statutory 87:11

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stepping 97:15steps 46:9 112:5Stevenson 12:6,6Stolen 62:6stomach 126:5stomper 96:12stone 97:15stop 39:15 103:1

184:14stopped 85:2stories 77:7storm 25:5 58:21

81:2Storm/Desert 166:1stormtrooper-loo...

59:17story 77:11 146:12

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stuff 54:15 67:1773:21 107:14,15183:14 195:2217:6

subject 96:10submitted 98:20

111:15 130:2subscribers 79:15subsequently

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suicides 89:4suit 114:4summer 137:22

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surg 66:8surge 34:8surgeon 97:4,9,10surgery 34:22 97:5surgical 97:5survival 133:6survive 63:8surviving 140:7

211:15Survivor 87:15survivors 87:18,21

171:5,8 219:12suspect 100:4

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253

163:8 164:12166:15 167:21185:13 186:21189:5 190:9 194:6195:2 203:20216:8,13

systemic 195:5systems 60:19 86:1

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taken 133:2 206:6212:6

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talent 31:10talk 4:19 30:15 39:1

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talking 50:1,16 51:858:14 61:11 71:20129:13 139:3159:19,19 170:15171:21 173:6174:12 176:9181:13 182:21189:16 193:16202:22 214:4

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120:18 121:12122:2 142:7

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63:15 69:21 75:1476:13 77:2 93:19148:18 149:17150:10 158:1

teams 79:9 80:13technical 14:19technology 104:7tedious 119:17teleconferences

94:22 95:1telehealth 30:6telephone 2:9

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54:8 63:5 70:2278:12 97:1 138:21139:4 143:14153:16 193:10199:21 213:18215:8 219:13

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test 127:11Texas 68:12 99:7text 192:9 193:17Thailand 135:4,9thank 4:8 8:3,9

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things 4:9 20:122:2 24:2 27:1528:2,12 38:20,2138:22 40:21 41:652:3 58:2,2,3,960:16 63:19 69:1170:12 72:8 75:2177:8 79:17 83:686:20 93:9 100:13100:15 102:15,18102:19 103:5,13106:19 107:8,15110:4,4,5,10112:13,22 113:14114:12 116:22126:3 129:13,15


254

129:20 130:11,18130:20 131:13,16132:14,18,19133:6,7,15 136:3136:18 140:17141:16 143:7,12143:13 152:3157:2,22 163:1164:7,15,21 173:1173:13 178:15181:14 182:5186:8 189:14190:3 192:4197:17 204:2205:2 209:9 214:4218:7

think 6:6,19 9:1223:12 32:6 47:849:15 50:17 52:2054:10 57:10 59:2062:11 63:8 82:17122:3 125:21131:5 133:18134:3 135:18136:19 139:15141:12,13 143:12162:1,11,14,15,19163:21 164:21166:22 168:8169:8 170:3,4,15170:16,18,19171:2 172:20175:3 177:5,6,15177:19 178:6181:4,10,10,11,17181:19 182:7,21183:5,20 184:2185:18,20 188:13189:12 193:22195:22 196:2197:3 198:6200:10,11 202:6207:15 208:4213:9 218:19220:9

thinking 22:20 98:8199:22 212:19

thinks 102:5

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thorny 104:20thorough 166:18thought 23:18 85:1

102:17 112:20172:10 175:6195:12

thoughts 96:21104:8

threatening 148:4three 8:6 11:1 14:3

23:11 29:15 38:2241:22 59:14 61:375:19 87:6 99:1106:10 109:21125:7,15 130:17153:11 154:11164:10 168:4169:19 173:14199:5,12 203:1,14209:17 211:13214:3

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16:3 18:16 21:1123:17 24:22 28:132:7 55:7 62:1164:6 70:14,1671:16 74:21 79:1880:18 83:4 84:391:2 92:5 93:1294:12 95:13 97:6101:17,18 102:10105:19 107:18108:11 109:11110:14 112:14,15112:19 113:16116:8,10 117:8118:16 124:6130:7,16 131:17140:3 141:14,14144:2 145:11147:4,7 151:17

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timeframe 92:9,14116:14,22 117:1

timeline 33:19116:4,5

Timeliness 86:3205:16

timely 28:17 29:18103:21

times 42:2,10 60:1375:20 107:12116:4 135:8136:10 140:6163:6

today 7:19 16:119:18 25:12 35:1156:19 96:3 102:2102:11 144:2149:17 187:5191:3,20 195:2196:6,17 197:16207:5,19

today's 84:9told 8:12,20 59:22

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100:22 132:16Tom's 132:17tomorrow 5:3,5

7:10 15:21 48:17ton 161:7 177:21tools 210:12,13top 65:4 72:16

77:17 85:22 86:18

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73:21 86:6 184:16total 119:20 150:16

150:18 151:20,22196:14

totally 56:7 119:7touch 92:15 137:18

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tours 107:3tower 57:1 64:22towering 126:14town 54:19 64:8

86:17 164:13track 59:6 138:4,14

188:17 189:4191:20 204:2,3

tracking 27:22 73:4139:7

tradeoff 48:5traditional 17:5trained 75:13training 11:7 28:10

31:11 35:14 47:174:14,16 75:17158:10 210:3212:20

transcribed 114:20transcribing

137:22transfer 158:20

188:20transferring 76:5transform 91:8

124:7transforming 91:6

91:18 92:3transition 27:15

63:14 127:8transitional 37:2

66:8transplants 29:13

34:16transport 38:17


255

48:2transportation 39:2

159:13traumatic 176:15travel 151:17,21

152:18traveling 152:12treat 17:4 32:4

190:1treated 32:8 133:12

135:10 182:11,15treating 32:11

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treatments 112:15tree 41:8tremendous 68:13

127:19 213:7trial 161:17tried 43:11 44:7

48:11 53:20164:17

trifecta 31:16trouble 118:10trousers 59:16true 26:3 118:19

180:9 201:19trust 174:8 178:3

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129:112015 90:21 102:6

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2016 99:5 127:15127:21 128:4

2017 1:9 29:15117:9 127:22152:19

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NEAL R. GROSSCOURT REPORTERS AND TRANSCRIBERS

1323 RHODE ISLAND AVE., N.W. (202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com

C E R T I F I C A T E

This is to certify that the foregoing transcript

In the matter of:

Before:

Date:

Place:

was duly recorded and accurately transcribed under

my direction; further, that said transcript is a

true and accurate record of the proceedings.

----------------------- Court Reporter

260

Former Prisoners of War AdvisoryCommittee Spring Meeting

Department of Veterans Affairs

05-17-17

New Orleans, LA

Robert G. CertainChairmen


1


+ + + + +

VETERANS BENEFITS, COMPENSATION, AND PENSION SERVICE

+ + + + +

FORMER PRISONERS OF WAR ADVISORY COMMITTEE

SPRING MEETING

+ + + + +

THURSDAY, MAY 18, 2017

+ + + + +

The Advisory Committee met in theSoutheast Louisiana VA Medical Center, Room1Q115, 2400 Canal Street, New Orleans, Louisiana,at 9:00 a.m., Robert Certain, Chairman,presiding.

PRESENT:

ROBERT CERTAIN, Chair LANE CARSON HARRY CORRE ROBERT HAIN SHOSHONA JOHNSON HAL KUSHNER JEFFREY MOORE SHIRLEY QUARLES


2

ALSO PRESENT:

LESLIE WILLIAMS, Designated Federal Officer CAROL BORDEN GERMAINE CARTER DR. LUMIE KAWASAKI DR. MICHAEL LANDRY TANYA PIERRE CARLETTA PORTER LA'TOYA PRIEUR DR. DEAN ROBINSON JOESEPH SINCENO DR. JAMES SMITH DR. ERNEST SNEED


3

C O N T E N T S

PageWelcome. . . . . . . . . . . . . . . . . . . . . . 4

Introductions. . . . . . . . . . . . . . . . . . . 8

Presentation by Dr. Kawasaki . . . . . . . . . . .15

Discussion . . . . . . . . . . . . . . . . .24

Presentation by Dr. Robinson . . . . . . . . . . .30

Discussion . . . . . . . . . . . . . . . . .40

Presentation by Dr. Landry . . . . . . . . . . . .52

Discussion . . . . . . . . . . . . . . . . .62

Presentation by Dr. Smith. . . . . . . . . . . . .70

Discussion . . . . . . . . . . . . . . . . .75

Presentation by Ms. Prieur . . . . . . . . . . . .77

Discussion . . . . . . . . . . . . . . . . .79

Presentation by Dr. Sinceno. . . . . . . . . . . .86

Discussion . . . . . . . . . . . . . . . . 101

Presentation by Ms. Borden . . . . . . . . . . . 115


4


2 (8:58 a.m.)

3 MR. CERTAIN: So is everybody in the

4 room, everybody that counts? The committee is

5 assembled, so let's begin by standing and

6 pledging allegiance to our flag.

7 (Pledge of Allegiance)

8 MR. CERTAIN: Today is Thursday, May

9 the 18th, imagine that. Today's agenda will be -

10 - we'll finish up at noon and be moved over to

11 the World War II museum. If you haven't been

12 there in a few years, it's much bigger, and there

13 are brochures that were in your packets yesterday

14 and there are some here on the table today if you

15 didn't take the opportunity to look at them.

16 We'll have lunch over there and then

17 try to finish up when we all get tired, and

18 cranky, and what have you, and seen all we can

19 see, so we can get back to the hotel and relax a

20 bit before we go to dinner at Mulatte's, and New

21 Orleans dress code applies tonight. That means

22 show up, and as you know, it's a fairly casual


5

1 town, so, and then what time should -- 7:00 is

2 the reservation?

3 MR. CARSON: 7:00 reservation.

4 MR. CERTAIN: The thing we need to

5 know is they have, like with any large group,

6 restaurants are reluctant to split the bill up,

7 so Lane has called in all kinds of things and

8 they're willing to do twos, right?

9 MR. CARSON: Two to a ticket.

10 MR. CERTAIN: Two to a ticket, but

11 that only applies to Corey's, I guess, right, and

12 Dr. Moore, and so, but all the rest of us should

13 probably bring cash so that we can pay the bill.

14 MR. CARSON: And you got the menu so

15 you got an idea of what the --

16 MR. CERTAIN: There are menus going

17 around and get an idea. It's Cajun food.

18 There's a jazz band over there or something.

19 MR. CARSON: It would be a Cajun --

20 MR. CERTAIN: Cajun band?

21 MR. CARSON: Cajun music, yeah. It's

22 a class Cajun restaurant, so they'll have Cajun


6

1 music, zydeco, that's it.

2 MR. CERTAIN: All right, Albert to

3 over by the flag is the POW team from over here,

4 so if you folks could introduce yourselves so

5 we'll know who you are, and we thank you for your

6 willingness to work with us and the former POWs

7 in the area, please.

8 MS. CARTER: Good morning, I'm

9 Germaine Carter, RN. Presently, I work with the

10 homeless as well as mental health.

11 MS. PORTER: Good morning, I'm

12 Carletta Porter. I work with PTSD residents.

13 MS. PIERRE: Good morning and welcome.

14 Pardon my tardiness, but I'm Tanya Pierre, and

15 I'm the coordinator of caregiver support services

16 here, and previously I was with homeless

17 veterans.

18 MR. CERTAIN: Thank you. Thank you

19 for being here today, and the others in the room

20 I think we all met yesterday. We are -- as we --

21 so a lot of administrative stuff here today. You

22 know, the 9:15 schedule is being changed


7

1 somewhat, so we'll hear from Leslie at another

2 time, and then administrative stuff.

3 So this applies to the committee

4 members particularly, and so we'll focus on the

5 committee members first and then other people in

6 the room if we have time or have something

7 important to add to it, then we'll recognize you.

8 Please wait for that.

9 Also I'll remind you that this is

10 going into the public record, so the microphones

11 are live, and when you speak, please remember to

12 state your name so our recorder can make accurate

13 notes, and then side conversations interfere with

14 all of that, plus they --

15 So we ask that if you have something

16 private to say to somebody near you, that you

17 pass notes or text messages and make sure your

18 phones are on silent, but otherwise, let's keep

19 side conversations down to an absolute minimum.

20 So how's that? Anything else for the

21 good of the order before we move forward?

22 Leslie, what comes next?


8

1 MS. WILLIAMS: Also we're actually

2 going to have two members from the FPOW team, Dr.

3 Kawasaki who is the Chief of Geriatrics --

4 PARTICIPANT: They are not officially

5 a part of the FPOW team, however as we advance

6 and identify all of our POWs, they will be more

7 active and help treat the POWs that we have here,

8 so they will be here at exactly 9:15.

9 MS. WILLIAMS: Okay.

10 MR. CERTAIN: At exactly 9:15, wow.

11 We like accuracy.

12 PARTICIPANT: That's pretty good for

13 geriatrics.

14 MR. CERTAIN: Yes, well, our elderly

15 people though, you know. So what do we do in the

16 meantime? Do you have something for us? Do

17 what?

18 MS. WILLIAMS: Yes, so they want the

19 committee to introduce themselves.

20 MR. CERTAIN: Oh, yes, okay, people,

21 we didn't introduce ourselves. Yes, I'm Robert

22 Certain. I'm the Chairman of this committee.


9

1 This is the VA Federal Advisory

2 Committee on Former Prisoners of War. It's a

3 statutory committee established back when Sonny

4 Montgomery was in the Congress if you even

5 remember that name from Mississippi, and so the

6 committee's been around for a very long time.

7 MS. WILLIAMS: Go Mississippi.

8 MR. CERTAIN: I have to talk to you,

9 huh? I was in Yazoo City for a long time. So,

10 and the most -- so the committee's made up of

11 people who some of us are former prisoners of

12 war. I was Vietnam.

13 Others have worked with us at the

14 Mitchell Center in Pensacola and others. I don't

15 know how they got on here. So that's who I am.

16 I currently live in San Antonio, Texas, and we'll

17 start with Dr. Quarles.

18 MS. QUARLES: Good morning, I'm

19 Shirley Quarles. I've been on this committee for

20 going on my second year. I'm enjoying it

21 immensely. I was former Chair of the Advisory

22 Committee for Wounded Veterans for about ten


10

1 years. I'm a retired colonel of 28 years, and so

2 thank you for hosting us.

3 COL. KUSHNER: I'm Hal Kushner. I'm

4 an eye surgeon from Daytona Beach, Florida, where

5 I've been practicing about 41 years. I've been a

6 doctor for 52 years, and I was a prisoner of war

7 in Vietnam for five-and-a-half years.

8 And I've been on this committee for

9 five years, I think, and I've enjoyed the

10 association and all of the different places we've

11 been and the hospitality of fine people like you

12 that have had us, so good morning and thank you.

13 DR. HAIN: I'm Bob Hain. I'm a

14 retired Navy physician and former Executive

15 Director of the Mitchell Center for Prisoner of

16 War Studies. This is my second meeting with this

17 go around. I've previously been on the

18 committee, and thank you for having us here.

19 MR. MOORE: I'm Jeff Moore. I'm a

20 retired Navy clinical neuropsychologist and

21 current Executive Director of the Robert E.

22 Mitchell Center in Pensacola, Florida. We've


11

1 been following repatriated prisoners of war from

2 Vietnam, Desert Storm, Iraqi Freedom, going back

3 to the spring of '73, and it's nice to meet you.

4 MR. CARSON: Good morning, I'm Lane

5 Carson. I was born in New Orleans 70 years ago

6 this summer uptown around Napoleon and Magazine,

7 and an ROTC grad, an Army combat platoon leader

8 in Vietnam, got wounded, came back home through

9 vocational rehabilitation that sent me to Tulane

10 Law School, and I served in the legislature for a

11 term-and-a-half, the first Vietnam veteran

12 elected, and then was an assistant district

13 attorney here in St. Tammany across the lake for

14 many years, and then finally Secretary of

15 Veterans Affairs under Government Jindal a few

16 years ago, and I've been working with you all on

17 this hospital now since 2005, so I'm so glad

18 you're here, and be sure to enjoy that tour.

19 It's a beautiful facility.

20 MS. CORRE: My name is Harry Corre.

21 I'm from Los Angeles, California. I'm a former

22 prisoner of war for three-and-a-half years in


12

1 Japan and the Philippines, and this is my second

2 meeting and I'm enjoying it very much. It's very

3 interesting and very educational, and I'm glad to

4 meet all of you. Thank you.

5 MS. JOHNSON: Shoshona Johnson, Iraq

6 POW. I don't have as much to add on. I'm

7 retired from the Army and I have, like, one more

8 meeting. They keep on telling me I have one more

9 meeting while I'm still on the committee, but

10 I've enjoyed my time being on the committee. You

11 all have a hell of a hospital here and you all

12 have been very hospitable, and I appreciate it.

13 Thank you very much.

14 MS. WILLIAMS: Good morning, I'm

15 Leslie Williams and I'm the Designated Federal

16 Officer for this committee as well as the Program

17 Manager at DVA's central office, and thank you

18 for hosting us. Oh, and we have Mr. Eric

19 Robinson who is the alternate DFO for the

20 committee.

21 MR. ROBINSON: Good morning.

22 MR. CERTAIN: All right, we've got


13

1 five minutes until the precise arrival.

2 DR. HAIN: Did you want to say

3 something about tomorrow's meeting?

4 MR. CERTAIN: Okay, tomorrow we're

5 going to try to finish up early. What's the -- I

6 have a 12:00 shuttle from the hotel so we'll need

7 to arrange it. I'd like to finish by 11:30.

8 Tomorrow we will be discussing the

9 recommendations, the progress of our 2017, the

10 current status of their 2016, and working on any

11 recommendations that come out of our meetings

12 here this week to the Secretary.

13 This committee reports to

14 Congressional committees dealing with Veterans'

15 Affairs through the Secretary of the VA, so every

16 time we meet, if we have recommendations for

17 changes, then we send those forward.

18 And then we will get updated on our

19 next meeting while we're here. It's going to be

20 an issue for some of us. I know that already,

21 and then we will try to depart here by 11:30 so

22 we can get back to the hotel around just before


14

1 noon and be able to start checking out and going

2 to the airport, okay?

3 So our folks have arrived. Wow, you

4 were right. This committee normally, by the way,

5 just while we're waiting for them to get into the

6 room, normally meets twice a year because of a

7 long rebuilding process that took place a couple

8 of years ago, then the ACMO office committed to

9 having three meetings this year to be a one-off

10 kind of a deal because we got behind in our work,

11 and we're catching up.

12 What we normally do is go to the

13 central office once a year and out into the field

14 once a year. This year with various budget

15 concerns, we're catching up on the field work.

16 Of course with the change in the

17 Secretary occurring at the same time, getting on

18 his schedule this year was a bit of a problem, so

19 we will be making one more field trip this year,

20 and then with the new fiscal year, we'll be out

21 one place and then back to the central office the

22 other time. All right, they're here.


15

1 DR. KAWASAKI: Do you want me to just

2 start?

3 MR. CERTAIN: Dr. Kawasaki, please do.

4 DR. KAWASAKI: Do you want me to just

5 talk here? Is that better? Do you want me to

6 stand up?

7 MR. CERTAIN: You know, I normally say

8 whatever makes you comfortable, but being

9 sideways to elderly people might create hearing

10 problems, so if you can be heard and understood,

11 then be as comfortable as you care to be.

12 DR. KAWASAKI: Okay, so I'll stand up.

13 So I'm here to tell you a little bit about what

14 we're doing in geriatrics in southeast Louisiana.

15 It's a pretty exciting time, I think, with not

16 only the new hospital, but just this great

17 opportunity to direct care to people as they're

18 getting older in a way that I believe is needed.

19 So for me, I am a geriatrician, Board

20 certified. I am very passionate about care for

21 people as they get older in New Orleans. We're

22 really trying to help those not only as they're


16

1 getting older to sort of help them to maintain

2 certain things in place, maintain their function

3 to the best we can, optimize peoples' health to

4 the best that we can, but also to look at those

5 who are probably the ones who, as they're getting

6 older, and certainly everyone ages differently,

7 but for those who are a little bit more frail, to

8 sort of help them.

9 So what we've done in geriatrics is

10 that there are three different sections of

11 geriatrics. The VA, I think, I have to say above

12 all other healthcare systems, is probably the

13 strongest when it comes to really helping people

14 as they start to get older, and it's not just

15 helping the person as they're getting older.

16 It's also looking at family members, their care

17 givers, how to support them.

18 So what we have right now currently in

19 southeast Louisiana, we have a home and community

20 section. This is a section that provides home

21 care services to veterans. The VA has been quite

22 innovative and proactive in terms of home care.


17

1 So outside the VA, if somebody needs

2 home care, it's usually they've come out of a

3 hospital. They get home care services because

4 they've been designated by Medicare to be

5 homebound, meaning it's very hard for them to get

6 out of the home for various reasons, and so they

7 are designated as homebound, but the VA actually

8 just broadened that.

9 And so back in the early 1970s, they

10 created a program known as home-based primary

11 care, and this is a program that basically says

12 if you're having any problems getting to the

13 clinics so the clinics can't be effective, then

14 you're eligible to be in the home care program,

15 home-based primary care, and you can stay in

16 home-based primary care as long as you want, and

17 on top of that, it's a very comprehensive program

18 unlike what you may get through the post-acute

19 care through how Medicare defines it.

20 And so for us after Hurricane Katrina,

21 home care is one of those programs that was ideal

22 in terms of serving veterans. We were the one


18

1 program that didn't need walls. All we needed

2 was a car, supplies, and a way to get to the

3 veteran's home to check on them.

4 So since Hurricane Katrina, we've done

5 a lot of growth and development. We've actually

6 created a program that's a bit unique to the rest

7 of a lot of the VAs in that not only do we have

8 home-based primary care and it has grown from

9 about, you know, maybe about 90 people before

10 Hurricane Katrina, to now we have about 500 that

11 we're serving, and they're all across southeast

12 Louisiana.

13 And we have physicians doing house

14 calls, nurse practitioners. It's a true team

15 model, nurses, psychologist, physical therapists,

16 occupational therapists, speech therapists,

17 dieticians, social workers, everyone making house

18 calls, and we all come together every week to

19 talk about veterans and how to help them.

20 In addition to that, after Hurricane

21 Katrina, we've created a program known as

22 Hospital at Home which is sort of a model that


19

1 basically puts hospital level care in the home

2 setting.

3 You know, we really are in a state in

4 healthcare where we can do that with the right

5 technology, the right resources, so you can do

6 that with telemedicine also in place, the right

7 levels of equipment that you can now bring into

8 the home. So when you combine Hospital at Home -

9 -

10 So what we do with Hospital at Home is

11 that we help people hopefully get out of the

12 hospital sooner than they need to be in the

13 hospital. I think for people as they get older,

14 hospitals can be sort of risky places, and it's

15 usually as people get older, you know, the ones

16 who are utilizing the hospital the most.

17 And I'm saying this very carefully

18 because Dr. Landry is right here who is the Chief

19 of Medicine who oversees all of the hospital --

20 but he's actually also been very supportive of

21 Hospital at Home to help people get out as

22 quickly as possible.


20

1 We can also admit people into Hospital

2 at Home who never set foot into the hospital. We

3 hear about them through the clinics, or through

4 the urgent care, or the emergency room, or other

5 VAs that say, "We have a veteran who we think

6 needs to come." They may have, like, signs of

7 heart failure or COPD.

8 And then we actually also do something

9 we call long-term acute care. These are people

10 who may have, you know, complex needs, or need

11 long-term IV antibiotics for, say, six weeks or

12 so, or they have complex wound issues that can

13 take weeks to manage, and we'll see them.

14 And what we're doing with Hospital at

15 Home is the nurses are going every day. The

16 physicians are actively involved just to sort of

17 help people as they're getting through it and

18 have done quite well with this program.

19 So when you combine Hospital at Home

20 and home-based primary care, you now have a very

21 broad continuum of services. We have acute care

22 for somebody who needs help immediately, long-


21

1 term acute care, to the primary care management

2 of home-based primary care, and it's the same

3 people all involved, so as people are

4 transitioning, we're sort of working with them.

5 There's another section of geriatrics

6 that we call hospice and palliative care. It's

7 for people who not only are towards the end of

8 their life, but also just really are a lot of

9 complex needs where the focus is on just your

10 quality of care.

11 "How we do we help you?" and to listen

12 very carefully to what your needs are, what your

13 preferences of care are in terms of, "I don't

14 want to be in the hospital for this. I want to

15 be with my family." Various issues we'll work

16 through with all veterans.

17 Another section that is coming out

18 with the new hospital we call extended care. It

19 involves the activation of our community living

20 center which is what the VA used to call the

21 nursing homes of the VA, but now it's gone

22 through a culture transformation now so it's less


22

1 institutional. It's very much so patient-driven.

2 So the community living center, it

3 changes everything. The design of the community

4 living center looks more like a home. We talk in

5 words of households and neighborhoods, the

6 community of the community living center.

7 The work practices are different so

8 that, you know, other than just working on pure

9 shifts, say a nurse works from 8:00 to 5:00, and

10 at 5:00, that nurse leaves, it's more, you know,

11 if the veteran needs us. It's the continuity of

12 the care, the preference of the care.

13 So say if 5:00 comes around and the

14 nurse is actively involved with a veteran on

15 something, or if the veteran says, "I really wish

16 you could stay with me for a little longer,"

17 they'll stay, and we will support that type of

18 practice.

19 And with that, we are also activating,

20 which we have now, various outpatient clinics.

21 You have the palliative care clinic, a geriatric

22 clinic, and then if patients do go into the


23

1 hospital, we have different consult services,

2 geriatrics and palliative care, geriatrics with

3 the idea that if a veteran does go into the

4 hospital, we're going to do whatever we can to

5 minimize their risks while they're in the

6 hospital.

7 So I very often say if somebody is

8 frail and they have some dementia and they go

9 into a hospital, they're at high risk for things

10 such as falls, and with the inpatient geriatric

11 consult, we're going to look very closely at home

12 to minimize that risk.

13 And with all of that, with all of the

14 providers in all of the different sections of

15 geriatrics, they're all working closely together.

16 So we anticipate there is going to be a group of

17 veterans that we're going to see moving from

18 place to place, the hospital, the CLC, the home

19 care, the clinic, and then we're going to be

20 working with them as they sort of transition, and

21 to sort of help in those transitions that can

22 sometimes be hard.


24

1 But really ultimately our mission in

2 geriatrics, we're trying very hard to make it

3 that veterans have as many choices as they can

4 and they get the preferences of care that they

5 want in terms of where they are and the kinds of

6 services and who they're working with to help

7 them as they go through this.

8 MR. CERTAIN: So this is unique to New

9 Orleans, this whole situation, or is that broad

10 into the VA?

11 DR. KAWASAKI: It is unique. I think

12 what's unique is the way the home care program is

13 set up as it's very broad, so it allows for

14 people to stay home more often than maybe they

15 would elsewhere.

16 The other thing too with it, unlike a

17 lot of the other VAs, home care is developed, and

18 nicely so, but very often the CLC becomes a

19 dominant factor, but for us, home care, because

20 of Hurricane Katrina, has become a very strong

21 program and set of services, and so now we have

22 set up so that we can work closely with all of


25

1 the other services to help maintain that idea. We

2 want to give veterans as many choices as they

3 want to be able to stay at home if that's what

4 they want.

5 COL. KUSHNER: I'm Hal Kushner for the

6 court reporter. That was a very good

7 presentation. Thank you very much, and you were

8 passionate and it comes through very well. I

9 have a question. Having tended two elderly

10 parents for years until they passed away, but

11 does your program apply, like home maintenance,

12 helping them clean up, clean the house, or going

13 to the market for them, going to the store,

14 things like that?

15 DR. KAWASAKI: We do. We do have a

16 couple of programs. We work with community

17 agencies. There are different aide programs, so

18 homemaker, home health aide, but we also have a

19 personal care attendant which is sort of an

20 opportunity for respite to care givers, but the

21 two of them together combine different things

22 such as helping with shopping, helping with


26

1 cleaning, helping with just some basic daily

2 activities.

3 Honestly, I wish we could do more.

4 We're limited on how many hours we can provide.

5 The personal care attendant, it's the equivalent

6 of 30 days a year, so it's about 240 hours a

7 year, and you can distribute however you want,

8 and then the homemaker home health aide is up to

9 10 hours a week, but it's pretty regular on that,

10 but I wish we could do more, but yes, we do have

11 those.

12 MR. CERTAIN: Dr. Quarles?

13 MS. QUARLES: Yes, you mentioned -

14 Shirley Quarles. You mentioned that you serve

15 about 500 FPOWs?

16 DR. KAWASAKI: Roughly, yes.

17 MS. QUARLES: Okay, what percentage of

18 those receive home healthcare?

19 DR. KAWASAKI: Oh, so the 500 veterans

20 are the home-based primary care veterans.

21 MR. CERTAIN: Those are not all POWs.

22 MS. QUARLES: Okay.


27

1 DR. KAWASAKI: They're not all POWs.

2 MS. QUARLES: And what percentage are

3 FPOWs? Do you know?

4 DR. KAWASAKI: You know, I don't

5 really know. I know that in the past, we've had

6 a few, but I'd say less than five at a time.


8 MR. CERTAIN: Yeah, we're a small

9 portion of the general population.

10 DR. KAWASAKI: But we're very happy to

11 have them.

12 MR. CERTAIN: Lane?

13 MR. CARSON: Dr. Kawasaki, Lane

14 Carson. I know the Director's moving in and

15 getting things online, and setting up our FPOW

16 committee and support personnel, and I believe

17 we're going to be looking at doing some type of

18 FPOW clinic within perhaps your department.

19 I'm not sure how, but we do in San

20 Antonio several months ago, and they have their

21 FPOW clinic and their geriatric program, so I'm

22 hoping that we'll take advantage and look at some


28

1 of the San Antonio models and we'll formally

2 organize the public law and the Director. That's

3 why we're here. Our focus is POWs.

4 DR. KAWASAKI: Yes, yes.

5 MR. CARSON: FPOWs, and that needs to

6 be an area we all need to work closer in,

7 coordinate better, and ultimately establish a

8 "clinic." It may not have to be as formal as San

9 Antonio, but you can see they've got a very

10 handout that explains how they set it up.

11 They've got a nice brochure that goes

12 into great detail about their special clinic and

13 how they address FPOW issues, challenges, special

14 medical problems, how the benefits department

15 comes in regularly to look at the evaluation of

16 that POW to see if they can get into a higher

17 disability. So I know we're all going to be

18 towards this, right? I mean, that's the area --

19 DR. KAWASAKI: Oh, absolutely,

20 somehow, another way, we're happy to be involved

21 as much as --

22 MR. CERTAIN: Dr. Kawasaki, this is


29

1 Robert Certain, the Chairman. And the reason we

2 asked to speak to your geriatric department here

3 is that except for the OIF/OEF former prisoners

4 of war, we're all over 65, so as this population

5 ages and nears the end of our lives, then our

6 focus of this committee was still a big part of

7 outreach to try to get every former prisoner of

8 war into the VA system appropriately rated, and

9 scheduled, and cared for.

10 We also recognize that the geriatric

11 department will become much more important in our

12 lives and in the lives of our fellows from the

13 various conflicts, particularly World War II, and

14 Korea, and more and more with Vietnam. So it's

15 good to crossfeed and to make those connections

16 before they're absolutely necessary, and so we

17 really appreciate what you're doing here in New

18 Orleans.

19 I know it was necessitated by Katrina

20 and finding a way to continue care when the

21 hospital is destroyed, and to think through some

22 things that will become a model for other


30

1 communities in the civilian world as well.

2 DR. KAWASAKI: I just want to say

3 Katrina, you know, by itself, as destructive as

4 it was, brought so many silver linings, and one

5 of them truly, like I said, home care remodeled

6 because of it, and it became, "So where do the

7 veterans need us the most?"

8 And now with this opportunity for

9 geriatrics to be sort of developing with the new

10 hospital itself also, it's just this continual

11 focus of, "How best can we help?" So something

12 like that to be able to service the needs

13 specifically of FPOWs, we can do that too. It's

14 a perfect time to be able to do that.

15 MR. CERTAIN: Excellent, we thank you.

16 Other questions or comments for Dr. Kawasaki?

17 DR. KAWASAKI: Thank you for this

18 opportunity.

19 MR. CERTAIN: Thank you. Who else?

20 PARTICIPANT: Dave Robinson, Chief of

21 Mental Health Service.

22 DR. ROBINSON: Good morning,


31

1 everybody. I'm Dean Robinson. I'm a

2 psychiatrist by trade, but just to give you a

3 little bit more background, I'm also recently

4 retired from the U.S. Air Force Reserve, and in

5 that capacity, I was also a flight surgeon for

6 many, many years, and so I got a chance to deploy

7 and get an experience with both active duty and

8 more frequently with reservists, and particularly

9 with reservists who were coming back into the

10 community and then having to figure out how to

11 use the healthcare system appropriately. There

12 are many things that they do not admit to when

13 they come through post-deployment briefing. I've

14 been able to see it on both ends and it has been

15 a real challenge.

16 The real opportunities here are

17 absolutely wonderful. Here in New Orleans, we

18 have a chance to start afresh in many respects

19 and design a healthcare system which is, I hope,

20 going to be better suited to the long-term needs

21 of people both in the recent conflicts and also

22 from all of the previous conflicts.


32

1 So my job here has been to try to take

2 a look at what we've got going and adjust it to

3 the realities that we face, and the lessons that

4 we're learning from having a lot of people teach

5 us what they really need. And accordingly, what

6 we're trying to design is a healthcare system

7 that's both flexible and also very consistent,

8 which is a tall order to get both going

9 simultaneously.

10 We, in New Orleans, are about to do

11 something that we haven't done in about a dozen

12 years, and that is open inpatient psychiatric

13 treatment. As a matter of fact, the fifth floor

14 of the building adjacent to us is going to be

15 devoted to mental health and we're going to have

16 20 beds which will be a tremendous improvement

17 over our current situation.

18 Since Katrina, we've been basically

19 sending our inpatients to other VA facilities,

20 the nearest in Biloxi, but there's also

21 Alexandria, Shreveport, Jackson, and although

22 these are fine facilities and they have a lot of


33

1 treatment that our veterans might need, it

2 involves taking people out of their community,

3 taking them out of their support system, and

4 sending them off somewhere and then trying to get

5 them back in with enough knowledge and continuity

6 to be able to follow through with whatever was

7 done wherever they went, and so that's been a

8 challenge, and continuity, being able to get

9 everybody on the same page at the same time, is

10 probably going to be the central framework and

11 key phrase in the VA for years to come.

12 We have a healthcare system which is

13 marvelous in its complexity, and incredibly

14 variable in the offerings that it can give, but

15 unless the right hand is speaking to the left

16 hand coherently, then a lot of times follow

17 through for that, especially from the standpoint

18 of veterans who may be coming into this

19 experience with a certain amount of trepidation

20 and confusion about what is available and what's

21 not available.

22 We have to have our act together and


34

1 be able to follow through in a manner that helps

2 explain to them, or else those opportunities can

3 go unmet, and I think we've all had experience

4 with people who clearly had a need, especially an

5 urgent need, and didn't know where to turn, and

6 when they finally did make contact with somebody,

7 were not really pointed in the right direction.

8 So what we're trying to do here in

9 mental health is to have an overall perspective

10 on all of the things that we have now that are

11 available, both for former POWs and also for all

12 of the other folks who are coming back from

13 recent conflicts, to have centralized care

14 management, and in mental health we call this a

15 mental health treatment coordinator, and to also

16 have enough networking with our other facilities

17 and our other resources, especially our

18 colleagues in medicine, and in surgery, and in

19 primary care so that we can intervene at a level

20 in which veterans can accept that care without

21 feeling like they're being stigmatized or labeled

22 as being a mental patient.


35

1 So there's a lot of different ways

2 we're going about doing this. First of all with

3 primary care, we've over the last few years

4 really improved and increased our presence in

5 primary care settings. We call this primary care

6 mental health integration.

7 We actually have personnel who are

8 standing by in primary care clinics now to offer

9 curbside consultation to the practitioners, the

10 physicians, the others who are in the building,

11 and also to be able to interact with veterans in

12 a setting in which they don't feel like they're

13 being sent off to mental health to deal with

14 their issues, and all of this is connected.

15 There's really not this mind/body

16 split that we've had traditionally in medical

17 care. It's really something that I think we can

18 work collaboratively a lot more effectively than

19 we could in the past. It's just being able to do

20 that, and being able to be timely about doing

21 that is critical.

22 So, I mean, there is no opportunity


36

1 like the present, and so if people present and

2 they have issues that we can help them deal with,

3 then we want to be Johnny On The Spot. We want

4 to be able to be effectively engaged quickly in

5 that. That's why the VA has done a huge push

6 toward same-day access in mental health, and

7 that's another phrase that you'll hear a lot now

8 days.

9 It's easier to say than it is to do,

10 and being able to find the opportunities, and to

11 get the space, and to get the personnel there,

12 and to, above all, be able to establish enough of

13 a connection with our veterans so that they feel

14 like their needs are being respected and they're

15 willing to come back.

16 That's an absolutely critical task,

17 and so we're learning, again, from our experience

18 on how to accomplish that in different

19 environments. We have found that one of the

20 things that veterans really appreciate is us

21 being able to reach out to them closer to their

22 homes.


37

1 There are a large number of our

2 veterans who are in the New Orleans metropolitan

3 area who can come see us here, but there's an

4 even larger number in our catchment area which we

5 need to be able to reach out to them.

6 And whether they're coming to us in a

7 Baton Rouge CBOC, or Bogalusa, or Houma, or any

8 one of the other places where we have satellite

9 clinics, one thing that can unite us all is

10 telehealth or telemedicine, and in mental health,

11 we've had, fortunately, a great deal of support

12 from the VA at developing telehealth resources.

13 As a matter of fact, I was one of the

14 first pilots of being able to do post-traumatic

15 stress disorder counseling via telehealth to one

16 of our CBOCs in the Longview area when I was

17 chief of mental health in Shreveport. That was

18 in the ancient past, 2002, so we've been doing

19 this at the VA for about 15 years, far longer

20 than most other healthcare systems.

21 And we have a better capacity through

22 our telehealth to unite all of this information


38

1 under a centralized medical record which is

2 something that we, I think, take for granted a

3 little bit here in the VA, but really our

4 centralized electronic record has been one of the

5 most valuable tools we could possibly have at

6 being able to unite all of these various

7 treatments under one roof.

8 So we were able to use our telehealth

9 capacity. We were able to use our medical record

10 in order to get everybody on the same page, and

11 because of that, the VA has been pretty much in

12 the forefront of the development of telehealth,

13 and I see that continuing and actually

14 strengthening.

15 And to tell you the truth, a lot of

16 the younger veterans tell us that they feel more

17 comfortable talking with us on a video screen

18 than they do face to face, and so, you know, I'm

19 fine with that, and we've had lots of advocacy

20 studies that have shown that much of our

21 treatment is as effective that way as it is face

22 to face, and so we're reorienting a lot of our


39

1 resources in that direction.

2 So here in New Orleans, we have mental

3 health offerings at both the central facility

4 which includes outpatient treatment, substance

5 abuse treatment, psychosocial treatment, rehab,

6 psychosocial rehab treatment, and now soon to be

7 as of July 10, inpatient treatment.

8 We also in New Orleans have the

9 capacity to reach out to the CBOCs, these

10 clinics, and push this treatment out to the local

11 level as much as possible. Through choice, we're

12 also trying to establish a network of community

13 providers who can give this service even closer

14 to home or in cases in which it's clearly not

15 feasible for our veterans to come in either

16 because of geographic limitation or physical

17 limitations.

18 And getting all of that under one roof

19 has been the core task and great challenge that

20 we've faced, but the veterans that we get

21 feedback from have told us how to do it. They've

22 told us what works, and they're telling us what


40

1 doesn't work. It's up to us to listen. So that

2 gives you a brief thumbnail of what we're doing

3 in mental health. Any questions or concerns

4 about this?

5 MR. CERTAIN: How is telehealth

6 working -- this is Certain again -- working with

7 the older population, the geriatric, who may or

8 may not be comfortable using telehealth and other

9 kinds of technology in their homes?

10 DR. ROBINSON: I'll give you a very

11 brief clinical example of that. A long time ago

12 when I was up in Shreveport, we had the Joint

13 Commission show up, and the Joint Commission, for

14 those of you who are aware of it, is our

15 regulatory inspection agency, so to speak, if you

16 want to call it that.

17 They came for a visit, and while they

18 were circulating around, it just so happened that

19 the physician reviewer was a psychiatrist. So I

20 was about to start a telehealth session with a

21 patient I had never seen before in Longview,

22 which is about 60 miles away from Shreveport.


41

1 I get a knock on the door. It's the

2 Joint Commission reviewer. He says, "Do you mind

3 if I sit in?" because he heard we were doing

4 this. I know the correct answer to that, so I

5 said, "Sure! As long as it's okay with the guy

6 on the other end, it's fine with me."

7 So he came in and sat down off camera,

8 and then I was introduced to the patient in

9 Longview via telehealth, and it was a very nice,

10 distinguished, 84-year-old gentleman who this was

11 the first time he had ever visited with a

12 psychiatrist.

13 He was dragged in there by his family

14 because he just wasn't himself. They thought he

15 was demented. He was withdrawn. He wouldn't

16 talk. He wasn't sleeping at night. He was

17 having trouble remembering things. He was

18 talking about people they had never heard of

19 before, having nightmares, and just generally

20 declining rapidly in his function.

21 As it turned out, this gentleman had

22 served in World War II in the invasion of Anzio,


42

1 the amphibious invasion which tried to leapfrog

2 the German defensive emplacements, and wound up

3 getting bogged down in months of intense

4 fighting.

5 His company was almost eliminated. He

6 wound up losing most of his friends. He was

7 wounded himself. He recuperated in England for a

8 while. He came back to the United States and

9 never talked about it again.

10 He went on to become a very successful

11 farmer in east Texas, a big patrimonious

12 operation in which he had lots of support within

13 the community. He got married. His wife never

14 heard about his wartime experiences. He never

15 talked about it. He just worked, and worked, and

16 worked, and that's the way he dealt it until he

17 retired, and then finally in his mid-70s, he

18 retired.

19 And at that point, he did what a lot

20 of people do when they retire, which is he

21 watched a lot of TV. What was going on in 2002,

22 2003 on the TV continuously? The buildup for the


43

1 war in Iraq and Afghanistan, the images of the,

2 you know, the armaments and all the rest of the

3 things.

4 He got that drilled into his

5 consciousness to the point where his defenses,

6 the things that he's used to keep himself going

7 all these years, basically collapsed. This

8 gentleman developed post-traumatic stress

9 disorder, acute post-traumatic stress disorder 60

10 years after the fact because his ways of dealing

11 with it were no longer as effective.

12 Recognizing that, and we were able to

13 do that via telehealth very successfully, and he

14 was able to respond to that within a few minutes

15 as if we were face to face, and we were able to

16 develop a treatment plan and get his family in

17 there and talk about what we were going to do,

18 and have his understanding of that enough so that

19 I think we were able to proceed, and we were able

20 to do that very effectively within about 45

21 minutes.

22 And so when we were all done and we


44

1 said goodbye, I looked at the reviewer and I

2 said, "What did you think?" and he said, "I just

3 wish my residents were here," and that was the

4 signal that we were on the right track with this,

5 because I don't care what their ages are.

6 If they're able to make a connection,

7 if we're able to get enough information, and

8 especially if we're able to network with the

9 family and other providers, and other people who

10 might have an immediate influence on them that

11 can extend way beyond we can do personally, then

12 all together, we have a very good shot at being

13 able to undo damage that may have been there for

14 a very long time.

15 So that's one example of how

16 telehealth can be used effectively even in an

17 older population, so they're remarkably more

18 accepting of this than I thought they would be.

19 MR. CERTAIN: His family brought him

20 the CBOC?

21 DR. ROBINSON: Yes.

22 MR. CERTAIN: Is that where the


45

1 telehealth instrumentation was?

2 DR. ROBINSON: Yes, the CBOC is the

3 satellite clinic in Longview -


5 DR. ROBINSON: - where we give general

6 primary care, and we had some mental health

7 offerings, but we didn't have a psychiatrist on

8 station at that time, so I was filling in that

9 role via telehealth.

10 MR. CERTAIN: Right, but is there any

11 equipment that's put into veterans' homes -

12 DR. ROBINSON: Yes, and that's the

13 next step.

14 MR. CERTAIN: - that you can work

15 with?

16 DR. ROBINSON: Exactly, you're right

17 on with what the next stage of this is, and we

18 are now doing some telehealth at home, both

19 outreach for psychiatric services, and also

20 counseling and psychotherapy. We're doing some

21 post-traumatic stress disorder counseling via

22 telehealth to home.


46

1 This is all in its infancy. The VA is

2 pretty much on the vanguard of this, and as we

3 get more information, we're going to publish it,

4 and we're going to try to disseminate it to the

5 field, but I can tell you the OEF/OIF veterans,

6 especially the ones who are under 40, are now

7 asking to meet with me via these.

8 We aren't there yet because of

9 security, privacy, and other considerations, but

10 we'll probably wind up getting there because this

11 is a mode of interaction that's much more

12 flexible and suited to their needs, and if we can

13 find a way to be able to stay connected with them

14 -

15 The one thing that we've shown over

16 and over again that is of paramount importance in

17 avoiding and trying to reduce the risk for

18 suicide is remaining connected, and so

19 suicidality and prevention of suicide has become

20 an absolute primary focus in the VA as it should

21 be.

22 And finding ways that we can do that


47

1 reliably and consistently in this digital culture

2 with people finding connections virtually as

3 opposed to personally, I think we can go there

4 too, and so we're embarking in that direction.

5 We're learning from them about how to do that

6 most effectively, and then trying to stay up with

7 the technology to do so.

8 MR. CARSON: Dr. Robinson, I have sort

9 of a similar point that I made with Dr. Kawasaki.

10 As our FPOW clinic comes online here at the

11 hospital, mental health input is so key in the

12 example you just gave, especially the older vets

13 as they come in and we start having PTSD, and

14 those FPOWs have a need to be upgraded perhaps in

15 their disability if they're not already at 100

16 percent for example.

17 They may be at 60 or something, but if

18 they come on with PTSD in the later years of

19 their life with DVA watching that and

20 coordinating it, and addressing it with them, we

21 might be able to get them to 100 percent

22 disability so they then could be eligible for DIC


48

1 for their surviving spouse. I want to make sure

2 that you will look too when we get that clinic

3 going.

4 I wanted to ask you one question

5 though. The vet centers, I believe we have one

6 in Baton Rouge, and one in this area, Kenner,

7 right?

8 DR. ROBINSON: And here, right.

9 MR. CARSON: There's two, right, and

10 that's an opportunity for vets in those areas to

11 come in with their mental health issues, right?

12 DR. ROBINSON: Right.

13 MR. CARSON: And they can see a

14 psychiatrist or someone there, and they have

15 group therapy and things of that nature, right?

16 DR. ROBINSON: Yes, sir, they have

17 counselors there. They have psychologists. I

18 believe they have social workers and they can do

19 therapy at the vet centers, and we have some

20 connection with them.

21 As a matter of fact, they attend our

22 mental health staff meetings, a representative


49

1 from the vet center does, and that's one way to

2 coordinate here. They do have access to our

3 clinical records, but -

4 MR. CARSON: Is it the same for the

5 outpatient clinics too, like the six or seven we

6 have, do we have a mental health segment?

7 DR. ROBINSON: Yes, sir, every one of

8 these CBOCs, every one of these outlying

9 satellite clinics has mental health in place that

10 can provide initial evaluation and some degree of

11 care. Now, Baton Rouge, a huge CBOC, we have 40

12 staff that provide that care.

13 MR. CARSON: Which raises the point,

14 Mr. Chairman, about is that too finite or too

15 detailed to address FPOW mental health issues out

16 in the hinterland at the outpatient clinics, at

17 the vet centers? They probably don't have a

18 separate unique FPOW section at the outpatient

19 clinic or at the vet centers, now, would they?

20 DR. ROBINSON: No, not a section per

21 se, but we can custom design treatment plans

22 around where veterans are engaged and what


50

1 capabilities they have to come in.

2 So the first and foremost task would

3 be to find out what's going on with them in the

4 present that's causing the most distress and most

5 risk, and then figure out how we can conform our

6 assets to whatever they can accept, and also what

7 would be of most benefit to them.

8 MR. CARSON: What about a group

9 therapy program for several World War II vets,

10 for example?

11 DR. ROBINSON: We've already got that

12 going.

13 MR. CARSON: And they can come

14 together from different sections of the state?

15 DR. ROBINSON: Yes, sir. In fact, we

16 had a telehealth group that was devoted to that

17 at one point. I'm not sure if it's still active,

18 but, you know, we definitely will find ways of

19 engaging them that they can accept and is

20 feasible to them logistically.

21 MR. CERTAIN: Yes, ma'am?

22 MS. JOHNSON: Shoshona Johnson, for


51

1 your mental health clinic for when they come in,

2 how close quarters is it? As a former prisoner

3 of war, a locked door is not my friend, so is it

4 like an open ward, or is it kind of close

5 quarters where, you know, you end up feeling a

6 little claustrophobic because it's so tight?

7 I don't know. In El Paso, we don't

8 have our own hospital, so we have to go to the

9 outside, and they've made it -- they put all the

10 military together, but they still kind of keep it

11 close quarters, and it's a little -- it can be a

12 bit much.

13 DR. ROBINSON: Yes, and if you'd asked

14 me that question six months ago while we were

15 over at 3500 Canal, the buildings that we had to

16 lease after Katrina to be able to continue to

17 function, I would have told you it's a big

18 problem.

19 In our new facility over there in the

20 outpatient tower, it's wonderful. It's open.

21 It's designed with veteran input. We've had all

22 kinds of comments and compliments about how


52

1 accessible the rooms are and how non-

2 claustrophobic it feels in comparison to the

3 other one, that I think your concerns, if you

4 walked over there, I think we'd be able to

5 quickly show you that we got the message.

6 MS. JOHNSON: Thank you.

7 DR. ROBINSON: Thank you all very

8 much.


10 DR. LANDRY: Good morning, my name is

11 Mike Landry. I'm the Chief of Medicine. So

12 first of all, thank you for your service and

13 thank you for your sacrifice. Welcome to New

14 Orleans. As a native New Orleanian, hopefully

15 you're enjoying your time here, and hopefully

16 you're enjoying seeing what we've built here

17 because, you know, we're pretty excited about it,

18 and it's pretty state-of-the-art, and we think

19 it's going to do wonders for the care of our

20 veterans.

21 So as mentioned, I'm the Chief of

22 Medicine. So for medicine service, we basically


53

1 touch, you know, many of the specialty sections

2 that are non-surgical, you know, the

3 cardiologists, the pulmonary, the GI. We also

4 run the hospital service so we're responsible for

5 most of the inpatient care primarily with

6 specialists feeding into that.

7 So just kind of briefly, I was here as

8 a native New Orleanian pre-Katrina. As Dr.

9 Kawasaki said, you know, Katrina brought a lot of

10 problems, but it also forced us to think

11 creatively. The Hospital at Home program was

12 something that came out of that.

13 We actually do a VIP service over at

14 Tulane because our veterans said they wanted to

15 be taken care of by VA doctors, you know, that

16 understood them, so we actually set up a whole

17 service at Tulane where our VA doctors go over to

18 Tulane and provide care to them, have access to

19 their VA records, and can put in orders when

20 they're discharged so that they can transition

21 back over here very seamlessly.

22 We got very good at doing directed


54

1 missions so that our urgent care, we can take a

2 patient that got some initial work-up that we

3 said, "They need to be admitted, but they don't

4 need to be in an emergency room."

5 So rather than send them to a

6 community emergency room to be admitted, we would

7 directly admit them to the service that we had.

8 So pre-Katrina, we probably wouldn't have done

9 that, so those were things that we got really

10 good at just based upon necessity.

11 So then we started planning the new

12 hospital and I had a chance of being involved

13 from the very beginning. It was kind of still

14 early in my career. I was like, "I want to help

15 build this hospital that I'm going to work in

16 that, you know, is going to benefit my father, my

17 grandfather, etcetera, because they're veterans

18 as well."

19 So I've had a chance to do that, and

20 the amazing part is that this was really built by

21 the veterans and with the veterans in

22 participation in that process because we had


55

1 doctors. We had nurses. We had VISN experts,

2 central office experts, the architects, but I was

3 sitting next to veterans and veterans' family

4 members, and so they had a say.

5 So when they spoke, we listened and

6 said, "Well, that's not going to work if they're

7 not going to be comfortable with it," so that was

8 a big part of what we built here, but as we're

9 moving forward now, we're kind of on the

10 precipice of being able to show everything.

11 The veterans get very excited when

12 they see the outpatient clinic. What I would

13 tell them is, "We've still got more to show you."

14 We just opened up our urgent care which is going

15 to transition into our emergency medicine

16 service.

17 We're getting ready in a couple of

18 months to open our inpatient mental health,

19 followed by inpatient med surg, followed by our

20 inpatient community living center that Dr.

21 Kawasaki runs, so it's all within the next three

22 to four months getting ready to open up for the


56

1 big show for everybody.

2 But for medicine, you know, we offer

3 a wide range of services. So we start with the

4 outpatient clinic where people come in. One of

5 the things we're doing there is we offer

6 basically treatment in three modalities which Mr.

7 Rivera, our director, has really enforced with

8 us.

9 We'll do it face to face. You know,

10 we utilize choice when we can't provide it

11 either, you know, because we don't have the

12 service or because we can't provide it timely,

13 and then we're also doing the telehealth within

14 medicine service. You know, we do things like

15 CHF classes, COPD classes, asthma education.

16 We do our GI education for our prep

17 for our colonoscopies via telehealth so that

18 patients don't have to come here. We send as

19 much care to them as possible through telehealth.

20 So we're using really all three of those

21 modalities to be able to provide that care.

22 And in the outpatient setting,


57

1 basically we have all of our clinics up and

2 running to provide that service. We have an

3 outpatient sleep lab that we didn't have pre-

4 Katrina where we can do our sleep studies in

5 house. If a patient needs choice, we coordinate

6 as much as possible with them.

7 One of the things at the outpatient

8 center that we're doing is we're having enough

9 staff here on board that we are offering, as we

10 get our last few people on board, outpatient

11 clinic services in every specialty every half-day

12 of the week.

13 So the patient presents to urgent

14 care. They get seen, but then they feel like

15 they need to see cardiology. Well, we have the

16 ability. Our goal is to provide that same

17 service that day so they don't have to go home,

18 get scheduled, come back in, etcetera. My goal

19 is if somebody comes in before 2:00, to try to

20 get them seen that day, so that's one of the

21 elements we're working on.

22 We also run most of the procedure


58

1 areas, so the cardiology catheterization, the GI

2 endoscopy, the colonoscopy, the lung procedures,

3 the stress testing for making sure patients don't

4 have - if they have angina, if they're at risk

5 for a heart attack. So many of those things are

6 up and running. We're continuing to expand those

7 services as we move into the more complex phase

8 of our hospital operation.

9 Then medicine service will also

10 operate all of the inpatient services as

11 mentioned. We have hospitalists that are

12 dedicated. They're specialty trained in hospital

13 medicine. That's what they do. So we are

14 dedicated to having a staff hospitalist in house

15 24/7, which is pretty unique.

16 Many other hospitals don't do that,

17 but even in the middle of the night, if a staff

18 physician needs to be involved in the care of a

19 patient, we have that person here and they can go

20 to the bedside and see the patient.

21 Also if a patient is in the ER and

22 they say, "Well, does this person need to come in


59

1 or not?" our staff hospitalist can go down to the

2 ER and visit with that patient and make that

3 determination.

4 Those hospitalists are also going to

5 be able to offer other services such as some of

6 the things that we're working on with Dr. Smith,

7 concurrent care with the surgeons so that the

8 surgeons do what they do best, but if they need

9 help from a medicine doctor, we have people that

10 are right there, and we're going to offer

11 concurrent care services.

12 We're going to have procedure teams,

13 etcetera, all designed to take care of patients

14 in that kind of vulnerable time when they're in

15 the hospital and they need somebody to come visit

16 them. We're going to have a specialist to do

17 that. We'll have the specialists that can still

18 come in and visit them, the cardiologists, the

19 kidney doctors, the lung doctors, etcetera. All

20 of them will continue to come in there and do

21 that.

22 It's an exciting time because, you


60

1 know, we have all of the latest equipment. You

2 know, one of the things with Katrina, we're not

3 piecemealing pieces of equipment together. You

4 know, we've got an opportunity to identify the

5 best equipment, the state-of-the art. We've been

6 able to get that in here. We're getting all of

7 that installed and operational so that all of the

8 things talk to each other, you know, and provide

9 the best care.

10 It's also exciting because we're

11 academically affiliated with two medical schools

12 here, which is pretty unique in that we can draw

13 trainees that we're here to train. Many of our

14 academic affiliates actually want to move many of

15 their educational opportunities, their daily

16 conferences and things over here to the VA, which

17 would be tremendous for us in recruiting down the

18 line because it's a pretty nice facility, and so

19 we can train them here and get them excited about

20 it. They already like coming to the VA, but now

21 they're going to love coming to the VA because

22 they're already aligned with the mission. Now we


61

1 can show them that they can have a career within

2 the VA.

3 You know, medicine service has 140 FTE

4 that they're filling. Pretty much most of those

5 are already filled, and FTE might not be one

6 person. It might be a couple people splitting

7 it, so I'm probably looking at 180 people maybe,

8 190 people that are coming on board, and I think

9 I probably am down to only about 20 positions

10 left to fill, so we're getting people that want

11 to come work here, national specialists that want

12 to come work here.

13 In the past, we often with a second -

14 you know, it's the stepsister to one of our

15 academic affiliates. Many of those people now

16 are coming and only wanting to work here. They

17 see what we have. They understand our mission.

18 They're excited about what we're building, the

19 teamwork that we already have in place, and so

20 they're wanting to come on board and be part of

21 that so, you know, it's great.

22 We have a wonderful building. You see


62

1 it, or have seen it, or hopefully will see it

2 before you're gone. You know, we have the

3 equipment. We're putting in place all of the

4 structure, some of the things that I mentioned,

5 but like I said, you know, it takes also the

6 doctors here to come in and provide the care, the

7 nurses, the respiratory therapists, etcetera, and

8 we're getting basically people leaving other jobs

9 wanting to come here.

10 This is becoming the employer of

11 choice right now for healthcare in the city, so

12 it's a very exciting time. So I'm not sure how

13 much time you all have left, but I'll stop there

14 and answer any questions. Yes, sir?

15 COL. KUSHNER: Yes, Hal Kushner. Does

16 your EMR, electronic medical record, talk to

17 Tulane and --

18 DR. LANDRY: Well, it's a little

19 unique, and to be honest, we tried to set it up

20 today without the urgency of having to do it

21 after Katrina. It might not be set up the same

22 way, but Tulane patients are actually considered


63

1 when they're over there -- I'm sorry, VA patients

2 are actually considered Tulane patients when

3 they're over there. All of the documentation is

4 done in the Tulane chart.

5 So while they're there, we don't

6 really use our EMR, but we use our EMR to get the

7 information to make sure that the care there is

8 safe, is consistent with what we're doing here,

9 and then at the time of discharge, of it's needed

10 during the hospital stay, they can pull it up

11 remotely, but then if not, at the time of

12 discharge, any consults that they need, their

13 medications, any notes back to the doctors here

14 we can put in while we're over there.

15 We can come back over here and

16 physically do it, but we can also access it

17 online, so it's basically just creating that

18 continuity so that's there, but direct

19 communication -

20 MR. CERTAIN: So it doesn't easily

21 import from their system to yours? You have to

22 manually input it?


64

1 DR. LANDRY: Well, compared to the

2 choice program, it's actually much easier because

3 Tulane has worked so closely with us -

4 MR. CERTAIN: Yes.

5 DR. LANDRY: - that we have people on

6 our staff here that actually have access to their

7 medical record, and they can actually import the

8 documents here. It doesn't go directly into

9 CPRS, but it will go into the VistA imaging

10 system, so we can do that. Many of our other

11 vendors in the city, we have to actually get them

12 to send us things, fax it, and then we have to

13 scan it in, whereas with Tulane, since we do so

14 much there -


16 DR. LANDRY: - they actually import it

17 over.

18 COL. KUSHNER: That's the same issue

19 in my location. The VA EMR doesn't talk to

20 anybody else so it's a problem. It's a real

21 problem.

22 DR. LANDRY: Yes, ma'am?


65

1 MS. QUARLES: Shirley Quarles. Two

2 opportunities that I think VAs across the country

3 are working toward are patient appointments and

4 wait time. What are your trends for patient

5 appointments and wait time?

6 DR. LANDRY: We're actually better

7 than the national average right now and better

8 than the VISN average. Part of it in the past

9 was following the standard process, so some of

10 our numbers in the past were a little bit higher,

11 but once we got our people trained and said,

12 "Okay, let's get our - let's follow the process,"

13 because we would have patients that would be

14 scheduled multiple times for appointments and

15 they never showed up.

16 Well, when you factor that into the

17 whole big scheme, those numbers would make our

18 number really grow, but when we said, "Well,

19 what's the patients that are actually enrolled in

20 the care that need the care and are getting it,

21 and we can case manage them and stuff?" our

22 numbers are actually right in line with what,


66

1 like I said, better than the national average.

2 I think our wait time right now is

3 about five days for access for new patients, and

4 I think it's about seven or eight days for

5 established patients.

6 MS. QUARLES: Excellent.

7 DR. LANDRY: It kind of fluctuates,

8 but it's definitely better than the national

9 VISN.

10 MS. QUARLES: That's great.

11 DR. LANDRY: And I think part of that

12 is our numbers were also a little bit high

13 because of the fragment in care that we had, but

14 we also have brought on a lot of specialists. I

15 mean, right now, well, on Monday, I had 46 people

16 in the hiring process that are coming on board.

17 Now, it's a lot of people.

18 So if you add the people, you can

19 create better access, but, you know, part of it

20 is also just adding it. As Mr. Rivera likes to

21 say, I think we went from 60 exam rooms in our

22 old facility to 440 over here, so you create the


67

1 structure. You add the people. You add the

2 space.

3 You know, we're where my goal is, like

4 I said, to have same-day appointments for people

5 in specialty care that if they're somewhere here

6 or if they're in their primary care, to be able

7 to send them up to the clinic that day.

8 We were also, because we have the new

9 space, able to strategically relocate things. So

10 we weren't trying to say, "Okay, this is all

11 built out. We have this little space here.

12 Let's put our back clinic in here." We can say

13 what's the best space for that clinic to be

14 because this clinic and this clinic work close

15 together? Why have them here when we can put

16 them here?

17 So it was a clean slate. We could

18 actually look at things and say, "What's best for

19 the veterans?" by co-locating services that

20 needed to be co-located. Did you have another

21 question?

22 MR. CERTAIN: Anything else?


68

1 DR. LANDRY: Yes, sir?

2 MR. CERTAIN: Lane, one last.

3 MR. CARSON: One quick one, the FPOW

4 advisory committee -

5 DR. LANDRY: Yes, sir.

6 MR. CARSON: - in San Antonio has,

7 like, the Director of Medical Services or

8 Medicine on the team, and I guess sort of like

9 coordinating mental health, and geriatrics, and

10 so forth. So as we move toward that, what would

11 be your role as you -

12 DR. LANDRY: I'd be happy to

13 participate in whatever role is needed.

14 MR. CARSON: Of course, but you would

15 be coordinating some of these services, right?


17 MR. CARSON: To make sure they're part

18 of the FPOW clinic, and --


20 MR. CARSON: -- how involved it would

21 be, and --

22 DR. LANDRY: We're actually trying to


69

1 move as much as possible to many areas, and like

2 I said, that gets into how we located clinics to

3 try to do multi-disciplinary type of clinics. So

4 one example is we actually have an ALS clinic

5 here for veterans, so we can actually co-locate

6 or have it where when a veteran comes in for one

7 clinic, they can be seen by multiple specialists

8 and multiple doctors.

9 So in a similar fashion, if we said,

10 "Okay, we're going to do an FPOW clinic and we

11 say" -- you know, we can offer an appointment at

12 any time, but if we try to co-locate it and say

13 here, when maybe they can see their FPOW primary

14 care doctor, the FPOW mental health, any

15 specialists and stuff like that, you know, we

16 also offer it at any time through telehealth and

17 stuff like that.

18 So we can also do it asynchronously,

19 but if we do it, one goal would be to try to get

20 everybody here at the same time to provide the

21 care so the veteran only has to make one stop.

22 MR. CERTAIN: Good, thank you. I


70

1 appreciate that.

2 DR. SMITH: Good morning, and again,

3 as Dr. Landry said, I'd like reiterate the fact

4 and thank you for your service, and your

5 sacrifice, and really are kind of excited to have

6 you here on site to be able to see what we're

7 doing.

8 I don't have a lot of time, but as

9 usual, we save the best to last. So I'd just

10 like to say that I think before you can talk

11 about where we're going with surgery, you have to

12 know where we're coming from, and before Katrina,

13 this was a full-service surgical hospital. It

14 was a center of excellence for things like heart

15 surgery and things like that.

16 Katrina happened. All of that pretty

17 much went away. And after a few years, they were

18 able to bring on site a surgery center, an

19 outpatient surgery center, which currently is

20 where we're still doing a lot of our cases, and

21 it is comprised of trailers, basically trailers

22 with slide-outs that were developed by a company


71

1 that is in the business of getting ORs for the

2 military to be out in the, you know, the

3 hinterlands.

4 There on site, we have three rooms

5 that we operate out of. We have two rooms that

6 do endoscopy, and then of course we have some

7 other services there. They were meant to be used

8 for about two years. We are now into our seventh

9 year, and so obviously we are very excited to

10 move into the new facility.

11 We do cases that are not outpatient

12 surgery at Tulane University at this point. So

13 it's not that we can't do the big cases. It's

14 just you can't do them on site. Tulane stepped

15 up to the plate and allowed us to have a service

16 on site, and so if there's a case that I need to

17 do, a cancer case, some cancer surgery, I will

18 take it to Tulane and do it there, but we expect

19 to open very soon.

20 We think that we're probably going to

21 open around August 1. That's kind of been the

22 moving target. We would like to pull it forward


72

1 a little bit and even do it before that, so it

2 just depends on when everything is ready. The

3 ORs are beautiful. We currently are looking

4 forward to moving into the suite which is just

5 above us here.

6 There will be eight operating rooms,

7 and that is based on the numbers that the VA

8 feels we will need with future growth. We have

9 one that's called a hybrid room, and that room is

10 meant for doing major vascular procedures by not

11 opening a patient, but putting in stents, but it

12 could be used if necessary to move into an open

13 heart surgery if you needed to, so this is really

14 very exciting. There is not a lot of those

15 within the VA at all.

16 We also, because of the fact that

17 we're just getting a brand-new hospital, they

18 have really been very good to us. We have two

19 robots that we'll be using here, so we'll be able

20 to do all of the urologic procedures, GYN

21 procedures.

22 A lot of the general surgery thoracic


73

1 surgeries that are done on robots, we'll be able

2 to do here without worrying about everybody

3 backed up on one machine. We'll have two.

4 And the VA traditionally has had a

5 hard time recruiting surgeons. We have found

6 that that has not been a problem for us here.

7 Everybody is very excited about trying to be part

8 of this new program, and so we actually have

9 applicants from all over the country in a lot of

10 different specialties that traditionally have

11 been difficult to hire.

12 I'm in the process of interviewing

13 very high-qualified people for chief of

14 neurosurgery, orthopedics, and we also have

15 several other people coming into those sections

16 that will be - we just think this is a very

17 awesome place.

18 I was brought here repurposed from the

19 VA in Oklahoma to build the program. When I got

20 here about three years ago, we really had bare-

21 bones surgeons because we didn't need much, but

22 now we've been building up to the point that I


74

1 think by the time we're ready to do the inpatient

2 type of operations, we're going to have the

3 ability to do everything on site here except for

4 cardiac surgery.

5 That will probably be about two years

6 down the road because we have to prove to the VA

7 that we have the infrastructure, that the ICUs

8 are working the way that they need to, that our

9 nursing staff is ready, and at that point, we'll

10 be able to pull the trigger and start doing that.

11 You may or may not know that our VISN

12 is comprised of eight hospitals. We expect to be

13 the referral site for all of those hospitals

14 except for Houston which is leaving to go to a

15 different VISN. We will take over their place as

16 a referral site for what essentially is

17 Louisiana, Mississippi, and Arkansas, and part of

18 Florida.

19 So we will be encompassing all of

20 those, and we'll expect to take patients from

21 other VISNs as well because of some of the things

22 we'll be able to do here. So we expect this to


75

1 be a very high-end surgical program. We are very

2 happy that we are not required to do this all on

3 day one.

4 We're going to phase this in, and

5 starting August 1, we'll be doing the same kinds

6 of cases we're doing at the outpatient surgery

7 center, mostly eye cases, hernia cases, small

8 cases like that, but we'll be expecting within

9 two months to be doing inpatient types of

10 procedures, and within six months, probably be

11 doing almost everything except again for open

12 heart surgery.

13 So this is your VA. We're very, very

14 excited about it, and I'll be happy to entertain

15 any questions.

16 MR. CERTAIN: Anything from the

17 committee? Yes, sir, Dr. Kushner?

18 COL. KUSHNER: Sir, Hal Kushner, do

19 you do cardiac caths?

20 DR. SMITH: With cardiac caths, we

21 have the ability to do them onsite here. We

22 haven't started, but they will probably start on


76

1 the same day that we open the surgical portion of

2 it. They will not be able to do interventional

3 types of things at that point. As soon as we

4 have the ICU and everything that we're

5 comfortable with, they'll be able to do basically

6 a full-service cardiac cath.

7 DR. LANDRY: We have a doctor that,

8 because that falls underneath -- we do have

9 doctors on VA staff that are doing them currently

10 out of Tulane, and then when we move the services

11 over here, those doctors are already on staff,

12 are a part of our staff, and they'll move over

13 here.

14 MR. CERTAIN: How far away is the

15 Tulane hospital?

16 DR. HAIN: A couple of blocks.

17 MR. CERTAIN: Is it the one across the

18 street?

19 DR. LANDRY: It's down about five

20 blocks.


22 DR. LANDRY: When we were in our old


77

1 hospital, it was almost katty-corner to it.

2 MR. CERTAIN: Any other questions?

3 All right, thank you, sir, and you can get back

4 to your work. La'Toya, I think you're next on

5 finance and travel issues.


7 DR. HAIN: The good news recently is

8 Dr. Shelton was photographed on TV doing

9 telemedicine from the VA central office.

10 PARTICIPANT: Oh, how cool was that?

11 DR. HAIN: He's still practicing.

12 MR. CERTAIN: Still working, yeah.

13 COL. KUSHNER: I'm not sure. I think

14 it's internal medicine.

15 PARTICIPANT: It violated HIPAA rules,

16 didn't it?

17 PARTICIPANT: I'm sure the patient

18 signed an agreement for that.


20 MS. PRIEUR: Good morning, everyone.

21 This is my last day with you. I have to travel

22 back to DC for a management meeting tomorrow,


78

1 but let's talk about getting you paid. I don't

2 like anybody to mess with my money, so I am not

3 going to mess with yours.

4 So for Concur Government Edition, we

5 need a few receipts. That would be hotel,

6 travel, if you traveled by air or a privately

7 owned vehicle, your honorarium pay. If you'll

8 sign those for me, please, and please give them

9 back to Leslie.

10 Our finance department is very strict

11 and they like to have the receipts back within

12 five days of your return to your home, so you can

13 email them to us, fax them. You can take a

14 picture on your phone and text them to us. We

15 will take it any way we can get it as long as we

16 get it within five days.

17 Also, Dr. Certain mentioned that you

18 would be looking at the next location for the

19 FPOW conference. I understand that August may be

20 an issue for some of you, if you would let me

21 know the date as soon as possible.

22 I say that because come September, the


79

1 chief financial officer's office starts sweeping

2 money, and that is because we rarely have a

3 budget come October 1, and we may or may not have

4 a continuing resolution to continue operating

5 October 1, so on or around September 15, they

6 start sweeping money to make sure we have enough

7 to continue operating if, in fact, we do not

8 receive a budget or a continuing resolution.

9 Unfortunately, DVA does not operate

10 the same way financially that VHA does, meaning

11 that we do not receive advanced funding for two

12 years in a row. We're funded year to year like

13 the majority of the federal government.

14 So once that date is chosen, please

15 communicate that to Leslie as soon as possible

16 because I have to make sure the funds are

17 available, and that we have them marked to make

18 sure you can have your third conference as

19 planned.


21 MS. PRIEUR: Yes, sir?

22 MR. CERTAIN: So you're suggesting


80

1 that we should use September 15 as a no later

2 than date?



5 MS. PRIEUR: Yes, sir, because they're

6 going to start sweeping money.


8 MS. PRIEUR: Back in the day, Leslie

9 will not appreciate this story because the Air

10 Force is at fault, but we didn't sweep funds.

11 People would have what we called slush funds, and

12 at the end of the year, we would just tuck money

13 away in different places which was great because

14 if we didn't have enough money for travel,

15 supplies, conferences, we wouldn't have to ask

16 for an unfunded request from budget.

17 We would just take some money out of

18 the slush fund, and it was usually under the

19 micro purchase limit of $3,000, so nobody noticed

20 until someone in the Air Force went before

21 Congress and said, "Hey, we need money for a new

22 jet." Congress said, "No."


81

1 Well, they had several tens of

2 millions of dollars in their slush fund and

3 bought the jet anyway which raised several eyes,

4 and they were like, "Hey, where in the heck did

5 you guys get this money from?" and they found out

6 that everybody was having, you know, little slush

7 funds on the side and we were not turning our

8 money back in at the end of the year.

9 MR. CERTAIN: Okay, I mean, all kinds

10 of things have happened that have created, on the

11 macro level, that have created major problems at

12 this tiny little area where we operate.


14 MR. CERTAIN: And everybody else in

15 the small groups get - like that one time when we

16 had a meeting in the central office. We didn't

17 even have water and coffee in the room because

18 that was not allowed.

19 MS. PRIEUR: That was prior to Leslie

20 and Eric on the panel?

21 MR. CERTAIN: Yes, it was. That was

22 three or four years ago.


82

1 MS. PRIEUR: Okay.

2 MR. MOORE: Now we have water.

3 MR. CERTAIN: And so we had to, you

4 know, we had to send somebody out to an off - out

5 of the building to buy it and bring it back. It

6 was crazy, so that's remedied more or less.


8 MR. CERTAIN: And as you know, this is

9 an unusual year for us because of the hiatus we

10 had that took almost 18 months to reconstitute

11 this committee and get everybody approved after

12 the term limits were imposed, and so that's when

13 ACMO said, "We'll do three this year." So that's

14 - then we'll back to two. We don't have that

15 much time.

16 MS. PRIEUR: Okay.

17 MR. CERTAIN: And so we'll be

18 finalizing that date as best we can on our

19 calendars tomorrow. The only outlier in that

20 possibility is when the Secretary wants to have

21 his meeting with the Chairs, so we'll need to -

22 if you have any access to knowing what his


83

1 calendar is, we'd like to get a preliminary idea

2 of what might be the schedule so that we don't

3 land something on top of that date.

4 MS. PRIEUR: Yes, sir, and I will work

5 with ACMO and see if I can get a date for you

6 very quickly. Also, I would like to apologize to

7 all of the committee members, especially Dr.

8 Kushner. We have a new budget analyst in our

9 office, and I understand that some of you had a

10 very difficult time booking your travel.

11 I apologize profusely. There are some

12 training issues that we are working out, and

13 please feel free to contact Leslie or I with any

14 questions, concerns, complaints.

15 COL. KUSHNER: Well, Carl and I had

16 two very interesting conversations which

17 culminated into my threatening to drive my car up

18 there and kill him, which is 650 miles.

19 MS. PRIEUR: Just give us a head's up

20 before you do that.

21 COL. KUSHNER: Clear the room.

22 DR. HAIN: Sort of a down in the weeds


84

1 question, when calculating the stipend, this

2 meeting is three days, you know, some of the

3 other things, a travel day, a departure day, how

4 do we figure the stipend?

5 MS. PRIEUR: It's calculated on the

6 form for you.

7 MS. QUARLES: I think it's 585 for

8 three days.

9 DR. HAIN: Do we do it for three days?

10 MS. PRIEUR: The stipend is for three

11 days, yes, but the per diem -

12 DR. HAIN: Yeah, the per diem, on the

13 sheet here, the per diem says how you calculate

14 it, but it just doesn't say for the stipend if

15 there's some difference like if it were a half-

16 day tomorrow and you're traveling, but we just

17 figure $195 for three days?


19 DR. HAIN: That answers that question.

20 MR. CERTAIN: Okay, and -

21 MS. PRIEUR: Any other questions?

22 Thank you. It's been a pleasure.


85

1 MR. CERTAIN: You too, and thank you

2 for your good humor. All right, cool, we're a

3 little bit ahead of schedule. Let's take a

4 break, and if you have some -- we're going to

5 have a few minutes if you have something things

6 you want to brief to us on your 101 thing. Will

7 you have time for that?

8 Okay, all right, what I'd like for you

9 to do, we're going to take a break now. If

10 you've identified in your own mind any

11 recommendations we need to consider tomorrow, if

12 you would jot those down and get them to us so

13 that Dr. Quarles and I can be formulating the

14 wordsmithing on that overnight, and so we can

15 have a rough draft of that by tomorrow to

16 expedite what we're doing tomorrow. Okay, take a

17 break, 11:00. You get 45 minutes.


19 went off the record at 10:16 a.m. and resumed at

20 11:01 a.m.)

21 MR. CERTAIN: All right, it's 11:00

22 again. Okay, could we take our seats and we'll


86

1 proceed on with our next line of work, Joe

2 Sinceno?

3 DR. SINCENO: Good afternoon, I'm Joe

4 Sinceno with the VA Regional Office. I've been

5 with you all a couple of days here. So a little

6 bit of background on me, I've been at the

7 veterans benefits office here. I started in the

8 loan and guarantee department maybe about 32

9 years doing just VBA work working on the VBA.

10 I'm a bit close to retirement, but I'm

11 having so much fun, I don't think I'm going to

12 retire right now. I'm Air Force. I did four

13 years in the Air Force. My father did 22 years

14 in the Air Force. He was a World War II veteran.

15 I have a son that's in the Louisiana National

16 Guard, a lieutenant that's currently serving now.

17 He had one tour in Kuwait. So we've got three

18 generations of military background.

19 Besides that, with my father being in

20 the Air Force over 22 years, I'm a military brat,

21 so I've been around the VA all my life. I can

22 remember when I was seven years old, my father


87

1 went to the VA down here to file for his

2 benefits, and he's 100 percent service connected

3 for a heart condition.

4 So when people talk about the VA, it

5 doesn't faze me. I know we have problems, but

6 the VA has - the whole VA system has been part of

7 my whole life. It has worked for me, my family,

8 my mother, my sisters, siblings, so this is the

9 greatest job that I don't know how - I guess I

10 was blessed by God to get into this job, but I

11 truly love the veterans.

12 I love the service that I'm able to

13 give to the veteran, and this has opened up

14 another era in my life dealing with FPOWs, FPOW

15 for DVA. We have some work to do to get things

16 back on track. I always, you know, knew about

17 FPOWs since I think it was like 2012. It was a

18 collateral of duty, but as you all met my boss

19 yesterday, Mark, I think we're going to step up

20 to what is needed for the FPOW.

21 Here in New Orleans, we have this

22 unique thing that we have two directors, the


88

1 director of the medical center here and the

2 director of DVA, that we work together on our

3 outreach, and we have been getting tremendous

4 success as far as reaching out to the CBOCs, town

5 hall meetings in addressing and bringing our

6 services to the veterans out there.

7 Currently right now, I go to Lake

8 Charles and Lafayette once a month. I do a Houma

9 clinic, and I also go through - we're trying to

10 coordinate where we're going to have some type of

11 VBA representation over here as well because if

12 you're here, I mean, it should be one stop

13 shopping.

14 There's no reason why we shouldn't

15 have someone here at this big facility that can

16 assist in VBA questions. If a POW comes over

17 here, why would they have to go two blocks just

18 to get VBA information when he's already here and

19 he's got an appointment here?

20 So that's what our directors are

21 working on now, that we're going to have a VBA

22 presence here so if they come into the hospital


89

1 for appointments, one of our VBA reps could

2 assist them with claims, appeals, whatever they

3 need, and also assist the family on things,

4 dependents and benefits, because that's important

5 as well.

6 Feel free to break in and ask me any

7 questions that you have during the presentation.

8 A little bit of background of information that we

9 have, we ran a report from our regional office on

10 the number of claims we have pending for FPOWs

11 since August of 2016.

12 Now, in our VBA system, we do have

13 ways of identifying or flagging POWs. I'm going

14 to do some backtracking and make sure that we get

15 all of our POWs flagged. If you're not familiar

16 with EDMS, it's our electronic file system that

17 they came up with. We no longer have paper files

18 that we deal with our veterans.

19 When I started back 30 years ago and

20 we had our file room with those stacks of files,

21 and someone talked about one sitting at their

22 desk. We used to have to put a red - a yellow


90

1 tape around the folder to show the POW, and those

2 files were treated in special areas. They were

3 expedited whenever we saw a POW folder.

4 Now all of those folders have been

5 retired and coded in electronically, so we have

6 our intake centers where they have scanned all of

7 them in and we have an electronic file. All of

8 that works together with people having better

9 access to the file, and it has really been an

10 improvement for us.

11 But in our system, we can flag things

12 as homeless veteran, financial hardship, POW,

13 Gulf War, or OIF/OEF. So whenever that rater,

14 veteran service rep, or developer is pulling that

15 file and they see that POW flag, we know we want

16 that case expedited, and I'm pretty sure Mark

17 will be behind us on that in our system.

18 Medical records are easily transferred

19 through - I think we're doing CAPRI. As Mark

20 stated, we don't use QTC. We do our C&P exams

21 with all three of the hospitals here, and we get

22 our files dumped over to us electronically from


91

1 the New Orleans VA Medical Center. So it's just

2 a matter of once they finish that C&P exam,

3 getting it over here, putting it in the system,

4 and we can pull it up electronically without

5 pushing that paperwork.

6 We used to have clerks from 1250

7 Partridge to here bringing folders back and forth

8 all day. You know, they were getting lost. Now

9 everything is electronic. We don't have to do

10 that and we can pull it up and look at it. Any

11 questions so far?

12 I passed out a couple of handouts.

13 Briefly in slides are just a summary of the VA

14 benefits book which most of you all already

15 received in benefits, and I've got a few add-ons

16 in there.

17 I like this pamphlet because I try -

18 when I do my outreach, I tell people, "Look, just

19 hang onto this. If you don't do anything more to

20 let your family members know that you're a

21 veteran," because a lot of times we have outreach

22 events and they don't even know the history of


92

1 their father, or, you know, the wife don't even

2 know when her husband served.

3 But I tell the veterans, "At least

4 keep this somewhere. Put your DD-214 in there, a

5 copy of it, because if anything happens to you,

6 that's the first thing that VHA and DVA is

7 looking for if you're not in the system is the

8 DD-214," so it's got a little pocket in the back

9 that you can stick your stuff in. "If not, let

10 your family members know where your DD-214s are

11 and all of that."

12 Just some information that you all can

13 read later on, there was some talk about

14 disability compensation for FPOWs. I put that

15 sheet in there about the presumptive conditions

16 for POWs, for service-connected claims. I have a

17 little flyer in there, individual

18 unemployability, what qualifies for

19 unemployability, and also dependents and

20 survivors burial and plot benefits that family

21 members can apply for. These are just little

22 handouts inside.


93

1 Now, to backtrack just a little bit,

2 as I said, on August 19, we had 27 claims for

3 FPOWs completed since August 19 of 2016. Two of

4 them were new claims, so this is a POW that has a

5 file for it to be a new claim in our system. Six

6 of them were reopened or increased claims, and 19

7 of them were dependents and burial claims for

8 dependents inquiring.

9 So as the POW population is aging and,

10 you know, there's always someone there that we

11 can take care of which is the dependents of the

12 POW, so they're just as important as the POW to

13 take care of.

14 My main goal at the VA is going to get

15 them all flagged so we'll know. Once we get that

16 record flagged as a POW like we used to do with

17 the old files, anytime someone goes into that

18 folder and pulls it up, they'll see FPOW flashed

19 in there, then they'll know to contact me so we

20 can special handle it like we do with the

21 homeless veterans. I'm also the homeless

22 veterans' ward there, so I get a lot of inquiries


94

1 about homeless veterans and POWs, and I'll be

2 relaying that information over to the hospital.

3 And I thank you all for that

4 information for that site. We've already started

5 bringing them lists for the POW site that we're

6 using, and we're going to be - Anthony and I, we

7 have 684 on this list, so we're going to be

8 working together to identify these so we can get

9 them in our system.

10 That way if Anthony contacts me, I can

11 look into our EDMS and see what the flash is. If

12 he flashes it as a POW, then he knows he's good

13 to go. So if somebody comes in here at the

14 hospital trying to get benefits and we don't have

15 any flash, we can get it verified pretty quickly,

16 so that's going to be -

17 The 684, that's just the Vietnam era

18 veterans. He and I also talked about running a

19 list for Persian Gulf, you know, POWs, and Korean

20 War, and we're going to get everything together.

21 I know how many is out there left, but there may

22 be some dependents out there, so if we can get


95

1 them identified, maybe the spouse is still

2 living, you know, and may be entitled to

3 benefits.

4 I was at an event in Franklin. We

5 went out to Franklin, Louisiana and they had a

6 young - a widow came in there. Her husband died

7 in 2012, and she was given some horrible

8 information. The veteran died of a service

9 connected disability. She received a letter

10 saying that the death was service connected.

11 She was getting DIC benefits, and one

12 of the DAP reps told her because he wasn't 100

13 percent, he was getting an IU like you're talking

14 about. The representative told her, "Well, he

15 wasn't 100 percent. You can't file. You can't

16 get education benefits. You can't get -" She

17 wanted to get education benefits and also apply

18 for CHAMPVA.

19 I told her, I said, "Ma'am, I'm sorry,

20 but you've been misinformed." I said - now, she

21 had everything documented and she had the rating

22 there, and I had to show her in the letter right


96

1 there that, "Look, it says right here in the

2 letter you are entitled to CHAMPVA. You are

3 entitled to education benefits."

4 I don't know why someone would tell

5 her that. I said - but, you know, she said,

6 "That's why I came out to this meeting to make

7 sure," and these are the positive things, the

8 things for all you to crack. There are these

9 town halls and CBOC visits that we're pulling up

10 and getting these people, these dependents the

11 benefits that they're entitled to. Otherwise,

12 she would have been going on and just taking this

13 other guy's word, the misinformation.

14 To me, outreach is very important.

15 I'm the veteran outreach coordinator. And like I

16 tell Mark, to me, it doesn't matter the size of

17 the crowd or anything. If I go out there and

18 just help one veteran or one veteran's spouse, I

19 figure my job is done.

20 And I've been as far as Shreveport

21 doing outreach trying to help somebody, and I'll

22 help them one veteran at a time, ten at a time,


97

1 whatever, you know, whatever the job calls for.

2 Okay, briefly I'm going to go through

3 a few slides here. This is disability

4 compensation. This one comprises of my slides.

5 It's compensation, education, loan guarantee

6 benefits, life insurance, voc rehab, veteran and

7 survivor benefits, dependents, and survivors

8 health care, vet centers and will be included in

9 there.

10 What is compensation for service

11 connected disability? A lot of our veterans,

12 they don't understand what the definition of

13 service connected compensation is. Service

14 connected disability is a disease or injury

15 incurred or aggravated while on active duty. The

16 disability does not have to be combat or wartime

17 related.

18 I'm finding that a lot of young

19 veterans, some people figure, "Well, I had that

20 condition before I went in." If you had it

21 before you went in and you signed on the dotted

22 line and they let you serve for four years, two


98

1 years, and you aggravated that injury, you're

2 still entitled to compensation for that injury.

3 A lot of veterans think, "Well, I had

4 a bum knee when I went in. I can't file a claim

5 for that," but you can file a claim for that as

6 long - you know, if you had it going in and you

7 passed the physical to get in, if you took your

8 entry exam and two years later, your knee starts

9 acting up, you can file a claim.

10 These are just some examples of the

11 compensation disabilities you may have, knee,

12 heart disease, PTSD. Our compensation

13 disabilities are rated anywhere from zero to 100

14 percent. VA ratings are independent of any

15 military rating. We have our own rating

16 schedule. So some people think that, you know,

17 if the military gives you a separation of pay,

18 then it should be equal to the military, but it's

19 two separate things.

20 Some veterans get upset if they get a

21 lower rating or a zero percent rating, and I

22 explain to them, "Zero percent rating means that


99

1 you got half of the battle done. If they give

2 you a zero percent or a ten percent, at least

3 they're acknowledging that you have a service

4 connected injury. Now, if that condition

5 worsens, you can always come in for an increase

6 for disability."

7 So that's probably what's happened

8 with some of these POWs that we have on here.

9 They probably were entitled to some type of

10 compensation and they're coming back in because

11 their condition has not improved or gotten worse,

12 and there's an increase.

13 We had some discussion yesterday about

14 permanent, total, or if they have a fear of

15 coming back in because they think they may lose

16 their benefits. If they have a permanent and

17 total disability and there is no future exam

18 scheduled for that condition, then you can rest

19 assured that that condition is probably going to

20 be permanent and total.

21 If the veteran would read the rating

22 decision, it would tell them what their future


100

1 exam - if there is a future exam or not. If

2 there is no indication that in five years, we're

3 going to call you back in and look at your knee,

4 or call you back in and look at this, then that's

5 not a permanent and total condition.

6 Now, I've seen some ratings where they

7 may have called them back in for a reexamination,

8 but their other conditions are permanent and

9 total, so those conditions get you at the 100

10 percent. There's no need for you to worry about,

11 you know, that other exam.

12 Once you get at 100, that's 100. They

13 don't go over. You can't get compensated over

14 100 percent. Even though the numbers may add up

15 over 100, to 150 or 200, once you get at 100,

16 you're maxed out. I think I heard someone

17 talking about that yesterday.

18 But basically how we figure out

19 compensation, you start out as 100 percent

20 healthy. If we give you a 50 percent rating,

21 that means that 50 percent of your body is

22 disabled and 50 percent is healthy.


101

1 So say we give you another 50 percent

2 compensation. You're 50 percent for your back

3 and you're 50 percent for your heart so we give

4 you another 50 percent. That's 50 percent of 50,

5 the remaining health that you have, so that's 25.

6 So you add the 50 and the 25 together

7 and that gives you 75, so they pay you at the 80

8 percent rate. So some veterans, they'll see two

9 fifties on there, "50 and 50 is 100." "Yes, sir,

10 50 and 50 is 100," but you've got to use VA math.

11 DR. HAIN: I guess by that same logic,

12 this is Bob Hain. By that same logic, let's say

13 someone is 90 percent without individual

14 unemployability and they want to get to 100

15 percent, they're going to have to get over 50

16 percent additional to get beyond five, so it's

17 six and above. They would have to get another 50

18 percent disability.

19 DR. SINCENO: Yes, that math is funny,

20 but once you get at 90, that means you're 90

21 percent disabled and 10 percent healthy. So if

22 they give you a 10 percent, most people think or


102

1 they'll say, "Well, all I need is 10 percent. If

2 I get another 10 percent rating, I'll be at 100."

3 DR. HAIN: They mean 50.

4 DR. SINCENO: So if you get a 10

5 percent rating, you're going to get that big old

6 long letter from the VA saying you're still at -

7 DR. HAIN: 90.

8 DR. SINCENO: You're still at 90

9 because 10 percent of 10 is only 0.1, so you're

10 90.1. If you had 90 - you got to be at 95 or

11 above to get to the next grade.

12 DR. HAIN: Right.

13 DR. SINCENO: So you probably would

14 need five tens to get to 100 percent. So that

15 unemployability thing is kind of - it's hard to

16 get there once you're at the 90 percent, and

17 understanding the function, you know, is to get

18 the POW at the 100 percent rating.

19 First of all, if they have one

20 condition, they have to be 60 percent if you only

21 have one condition for your heart. If you're at

22 60 percent, then you can be considered. With one


103

1 condition, you can be considered for

2 unemployability. If you have a combination of

3 conditions, you have to be at 70 percent grade.

4 So if you have four or five of them and they add

5 up to 70, then you can put in the claim for

6 unemployability. So that's basically how -

7 DR. HAIN: VA math.

8 MR. CERTAIN: Okay, just a head's up,

9 the required ethics training will occur by dial

10 in promptly at 11:30, so in seven minutes we'll

11 be having to go to that.

12 DR. SINCENO: I just wanted to go over

13 this about the basic rates because this is very

14 important to family members, veterans, and

15 everything. This is the current rates for

16 compensation for veterans. You can see 10

17 percent is $133.57. A 100 percent single veteran

18 is $2,915.55.

19 MS. QUARLES: This is before taxes?

20 DR. SINCENO: No taxes.

21 MS. QUARLES: No taxes, that's fine.

22 I thought it was 50 percent and then it was no


104

1 taxes.

2 MR. CERTAIN: No, any of this is -


4 DR. SINCENO: Everything from the VA

5 that we give you, DVA gives you is tax free.


7 DR. SINCENO: So this is all tax free

8 money, and you get an extra stipend for the

9 spouse. If you have a spouse and a child, that

10 veteran would ask for his child and get a little

11 bit more for that. Any children over the age of

12 18, they must be in college or school to receive

13 that, continuing with their benefits after the

14 age of 18.

15 If you are rated at 100 percent, if

16 the veteran is 100 percent and you have a child

17 that's going to college, then they would apply

18 for the Chapter 35 education benefit which would

19 give them $1,000 a month.

20 At that point, you would have to take

21 your child off of the award because if he stayed,

22 you could keep him on the award, but you would


105

1 only get $260 a month for him. So you know the

2 cost of college now days. $1,000 is not much,

3 but it's better than $260.

4 One thing we have unique here in

5 Louisiana is the Louisiana Department of Veterans

6 Affairs, they do have what they call an education

7 for survivors or dependents of veterans with 100

8 percent. If you go to a Louisiana state approved

9 school, you will get your tuition and fees

10 waived. It cannot be a private institution, but

11 any Louisiana state approved school, you get your

12 tuition and fees waived.

13 So that's in addition to the $1,000

14 they would get from the Chapter 35 if they're a

15 full-time student, but it has to be a school like

16 LSU, Nicholls State, a state approved school. It

17 can't be a private school like Loyola or Tulane

18 which are more expensive. They can use their

19 Chapter 35 education benefits, but $1,000 a month

20 at those schools is nothing but a drop in the

21 bucket because of the costs. So all of this is

22 tax-free money.


106

1 The widows benefit if the veteran dies

2 of a service connected condition I think is

3 $1,255, $1,200 and something a month. So if the

4 veteran is - we get a lot of times. A lot of

5 times they think they're going to get the same

6 amount the veteran was getting, if a widow has to

7 come in and cry for DIC benefits to get that

8 reduced amount.

9 The good thing about compensation

10 rates and payments, it doesn't matter what your

11 income is. You could be a millionaire. Everyone

12 is entitled to this amount once you get rated at

13 one of these percentages, so it doesn't matter if

14 you were enlisted or officer. Everybody gets

15 paid the same thing.

16 It doesn't matter if you're still

17 working. We have some veterans that are 100

18 percent service connected working at the VA

19 office, retired military, and they're getting

20 their compensation as well.

21 MR. CERTAIN: The only fly in that

22 ointment is the spouses who are getting DIC are


107

1 penalized if their husband - if they are also

2 getting a benefit from the DoD, a retirement

3 benefit.

4 DR. SINCENO: Yes.

5 MR. CERTAIN: $15,000 a year. It's an

6 offset. It's like CRC. There's an offset and it

7 amounts to $15,000 a year for widows from the --

8 the DIC is -- the amount that widows get in DIC

9 is subtracted from the pension that we pay for if

10 we set that aside in our military retirement pay.

11 And the Congress has to solve that

12 problem, and right now, their temporary

13 sustainment of the partial payback is due to

14 expire in the middle of this next fiscal year

15 unless they act on it this year. So write your

16 Congressman. Write your Senator and encourage

17 them to stop doing that kind of stuff.

18 DR. SINCENO: That's why I said these

19 committees like this have a lot of pull on

20 Washington, D.C., and that's what you need to

21 bring up to them because if you paid into SBP for

22 your spouse, she should be entitled to keep it


108

1 just like -

2 Well, if you're retired from the

3 military, they used to offset all of that as

4 well. They no longer do that. They have CRDP,

5 concurrent retirement disability. So you can get

6 your full military retirement, and if you're

7 rated 50 percent or higher, you get to keep all

8 of your VA compensation.

9 MR. CERTAIN: So the Military

10 Coalition is on record with the Congress trying

11 to get them to resolve this issue. They won't do

12 it all at once, but at least to keep the

13 difference working and moving towards that

14 direction, because it's a lot of money.

15 And so whatever organizations you're

16 part of, from the VFW to the DAV, MOA, and all

17 the rest of the military coalition, be sure to

18 pay attention to their legislative alerts and

19 participate in those to continue to put that in

20 front of your members of the Congress.

21 DR. SINCENO: Because they're the ones

22 who got that CRDP through.


109

1 MR. CERTAIN: Yes.

2 DR. SINCENO: It was an organization

3 that pushed that through.

4 MR. CERTAIN: All right, thank you.

5 DR. SINCENO: Any questions or

6 anything? Thank you all.

7 MR. CERTAIN: Thank you. Thank you

8 for your dedicated work.

9 MS. JOHNSON: Oh, wait, I'm sorry. Do

10 you know how many former prisoners of war in your

11 area are receiving a pension instead of

12 compensation?

13 DR. SINCENO: No, I can look at this

14 list, but, I mean, most of these were on burial

15 claims that we had.

16 MR. CERTAIN: And you made a comment

17 about -

18 DR. SINCENO: The pension, you all

19 really need to work on that pension because, I

20 mean, I think for a POW to receive a pension

21 that's $1,071 a month with no income, pension is

22 income-based. So if you get $100 from Social


110

1 Security or $500 from Social Security, they

2 subtract that from your VA pension, which I think

3 is ridiculous because can't nobody live off of

4 $1,071, $1,110 a month.

5 And for a service member to say,

6 "Well, you know, you have no income. That's the

7 max you can get," but if they go out there and

8 get $500 from Social Security, we'll subtract

9 that $500 from them and you're still at $1,071 a

10 month. So pension, you know, if they can get

11 compensation, that is the way to go definitely.

12 PARTICIPANT: There should be no POW

13 getting -

14 MR. CERTAIN: You mentioned a number

15 of people on your list of POWs, and then you said

16 those were only Vietnam era POWs? Is that what

17 you said?

18 DR. SINCENO: Well, the list that we

19 ran from the website, they were just POW -

20 MR. CERTAIN: From the Mitchell Center

21 website?

22 DR. SINCENO: I think, yeah, the


111

1 Vietnam area.

2 MR. SMITH: There are other sites that

3 will give you Korea and everybody else, but I

4 started out last night and I was able to print

5 all of the Vietnam era.

6 MR. CERTAIN: And how many - what was

7 the number?

8 DR. SINCENO: We got 684.

9 PARTICIPANT: That's too many.

10 MR. CERTAIN: That's too many.

11 PARTICIPANT: So not in your -

12 DR. SINCENO: No, no, that's just -

13 MR. CERTAIN: Not in your area.

14 DR. SINCENO: - everybody that came

15 back.

16 MR. CERTAIN: Yeah.

17 MR. MOORE: There were 662.

18 DR. SINCENO: That's what we have.

19 That's the list.


21 (Simultaneous speaking)

22 MR. MOORE: 662 total.


112

1 MR. CERTAIN: So that was the total?

2 Many of those are dead.

3 DR. SINCENO: Yeah, probably a lot of

4 them are deceased.

5 MR. MOORE: Thirty percent.

6 DR. SINCENO: Thirty percent, and this

7 just has the date of incident and the date of

8 return.

9 MR. MOORE: Yes.


11 MR. CARSON: Did you say 680?

12 DR. SINCENO: It's showing 684, but

13 Anthony and I, we're going to purge it. We're

14 going to go through it.

15 MR. CERTAIN: That sounds like OIF/OEF

16 were added.

17 DR. SINCENO: Your names are on here.

18 MR. SMITH: I saw Kushner's name. I

19 saw a few names. Your name is on that list.

20 MS. QUARLES: Wow, Bob, wow, wow, wow.

21 MR. SMITH: One of the things that

22 people who were using this fraudulently, what


113

1 they were doing is they're taking someone that is

2 deceased on the list, where somebody didn't come

3 back.

4 There's a list that says those who

5 didn't come back on the same website, and that's

6 where we're finding that people are trying to use

7 it fraudulently. That's how they're getting it

8 though. They're using information just from the

9 website.

10 MS. QUARLES: From somebody else's --

11 oh.

12 MR. SMITH: And they don't go back and

13 check. That's what is making cross reference.

14 They're going and using that. And of course if

15 you just use the right information and talk to

16 the right person, that puts you in. That's why

17 we're trying to streamline it where only a couple

18 of people would be able to go in the system and

19 write in, "Verified POW."

20 Not just anybody can log in and put

21 that in because right now, there are like 500

22 people in the computer as POW. I know some of


114

1 the people are 45 years old saying they were in

2 Vietnam.

3 MR. CERTAIN: I know, yeah.

4 MR. SMITH: Come on, man. I'm not a

5 brain surgeon, but come on, people.

6 MR. CERTAIN: He was captured as an

7 infant.

8 MR. SMITH: Right, like, "You're 45.

9 You were in Vietnam?"

10 DR. SINCENO: I think we're not too

11 off of the ballpark because like I said, we only

12 had 27 claims since August.

13 MR. CERTAIN: And the two new ones

14 that you added since August are verified?

15 DR. SINCENO: Yes, but I'm going to go

16 back and verify them.

17 MR. MOORE: This is Dr. Moore. I

18 looked at the list. This is the correct list.

19 This has approximately 18 civilians.

20 MR. CERTAIN: Oh, okay.

21 MR. MOORE: So the number that I gave

22 previously were military, DoD, and this includes


115

1 civilians.

2 MR. CERTAIN: Thank you. All right,

3 good. All right, thank you for that, and we have

4 on the line, Carol Borden who is the attorney

5 from the Office of General Counsel for our annual

6 ethics training, so everybody wake up and pay

7 attention. Why are you laughing, Carol?

8 MS. BORDEN: I'm hoping no one is down

9 like chomping on lunch, but if you're eating

10 lunch, that's fine, but welcome everyone.

11 MR. CERTAIN: No, we haven't had

12 lunch. We're going out.

13 MS. BORDEN: My name is Carol Borden.

14 I am one of the ethics attorneys here at the

15 central office. We are a small group of 12

16 attorneys that basically do ethics for the entire

17 VA. We're highly specialized, and that's a good

18 thing. Most of us have ethics training, and so

19 that's why I'm going to be presenting some ethics

20 training to you guys today.

21 I'm sorry that I could not attend the

22 meeting. Hopefully you guys are enjoying and


116

1 getting a lot of work done. It's a great

2 location, I hear, but, so that's good.

3 So let me just go ahead and get

4 started. I don't know if you guys have a copy of

5 my PowerPoint presentation, but if it's not like

6 on a screen or anything, you should have a hard

7 copy, and if you don't have a hard copy, then I'm

8 sure Leslie will provide you one.

9 MR. CERTAIN: It's on the screen.

10 MS. BORDEN: Okay, great.

11 MS. WILLIAMS: Ma'am, if you'll just

12 say, "Next," I'll change the slide for you.

13 MS. BORDEN: Okay, all right, so I'm

14 going to jump around in the slides because some

15 of these slides are more relevant than others,

16 and I certainly don't want to lose everybody's

17 interest by going through and reading the slides,

18 and I do, you know, want to allow some time for

19 questions to be asked.

20 If you have a question or a concern,

21 then just go ahead and, you know, raise your

22 question or your concern right then and there.


117

1 It will be beneficial and it will be more

2 relevant I guess if you raise it as I'm

3 discussing that particular point.

4 So I'd like to turn to slide number

5 three which is probably the most important slide

6 in the deck. So here you have our telephone

7 number here at the central office and you have

8 our email address.

9 Toward the end of the presentation, I

10 will give you a lot more email addresses for the

11 different areas of the country that you can

12 certainly reach out to any of those email

13 addresses, and that information will more likely

14 than not come back to me for a response, but any

15 member on the team can answer any question or

16 concern that you have.

17 So this is our contact information,

18 and this information is important because if you

19 find yourself in a situation where you think that

20 perhaps you have an ethical dilemma that you need

21 assistance with, if you reach out to us and you

22 put your request in writing and you just load all


118

1 of the facts, if I or anyone else on our team

2 provides you with advice, then you are going to

3 receive what we call the Safe Harbor which is

4 that more likely than not, action will not be

5 taken against you.

6 So if there's, like, you know,

7 anything that's criminal in nature, it's for the

8 Justice Department to determine, but you

9 certainly have the defense that you can use that

10 you relied in good faith on the advice of your

11 ethics counselor. So --

12 MR. CERTAIN: Carol?

13 MS. BORDEN: -- that's why it's very

14 important if you have a situation that you're

15 working on while you're on the committee that you

16 think is going to impact you, either an

17 organization that you are currently working for,

18 of if you have a financial holding in a

19 particular matter that you're working on, if you

20 think there's a possible conflict, then certainly

21 pick up the phone and give us a call so that we

22 can reach out and help you.


119

1 MR. CERTAIN: Carol? This is Robert

2 Certain.

3 MS. BORDEN: Yes?

4 MR. CERTAIN: Just for the information

5 of our committee here, this briefing starts on

6 page 72 in the handout that you have in your book

7 on tab six. Okay, go ahead.

8 MS. BORDEN: Okay, great, thank you.

9 I'm now on slide number five and this one talks

10 about, "When do the ethics rules apply to you?"

11 and it's important. I guess the overarching

12 premise here is that the ethics rules are going

13 to apply to you all the time.

14 As special government employees, you

15 are considered to be federal employees while you

16 are serving and conducting committee business,

17 and in some cases even when you're not, and I'll

18 explain that in a minute.

19 So the ethics rules are going to apply

20 to you whether or not you're receiving

21 compensation for your service on the board,

22 whether you're not receiving compensation, and


120

1 it's going to apply to you, like I said, in some

2 cases even when you're not.

3 So let me give you an example when

4 you're not in committee where the rules might

5 apply. So let's say you are out in private

6 industry and you're going about doing whatever it

7 is that you do, and someone approaches you and

8 they say, "Hey, you know, I understand you serve

9 on a VA committee, and, you know, this is a great

10 committee, and, you know, these are our

11 interests, blah, blah, blah, blah," and then you

12 proceed to say -- and then they say, "Let's go

13 out to lunch."

14 "I'd like to take you out to lunch and

15 maybe talk about, you know, your role on the

16 committee and maybe some other things that maybe,

17 you know, you might be doing, or some of the

18 policies that you're proposing," and you go out

19 to lunch with that person and you accept -- and

20 they offer to pay for that lunch, and you allow

21 them to pay for that lunch, or, like, let's say

22 it does not exceed $50.


121

1 Well, you -- there is a very strong

2 possibility that you may have violated the ethics

3 rule when you accept dinner, so, because it is a

4 gift, and it would be against -- from a private

5 source because it's an entity that does business,

6 or in this case, is seeking to do business with

7 the VA.

8 So it's important to note that even

9 when you're not acting in your official capacity

10 like you are now and actually in a committee

11 meeting, there may be situations that present

12 themselves at some future date or at some other

13 time that could break those ethics rules, so, and

14 we find usually that to be, like, in the areas of

15 a gift or financial holding, so keep that in

16 mind.

17 So while we're talking about some of

18 the holdings on slide number six, this slide

19 doesn't pertain to you in that this committee is

20 not required to file a 278 financial disclosure

21 report.

22 So a 278 financial disclosure report


122

1 is a report that some committees in VA are

2 required to file, and this report, on this

3 report, special government employees are required

4 to list all of their outside positions, all of

5 their financial holdings, the holdings of their

6 spouse, their dependent kids.

7 We are looking for, you know, outside

8 interests that you may have, and those reports

9 are confidential. It goes to me. I review those

10 reports and I certify those reports.

11 So the value of these reports is that

12 it gives me a chance to kind of look at, you

13 know, a person's underlying assets and to look at

14 what they do on the committee, and then based on

15 all of that information, look to see whether or

16 not, or determine to see whether or not there's a

17 potential conflict of interest.

18 And the reason why these reports are

19 so good is because even though you have it kind

20 of helping you in looking at what you have to

21 say, you know, "Okay, Bob, you know, there might

22 be a potential conflict of interest. I see that


123

1 you hold, you know, a stock in this particular

2 company, and this company does, you know, work on

3 the committee," or, "You're part of this

4 organization, and, you know, there's a matter

5 involving this organization before the committee,

6 and therefore you may have a conflict of

7 interest. You might want to recuse yourself."

8 So because I don't have the benefit of

9 looking at a disclosure report on your behalf,

10 you guys are going to have to kind of pay real

11 close attention and try to manage your conflicts,

12 at least initially identify those conflicts

13 initially as best as you can, and then the burden

14 is really going to be on you to come to me or

15 come to another member of the team to discuss a

16 potential conflict of interest so that we can try

17 to resolve that conflict.

18 And, you know, that may involve, you

19 know, a waiver. It may involve, you know, you

20 having to recuse yourself. Depending on what the

21 matter is, you know, in some cases, it may

22 require divestiture. I'm not seeing that, but


124

1 that does happen.

2 So it's important that you just, as

3 you go throughout the, you know, the business of

4 the committee, that you just, you know, keep in

5 mind what you're talking about, what matters

6 you're talking about, and just, you know, always

7 ask yourself, you know, "Is this going to impact

8 me in some kind of way financially or an

9 organization that I work for that may pose a

10 conflict of interest that I need to let the

11 ethics folks know about?" and we can help you try

12 to mitigate that.

13 All right, so there are several

14 categories on slide seven of ethics laws that you

15 are going to be bound by. First and foremost are

16 the criminal conflict of interest statutes, and

17 those statutes are found in 18 USC Section 201

18 through Section 209.

19 We're going to talk a little bit about

20 some of those statutes. The other one is the

21 standards of ethical conduct. It's for executive

22 branch employees. Those are basically our


125

1 regulations, and you are bound by those

2 regulations as well.

3 Now, as special government employees,

4 you are not going to be held to the same, for all

5 of these regulations, to the same standards that

6 somebody like myself would be held to, for

7 example, the Hatch Act. You know, the Hatch Act

8 basically says that I cannot participate in

9 partisan political activities.

10 However, there is an exception in the

11 Hatch Act for special government employees, and

12 so you can participate in partisan political

13 activities. You just can't participate in

14 partisan political activity while you are, you

15 know, sitting there in a committee meeting, if

16 you are in a federal building, or in a federal

17 place. You have to do it kind of off, you know,

18 when you are outside of this committee and

19 outside of business work, okay.

20 So the first conflict of interest

21 statute on slide eight that I want to talk about

22 is 18 USC 208. Now, I'd really like to kind of


126

1 take some time and read this statute because it

2 is by far one of the most important conflict of

3 interest statutes that we have, and it is

4 criminal. So if you, you know, breach this

5 statute, you could possibly face criminal issues.

6 So 18 USC 208 basically says that it

7 is a crime for you to participate personally and

8 substantially as a government officer or employee

9 in a particular matter which will directly and

10 predictably affect your financial interests or a

11 financial interest imputed to you.

12 The whole purpose of this particular

13 statute is to prevent folks that work for the

14 federal government from basically lining their

15 own pocket. So if you're working on something in

16 the committee that is - and you're personally

17 involved in it, and you're substantially involved

18 in it, and you're working on something that is a

19 particular matter, and that means you can

20 identify that matter, so it's a contract. It's a

21 piece of litigation. It's a grant.

22 It's something that you can identify


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1 and it has specific parties that you can point

2 to, specific people that you can point to, and if

3 that matter that you're working on is somehow

4 going to benefit you financially or benefit

5 somebody that's close to you financially, then

6 you should have, you know, red flags going off

7 and saying, "Wait a minute. Wait a minute. This

8 may be a conflict of interest. You know, let me

9 pick up the phone and call the ethics attorney.

10 Let me shoot an email and see what I can do."

11 If you're there on the committee and

12 that happens, recuse yourself from the matter.

13 Step outside and give me a call, or certainly

14 call somebody in the group and we'll be more than

15 happy to help you, you know, walk you through

16 what needs to be done.

17 So the last part of the statute says

18 the financial interests are imputed to you. So

19 under this statute, there are certain financial

20 interests that are going to be imputed to you

21 which means that when we're looking at your

22 financial holdings or your affiliations, we are


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1 looking to -- we are not just looking at yours.

2 We're also looking at the financial

3 interests that are going to be imputed to you,

4 and slide number nine lists that financial

5 interests that are going to be imputed to you

6 which means that when we look at those interests,

7 we're going to treat those interests as if they

8 were your own, and this is one of the things we'd

9 look for if you were required to file a financial

10 disclosure report.

11 So we're going to look at your

12 spouse's financial interests, your minor child's

13 financial interests, you know, if you're in a

14 partnership, the general partner's interests. If

15 you're involved in an organization where you

16 serve as an officer, director, trustee, general

17 partner, or employee, we're going to impute those

18 financial interests to you, or if you are

19 negotiating or you have an arrangement concerning

20 future employment, you know, with another company

21 or an organization, we're going to look at those

22 financial interests, or the financial interests


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1 of that person or that organization as if they

2 were your own, okay.

3 So I talked about a particular matter

4 already. That's on slide number ten. Again, I

5 said, you know, in order to trigger 18 USC 208,

6 it has to involve a particular matter, and here

7 again on this slide, I just kind of list what

8 particular matters are.

9 It does not involve broad policy, and

10 my understanding is that the committee basically

11 deals with broad policy matters. You're not

12 really dealing with specific party matters.

13 You're dealing with, you know, broad issues and

14 you're giving broad recommendation that will then

15 go back to VA for a review and possible

16 implementation.

17 So as long as it's broad policy

18 matters, you're not going to have a problem and

19 208 is not going to be triggered. Again, it's

20 only going to be triggered if you're talking

21 about something specific. Again, if you're not

22 sure, you know, just reach out to us, and we're


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1 more than happy to assist you with that.

2 On slide 11, and even if you think it

3 is a specific matter, there has to be a direct

4 and predictable effect between whatever it is

5 you're working on and the financial nexus, you

6 know, that's going to be linked back to you.

7 So we're not necessarily looking to

8 see if you're going to receive a financial gain

9 from the matter that you're working on because it

10 doesn't matter. It could be either a gain or a

11 loss, so we're just looking to see if there a

12 financial nexus?

13 All right, so there are sections of

14 particular matters of general applicability, so,

15 and this applies to you, so this is like one of

16 those little sections. So you can participate in

17 a particular matter of general applicability

18 where the qualifying financial interest arises

19 from your non-federal employment, okay, so you

20 can participate.

21 So if you're working on a policy

22 matter and that matter, you're working in an


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1 industry that is, let's say healthcare, right,

2 so, and you work for Kaiser. So you're working

3 on a matter that could affect overall healthcare

4 for VA.

5 So, you know, some veterans or some

6 folks may go to Kaiser, so that policy if

7 implemented could affect Kaiser. You can work on

8 that provided that you don't own stock in Kaiser,

9 okay. The only problem, again, that's going to

10 come up is when you own stock.

11 And just to kind of make a distinction

12 here, so the criminal conflict of interest is

13 looking for financial nexus. If there is no

14 financial nexus, say you're just a member of an

15 organization that could benefit by something that

16 you're working on, then you have no financial

17 ties one way or the other to this outside

18 organization, then we're going to say that you

19 have a covered relationship with that entity.

20 And there still very well could be a

21 problem, but that problem would then fall under

22 the regulation, the ethics regulation, which is


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1 not criminal in nature, but nevertheless, you

2 still want to go ahead and reach out to us for

3 assistance.

4 So again, if you find yourself in a

5 situation where you think there may be a conflict

6 of interest, on slide number 13 we talk a little

7 bit about, you know, trying to get a waiver, you

8 know, some of the things we could do, recusal.

9 We could go to the Office of Ethics and try to

10 get you a waiver so that you can continue to work

11 on that issue.

12 Slide number 14 deals with

13 appearances, and I'm going to have to say this is

14 probably - okay, contacting us is probably the

15 most important slide, and then the appearance

16 issue is certainly if not as important as that,

17 very close to it because, you know, appearances

18 really do matter.

19 And, you know, I tell employees all

20 the time that, you know, you may be involved in

21 something that is completely permissible and

22 acceptable under the ethics rules, but a


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1 reasonable person kind of walking by, you know,

2 looking at the situation and not knowing what the

3 ethics rules say, you know, if that reasonable

4 person would question your impartiality, question

5 the impartiality of the committee or the

6 integrity of the agency, you know, there is an

7 optics issues. There is an appearance issue and

8 you should stay clear on that issue or that

9 matter.

10 So in keeping with the appearance

11 matters, the Office of Government Ethics recently

12 changed, and that change, it was to the gift

13 rule, and the gift rule now basically puts a

14 burden on the employee and requires the employee

15 to kind of go through an optics test, if you

16 will, before they accept a permissible gift.

17 So under the gift rule, for example,

18 you can accept a gift from a prohibited source,

19 and that, again, is someone who does business

20 with the VA or seeks to do business with the VA,

21 provided that the gift is valued at $20 or less

22 or does not exceed the $50 threshold from that


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1 one particular source for the calendar year.

2 So there is an exception for the gift

3 rule if people were to go out with a prohibited

4 source and that prohibited source were to, you

5 know, just buy your lunch, for example.

6 The rules were changed this year to

7 require now that you undergo your own optics

8 analysis and ask yourself the question, "Okay,

9 even though I can accept this gift because it's

10 permissible under the rules, you know, how do the

11 optics look? Would a reasonable person question

12 my integrity or the integrity of the agency, or

13 the integrity of this committee or this program?"

14 and if the answer is yes, you should not accept

15 that gift, okay.

16 So that's a big change. It kind of

17 puts the burden now on the employee to go through

18 that analysis, and that's really because optics

19 has become, you know, very, very important,

20 especially for VA.

21 So on slide number 16, we're going to

22 move into and talk about prohibited compensation.


135

1 So prohibited compensation, this basically says

2 that, you know, don't accept a bribe for doing

3 your work on the committee. You can't do that,

4 and you can't be paid by an outside source for

5 doing your work on the committee, so that would

6 kind of look to be as if it were a bribe, so just

7 keep that in mind as you move forward with that.

8 The next major criminal conflict of

9 interest statutes are found on slide number 17,

10 18 USC 203 and 205, and those two statutes

11 basically are designed to prevent people from

12 working on a committee matter and then if they

13 leave the committee, going to an outside

14 organization and coming back to the VA

15 representing the opposite view, or a different

16 view, or advocating for an outside organization

17 on a matter that they may have been involved in,

18 okay.

19 So again, here we're not talking about

20 broad policy type of stuff, but we are talking

21 about if you work on a matter on the committee,

22 you are prohibited by these two criminal conflict


136

1 of interest statutes from coming back, switching

2 sides if you will, after you leave the committee,

3 and representing that to the agency.

4 Now, that being said, once you leave

5 the committee, if you find yourself in a

6 situation where you're like, you know, "I don't

7 know if, you know, I kind of sort of may have

8 worked on this issue. I'm really not sure, and

9 now I'm working for this organization and, you

10 know, I want to advocate this position for this

11 organization, you know, back to the VA. I want

12 to, you know, reach out to, you know, ethics. Is

13 that permissible?"

14 So even after you leave the committee,

15 if you're ever unsure of what to do or whether or

16 not it's ethical or permissible, you know, you

17 can still reach out to us. You can still reach

18 out to me and you can still say, "Hey, I'm not

19 quite sure. Can I do this?" and we'll provide

20 you with written guidance as to what you can or

21 cannot do.

22 You know, keep in touch with ACMO.


137

1 ACMO is also a really good source, and they could

2 possibly also evaluate you as well, but certainly

3 when it comes to any of the conflict of interest

4 statutes, you definitely want to reach out of

5 ethics.

6 So the switching sides prohibition

7 also extends to post-government employment. So,

8 you know, again, I mentioned that if you leave,

9 you know, you can't switch sides and represent

10 back to the government.

11 So on slide 18, you are introduced to

12 the lifetime ban, and the lifetime ban is a ban.

13 Basically, it's a switching sides ban, but it

14 also says that for the lifetime of that

15 particular matter that you worked on, the

16 specific party that you worked on, there is a

17 lifetime ban from you representing back to the

18 government in connection with that particular

19 matter.

20 You can work behind the scenes for an

21 organization on that, but you cannot represent

22 back to the agency. Now, representing back can


138

1 look very, very different. So it could be an in

2 person representation where you show up at the

3 agency in person.

4 It could be a representation where you

5 can pick up a phone and represent the matter. It

6 could be a situation where you, you know, you

7 send - you know, a colleague is being sent to the

8 organization and they say, "Oh, you know, Bob who

9 was on the committee, you know, says hello, and

10 this is what we think about this particular

11 issue."

12 All of those circumstances are going

13 to be viewed as representing back to the agency.

14 So behind the scenes really is behind the scenes.

15 You know, you're just working behind the scenes.

16 You might be in an organization, but you are not

17 the face and center of that organization back

18 before the VA on that particular matter.

19 All right, okay, so let's talk a

20 little bit about the standards of conduct, and

21 that's kind of starting on slide 20. So the

22 standards of conduct, again, this refers to our


139

1 regulations, and our regulations are not criminal

2 in nature. They are more or less administrative

3 in nature.

4 And the basic overall reaching premise

5 in the standards of conduct is that public

6 service is a public trust. So as committee

7 members, you are considered to be public

8 servants, and so you know, what you do on the

9 committee, we want it to be -- it is one of the

10 reasons why these committees are open to the

11 public, and, you know, we need to, you know,

12 always have, you know, an environment of trust

13 and where the public can trust the VA in

14 fulfilling and accomplishing its mission, so

15 that's the overarching concept that's in the

16 standards of conduct.

17 So the standards of conduct starts,

18 you know, the standards start off with basically

19 listing 14 principles, but all of it will

20 basically boil down to two basic concepts that

21 are important for you to remember as you serve on

22 the committee.


140

1 One is, you know, don't use your

2 position on the committee for your own private

3 gain or for the private gain of, you know, anyone

4 that's closely tied to you. And the other thing

5 is while you're serving on the committee, you

6 know, don't get unauthorized preferential

7 treatment to any person, organization, or entity

8 that you may know or that you may be affiliated

9 with, and if you just remember those two points,

10 I think you're going to do fine and you shouldn't

11 run across any major issues.

12 So in keeping with that theme is the

13 next slide on page 21 which covers the misuse of

14 position. Again, while you're serving on the

15 committee, don't misuse your position. You know,

16 don't - if you're, you know, at a dinner party,

17 you certainly have the right to express your

18 views on certain matters, but you can't hold

19 yourself out as representing the voice of the

20 committee.

21 So if somebody asks you a question,

22 you know, related to the committee and you want


141

1 to express your own personal views, you can do

2 that, but, you know, we ask that, you know, you

3 preface that by just saying, "You know, these are

4 my views and not necessarily the views of the VA

5 committee that I serve on," and that way there's

6 no confusion.

7 Okay, so if you come across any non-

8 public information and I don't believe that you

9 should, but if you do, then remember it's non-

10 public, and so we need to make sure we keep it

11 that way, and you want to probably notify ACMO

12 immediately or your chair to let them know that

13 this is an issue.

14 Don't use government property for

15 anything for other than authorized purposes, so,

16 you know, don't misuse computers while you're on

17 site at a government facility, or the telephones,

18 or anything like that.

19 All right, on teaching, speaking, and

20 writing, you cannot receive compensation for

21 teaching, speaking, and writing that relates to

22 your official duties on the committee. So if it


142

1 involves - you can teach, speak, and write about

2 a matter, you know.

3 We consider all of you guys to be

4 experts, and that's why we may have asked you to

5 serve on the committee, but you can't ask for

6 payment for teaching, speaking, or writing if it

7 relates to your official duties as committee

8 members. So what does that mean?

9 So on slide 22, it kind of lists some

10 factors that we would consider when analyzing a

11 teaching, speaking, or writing situation, and

12 again, if you find yourself being asked to teach,

13 speak, or write about something and you're not

14 sure, you know, "Hey, can I speak or write about

15 this? Can I accept an honorarium? Can I accept

16 payment or whatever for this?" and you're not

17 sure, reach out to us.

18 Reach out to me and I'll be more than

19 happy to look at it, but what I would do in a

20 case like that is I would basically go through

21 this checklist on slide 22, and I would ask the

22 question or ask you the question, you know, "Were


143

1 you - is what you're teaching, speaking, or

2 writing about, is that undertaken as part of your

3 official duties as a committee member?"

4 "Was the invitation to speak, teach,

5 or write offered to you because of your position

6 on the committee, and was the invitation from

7 someone who could benefit from your government

8 service?"

9 Again, we would look at whether or not

10 the teaching, speaking, or writing involved non-

11 public information, and we would look to see

12 whether or not the subject matter deals with any

13 specific matter which was assigned to you while

14 you were serving on the committee.

15 So that being said, let me just say

16 this. So for example, part of my duties here at

17 VA is to do training, to provide ethics training.

18 So I still, you know, have some - I'm going to

19 have some thoughts and some ideas about, you

20 know, ethics in general, you know, how, you know,

21 organizations should structure their environment

22 in a more ethical manner, and so there's nothing


144

1 that would prevent me from teaching, speaking, or

2 writing about ethics generally, okay. It just

3 would be a problem if I started talking about my

4 interests financially from talking, teaching,

5 speaking, or writing about - for compensation

6 about what I do here. I'm not going to accept

7 compensation. That's a different story.

8 All right, so on slide number 24, I

9 talk about gifts, and I think I kind of touched

10 on that already. We talked about already about

11 sources. On slide number 25, we talked about the

12 de minimis exception, the gift exception, which

13 is the $20 per occasion that you can accept, but

14 no more than $50 during a calendar year from the

15 same prohibited source, so that's going to be

16 okay.

17 Charitable fundraising, you can engage

18 in charitable fundraising as a special government

19 employee as long as you're not soliciting funds

20 or support from a person whose interests may be

21 substantially affected by what you're doing on

22 the committee, so it's important to keep that in


145

1 mind.

2 So some of the other ethics laws that

3 are going to apply to you is the emoluments

4 clause which prohibits the receipt of gifts,

5 declarations, or titles of nobility from a

6 foreign government.

7 The foreign gifts and decorations act,

8 that's going to apply to you, so you cannot

9 accept a gift from a foreign government where its

10 value is more than $375, and if that happens, you

11 just want to make sure you let us know.

12 Now this is, again, we would look to

13 see whether or not you're being offered this gift

14 as part of your federal duties, part of your, you

15 know, your duties as committee members.

16 So in your outside, you know,

17 organization, as part of your job, or let's say

18 travel to Thailand and you're representing the

19 committee, you know, we're not really - we should

20 - you know, unless there's a link between what

21 you're doing there and your federal service that

22 there should not - this statute or this act


146

1 should not be triggered.

2 This is also the last slide, and of

3 course, not acting as an agent of a foreign

4 principal registered under the foreign agents

5 registration act. So if you find yourself in

6 foreign waters, pick up the phone and give me a

7 call, or, you know, reach out to anyone on the

8 ethics committee.

9 The Hatch Act I mentioned a little bit

10 earlier when I first started speaking. Again,

11 the Hatch Act applies to you, but it only applies

12 to you when you're engaged in government

13 business. Other than that, you're not bound by

14 the same restrictions that I am.

15 You can engage in partisan political

16 activities. You can solicit and receive

17 political contributions, just not while you were

18 engaged in committee business, or on federal

19 property, or in a federal vehicle.

20 So where to get ethics advice, again,

21 Tammy Kennedy is our designated agency ethics

22 official. That's her name. At central office,


147

1 the ethics officials, I'm one of them. Jonathan

2 Gurland is one, Chris is the other one. He's the

3 newest member to our team. That's our address.

4 That's our phone number.

5 That's where you can reach us, and

6 then if you can't get ahold of us, you certainly

7 can, on the last slide, slide 30, you can reach

8 out or send your request to any of these email

9 boxes, and they will be more than happy to

10 provide you with assistance or advice.

11 Okay, so are there any questions? I

12 know that was fast, but --

13 MR. CERTAIN: I don't see any

14 questions or anybody that has a hand up. Thank

15 you for your time today. I appreciate that.

16 MS. BORDEN: No worries, and on behalf

17 of the ethics team, we'd like to say thank you

18 for your service on the committee. We really

19 appreciate it. I enjoy speaking with just all of

20 the special advisory committees.

21 It kind of gives me a chance to kind

22 of see all of the other things that VA is


148

1 involved in, so I really appreciate what you guys

2 do, and I hope you guys continue and have some

3 great training.


5 MS. BORDEN: Thank you.

6 MR. CERTAIN: All right, Leslie,

7 what's the drill now?

8 MS. WILLIAMS: So we are actually

9 about to dismiss to head over the museum for

10 lunch and the tour.

11 MR. CERTAIN: What about our

12 belongings? Should we take them with us and

13 leave them on the bus? Will that be secure?

14 Will they be staying with us? What happens with

15 the things that we need to take back to the

16 hotel?

17 COL. KUSHNER: Are we coming back

18 here?

19 MS. WILLIAMS: We are not, so what all

20 you don't wish - you can leave the binders. I

21 would take the iPads.

22 MR. CERTAIN: All right, don't worry


149

1 about that.

2 COL. KUSHNER: Actually, are we coming

3 back tomorrow here?

4 MS. WILLIAMS: Yes, yes, so we will be

5 back in this room tomorrow.

6 MR. CERTAIN: So the bus is not

7 staying with us?

8 MS. WILLIAMS: No.

9 MR. CERTAIN: So the question is --

10 MS. WILLIAMS: Oh, it is going to

11 stay?

12 MR. CERTAIN: Okay, so can we go to

13 the hotel and drop things off and then go to the

14 museum? Can we - you know, what do we do with

15 things? Do we have to lug these around all

16 afternoon?

17 COL. KUSHNER: That would be ideal if

18 we could go to the hotel and drop these off and

19 go to the museum. It's not that far from the

20 hotel.


22 MR. CERTAIN: Can we do that?


150

1 MS. WILLIAMS: Yes, we can do that.


3 MS. WILLIAMS: So we're going to go to

4 the hotel and drop off belongings. Ladies, get

5 flat shoes, and then we're going to head over to

6 the museum.


8 went off the record at 12:13 p.m.)

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115:4 127:9attorneys 115:14

115:16August 71:21 75:5

78:19 89:11 93:293:3 114:12,14

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11:8 13:22 14:2117:9 31:9 33:534:12 36:15 42:853:21 57:18 63:1363:15 67:12 77:377:22 78:9,1180:8 81:8 82:5,1487:16 89:19 91:792:8 99:10,15100:3,4,7 101:2111:15 113:3,5,12114:16 117:14129:15 130:6135:14 136:1,11137:10,17,22,22138:13,17 148:15

148:17 149:3,5backed 73:3background 31:3

86:6,18 89:8backtrack 93:1backtracking 89:14ballpark 114:11ban 137:12,12,12

137:13,17band 5:18,20bare- 73:20based 54:10 72:7

122:14basic 26:1 103:13

139:4,20basically 17:11

19:1 32:18 43:752:22 56:6 57:162:8 63:17 70:2176:5 100:18 103:6115:16 124:22125:8 126:6,14129:10 133:13135:1,11 137:13139:18,20 142:20

Baton 37:7 48:649:11

battle 99:1Beach 10:4beautiful 11:19

72:3becoming 62:10beds 32:16bedside 58:20beginning 54:13behalf 123:9 147:16believe 15:18 27:16

48:5,18 141:8belongings 148:12

150:4beneficial 117:1benefit 50:7 54:16

104:18 106:1107:2,3 123:8127:4,4 131:15143:7

benefits 1:3 28:1486:7 87:2 89:4

91:14,15 92:2094:14 95:3,11,1695:17 96:3,1197:6,7 99:16104:13 105:19106:7

best 16:3,4 30:1159:8 60:5,9 67:1367:18 70:9 82:18123:13

better 15:5 28:731:20 37:21 65:665:7 66:1,8,1990:8 105:3

beyond 44:11101:16

big 29:6 42:1151:17 55:8 56:165:17 71:13 88:15102:5 134:16

bigger 4:12bill 5:6,13Biloxi 32:20binders 148:20bit 4:20 14:18 15:13

16:7 18:6 31:338:3 51:12 65:1066:12 72:1 85:386:6,10 89:8 93:1104:11 124:19132:7 138:20146:9

blah 120:11,11,11120:11

blessed 87:10blocks 76:16,20

88:17board 15:19 57:9

57:10 61:8,2066:16 119:21

Bob 10:13 101:12112:20 122:21138:8

body 100:21Bogalusa 37:7bogged 42:3boil 139:20bones 73:21


153

book 91:14 119:6booking 83:10Borden 2:2 3:17

115:4,8,13,13116:10,13 118:13119:3,8 147:16148:5

born 11:5boss 87:18bought 81:3bound 124:15

125:1 146:13boxes 147:9brain 114:5branch 124:22brand-new 72:17brat 86:20breach 126:4break 85:4,9,17

89:6 121:13bribe 135:2,6brief 40:2,11 85:6briefing 31:13

119:5briefly 53:7 91:13

97:2bring 5:13 19:7

70:18 82:5 107:21bringing 88:5 91:7

94:5broad 20:21 24:9

24:13 129:9,11,13129:14,17 135:20

broadened 17:8brochure 28:11brochures 4:13brought 30:4 44:19

53:9 66:14 73:18bucket 105:21budget 14:14 79:3

79:8 80:16 83:8build 54:15 73:19building 32:14

35:10 61:18,2273:22 82:5 125:16

buildings 51:15buildup 42:22built 52:16 54:20

55:8 67:11bum 98:4burden 123:13

133:14 134:17burial 92:20 93:7

109:14bus 148:13 149:6business 71:1

119:16 121:5,6124:3 125:19133:19,20 146:13146:18

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CC 3:1C&P 90:20 91:2Cajun 5:17,19,20

5:21,22,22calculate 84:13calculated 84:5calculating 84:1calendar 83:1

134:1 144:14calendars 82:19California 11:21call 20:9 21:6,18,20

34:14 35:5 40:16100:3,4 105:6118:3,21 127:9,13127:14 146:7

called 5:7 72:980:11 100:7

calls 18:14,18 97:1camera 41:7Canal 1:12 51:15cancer 71:17,17capabilities 50:1capacity 31:5 37:21

38:9 39:9 121:9CAPRI 90:19captured 114:6car 18:2 83:17cardiac 74:4 75:19

75:20 76:6cardiologists 53:3

59:18cardiology 57:15

58:1care 15:11,17,20

16:16,21,22 17:217:3,11,14,15,1617:19,21 18:819:1 20:4,9,20,2121:1,1,2,6,10,1321:18 22:12,12,2123:2,19 24:4,1224:17,19 25:19,2026:5,20 29:2030:5 34:13,19,2035:3,5,5,8,17 44:545:6 49:11,1252:19 53:5,15,1854:1 55:14 56:1956:21 57:14 58:1859:7,11,13 60:962:6 63:7 65:2065:20 66:13 67:567:6 69:14,2193:11,13 97:8

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21:12caregiver 6:15Carl 83:15Carletta 2:5 6:12Carol 2:2 115:4,7

115:13 118:12119:1

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Carter 2:3 6:8,9case 65:21 71:16

71:17 90:16 121:6142:20

cases 39:14 70:2071:11,13 75:6,7,775:8 119:17 120:2123:21

cash 5:13

casual 4:22catching 14:11,15catchment 37:4categories 124:14cath 76:6catheterization

58:1caths 75:19,20causing 50:4CBOC 37:7 44:20

45:2 49:11 96:9CBOCs 37:16 39:9

49:8 88:4center 1:12 9:14

10:15,22 21:2022:2,4,6 49:155:20 57:8 70:1470:18,19 75:788:1 91:1 110:20138:17

centers 48:5,1949:17,19 90:697:8

central 12:17 14:1314:21 33:10 39:355:2 77:9 81:16115:15 117:7146:22

centralized 34:1338:1,4

certain 1:13,16 4:34:8 5:4,10,16,206:2,18 8:10,14,208:22 9:8 12:2213:4 15:3,7 16:224:8 26:12,2127:8,12 28:2229:1 30:15,1933:19 40:5,644:19,22 45:4,1045:14 50:21 52:963:20 64:4,1567:22 68:2 69:2275:16 76:14,17,2177:2,12,19 78:1779:20,22 80:4,781:9,14,21 82:3,882:17 84:20 85:1


154

85:21 103:8 104:2106:21 107:5108:9 109:1,4,7109:16 110:14,20111:6,10,13,16,20112:1,10,15 114:3114:6,13,20 115:2115:11 116:9118:12 119:1,2,4127:19 140:18147:13 148:4,6,11148:22 149:6,9,12149:22 150:2

certainly 16:6116:16 117:12118:9,20 127:13132:16 137:2140:17 147:6

certified 15:20certify 122:10chair 1:16 9:21

141:12Chairman 1:13 8:22

29:1 49:14Chairs 82:21challenge 31:15

33:8 39:19challenges 28:13CHAMPVA 95:18

96:2chance 31:6,18

54:12,19 122:12147:21

change 14:16116:12 133:12134:16

changed 6:22133:12 134:6

changes 13:17 22:3Chapter 104:18

105:14,19charitable 144:17

144:18Charles 88:8chart 63:4check 18:3 113:13checking 14:1checklist 142:21

CHF 56:15chief 8:3 19:18

30:20 37:17 52:1152:21 73:13 79:1

child 104:9,10,16104:21

child's 128:12children 104:11choice 39:11 56:10

57:5 62:11 64:2choices 24:3 25:2chomping 115:9chosen 79:14Chris 147:2circulating 40:18circumstances

138:12city 9:9 62:11 64:11civilian 30:1civilians 114:19

115:1claim 93:5 98:4,5,9

103:5claims 89:2,10

92:16 93:2,4,6,7109:15 114:12

class 5:22classes 56:15,15clause 145:4claustrophobic

51:6 52:2CLC 23:18 24:18clean 25:12,12

67:17cleaning 26:1clear 83:21 133:8clearly 34:4 39:14clerks 91:6clinic 22:21,22

23:19 27:18,2128:8,12 45:347:10 48:2 49:1951:1 55:12 56:457:11 67:7,12,1367:14,14 68:1869:4,7,10 88:9

clinical 10:20 40:1149:3

clinics 17:13,1320:3 22:20 35:837:9 39:10 49:5,949:16 57:1 69:2,3

close 51:2,4,1167:14 86:10123:11 127:5132:17

closely 23:11,1524:22 64:3 140:4

closer 28:6 36:2139:13

co-locate 69:5,12co-located 67:20co-locating 67:19coalition 108:10,17code 4:21coded 90:5coffee 81:17coherently 33:16COL 10:3 25:5

62:15 64:18 75:1877:13 83:15,21148:17 149:2,17

collaboratively35:18

collapsed 43:7collateral 87:18colleague 138:7colleagues 34:18college 104:12,17

105:2colonel 10:1colonoscopies

56:17colonoscopy 58:2combat 11:7 97:16combination 103:2combine 19:8

20:19 25:21come 13:11 17:2

18:18 20:6 31:1333:11 36:15 37:339:15 47:13,1848:11 50:1,1351:1 56:4,1857:18 58:22 59:1559:18,20 61:11,12

61:20 62:6,963:15 78:22 79:388:22 99:5 106:7113:2,5 114:4,5117:14 123:14,15131:10 141:7

comes 7:22 16:1322:13 25:8 28:1547:10 57:19 69:688:16 94:13 137:3

comfortable 15:815:11 38:17 40:855:7 76:5

coming 21:17 31:933:18 34:12 37:660:20,21 61:8,1666:16 70:12 73:1599:10,15 135:14136:1 148:17149:2

comment 109:16comments 30:16

51:22Commission 40:13

40:13 41:2committed 14:8committee 1:5,11

4:4 7:3,5 8:19,229:2,3,19,22 10:810:18 12:9,10,1612:20 13:13 14:427:16 29:6 68:475:17 82:11 83:7118:15 119:5,16120:4,9,10,16121:10,19 122:14123:3,5 124:4125:15,18 126:16127:11 129:10133:5 134:13135:3,5,12,13,21136:2,5,14 138:9139:6,9,22 140:2140:5,15,20,22141:5,22 142:5,7143:3,6,14 144:22145:15,19 146:8146:18 147:18


155

committee's 9:6,10committees 13:14

107:19 122:1139:10 147:20

communicate79:15

communication63:19

communities 30:1community 16:19

21:19 22:2,3,6,625:16 31:10 33:239:12 42:13 54:655:20

company 42:570:22 123:2,2128:20

compared 64:1comparison 52:2compensated

100:13compensation 1:3

92:14 97:4,5,1097:13 98:2,11,1299:10 100:19101:2 103:16106:9,20 108:8109:12 110:11119:21,22 134:22135:1 141:20144:5,7

complaints 83:14completed 93:3completely 132:21complex 20:10,12

21:9 58:7complexity 33:13compliments 51:22comprehensive

17:17comprised 70:21

74:12comprises 97:4computer 113:22computers 141:16concept 139:15concepts 139:20concern 116:20,22

117:16concerning 128:19concerns 14:15

40:3 52:3 83:14Concur 78:4concurrent 59:7,11

108:5condition 87:3

97:20 99:4,11,1899:19 100:5102:20,21 103:1106:2

conditions 92:15100:8,9 103:3

conduct 124:21138:20,22 139:5139:16,17

conducting 119:16conference 78:19

79:18conferences 60:16

80:15confidential 122:9conflict 118:20

122:17,22 123:6123:16,17 124:10124:16 125:20126:2 127:8131:12 132:5135:8,22 137:3

conflicts 29:1331:21,22 34:13123:11,12

conform 50:5confusion 33:20

141:6Congress 9:4 80:21

80:22 107:11108:10,20

Congressional13:14

Congressman107:16

connected 35:1446:13,18 87:295:9,10 97:11,1397:14 99:4 106:2106:18

connection 36:1344:6 48:20 137:18

connections 29:1547:2

consciousness43:5

consider 85:11142:3,10

considerations46:9

considered 62:2263:2 102:22 103:1119:15 139:7

consistent 32:763:8

consistently 47:1consult 23:1,11consultation 35:9consults 63:12contact 34:6 83:13

93:19 117:17contacting 132:14contacts 94:10continual 30:10continue 29:20

51:16 59:20 79:479:7 108:19132:10 148:2

continuing 38:1358:6 79:4,8104:13

continuity 22:1133:5,8 63:18

continuously 42:22continuum 20:21contract 126:20contributions

146:17conversations 7:13

7:19 83:16cool 77:10 85:2coordinate 28:7

49:2 57:5 88:10coordinating 47:20

68:9,15coordinator 6:15

34:15 96:15COPD 20:7 56:15

copy 92:5 116:4,7,7core 39:19Corey's 5:11Corre 1:17 11:20,20correct 41:4 114:18cost 105:2costs 105:21Counsel 115:5counseling 37:15

45:20,21counselor 118:11counselors 48:17country 65:2 73:9

117:11counts 4:4couple 14:7 25:16

55:17 61:6 76:1686:5 91:12 113:17

course 14:16 68:1471:6 113:14 146:3

court 25:6covered 131:19covers 140:13CPRS 64:9crack 96:8cranky 4:18crazy 82:6CRC 107:6CRDP 108:4,22create 15:9 66:19

66:22created 17:10 18:6

18:21 81:10,11creating 63:17creatively 53:11crime 126:7criminal 118:7

124:16 126:4,5131:12 132:1135:8,22 139:1

critical 35:21 36:16cross 113:13crossfeed 29:15crowd 96:17cry 106:7culminated 83:17culture 21:22 47:1curbside 35:9


156

current 10:21 13:1032:17 103:15

currently 9:1616:18 70:19 72:376:9 86:16 88:7118:17

custom 49:21

DD.C 107:20daily 26:1 60:15damage 44:13DAP 95:12date 78:21 79:14

80:2 82:18 83:3,5112:7,7 121:12

DAV 108:16Dave 30:20day 20:15 57:17,20

67:7 75:3 76:177:21 80:8 84:3,384:16 91:8

days 26:6 36:8 66:366:4 78:12,1684:2,8,9,11,1786:5 105:2

Daytona 10:4DC 77:22DD-214 92:4,8DD-214s 92:10de 144:12dead 112:2deal 14:10 35:13

36:2 37:11 89:18dealing 13:14 43:10

87:14 129:12,13deals 129:11

132:12 143:12dealt 42:16Dean 2:6 31:1death 95:10deceased 112:4

113:2decision 99:22deck 117:6declarations 145:5declining 41:20decorations 145:7

dedicated 58:12,14109:8

defense 118:9defenses 43:5defensive 42:2defines 17:19definitely 50:18

66:8 110:11 137:4definition 97:12degree 49:10demented 41:15dementia 23:8depart 13:21department 1:1

27:18 28:14 29:229:11 78:10 86:8105:5 118:8

departure 84:3dependent 122:6dependents 89:4

92:19 93:7,8,1194:22 96:10 97:7105:7

Depending 123:20depends 72:2deploy 31:6Desert 11:2design 22:3 31:19

32:6 49:21designated 2:2

12:15 17:4,7146:21

designed 51:2159:13 135:11

desk 89:22destroyed 29:21destructive 30:3detail 28:12detailed 49:15determination 59:3determine 118:8

122:16develop 43:16developed 24:17

43:8 70:22developer 90:14developing 30:9

37:12

development 18:538:12

devoted 32:1550:16

DFO 12:19dial 103:9DIC 47:22 95:11

106:7,22 107:8,8died 95:6,8diem 84:11,12,13dies 106:1dieticians 18:17difference 84:15

108:13different 10:10

16:10 22:7 23:123:14 25:17,2135:1 36:18 50:1473:10 74:15 80:13117:11 135:15138:1 144:7

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28:2 56:7 68:788:1,2 128:16

Director's 27:14directors 87:22

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98:13disability 28:17

47:15,22 92:1495:9 97:3,11,1497:16 99:6,17101:18 108:5

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discharge 63:9,12discharged 53:20disclosure 121:20

121:22 123:9128:10

discuss 123:15discussing 13:8

117:3discussion 3:6,8

3:10,12,14,1699:13

disease 97:1498:12

dismiss 148:9disorder 37:15 43:9

43:9 45:21disseminate 46:4distinction 131:11distinguished

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69:14 76:7doctors 53:15,17

55:1 59:19,1962:6 63:13 69:876:9,11

documentation63:3

documented 95:21documents 64:8DoD 107:2 114:22doing 15:14 18:13

20:14 27:17 29:1735:2,20 37:1840:2 41:3 45:1845:20 53:22 56:556:13 57:8 63:870:7,20 72:1074:10 75:5,6,9,1176:9 77:8 85:1686:9 90:19 96:21107:17 113:1


157

120:6,17 135:2,5144:21 145:21

dollars 81:2dominant 24:19door 41:1 51:3dotted 97:21dozen 32:11Dr 2:3,4,6,7,7 3:5,7

3:9,11,15 5:12 8:29:17 10:13 13:215:1,3,4,12 19:1824:11 25:15 26:1226:16,19 27:1,427:10,13 28:4,1928:22 30:2,16,1730:22 40:10 44:2145:2,5,12,16 47:847:9 48:8,12,1649:7,20 50:11,1551:13 52:7,1053:8 55:20 59:662:18 64:1,5,1664:22 65:6 66:766:11 68:1,5,1268:16,19,22 70:270:3 75:17,2076:7,16,19,2277:7,8,11 78:1783:7,22 84:9,1284:19 85:13 86:3101:11,19 102:3,4102:7,8,12,13103:7,12,20 104:4104:7 107:4,18108:21 109:2,5,13109:18 110:18,22111:8,12,14,18112:3,6,12,17114:10,15,17

draft 85:15dragged 41:13draw 60:12dress 4:21drill 148:7drilled 43:4drive 83:17drop 105:20 149:13

149:18 150:4

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128:17 133:14,14134:17 144:19

employees 119:14119:15 122:3124:22 125:3,11132:19

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encompassing74:19

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146:15engaged 36:4

49:22 146:12,18engaging 50:19England 42:7enjoy 11:18 147:19enjoyed 10:9 12:10enjoying 9:20 12:2

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evaluate 137:2evaluation 28:15

49:10event 95:4


158

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38:16 57:14 83:1389:6

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118:18 121:15,20121:22 122:5126:10,11 127:18

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financially 79:10124:8 127:4,5144:4

find 36:10 46:1350:3,18 117:19121:14 132:4136:5 142:12146:5

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74:18


159

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29:6 30:11 46:20folder 90:1,3 93:18folders 90:4 91:7folks 6:4 14:3 34:12

124:11 126:13131:6

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followed 55:19,19following 11:1 65:9food 5:17foot 20:2Force 31:4 80:10

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146:3,4,6foremost 50:2

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formulating 85:13forth 68:10 91:7fortunately 37:11forward 7:21 13:17

55:9 71:22 72:4135:7

found 36:19 73:581:5 124:17 135:9

four 55:22 81:2286:12 97:22 103:4

FPOW 8:2,5 27:1527:18,21 28:1347:10 49:15,1868:3,18 69:10,1369:14 78:19 87:1487:20 93:18

FPOWs 26:15 27:328:5 30:13 47:1487:14,17 89:1092:14 93:3

fragment 66:13frail 16:7 23:8framework 33:10Franklin 95:4,5fraudulently 112:22

113:7free 83:13 89:6

104:5,7Freedom 11:2frequently 31:8friend 51:3friends 42:6front 108:20FTE 61:3,5fulfilling 139:14full 108:6full-service 70:13

76:6full-time 105:15fun 86:11function 16:2 41:20

51:17 102:17fund 80:18 81:2funded 79:12funding 79:11fundraising 144:17

144:18funds 79:16 80:10

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99:22 100:1121:12 128:20

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78:4 79:13 119:14122:3 125:3,11126:8,14 133:11137:10,18 141:14141:17 143:7144:18 145:6,9146:12

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37:11 39:19 61:2166:10 80:13 116:1116:10 119:8120:9 148:3

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115:22 116:4123:10 142:3148:1,2

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13:2 76:16 77:777:11 83:22 84:984:12,19 101:11101:12 102:3,7,12103:7

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half 99:1half- 84:15half-day 57:11hall 88:5halls 96:9hand 33:15,16

147:14handle 93:20handout 28:10

119:6handouts 91:12

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70:16 81:10 99:7happens 92:5

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24:2 73:5 102:15116:6,7

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70:14 72:13 75:1287:3 98:12 101:3102:21

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16:8 18:19 19:1119:21 20:17,22

21:11 23:21 24:625:1 30:11 36:254:14 59:9 96:1896:21,22 118:22124:11 127:15

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120:8 136:18142:14

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73:13higher 28:16 65:10

108:7highly 115:17hinterland 49:16hinterlands 71:3HIPAA 77:15hire 73:11hiring 66:16history 91:22hold 123:1 140:18holding 118:18

121:15holdings 121:18

122:5,5 127:22home 11:8 16:19,20

16:22 17:2,3,6,1417:21 18:3,2219:1,8,8,10,2120:2,15,19 22:423:11,18 24:12,1424:17,19 25:3,1125:18 26:8,1830:5 39:14 45:1845:22 53:11 57:1778:12

home-based 17:1017:15,16 18:820:20 21:2 26:20

homebound 17:5,7homeless 6:10,16


161

90:12 93:21,2194:1

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142:15hope 31:19 148:2hopefully 19:11

52:14,15 62:1115:22

hoping 27:22 115:8horrible 95:7hospice 21:6hospitable 12:12hospital 11:17

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58:16 74:12,1390:21

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25:12 57:5 58:14

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44:7 46:3 63:788:18 89:8 92:1294:2,4 95:8 113:8113:15 117:13,17117:18 119:4122:15 141:8143:11

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32:12 39:7 53:5

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63:22inquiries 93:22inquiring 93:8inside 92:22inspection 40:15installed 60:7institution 105:10institutional 22:1instrumentation

45:1insurance 97:6intake 90:6integration 35:6integrity 133:6

134:12,12,13intense 42:3interact 35:11interaction 46:11interest 116:17

122:17,22 123:7123:16 124:10,16125:20 126:3,11127:8 130:18131:12 132:6135:9 136:1 137:3

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interfere 7:13internal 77:14intervene 34:19interventional 76:2interviewing 73:12introduce 6:4 8:19

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137:11Introductions 3:4invasion 41:22 42:1


162

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issues 20:12 21:1528:13 35:14 36:248:11 49:15 77:583:12 126:5129:13 133:7140:11

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knowing 82:22133:2

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19:18 52:10,1162:18 64:1,5,1664:22 65:6 66:766:11 68:1,5,1268:16,19,22 70:376:7,19,22

Lane 1:16 5:7 11:427:12,13 68:2

large 5:5 37:1larger 37:4latest 60:1laughing 115:7law 11:10 28:2


163

laws 124:14 145:2leader 11:7leapfrog 42:1learning 32:4 36:17

47:5lease 51:16leave 135:13 136:2

136:4,14 137:8148:13,20

leaves 22:10leaving 62:8 74:14left 33:15 61:10

62:13 94:21legislative 108:18legislature 11:10Leslie 2:2 7:1,22

12:15 78:9 79:1580:8 81:19 83:13116:8 148:6

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65:12 67:12 78:185:3 101:12 120:5120:12,21 131:1138:19 145:17

letter 95:9,22 96:2102:6

level 19:1 34:1939:11 81:11

levels 19:7lieutenant 86:16life 21:8 47:19

86:21 87:7,1497:6

lifetime 137:12,12137:14,17

likes 66:20limit 80:19limitation 39:16limitations 39:17limited 26:4limits 82:12line 60:18 65:22

86:1 97:22 115:4lining 126:14linings 30:4link 145:20linked 130:6

list 94:7,19 109:14110:15,18 111:19112:19 113:2,4114:18,18 122:4129:7

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22:6 55:20 95:2load 117:22loan 86:8 97:5local 39:10located 69:2location 64:19

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17:16 40:11 41:544:14 78:15 98:6102:6 129:17144:19

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15:14 16:19 18:1274:17 86:15 95:5105:5,5,8,11

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164

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mentioned 26:1326:14 52:21 58:1162:4 78:17 110:14137:8 146:9

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107:14Mike 52:11miles 40:22 83:18military 51:10 71:2

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121:16 124:5135:7 145:1

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74:17misuse 140:13,15

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80:6,12,14,17,2181:5,8 104:8105:22 108:14

Montgomery 9:4month 88:8 104:19

105:1,19 106:3109:21 110:4,10

months 27:20 42:351:14 55:18,2275:9,10 82:10

Moore 1:19 5:1210:19,19 82:2111:17,22 112:5,9114:17,17,21

morning 6:8,11,139:18 10:12 11:412:14,21 30:2252:10 70:2 77:20

mother 87:8move 7:21 58:7

60:14 68:10 69:171:10 72:12 76:1076:12 134:22135:7

moved 4:10moving 23:17

27:14 55:9 71:2272:4 108:13

Mulatte's 4:20multi-disciplinary

69:3multiple 65:14 69:7

69:8museum 4:11

148:9 149:14,19150:6

music 5:21 6:1

NN 3:1,1name 7:12 9:5

11:20 52:10112:18,19 115:13146:22

names 112:17,19Napoleon 11:6national 61:11 65:7

66:1,8 86:15native 52:14 53:8nature 48:15 118:7

132:1 139:2,3Navy 10:14,20near 7:16nearest 32:20nears 29:5necessarily 130:7

141:4necessary 29:16

72:12necessitated 29:19necessity 54:10need 5:4 13:6 18:1

19:12 20:10 28:630:7 32:5 33:134:4,5 37:5 47:1454:3,4 57:1558:22 59:8,1563:12 65:20 71:1672:8 73:21 74:878:5 80:21 82:2185:11 89:3 100:10102:1,14 107:20


165

109:19 117:20124:10 139:11141:10 148:15

needed 15:18 18:163:9 67:20 68:1372:13 87:20

needs 17:1 20:6,1020:22 21:9,1222:11 28:5 30:1231:20 36:14 46:1257:5 58:18 127:16

negotiating 128:19neighborhoods

22:5network 39:12 44:8networking 34:16neuropsychologist

10:20neurosurgery

73:14never 20:2 40:21

41:18 42:9,13,1465:15

nevertheless 132:1new 1:12 4:20 11:5

14:20 15:16,2121:18 24:8 29:1730:9 31:17 32:1037:2 39:2,8 51:1952:13,14 53:854:11 66:3 67:871:10 73:8 80:2183:8 87:21 91:193:4,5 114:13

newest 147:3news 77:7nexus 130:5,12

131:13,14nice 11:3 28:11

41:9 60:18nicely 24:18Nicholls 105:16night 41:16 58:17

111:4nightmares 41:19nine 128:4nobility 145:5non- 52:1 141:7,9

143:10non-federal 130:19non-surgical 53:2noon 4:10 14:1normally 14:4,6,12

15:7note 121:8notes 7:13,17 63:13noticed 80:19notify 141:11number 37:1,4

65:18 89:10110:14 111:7114:21 117:4,7119:9 121:18128:4 129:4 132:6132:12 134:21135:9 144:8,11147:4

numbers 65:10,1765:22 66:12 72:7100:14

nurse 18:14 22:922:10,14

nurses 18:15 20:1555:1 62:7

nursing 21:21 74:9

OO 3:1obviously 71:9occasion 144:13occupational 18:16occur 103:9occurring 14:17October 79:3,5OEF/OIF 46:5offer 35:8 56:2,5

59:5,10 69:11,16120:20

offered 143:5145:13

offering 57:9offerings 33:14

39:3 45:7office 12:17 14:8,13

14:21 55:2 77:979:1 81:16 83:9

86:4,7 89:9106:19 115:5,15117:7 132:9133:11 146:22

officer 2:2 12:16106:14 126:8128:16

officer's 79:1official 121:9

141:22 142:7143:3 146:22

officially 8:4officials 147:1offset 107:6,6

108:3oh 8:20 12:18 26:19

28:19 77:10 109:9113:11 114:20138:8 149:10

OIF/OEF 29:3 90:13112:15

ointment 106:22okay 8:9,20 13:4

14:2 15:12 26:1726:22 27:7 41:565:12 67:10 69:1076:21 77:19 79:2080:4 81:9 82:1,1684:20 85:8,16,2297:2 103:8 104:3104:6 112:10114:20 116:10,13119:7,8 122:21125:19 129:2130:19 131:9132:14 134:8,15135:18 138:19141:7 144:2,16147:11 149:12,21

Oklahoma 73:19old 66:22 76:22

86:22 93:17 102:5114:1

older 15:18,21 16:116:6,14,15 19:1319:15 40:7 44:1747:12

once 14:13,14

65:11 79:14 88:891:2 93:15 100:12100:15 101:20102:16 106:12108:12 136:4

one-off 14:9ones 16:5 19:15

46:6 108:21114:13

online 27:15 47:1063:17

onsite 75:21open 32:12 51:4,20

55:18,22 71:19,2172:12 75:11 76:1139:10

opened 55:1487:13

opening 72:11operate 58:10 71:5

79:9 81:12operating 72:6 79:4

79:7operation 42:12

58:8operational 60:7operations 74:2opportunities

31:16 34:2 36:1060:15 65:2

opportunity 4:1515:17 25:20 30:830:18 35:22 48:1060:4

opposed 47:3opposite 135:15optics 133:7,15

134:7,11,18optimize 16:3order 7:21 32:8

38:10 129:5orders 53:19organization 109:2

118:17 123:4,5124:9 128:15,21129:1 131:15,18135:14,16 136:9136:11 137:21


166

138:8,16,17 140:7145:17

organizations108:15 143:21

organize 28:2Orleanian 52:14

53:8Orleans 1:12 4:21

11:5 15:21 24:929:18 31:17 32:1037:2 39:2,8 52:1487:21 91:1

ORs 71:1 72:3orthopedics 73:14outlier 82:19outlying 49:8outpatient 22:20

39:4 49:5,16,1851:20 55:12 56:456:22 57:3,7,1070:19 71:11 75:6

outreach 29:745:19 88:3 91:1891:21 96:14,15,21

outside 17:1 51:9122:4,7 125:18,19127:13 131:17135:4,13,16145:16

overall 34:9 131:3139:4

overarching 119:11139:15

overnight 85:14oversees 19:19owned 78:7


4:1p.m 150:8packets 4:13page 3:2 33:9 38:10

119:6 140:13paid 78:1 106:15

107:21 135:4palliative 21:6

22:21 23:2

pamphlet 91:17panel 81:20paper 89:17paperwork 91:5paramount 46:16Pardon 6:14parents 25:10part 8:5 29:6 54:20

55:8 61:20 65:866:11,19 68:1773:7 74:17 76:1287:6 108:16 123:3127:17 143:2,16145:14,14,17

partial 107:13PARTICIPANT 8:4

8:12 30:20 77:1077:15,17 110:12111:9,11

participate 68:13108:19 125:8,12125:13 126:7130:16,20

participation 54:22particular 117:3

118:19 123:1126:9,12,19 129:3129:6,8 130:14,17134:1 137:15,18138:10,18

particularly 7:429:13 31:8

parties 127:1partisan 125:9,12

125:14 146:15partner 128:17partner's 128:14partnership 128:14Partridge 91:7party 129:12

137:16 140:16Paso 51:7pass 7:17passed 25:10 91:12

98:7passionate 15:20

25:8patient 34:22 40:21

41:8 54:2 57:5,1358:19,20,21 59:265:3,4 72:1177:17

patient-driven 22:1patients 22:22

56:18 58:3 59:1362:22 63:1,265:13,19 66:3,574:20

patrimonious42:11

pay 5:13 78:7 98:17101:7 107:9,10108:18 115:6120:20,21 123:10

payback 107:13payment 142:6,16payments 106:10penalized 107:1pending 89:10Pensacola 9:14

10:22pension 1:3 107:9

109:11,18,19,20109:21 110:2,10

people 7:5 8:15,209:11 10:11 15:915:17,21 16:1318:9 19:11,13,1519:21 20:1,9,1721:3,3,7 24:1431:21 32:4 33:234:4 36:1 41:1842:20 44:9 47:256:4 57:10 59:961:6,7,8,10,1562:8 64:5 65:1166:15,17,18 67:167:4 73:13,1580:11 87:4 90:891:18 96:10 97:1998:16 101:22110:15 112:22113:6,18,22 114:1114:5 127:2 134:3135:11

peoples' 16:3

percent 47:16,2187:2 95:13,1598:14,21,22 99:299:2 100:10,14,19100:20,21,22101:1,2,3,4,4,8,13101:15,16,18,21101:21,22 102:1,2102:5,9,14,16,18102:20,22 103:3103:17,17,22104:15,16 105:8106:18 108:7112:5,6

percentage 26:1727:2

percentages106:13

perfect 30:14permanent 99:14

99:16,20 100:5,8permissible 132:21

133:16 134:10136:13,16

Persian 94:19person 16:15 58:19

58:22 61:6 113:16120:19 129:1133:1,4 134:11138:2,3 140:7144:20

person's 122:13personal 25:19

26:5 141:1personally 44:11

47:3 126:7,16personnel 27:16

35:7 36:11perspective 34:9pertain 121:19phase 58:7 75:4Philippines 12:1phone 78:14

118:21 127:9138:5 146:6 147:4

phones 7:18photographed 77:8phrase 33:11 36:7


167

physical 18:1539:16 98:7

physically63:16physician 10:14

40:19 58:18physicians 18:13

20:16 35:10pick 118:21 127:9

138:5 146:6picture 78:14piece 126:21piecemealing 60:3pieces 60:3Pierre 2:4 6:13,14pilots 37:14place 14:7,21 16:2

19:6 23:18,1849:9 61:19 62:373:17 74:15125:17

places 10:10 19:1437:8 80:13

plan 43:16planned 79:19planning 54:11plans 49:21plate 71:15platoon 11:7please 6:7 7:8,11

15:3 78:8,8 79:1483:13

pleasure 84:22Pledge 4:7pledging 4:6plot 92:20plus 7:14pocket 92:8 126:15point 42:19 43:5

47:9 49:13 50:1771:12 73:22 74:976:3 104:20 117:3127:1,2

pointed 34:7points 140:9policies 120:18policy 129:9,11,17

130:21 131:6135:20

political 125:9,12125:14 146:15,17

population 27:929:4 40:7 44:1793:9

Porter 2:5 6:11,12portion 27:9 76:1pose 124:9position 136:10

140:2,14,15 143:5positions 61:9

122:4positive 96:7possibility 82:20

121:2possible 19:22

39:11 56:19 57:669:1 78:21 79:15118:20 129:15

possibly 38:5 126:5137:2

post-acute 17:18post-deployment

31:13post-government

137:7post-traumatic

37:14 43:8,945:21

potential 122:17,22123:16

POW 6:3 12:6 28:1688:16 90:1,3,1290:15 93:4,9,1293:12,16 94:5,12102:18 109:20110:12,19 113:19113:22

PowerPoint 116:5POWs 6:6 8:6,7

26:21 27:1 28:334:11 89:13,1592:16 94:1,1999:8 110:15,16

practice 22:18practices 22:7practicing 10:5

77:11

practitioners 18:1435:9

pre- 57:3pre-Katrina 53:8

54:8precipice 55:10precise 13:1predictable 130:4predictably 126:10preface 141:3preference 22:12preferences 21:13

24:4preferential 140:6preliminary 83:1premise 119:12

139:4prep 56:16presence 35:4

88:22present 1:15 2:1

36:1,1 50:4121:11

presentation 3:5,73:9,11,13,15,1725:7 89:7 116:5117:9

presenting 115:19Presently 6:9presents 57:13presiding 1:13presumptive 92:15pretty 8:12 15:15

26:9 38:11 46:252:17,18 58:1560:12,18 61:470:16 90:16 94:15

prevent 126:13135:11 144:1

prevention 46:19previous 31:22previously 6:16

10:17 114:22Prieur 2:5 3:13 77:6

77:20 79:21 80:380:5,8 81:13,1982:1,7,16 83:4,1984:5,10,18,21

primarily 53:5primary 17:10,15

17:16 18:8 20:2021:1,2 26:2034:19 35:3,5,5,845:6 46:20 67:669:13

principal 146:4principles 139:19print 111:4prior 81:19prisoner 10:6,15

11:22 29:7 51:2prisoners 1:5 9:2

9:11 11:1 29:3109:10

privacy 46:9private 7:16 105:10

105:17 120:5121:4 140:2,3

privately 78:6proactive 16:22probably 5:13 16:5

16:12 33:10 46:1049:17 54:8 61:7,971:20 74:5 75:1075:22 99:7,9,19102:13 112:3117:5 132:14,14141:11

problem 14:1851:18 64:20,2173:6 107:12129:18 131:9,21131:21 144:3

problems 15:1017:12 28:14 53:1081:11 87:5

procedure 57:2259:12

procedures 58:272:10,20,21 75:10

proceed 43:19 86:1120:12

process 14:7 54:2265:9,12 66:1673:12

profusely 83:11


168

program 12:1617:10,11,14,1718:1,6,21 20:1824:12,21 25:1127:21 50:9 53:1164:2 73:8,19 75:1134:13

programs 17:2125:16,17

progress 13:9prohibited 133:18

134:3,4,22 135:1135:22 144:15

prohibition 137:6prohibits 145:4promptly 103:10property 141:14

146:19proposing 120:18prove 74:6provide 26:4 49:10

49:12 53:18 56:1056:12,21 57:2,1660:8 62:6 69:20116:8 136:19143:17 147:10

provided 131:8133:21

providers 23:1439:13 44:9

provides 16:20118:2

psychiatric 32:1245:19

psychiatrist 31:240:19 41:12 45:748:14

psychologist 18:15psychologists

48:17psychosocial 39:5

39:6psychotherapy

45:20PTSD 6:12 47:13,18

98:12public 7:10 28:2

139:5,6,7,11,13

141:8,10 143:11publish 46:3pull 63:10 71:22

74:10 91:4,10107:19

pulling 90:14 96:9pulls 93:18pulmonary 53:3purchase 80:19pure 22:8purge 112:13purpose 126:12purposes 141:15push 36:5 39:10pushed 109:3pushing 91:5put 45:11 51:9

53:19 63:14 67:1267:15 89:22 92:492:14 103:5108:19 113:20117:22

puts 19:1 113:16133:13 134:17

putting 62:3 72:1191:3

QQTC 90:20qualifies 92:18qualifying 130:18quality 21:10Quarles 1:19 9:17

9:18,19 26:12,1326:14,17,22 27:227:7 65:1,1 66:666:10 84:7 85:13103:19,21 104:3,6112:20 113:10

quarters 51:2,5,11question 25:9 48:4

51:14 67:21 84:184:19 116:20,22117:15 133:4,4134:8,11 140:21142:22,22 149:9

questions 30:1640:3 62:14 75:15

77:2 83:14 84:2188:16 89:7 91:11109:5 116:19147:11,14

quick 68:3quickly 19:22 36:4

52:5 83:6 94:15quite 16:21 20:18

136:19

Rraise 116:21 117:2raised 81:3raises 49:13ran 89:9 110:19range 56:3rapidly 41:20rarely 79:2rate 101:8rated 29:8 98:13

104:15 106:12108:7

rater 90:13rates 103:13,15

106:10rating 95:21 98:15

98:15,21,21,2299:21 100:20102:2,5,18

ratings 98:14 100:6reach 36:21 37:5

39:9 117:12,21118:22 129:22132:2 136:12,17136:17 137:4142:17,18 146:7147:5,7

reaching 88:4139:4

read 92:13 99:21126:1

reading 116:17ready 55:17,22 72:2

74:1,9real 31:15,16 64:20

123:10realities 32:3really 15:22 16:13

19:3 21:8 22:1524:1 27:5 29:1732:5 34:7 35:4,1535:17 36:20 38:354:9,20 56:7,2063:6 65:18 70:572:13,18 73:2090:9 109:19123:14 125:22129:12 132:18134:18 136:8137:1 138:14145:19 147:18148:1

reason 29:1 88:14122:18

reasonable 133:1,3134:11

reasons 17:6139:10

rebuilding 14:7receipt 145:4receipts 78:5,11receive 26:18 79:8

79:11 104:12109:20 118:3130:8 141:20146:16

received 91:15 95:9receiving 109:11

119:20,22recognize 7:7

29:10Recognizing 43:12recommendation

129:14recommendations

13:9,11,16 85:11reconstitute 82:10record 7:10 38:1,4

38:9 62:16 64:785:19 93:16108:10 150:8

recorder 7:12records 49:3 53:19

90:18recruiting 60:17

73:5


169

recuperated 42:7recusal 132:8recuse 123:7,20

127:12red 89:22 127:6reduce 46:17reduced 106:8reexamination

100:7reference 113:13referral 74:13,16refers 138:22regional 86:4 89:9registered 146:4registration 146:5regular 26:9regularly 28:15regulation 131:22

131:22regulations 125:1,2

125:5 139:1,1regulatory 40:15rehab 39:5,6 97:6rehabilitation 11:9reiterate 70:3related 97:17

140:22relates 141:21

142:7relationship 131:19relax 4:19relaying 94:2relevant 116:15

117:2reliably 47:1relied 118:10relocate 67:9reluctant 5:6remaining 46:18

101:5remarkably 44:17remedied 82:6remember 7:11 9:5

86:22 139:21140:9 141:9

remembering41:17

remind 7:9

remodeled 30:5remotely 63:11reopened 93:6reorienting 38:22rep 90:14repatriated 11:1report 89:9 121:21

121:22 122:1,2,3123:9 128:10

reporter 25:6reports 13:13 122:8

122:10,10,11,18represent 137:9,21

138:5representation

88:11 138:2,4representative

48:22 95:14representing

135:15 136:3137:17,22 138:13140:19 145:18

reps 89:1 95:12repurposed 73:18request 80:16

117:22 147:8require 123:22

134:7required 75:2 103:9

121:20 122:2,3128:9

requires 133:14reservation 5:2,3Reserve 31:4reservists 31:8,9residents 6:12 44:3resolution 79:4,8resolve 108:11

123:17resources 19:5

34:17 37:12 39:1respected 36:14respects 31:18respiratory 62:7respite 25:20respond 43:14response 117:14responsible 53:4

rest 5:12 18:6 43:299:18 108:17

restaurant 5:22restaurants 5:6restrictions 146:14resumed 85:19retire 42:20 86:12retired 10:1,14,20

12:7 31:4 42:1742:18 90:5 106:19108:2

retirement 86:10107:2,10 108:5,6

return 78:12 112:8review 122:9

129:15reviewer 40:19 41:2

44:1ridiculous 110:3right 5:8,11 6:2

12:22 14:4,2216:18 19:4,5,6,1828:18 33:15 34:744:4 45:4,10,1648:7,8,9,11,12,1559:10 62:11 64:1565:7,22 66:2,1568:15 77:3 80:785:2,8,21 86:1288:7 95:22 96:1102:12 107:12109:4 111:20113:15,16,21114:8 115:2,3116:13,22 124:13130:13 131:1138:19 140:17141:19 144:8148:6,22

risk 23:9,12 46:1750:5 58:4

risks 23:5risky 19:14Rivera 56:7 66:20RN 6:9road 74:6Robert 1:13,16,17

8:21 10:21 29:1

119:1Robinson 2:6 3:7

12:19,21 30:20,2231:1 40:10 44:2145:2,5,12,16 47:848:8,12,16 49:749:20 50:11,1551:13 52:7

robots 72:19 73:1role 45:9 68:11,13

120:15roof 38:7 39:18room 1:12 4:4 6:19

7:6 14:6 20:4 54:454:6 72:9,9 81:1783:21 89:20 149:5

rooms 52:1 66:2171:4,5 72:6

ROTC 11:7Rouge 37:7 48:6

49:11rough 85:15Roughly 26:16row 79:12rule 121:3 133:13

133:13,17 134:3rules 77:15 119:10

119:12,19 120:4121:13 132:22133:3 134:6,10

run 53:4 57:22140:11

running 57:2 58:694:18

runs 55:21

SS 3:1sacrifice 52:13 70:5safe 63:8 118:3same-day 36:6 67:4San 9:16 27:19 28:1

28:8 68:6sat 41:7satellite 37:8 45:3

49:9save 70:9saw 90:3 112:18,19


170

saying 19:17 95:10102:6 114:1 127:7141:3

says 17:11 22:1541:2 84:13 96:1113:4 125:8 126:6127:17 135:1137:14 138:9

SBP 107:21scan 64:13scanned 90:6scenes 137:20

138:14,14,15schedule 6:22

14:18 83:2 85:398:16

scheduled 29:957:18 65:14 99:18

scheme 65:17school 11:10

104:12 105:9,11105:15,16,17

schools 60:11105:20

screen 38:17 116:6116:9

se 49:21seamlessly 53:21seats 85:22second 9:20 10:16

12:1 61:13Secretary 11:14

13:12,15 14:1782:20

section 16:20,2021:5,17 49:18,20124:17,18

sections 16:1023:14 50:14 53:173:15 130:13,16

secure 148:13security 46:9 110:1

110:1,8see 4:19 20:13

23:17 28:9,1631:14 37:3 38:1348:13 55:12 57:1558:20 61:17,22

62:1 69:13 70:683:5 90:15 93:1894:11 101:8103:16 122:15,16122:22 127:10130:8,11 143:11145:13 147:13,22

seeing 52:16123:22

seeking 121:6seeks 133:20seen 4:18 40:21

57:14,20 62:169:7 100:6

segment 49:6Senator 107:16send 13:17 54:5

56:18 64:12 67:782:4 138:7 147:8

sending 32:19 33:4sent 11:9 35:13

138:7separate 49:18

98:19separation 98:17September 78:22

79:5 80:1servants 139:8serve 26:14 97:22

120:8 128:16139:21 141:5142:5

served 11:10 41:2292:2

service 1:3 30:1230:21 39:13 52:1252:22 53:4,13,1754:7 55:16 56:1256:14 57:2,1758:9 61:3 70:471:15 87:2,1290:14 95:8,1097:10,13,13 99:3106:2,18 110:5119:21 139:6143:8 145:21147:18

service-connected

92:16services 6:15 16:21

17:3 20:21 23:124:6,21 25:145:19 56:3 57:1158:7,10 59:5,1167:19 68:7,1571:7 76:10 88:6

serving 17:2218:11 86:16119:16 140:5,14143:14

session 40:20set 20:2 24:13,21

24:22 28:10 53:1662:19,21 107:10

setting 19:2 27:1535:12 56:22

settings 35:5seven 49:5 66:4

86:22 103:10124:14

seventh 71:8sheet 84:13 92:15Shelton 77:8shifts 22:9Shirley 1:19 9:19

26:14 65:1shoes 150:5shoot 127:10shopping 25:22

88:13Shoshona 1:18

12:5 50:22shot 44:12show 4:22 40:13

52:5 55:10,1356:1 61:1 90:195:22 138:2

showed 65:15showing 112:12shown 38:20 46:15Shreveport 32:21

37:17 40:12,2296:20

shuttle 13:6siblings 87:8side 7:13,19 81:7

sides 136:2 137:6,9137:13

sideways 15:9sign 78:8signal 44:4signed 77:18 97:21signs 20:6silent 7:18silver 30:4similar 47:9 69:9Simultaneous

111:21simultaneously

32:9Sinceno 2:6 3:15

86:2,3,4 101:19102:4,8,13 103:12103:20 104:4,7107:4,18 108:21109:2,5,13,18110:18,22 111:8111:12,14,18112:3,6,12,17114:10,15

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In the matter of:

Before:

Date:

Place:




----------------------- Court Reporter

177

Former Prisoners of War AdvisoryCommittee Spring Meeting


05-18-17

New Orleans, LA

Robert G. CertainChairman


1


+ + + + +

ADVISORY COMMITTEE ON FORMER PRISONERS OF WAR

+ + + + +

BIANNUAL MEETING

+ + + + +

FRIDAY MAY 19, 2017

+ + + + +

The Committee met in the SoutheastLouisiana V.A. Medical Center, Room 1Q115, 2400Canal Street, New Orleans, Louisiana, at 9:00a.m., Rev. Robert Certain, Chairman, presiding.

PRESENT

REV. ROBERT CERTAIN, D. Min., ChairLANE CARSON, MemberHARRY CORRE, MemberROBERT HAIN, MemberSHOSHONA JOHNSON, MemberHAL KUSHNER, Member

JEFFREY MOORE, Member

SHIRLEY QUARLES, Member


2

ALSO PRESENT

LESLIE WILLIAMS, Designated Federal Officer

DR. ERNEST SNEED, New Orleans Medical Center

LA'TOYA PRIEUR, Department of Veterans Affairs

DR. LUMIE KAWASAKI, Chief of Geriatrics and

Extended Care, New Orleans V.A. Medical

Center

DR. DEAN ROBINSON, Chief of Mental Health,

New Orleans V.A. Medical Center

DR. MICHAEL LANDRY, Chief of Medicine,

New Orleans V.A. Medical Center

DR. JAMES SMITH, Chief of Surgery, New Orleans

V.A. Medical Center

ANTHONY SMITH

JOSEPH SINCENO, VOC


3

CONTENTS

Opening Remarks. . . . . . . . . . . . . . . . . . 4

Discussion and Vote on Next Meeting Date

and Location . . . . . . . . . . . . . . . . . . . 7

Discussion of 2017 Recommendations . . . . . . . .44

Open Discussion. . . . . . . . . . . . . . . . . .66

Adjourn. . . . . . . . . . . . . . . . . . . . . .68


4


2 (9:02 a.m.)

3 CHAIR CERTAIN: All right, everybody.

4 It's 9 o'clock, and let's do, again, if you can,

5 stand and let's pledge allegiance and then we'll

6 get under way.

7 (Pledge)

8 All right. For this last little while

9 together this morning, and I think we're not

10 going to be here all that long, my proposal is

11 that we find out from Leslie -- we're going to

12 get -- Joe Milligan has actually been listening

13 both days, but he said he -- I got an email from

14 him this morning, he said, but every time I try

15 to speak, I don't get any response, so we weren't

16 hearing him, but he was hearing us, and so he has

17 been a full participant, if you will, to both --

18 on both days, and he was intending to call-in

19 this morning and maybe we can figure out how to

20 make that work so that we can hear him.

21 We need to look at our calendars to

22 find a date for our final meeting of this fiscal


5

1 year. Leslie has travel obligations, others,

2 obviously, have other obligations, and so we may

3 have to recognize we'll be not everybody present

4 next time, then decide on a primary location, and

5 a backup in case the primary doesn't work out,

6 either because they can't receive us or because

7 of budget issues.

8 And then we'll get a report from

9 Leslie about where our two sets of

10 recommendations are, 2016 set, which I think are

11 in the Secretary's office, that got there just as

12 the new administration was coming onboard, and so

13 it didn't get signed, and the new Secretary's

14 probably up to his eyeballs in alligators, and

15 hasn't gotten to them yet either.

16 And then the other set, we'll find

17 out, from January, is -- I will tell you that

18 from what Leslie's told me already, it's gone a

19 lot further a lot faster than anything we've done

20 in several years, so that's good.

21 And then if we can get out of here

22 sooner than 11:00, then we'll get out of here


6

1 sooner than 11:00. We've been asked that any

2 recommendations that we identify from this one,

3 we just put on hold, and merge them in with the

4 next -- after the next meeting, so that they

5 don't have another set going through at the same

6 time.

7 And I think the other thing that I've

8 tried to do, or committed to do, is that, we

9 don't repeat ourselves. If we have a set that's

10 pending, we don't redo something and enter it

11 again. And if something has been reject two or

12 three times already, not to beat that dead horse

13 again until people have forgotten they rejected

14 it or we come up with better arguments for why

15 they should pay attention to us.

16 All right. And Joe's roofers are

17 there today, so he may or may not be able to

18 hear. Do you have his cell number, you could

19 send him a text or?

20 MS. WILLIAMS: I do.

21 CHAIR CERTAIN: Okay. Let's send him

22 a text and say, good luck. Okay. What shall we


7

1 start with first, Leslie?

2 MS. WILLIAMS: Maybe selecting the

3 dates for the next conference, and the reason

4 being is because all of my management is meeting

5 today, so this will be a good opportunity for me

6 to shoot them a courtesy text with the dates, and

7 they can discuss it while they're meeting.

8 CHAIR CERTAIN: Okay. So I ask you to

9 look from August the 15th to September the 15th,

10 and I know that, right off the board, that Dr.

11 Kushner and Dr. Quarles both have concerns about

12 August. And Leslie has travel requirements in

13 September.


15 CHAIR CERTAIN: So let's get those on

16 since we can't meet without the DFO.

17 COL. KUSHNER: Well, me, personally,

18 I haven't taken any time in September and I can't

19 do August.

20 MS. WILLIAMS: Okay. So no time in

21 August?

22 MS. QUARLES: In fact, for me, Leslie


8

1 and Bob, I am open the last week of August,

2 around September, and so just the last week in

3 August is when I start availability.

4 MS. WILLIAMS: Okay. So I believe --

5 CHAIR CERTAIN: Leslie and I tended to

6 look at August 8 through 10; 8 through 11.

7 MS. QUARLES: August?

8 CHAIR CERTAIN: As a tentative date to

9 work for her.

10 MS. QUARLES: Okay. So, Leslie, what

11 doesn't work for you in September?

12 MS. WILLIAMS: I am about to tell you

13 right now. I'm trying to find the slide that

14 La'Toya used, because it has all the travel

15 coming up.

16 CHAIR CERTAIN: Well, while she's

17 waiting for that, who's got dates that are

18 unavailable on your calendars?

19 MR. CARSON: I'm good.

20 MS. WILLIAMS: Eric, can you do me a

21 favor? Can you pull out the dates?

22 CHAIR CERTAIN: You're good. Harry?


9

1 MR. CORRE: I'm good any time.

2 CHAIR CERTAIN: Shoshona?

3 MS. JOHNSON: I'm good.

4 CHAIR CERTAIN: It'll be your last

5 meeting, you know?

6 MS. JOHNSON: Yes, I know. I've been

7 saying for the last two months.

8 CHAIR CERTAIN: And August is

9 completely out for you, but you're available

10 starting when?

11 COL. KUSHNER: 1 September.

12 MS. WILLIAMS: 1 September?

13 MR. MOORE: I'm good.

14 CHAIR CERTAIN: And you're a Navy.

15 MR. MOORE: I'd like to say the longer

16 that we give DoD and VA a chance to work out the

17 schedule, the better, but it's been 15 years, so

18 I'm not sure that that's a valid statement on my

19 part.

20 DR. HAIN: Why don't we just try -- I

21 would propose 6, 7, 8 September, and see if that

22 would work for everybody. It's the first full


10

1 week in September?

2 MS. QUARLES: You'll find that

3 Leslie's been set.

4 COL. KUSHNER: I'll vote for that.

5 MS. WILLIAMS: Actually, so I will be

6 on travel the last week of August. The last week

7 of August and -- the beginning of August and the

8 last week of August.

9 CHAIR CERTAIN: What do you mean, the

10 beginning of August?

11 MS. WILLIAMS: So I will be on travel

12 to August 2nd, and then after that, my next

13 travel dates are going to be the 26th through

14 September 1st.

15 CHAIR CERTAIN: Okay. So September 5

16 or 6, what did you say? We need three dates,

17 right, 6 through 8?

18 DR. HAIN: 6 through 8 for the

19 meeting, travel on 5 and 8.

20 MS. QUARLES: Is that workable,

21 Leslie?

22 MS. WILLIAMS: Yes. For me, it works.


11

1 MS. QUARLES: Does that work for you,

2 Eric?

3 (Off mic comments)

4 MS. QUARLES: So traveling 5 and 8.

5 MS. WILLIAMS: Correct. So the other

6 thing, I know we were looking at having the next

7 meeting San Francisco, so right now, due to

8 budget constraints, we are considering alternate

9 locations, so I did some research on my own. I

10 looked at Atlanta, Pensacola, Florida, in fact,

11 my sister and I did a cost comparison, are there

12 any other sites that the committee is interested

13 in traveling to or feel that we need to travel

14 to?

15 DR. HAIN: You know, Orlando has a

16 brand new VA.

17 MS. WILLIAMS: Oh, Orlando?

18 DR. HAIN: That might be something

19 worth seeing.

20 CHAIR CERTAIN: Well, I was just

21 talking to Jeff, Jeff Moragne, who sends his

22 greetings, by the way, who's sorry he couldn't


12

1 make it out here, and Jeff --

2 (Off mic comments)

3 I forgot what I was saying. Harry,

4 you did this to me again.

5 MR. CORRE: I'm sorry.

6 CHAIR CERTAIN: Oh, Jeff sends his

7 greetings. His recommendation is that we go to

8 places that are troubled because he thinks that

9 we have the insight to help.

10 COL. KUSHNER: Does he recommend any

11 specific VA?

12 CHAIR CERTAIN: No, he just said --

13 we've been to two really good places now in a

14 row.

15 MS. QUARLES: Is San Francisco having

16 issues, Bob?

17 CHAIR CERTAIN: That's why they were

18 on the list before.

19 MS. QUARLES: Yes.

20 CHAIR CERTAIN: Atlanta has a new

21 director and they're in turmoil.

22 MS. QUARLES: So Atlanta is a great


13

1 VA, however, their director is relatively new.

2 She's not been there a year yet, she's trying to

3 get her feet wet, and that is a hotbed of

4 everything.

5 CHAIR CERTAIN: And she came out of

6 Detroit, so she's worked with Fletcher a long

7 time, so she knows how to deal with hotbed

8 issues.

9 MS. QUARLES: And she's Air Force, by

10 the way.

11 CHAIR CERTAIN: So my experience in

12 Atlanta was that I suspected that the so-called -

13 - the doctor that I was seeing was not truly a

14 POW-trained physician, because they didn't answer

15 the questions that I asked in a way that I felt

16 they were confident with in their answer, and

17 that the POW advocate there never returned my

18 phone calls in ten years.

19 I think she knew who I was and that's

20 why she didn't do it. So I think that's a

21 difficult space and whether or not we want to

22 intrude on the administrator, but that's one


14

1 reason that's on the list, is because it's not a

2 well-run POW situation, and there are lots of us

3 in the area.

4 And Pensacola, well, those of us in

5 the non-POW group have been there so many times--

6 DR. HAIN: Well, it's not a hospital.

7 It's not a VA hospital.

8 CHAIR CERTAIN: Yes, it's a clinic.

9 DR. HAIN: Now, Biloxi is not too far

10 from there. I don't know what the reputation --

11 MR. MOORE: That's a pretty good

12 place.

13 DR. HAIN: -- of Biloxi is.

14 MS. QUARLES: It has a CBOC there?

15 MR. MOORE: A clinic.

16 DR. HAIN: Biloxi has a hospital in

17 the regional office and a regional office is

18 there. How serious are the budgetary constraints

19 we're talking about here?

20 MS. WILLIAMS: So in order to get the

21 money, I would have to write a UFR, which is a

22 funding request, so along with that, I'll have to


15

1 write a strong justification to requesting why we

2 need this money.

3 DR. HAIN: Do you have any

4 recommendations for a place?

5 MS. WILLIAMS: San Francisco would

6 have been my first choice, because I know that VA

7 is having problems, but I do think if we were to

8 go somewhere down South, with the costs, so if

9 I'm basing it off costs, if we go somewhere down

10 South, I think that we'll be able to get the

11 money.

12 MS. QUARLES: South and East Coast.

13 MS. WILLIAMS: Yes. But now, I will

14 say this, because we saved money for this

15 conference and we've saved money from San

16 Antonio, I don't believe I'll have to request as

17 much money, so that's the one good thing that we

18 have on our side is, even though I'll be doing a

19 UFR, I won't be requesting the totality of the

20 conference, it'll only be the difference.

21 CHAIR CERTAIN: And I think we can --

22 MR. MOORE: Well, I'm fine that it's


16

1 unfunded. I mean, you know, you can also make an

2 argument if you have a certain amount, it's going

3 to get people's attention.

4 COL. KUSHNER: How long does it take

5 you to find out if they will fund San Francisco?

6 MS. WILLIAMS: Well, I've already

7 started on a UFR, based off of the cost

8 comparisons that I created, I just have to submit

9 it for review, so that's the first thing I'll do

10 when I return back to D.C.

11 So the decision was made for me to

12 submit after this conference so we can see what

13 the cost was. And so now, after this conference,

14 I'll have the complete cost and I may have to

15 make an adjustment, but everything is already

16 written up.

17 MR. MOORE: Can't you use as

18 justification the committee has gone to two great

19 places and there's been some suggestion that we

20 go to a place like San Francisco?

21 MS. WILLIAMS: So that's part of it,

22 but the other information that I included, the


17

1 fact that the committee had only met one year,

2 and that a promise was made by the, you know,

3 Secretary that we would have three meetings this

4 year, that alone, then, should hold a lot of

5 weight.

6 MR. MOORE: That's pretty strong.

7 MS. QUARLES: It is, and not only

8 that, we have several members that are not here

9 at this committee.

10 CHAIR CERTAIN: Which saved money.

11 MS. QUARLES: Which saves money.

12 MS. WILLIAMS: And we saved money from

13 San Antonio too.

14 CHAIR CERTAIN: And then, you know, we

15 had -- so we're not expending a lot of money.

16 While we've had a very hospitable time here and

17 New Orleans is a nice place to come and enjoy

18 things, and we took a tour of the museum, we

19 don't normally get out of the meeting spot for

20 three days.

21 It's that, we don't go on vacation

22 when we travel. We go to support the VA and to


18

1 address issues that we see in a particular

2 population of veterans that we represent. So I

3 think that part of the concern in your department

4 was that we were looking for neat places to go,

5 but we've never asked for Honolulu or Puerto

6 Rico.

7 MS. WILLIAMS: That is correct.

8 CHAIR CERTAIN: And Puerto Rico's got

9 all kinds of problems.

10 MS. WILLIAMS: Puerto Rico would be

11 nice.

12 COL. KUSHNER: I'm sure the Embassy in

13 Paris has a clinic.

14 CHAIR CERTAIN: So it's not -- San

15 Francisco isn't because we all want to go to the

16 Fisherman's Wharf and eat more. So we're going

17 there because we understand -- we're proposing

18 that because we understand that the POW work

19 there is not of a high quality, and we want to go

20 see that, and give advice to the Secretary, and

21 the Undersecretary, on how to improve that site.

22 So that's our --


19

1 DR. HAIN: Well, do we want to say San

2 Francisco first and Atlanta second?

3 CHAIR CERTAIN: I think we still stick

4 with San Francisco as a first and then have --

5 that's why I say, have a backup with a troubled

6 system that needs the experience and the

7 disinterested third party outside the chain of

8 command, which is what we are, that can offer

9 good counsel and advice to the Secretary for

10 improving one of his centers. Yes.

11 MR. CORRE: I understand where you're

12 coming from, and I don't really know what the

13 problems are at some of the regional areas. I do

14 know that West L.A. is in the worst possible

15 shape that -- you know, a hospital that I know

16 of, in the fact that we've had approximately five

17 directors within a year and a half to two years.

18 But one of the things that throws that

19 whole thing out as far as we're concerned from a

20 POW point of view, is that the POW population is

21 now gone from 200 down to 5. Now, that's as much

22 as I can get.


20

1 CHAIR CERTAIN: And the population's

2 gone down because of deaths, moves?

3 MR. CORRE: Death, attrition, et

4 cetera, plus the fact, Vietnam vets, POWs, were

5 extremely low in all the years that I was there,

6 and I've been with it for almost 20 years. So I

7 would kind of rule it out in that respect.

8 I know for a fact as far as doctors

9 are concerned, when I first came on, doctors were

10 dedicated to POWs. And I worked very closely

11 with them, Dr. Hain and Dr. Marshall (phonetic).

12 And they were dedicated themselves, extremely,

13 but they are no longer attached to it.

14 And POWs go to nurse practitioners, et

15 cetera, not dedicated doctors, to POW, at all.

16 The regional office, because I had talked to them

17 when I got back from the last meeting, I think

18 are beefing up and getting POW representation

19 within the regional office.

20 I would say there is a much larger

21 FPOW population in the San Diego area, much, much

22 larger, I don't know the status of that hospital


21

1 though, so as far as POWs are concerned, and I

2 don't know anything about it.

3 But I do know that they have a fairly

4 large POW population.

5 MS. WILLIAMS: So I believe Mary Lynn

6 Sherman works at Loma Linda, which is not in San

7 Diego, but I think it's, maybe, 40 minutes from

8 San Diego. It's closer to Temecula.

9 MR. CORRE: A little over that.

10 MS. WILLIAMS: So I could always reach

11 out to her, because I know she has been -- she

12 has spoken at the D.C. meeting, I believe, and

13 she's very involved with the community, so she

14 would be a good resource that I can reach out to

15 kind of gauge some information about Loma Linda.

16 MR. CORRE: Yes. Loma Linda has a

17 fairly large -- well, I don't know now, I haven't

18 been -- how many years since we've been there.

19 That comes under West L.A., and we used to visit

20 it as POWs every -- at least once a month to

21 head-up counseling and for all services, you

22 know, of the personnel.


22

1 I am about the sole personnel operator

2 for POWs at West L.A. Marilyn and I are both

3 service officers, but I'm a coordinator for the

4 regional office and the hospital for POWs.

5 MS. WILLIAMS: For the L.A. regional

6 office, correct?

7 MR. CORRE: That's correct. And then

8 also, Loma Linda does come under that, but Loma

9 Linda is 72 miles from my home; one way.

10 CHAIR CERTAIN: I was at Loma Linda a

11 few years ago, and Louis Zamperini and I were

12 part of the POW advisory committee at that

13 hospital. It was going well then. It had a

14 really good physician.

15 MR. CORRE: They do.

16 CHAIR CERTAIN: And so it was a good

17 operation.

18 MR. CORRE: It is a good operation.

19 From our experience, it was always a good

20 operation.

21 CHAIR CERTAIN: I don't think we

22 should worry about going to Loma Linda.


23

1 MS. WILLIAMS: So one I think can say

2 is, I used to work at the San Diego Regional

3 Office, and I do know, that regional office, they

4 are leading in outreach to their POW community,

5 so whenever I run the numbers every month, San

6 Diego has more hours than any other regional

7 office, but secondly, every month, they host a

8 meeting for FPOWs and they actually allow the

9 staff, like, when I was there, they gave us the

10 opportunity to go down and meet them, and talk to

11 them about benefits.

12 So I do know the regional office is

13 very squared away.

14 CHAIR CERTAIN: So let's not worry

15 about them.

16 DR. HAIN: Did we decide on the dates?

17 MS. WILLIAMS: Yes. The dates --

18 CHAIR CERTAIN: Right now, our first

19 choice is going to be September, starting travel

20 on the 5th, 6th, 7th, and 8th, and leave on the

21 8th, if we can, or not, depending upon where we

22 are and the time of day. If you're on the West


24

1 Coast, you'd have to leave on the 9th, probably,

2 for people living on the East Coast.

3 DR. HAIN: Well, let's decide that

4 maybe San Francisco should be our first choice

5 and then we just need an alternate, and if

6 budgets are so terrible, we can, you know, say

7 Atlanta. And we can research it. We can always

8 go back to someplace that we've been before, like

9 godawful Philadelphia or Boston.

10 CHAIR CERTAIN: You know, someplace

11 that's less expensive to travel to. I understand

12 we didn't go to Washington, to central office,

13 this time because of the cost, right?

14 MS. WILLIAMS: Yes. Correct. I mean,

15 we could always look at D.C., but I thought it

16 was -- well, we discussed that we'll probably go

17 to D.C. for spring because --

18 CHAIR CERTAIN: Right.

19 MS. WILLIAMS: -- of whom we would

20 like to invite, but I mean, we could always still

21 consider D.C.

22 CHAIR CERTAIN: Yes. I still think


25

1 that the spring in D.C., and we want to do it

2 when the Congress is in session, so we have to

3 figure their spring break, and then that would

4 be, probably, our next meeting, and then our

5 second meeting of that fiscal year would be in

6 the late summer, you know, before September the

7 15th, again, so we used to schedule them in

8 October, and since the Congress is incapable of

9 passing a budget in time, we've canceled, I

10 think, three years in a row, October meetings,

11 and so I said, when I came onboard, we're not

12 doing that again because we can't -- we have no

13 confidence in October.

14 MS. QUARLES: So, Bob, we're looking

15 at February next year and June? Are you saying

16 February?

17 CHAIR CERTAIN: February? I said

18 spring.

19 MS. QUARLES: Well, February is

20 winter, but it's really the spring calendar, if

21 you will.

22 CHAIR CERTAIN: Was that right?


26

1 Whatever.

2 MS. WILLIAMS: So just to kind of give

3 you a picture, so when I did the research,

4 there's a $10,000 difference between Atlanta and

5 San Francisco.

6 COL. KUSHNER: Total?

7 MS. WILLIAMS: $10,000.

8 MR. CORRE: How much?

9 CHAIR CERTAIN: $10,000 less expensive

10 to go to Atlanta over --

11 MS. WILLIAMS: Correct. Because --

12 MS. QUARLES: Right. And so how much

13 do we have saved from --

14 MS. WILLIAMS: So that, I do not know.

15 More than likely, the UFR would have to be for,

16 maybe, $25,000.

17 CHAIR CERTAIN: To go to San

18 Francisco? Or $15,000 to go to Atlanta.

19 MS. WILLIAMS: To go to Atlanta. Yes.

20 MR. MOORE: And Orlando? You had

21 mentioned Orlando?

22 MS. WILLIAMS: Now, I didn't do -- so


27

1 for Pensacola, Florida, that actually was the

2 same as Atlanta, so I came up with $30,000 for

3 Atlanta, $30,000 for Pensacola, and $40,000 for

4 San Francisco, and that's based off of 14

5 individuals.

6 COL. KUSHNER: Well, Mr. Chairman, I

7 propose that we choose San Francisco as number

8 one and then have a backup of Atlanta or Orlando,

9 whichever is cheaper.

10 CHAIR CERTAIN: Well, or where the

11 staff at the medical center can receive us.

12 That's another issue that we've run into before.

13 So San Francisco staff may not be in a position

14 because of training and things.

15 COL. KUSHNER: Well, we can find out.

16 You know, we can find out and propose one, two,

17 three, and then --

18 CHAIR CERTAIN: All right. And why

19 Orlando?

20 COL. KUSHNER: It's a brand new VA.

21 I mean, they just completed it and I want to see

22 it.


28

1 CHAIR CERTAIN: It's a short drive for

2 you.

3 COL. KUSHNER: That's right. It's not

4 an exciting trip.

5 MS. QUARLES: Is Phoenix about the

6 same cost as San Francisco, Leslie?

7 MS. WILLIAMS: Now, I can do the

8 research for Phoenix.

9 CHAIR CERTAIN: Phoenix is still a

10 troubled place. I mean, they had a massive

11 problem out there. Well, they were, just because

12 there was all the false appointments and things.

13 I don't know what their POW program was like.

14 MS. WILLIAMS: Okay. Yes, because I'm

15 looking at -- and I think the biggest thing for

16 San Francisco is the, one, lodging rate is

17 double, more than the other two locations, but

18 then the second thing is the taxes are more

19 expensive, and that's the only difference,

20 really.

21 I mean, airfare is a bit more

22 expensive, but it's only a $100 difference


29

1 between Florida and San Francisco in terms of

2 airfare.

3 MR. CORRE: You can save on mine.

4 CHAIR CERTAIN: You drive up, would

5 you?

6 MR. CORRE: I could almost drive.

7 CHAIR CERTAIN: Get the train.

8 COL. KUSHNER: Nice train.

9 CHAIR CERTAIN: It's only 800 miles.

10 CHAIR CERTAIN: Yes, it's a nice

11 train.

12 MS. WILLIAMS: But I do think that

13 with the money we've already saved and with a

14 strong justification, that we can get San

15 Francisco approved.

16 DR. HAIN: Okay. Well, let's go with

17 --

18 CHAIR CERTAIN: Let's shoot for San

19 Francisco.

20 DR. HAIN: San Francisco and Atlanta.

21 CHAIR CERTAIN: And then --

22 MS. WILLIAMS: So, okay, and Atlanta


30

1 is number two?

2 CHAIR CERTAIN: But check with the

3 administrator there to ask if that would be

4 possible for her to take us there at that time as

5 a secondary choice.


7 CHAIR CERTAIN: And Shirley knows

8 here, has worked with her before, and --

9 MS. QUARLES: And I can give her a

10 call and check on her status and see if she's

11 open to taking us on. Lynette's a hard worker

12 and she would want not to say not to us because -

13 -

14 CHAIR CERTAIN: And we're only

15 concerned about POW work that's being done in the

16 medical center. We're not worried about anything

17 else that's going on in it.

18 MS. WILLIAMS: So what would be the

19 third option? Phoenix?

20 CHAIR CERTAIN: Let's check into

21 Phoenix and see what that --

22 COL. KUSHNER: Phoenix for problem


31

1 area and Orlando for new place.


3 COL. KUSHNER: How's the VA in Las

4 Vegas doing?


6 MS. WILLIAMS: Do we have alternate

7 dates for the conference?

8 CHAIR CERTAIN: Well, the alternate

9 dates would have to be in August.

10 MS. WILLIAMS: Okay. So what are some

11 --

12 CHAIR CERTAIN: And so early August --

13 you'd be available in early August, right, but

14 you're not available at all.

15 COL. KUSHNER: I wish I were.

16 MS. QUARLES: I can be available the

17 last week of August moving forward.

18 CHAIR CERTAIN: Oh, so starting the

19 28th?

20 DR. HAIN: Leslie isn't, but you're

21 not going to be available the last week.

22 MS. WILLIAMS: No.


32

1 CHAIR CERTAIN: But you're traveling

2 that week.

3 MS. WILLIAMS: So August 26th to

4 September 1st, I'll be on official travel, and

5 then the same thing -- I actually come back to

6 D.C. on August 1st or 2nd, so the end of July to

7 the beginning of August. Yes, July 29th to

8 August 2nd is the official travel I'll be on.

9 CHAIR CERTAIN: So it's between the

10 first full week in August, which is the 7th.

11 COL. KUSHNER: I just looked at my

12 calendar and I, you know?

13 CHAIR CERTAIN: But what we need is a

14 quorum. I'd hate to cut anybody out because of

15 other obligations that are on their calendars,

16 but the alternate dates would have to be, like,

17 the 7th, starting around the 7th of August,

18 right, for you?

19 MS. WILLIAMS: Okay. Yes.

20 CHAIR CERTAIN: We have to have a DFO.

21 We can't have a legal meeting without one.

22 MS. WILLIAMS: So we can, what, August


33

1 7th through the 9th?

2 CHAIR CERTAIN: Well, some time in

3 that week.


5 CHAIR CERTAIN: Whatever the start and

6 end dates are, as a backup for schedule, but

7 let's go for right after Labor Day at San

8 Francisco as our primary.


10 CHAIR CERTAIN: And we'll keep the

11 September dates as our primary dates.


13 CHAIR CERTAIN: And if we can't get

14 that dates, then we'll look back at in that

15 August week. And we'll look into Phoenix, don't

16 know anything about their POW program, we know

17 that hospital has been in the headlines, in very

18 unpleasant ways, for several years.

19 MS. WILLIAMS: Okay. So I'll pull the

20 numbers, because that's the other thing, when I -

21 -

22 CHAIR CERTAIN: But August is 115


34

1 degrees in Phoenix too.

2 MS. WILLIAMS: No, I think if the

3 numbers -- I'll pull the numbers to show what the

4 outreach looks like in that area, but also, the

5 number of average days that claims are processed.

6 Like, I do a data analysis, and I include that

7 with my write-up with the justification.

8 CHAIR CERTAIN: Okay.

9 MS. WILLIAMS: Because ultimately,

10 it's just to show VA the business need of why we

11 need this money.

12 CHAIR CERTAIN: Right. Okay. Good.

13 MS. QUARLES: That's great, Leslie.

14 CHAIR CERTAIN: All right.

15 MS. QUARLES: I'm just curious,

16 Leslie, and, Bob, if you don't mind my asking, do

17 you get a budget for this committee at the

18 beginning of the fiscal year for that year or

19 does it work, like, as needed?

20 MS. WILLIAMS: No, so I'll be honest

21 with you about the budget, so there is a budget

22 for the FPOW committee. It is $90,000, is what


35

1 the charter allots for this committee. So

2 essentially, what happened is, the year, the

3 committee only met one time, because that money

4 wasn't utilized a lot, it was turned back in, so

5 when they -- the next fiscal year, when they made

6 the request, the request was only made for, I

7 believe, $65,000.

8 And so I think with VA, how it works

9 is, when you request your budget, you request it

10 two years in a row. So when my office started

11 the program and they transferred us to budget, we

12 only got $65,000, and then for next fiscal year,

13 it's the same.

14 MS. QUARLES: $65,000 again.

15 MS. WILLIAMS: Correct. So then what

16 my leadership is going to do, and they're working

17 really hard on this, to see how we go back to the

18 $90,000.

19 CHAIR CERTAIN: Okay. The

20 justification was that, the reason that money was

21 turned back, which results in a reduction of the

22 budget. If you don't use it, you get less money.


36

1 MS. WILLIAMS: Well, also, they

2 requested less, too, for the next fiscal year, so

3 because they -- I mean, they were giving --

4 CHAIR CERTAIN: Who is they?

5 MS. WILLIAMS: So Compensation Service

6 was the office who originally had the program. I

7 don't know, Eric, are you familiar with what

8 happened?

9 CHAIR CERTAIN: But that was because

10 of failure on the part of VA to reconstitute this

11 committee in a timely fashion.

12 MR. ROBINSON: That had something to

13 do with Compensation Service transferring the

14 program over to the veteran office in advance,

15 and that's what kind of threw things off, but you

16 were right, Leslie, about the one meeting last

17 year, because there's only one meeting, less

18 money was used, so for the next fiscal year, they

19 were getting so much money.

20 CHAIR CERTAIN: Yes, I think the

21 actuarial said, well, they're not using that much

22 money, we don't have to budget that much money,


37

1 but the reason we didn't use that much money was

2 because the process for approval of members to

3 this committee was delayed for a very long time

4 in VA headquarters.

5 And so it was not this committee's

6 issue, it was out of ACMO and whoever was not

7 pressing on the appointments. That's why we're

8 trying to keep, always, the right number, plus

9 one, in the pipeline for committee appointments,

10 because some of us get -- well, you know, if

11 you've been on one term, and you're eligible for

12 reappointment, and that you're in the pipeline

13 for reappointment, if you're timing out, then

14 we've got one person there to replace you, and

15 then just because people have a tendency to die,

16 every once in a while, and then we have to have

17 an outlier, and additional one, to cover that

18 resignation, and failure to perform, which will

19 result in removal, because it's not a resume

20 line. This is a work line.

21 MR. CORRE: I'm not going.

22 CHAIR CERTAIN: You're not going?


38

1 MS. WILLIAMS: So there is something

2 I do want to put forth to the committee, does

3 anyone in the room know Mr. William Richardson?

4 COL. KUSHNER: Oh, the guy that used

5 to be Governor of New Mexico?

6 CHAIR CERTAIN: No, he was on this --

7 he's on this committee of current POWs, never

8 shown up.

9 COL. KUSHNER: He's never been to the

10 meeting.

11 MS. WILLIAMS: Yes. And so I think

12 this is his fourth meeting that he has not

13 participated in, and so unfortunately, for him,

14 as well as myself, it's placed me in a position

15 to where I have to request for Mr. Richardson to

16 be removed from the committee due to inactivity.

17 I really did not want to do that. In

18 fact, when I spoke to him, he said he would be at

19 this meeting. He assured me. And I went as far

20 as to even have his travel booked, and then I

21 never heard back from him. So I don't want to

22 just make the sole decision on myself. How does


39

1 the committee feel about that?

2 DR. HAIN: We can send him a letter

3 thanking him for his dedicated service and look

4 forward to working with him in the future.

5 Aloha.

6 CHAIR CERTAIN: Yes, I had voiced the

7 same opinion that if you missed one meeting,

8 we'll forgive you, if we have call-in, and if you

9 call-in then you're at the meeting.


11 CHAIR CERTAIN: If you don't call-in

12 because you can't get here, then that's a miss,

13 so that's the shame on you. Two meetings, it's a

14 shame on us. So two meetings in a row, that's a

15 full year out of a three-year appointment.

16 That's just too much. And so unless there's a

17 really, really good reason, like, you have to

18 attend your funeral.

19 MS. WILLIAMS: Now, I know his wife

20 was sick, so when I spoke to him, he said his

21 wife was sick and he was tending to her, but she

22 was all better, which is why he would be at this


40

1 meeting.

2 MS. QUARLES: But it's okay to resign

3 your position.

4 CHAIR CERTAIN: It's okay to resign.

5 It's okay for us to say, we understand that your

6 first priority is to take care of your wife, and

7 so we're going to have you -- we're going to have

8 a replacement that doesn't have that concern.

9 DR. HAIN: I guess we decided on the

10 dates and the places. I would recommend, Mr.

11 Chairman, we move on.

12 CHAIR CERTAIN: I agree. I think

13 we've done that. We've moved on.

14 DR. HAIN: Beat that to death.

15 CHAIR CERTAIN: We have a list of

16 places that are potential backups and we have

17 potential backup dates if necessary. All right.

18 So where are we? Does anybody have any

19 recommendation you want us to put into our mix

20 for reconsideration at our next meeting?

21 Well, here, it's just, we have some

22 obvious best practices that are in the -- working


41

1 in this hospital because they had a blank slate

2 to start with, and they like what they -- so what

3 Lane brought home from San Francisco as a way of

4 modeling their POW clinic business, and so that's

5 good, and so it's really fantastic that -- but

6 not every hospital is ever going to get this

7 opportunity, God willing, so I didn't see

8 anything.

9 The notes I made were things that were

10 in process already and that was the outreach to

11 every former prisoner of war we can locate to get

12 into the system and properly evaluated, and then

13 telehealthcare, I think is in process throughout

14 the system, is it not, for remote care?

15 MS. WILLIAMS: That, I do not know,

16 because I know -- in fact, let me ask you this,

17 ask this committee, before I speak on it, let me

18 ask the question to make sure my information is

19 accurate.

20 COL. KUSHNER: I'd just like to make

21 a comment. I particularly like the home

22 healthcare aspect of the way this VA functions.


42

1 I think that's just a wonderful service for

2 elderly veterans, specifically, POWs who are

3 homebound, and Dr. Kawasaki, is that the lady?

4 CHAIR CERTAIN: Yes.

5 COL. KUSHNER: I just thought her

6 presentation was fabulous and I wish that ever VA

7 in the country could mobilize resources --

8 CHAIR CERTAIN: Yes. And I'd hope

9 that this hospital would have write-ups and

10 brochures that explain what they're doing in

11 those regards.

12 DR. SNEED: Yes, I'll mention it to

13 her so she can send them along.

14 CHAIR CERTAIN: I was going to say, if

15 we can post that back to the Secretary as a best

16 practice that can be adapted across the system,

17 and we'll focus on former POWs, but we can also,

18 then, coordinate with other subcommittees that

19 might have telehealth in their list of concerns,

20 so we can coordinate with whatever their

21 recommendations are.

22 MS. WILLIAMS: Now, are you asking for


43

1 a write-up on telehealth or --

2 CHAIR CERTAIN: We're asking this

3 hospital to --


5 CHAIR CERTAIN: -- with their remote

6 hospital-at-home program and that sort of thing,

7 that we heard about from Dr. Kawasaki, so that we

8 can do, with what they're doing, the same that we

9 did with San Antonio after January.

10 MS. QUARLES: And I don't recall why

11 -- did they have a home health services in the

12 San Antonio FPOW?

13 CHAIR CERTAIN: Not in a way they did

14 here. This was a result of necessity here, but

15 it seems like a program -- a way of dealing with

16 remote veterans and elderly veterans that could

17 be easily adapted in any setting.


19 CHAIR CERTAIN: Okay? So once you get

20 home and start processing your experience here,

21 if you have other ideas, things come to you, just

22 shoot us an email, copy me, copy Leslie, and


44

1 Shirley, and we'll get it into the mix for

2 consideration at the next meeting, okay?

3 MS. QUARLES: And, Mr. Chair, I had

4 one question.

5 CHAIR CERTAIN: Yes.

6 MS. QUARLES: Do you anticipate

7 getting a response on the recommendations for

8 2016, like, in the next month or so?

9 MS. WILLIAMS: Okay. So the thing

10 with the 2016 recommendations, they are at the

11 Sec VA office awaiting signature. So when they

12 first arrived there, Secretary McDonald, he was

13 in office, and he left, and so I was told that

14 they wanted to wait until the new Secretary came

15 on before anything was signed. He's come on.

16 And I know, as of now, he have not

17 signed the recommendations, so they are awaiting

18 his signature.


20 MS. WILLIAMS: Yes. And so for that,

21 I can follow-up with ACMO, because they're the

22 liaison between my office and the Sec VA, and


45

1 then they'll be able to give me a status.


3 MS. WILLIAMS: And as far as the 2017

4 recommendations, so let me just say this, I know

5 it was given to this committee as a best practice

6 to submit it in two parts. So for VBA, that is

7 not a best practice, and reason being is, when I

8 was sending them out, it was very confusing for

9 the business lines because the first thing, they

10 came back to me and said, well, you already sent

11 us this, and I'm like, no, it's two parts.

12 So moving forward, I do think that we

13 should just submit it as one part. But once I

14 was able to explain it to them, we did get our

15 responses back fairly quickly. They've undergone

16 concurrence in my office. Now they're with 20P,

17 which is the front office for VBA, and once they

18 leave there, they'll go to ACMO.

19 So Part 1 and Part 2 are moving fairly

20 fast. I can honestly say, we received a lot of -

21 - a lot of the recommendations were passed. They

22 concurred with -- it was only one of them that we


46

1 concurred in principle --

2 CHAIR CERTAIN: And that was the

3 localized outreach recommendation.

4 MS. WILLIAMS: Correct. And for that

5 one, it was because of the PII that was

6 associated with it, but the other thing that

7 we've done in my office, since I was already in

8 the program, is, whenever we submit the

9 recommendation, and this is actually something,

10 when you were over the women's, that your

11 committee was doing, which is where I got this

12 from, but we have them doing an action plan as

13 well.

14 So not only are they telling us if

15 they concur with it, but we asked them to tell us

16 how they're going to implement it and when

17 they're going to implement it, so that way we'll

18 be able to hold them to timeframes and we can

19 monitor the progress of those recommendations.

20 CHAIR CERTAIN: Good.

21 MS. QUARLES: That's excellent.

22 Leslie, also, when they say, concurring


47

1 principle, for the most part means, they concur,

2 they just have to figure out how to get it done.

3 MS. WILLIAMS: Correct.

4 CHAIR CERTAIN: So if we get this

5 answer back complete, or when we do, one

6 recommendation we might come back to is, with the

7 concurring principle, to say, instead of doing it

8 by region, to do it, the initial outreach, from

9 the central office, which was what the RO

10 director here recommended yesterday -- or the

11 first day we were here, to have that initial

12 outreach go down from the central office, with

13 follow-up from the regions.

14 And so we can come back with that

15 later.

16 MS. WILLIAMS: And then for

17 Recommendation Number 5, VBA did non-concur, and

18 that is the one where the committee has

19 requested, on an annual basis, that VA reports

20 the accounting of all FPOWs nationwide. And the

21 reason why we had to concur is because, legally,

22 we can't disclose certain information.


48

1 So we're trying to figure out a way to

2 be able to give the data to the committee without

3 disclosing any PII.

4 CHAIR CERTAIN: PII is?

5 MS. WILLIAMS: So their personally

6 identifiable information.

7 CHAIR CERTAIN: Oh, right. Exactly.

8 Okay.

9 MS. WILLIAMS: Yes. And I think the

10 wording is kind of what confused them because the

11 committee asked for it to be, for the locations,

12 for each FPOW, and that's something that we

13 cannot give, but I do think a workaround would be

14 is, we can maybe, on the intranet Web site, we

15 can just map it out and we can just show the

16 number in each state, and not give specific

17 information, because that's the other thing that

18 we are working on -- my boss is emailing me back

19 about the dates.

20 But that's the other thing that we're

21 working on, is to consolidate the list for

22 coordinators and advocates to make the


49

1 information available on the external Web page,

2 but I think if we added that feature, that would

3 be more doable.

4 CHAIR CERTAIN: Okay. That sounds

5 reasonable.

6 MS. JOHNSON: I have a question. Why

7 would they think that we want all that

8 information? If we're just asking for a number,

9 why would they think that we wanted everybody's,

10 like, name, Social Security number, and age? I

11 mean, I don't think we went that far in the

12 request.

13 MS. WILLIAMS: No. So they just asked

14 for the geographical location. So that's why I

15 think --

16 MS. JOHNSON: So why would they think

17 -- I mean, we're asking for the number in each

18 state, or something like that, we weren't asking

19 for all that information, so why are they denying

20 it thinking we do? You know, they're digging too

21 far.

22 MS. WILLIAMS: No, no, I understand


50

1 what you're saying, and that's why I think if we

2 were to be able to do the map and just show the

3 numbers, that's feasible.

4 MS. JOHNSON: All right. I just --

5 MS. WILLIAMS: At this point in time,

6 based off of what I've learned since being here

7 with the use of lists, my only concern would be

8 if I were take the list that we have now and base

9 it off that data, the numbers would 100 percent

10 be incorrect. That is my only concern.

11 So one of the things that I've decided

12 to do is, the list that Mr. Smith had, is to just

13 take that list and compare it to the list that I

14 have, and once I can identify who's supposed to

15 be on the list, then I think it'll make it easier

16 for me to weed out who's not supposed to be on

17 the list, we can run those names against VA

18 system, and then we can just kind of fine-tune it

19 to have -- to get at least as close as possible,

20 so to be precise.

21 It's not going to be 100 percent

22 correct, but at least be close enough, because


51

1 right now, I don't think those numbers would even

2 be close.

3 MR. CORRE: Would that list that I

4 gave you be out of date?

5 MS. WILLIAMS: You said, is it out of

6 date?

7 MR. CORRE: Would it be out of date

8 for your analysis?

9 MS. WILLIAMS: No, so it would be

10 factored into because I would just have to do a

11 comparison. Because I didn't tell everyone in

12 the committee this, but while we were sitting

13 here, I looked up every POW name on the list that

14 I have, and Dr. Certain is the only one who was

15 on our list, so that is a bit, you know,

16 concerning for me, because this is the list that

17 BRD gave to VA.

18 MS. QUARLES: Harry isn't on there?



21 MS. WILLIAMS: So that's why I think

22 it's smart to do a comparison between what I have


52

1 and the list I got from Mr. Smith, because then

2 that way, we can really separate whom should be

3 on the list, who should not be on the list, but

4 then also, once we run all of the names against

5 VA's system, so let's say, in example, if we have

6 someone who's on the list who's in VA system, but

7 when I compare all the data, in actuality,

8 they're not an FPOW.

9 So it would also allow me to identify

10 fraudulent FPOWs as well.

11 CHAIR CERTAIN: This is what Dr.

12 Singer used to do when he was with the VA back --

13 because he kept up with everybody.

14 MR. MOORE: But again, don't forget

15 that that list is only Vietnam-era.

16 CHAIR CERTAIN: Yes, the list that --

17 MS. WILLIAMS: That he had?

18 MS. JOHNSON: That's why Bob is the

19 only one that's on there.


21 CHAIR CERTAIN: No, he's on that list,

22 but he's not on the other list she had.


53

1 MR. CORRE: Leslie, for your

2 information, I'm on Page 77 of the list I gave

3 you.

4 MS. WILLIAMS: So my boss just -- so

5 my director, she just sent me a message and the

6 dates that we have, she's saying those dates are

7 not feasible because it's too close to Labor Day

8 as well as, individuals will be on vacation, so

9 she wants to know if the committee will look at

10 the following week.

11 MS. QUARLES: This is in September?


13 CHAIR CERTAIN: The following week?

14 MR. MOORE: The following week is fine

15 with me.

16 MS. JOHNSON: It's fine with me too.

17 Oh, wait a minute, the following week, isn't that

18 POW Day stuff?


20 COL. KUSHNER: That's the 19th.

21 MS. JOHNSON: 19th? So what time was

22 we originally saying?


54

1 CHAIR CERTAIN: The 5th through.

2 MS. JOHNSON: Oh, okay. Okay.

3 MR. CORRE: So this will be the 12th

4 through the 10th now.

5 MS. JOHNSON: Okay. We got, like, two

6 weeks in-between there. Okay. See, this is what

7 happens when it doesn't matter.

8 DR. HAIN: You're saying now we

9 consider the week of --

10 CHAIR CERTAIN: The week of the 11th.

11 DR. HAIN: -- the following week.

12 MR. CORRE: 12 through 15.

13 DR. HAIN: 12 through 15.

14 MS. JOHNSON: Okay. When you're

15 retired, retired, it doesn't make a difference

16 what day it is.

17 MS. WILLIAMS: So we're saying the

18 travel dates would be 12 through the 15th?

19 CHAIR CERTAIN: Hal, can you make that

20 one?

21 MR. MOORE: Yes, even better.

22 MS. JOHNSON: Okay. It's all good.


55

1 DR. HAIN: September.

2 MS. WILLIAMS: So she did say the 12th

3 through the 15th would be good dates.

4 CHAIR CERTAIN: Okay.

5 MS. WILLIAMS: Yes. No, it'll be the

6 11th and the 15th.


8 CHAIR CERTAIN: The travel day would

9 be the 11th.

10 DR. HAIN: And we'll be meeting --

11 CHAIR CERTAIN: And the 15th. So 12,

12 13, 14.

13 MS. WILLIAMS: Oh, actually, no, it'll

14 be the 12th through the 14th. Yes, it'll be the

15 12th through the 14th.

16 MR. CORRE: Travel would be on the

17 14th?

18 MS. WILLIAMS: Yes. And the one thing

19 I will say, if anyone is planning to extend their

20 stay, if you can let me know beforehand, that way

21 when I do the LOI with the hotel, I can have that

22 included to make sure that you get the government


56

1 rate.

2 CHAIR CERTAIN: What was the first

3 thing you said? I'm sorry. She was talking

4 about this.

5 MS. WILLIAMS: So if anyone is

6 planning to extend their stay, so whenever we

7 travel, that way I can include that into the LOI,

8 but also, if anyone is going to drive, then I

9 would need to know that so I can include the

10 parking into the LOI.

11 MR. CORRE: If it's the 12th through

12 the 15th, that means travel on the 11th and

13 travel on the 15th.

14 CHAIR CERTAIN: The meeting would be

15 the 12th through the 14th.

16 MR. CORRE: And meetings would be 12th

17 through the 14th, so it would be travel on the

18 11th and travel on the 15th.

19 MS. WILLIAMS: Yes, so essentially,

20 like how we're going to do today, disperse at

21 noon, if not before, and then travel on the same

22 day; the last day of the meeting. Now, I believe


57

1 -- who is on the West Coast -- I mean, I'm sorry,

2 the East Coast?

3 So let's say we went to -- you're on

4 the East Coast, so --

5 DR. HAIN: Well, Alabama.

6 CHAIR CERTAIN: He has to go through

7 Atlanta to get there.

8 DR. HAIN: Yes, I have to go to

9 Atlanta.


11 DR. HAIN: And then I have to go --

12 CHAIR CERTAIN: So these three guys

13 are on the East Coast.

14 MS. WILLIAMS: So we may have to speak

15 offline, but if we're going to be on the West

16 Coast, for individuals like myself, Dr. Hain, and

17 Eric, who are on the East Coast, then our travel

18 day may vary by one day, because we have to take

19 into consideration the time difference, and it'll

20 really be at your discretion, so if you don't

21 mind traveling late, then --

22 CHAIR CERTAIN: The red-eye.


58

1 MS. WILLIAMS: Yes. But if, for

2 whatever reason, you decide that you do not want

3 to stay an extra day --

4 CHAIR CERTAIN: Yes, because everybody

5 on this side of the room is on the East Coast.

6 DR. HAIN: I would travel 11th to get

7 there, the meeting, 12, 13, and 14, and to be

8 reasonable, I'd go home the morning of the 15th.


10 MS. QUARLES: Yes, that sounds pretty

11 reasonable.

12 DR. HAIN: Yes. Because I have to go

13 through Atlanta, take a plane from Atlanta to

14 Huntsville --

15 CHAIR CERTAIN: Okay?

16 MS. JOHNSON: Do you see how they

17 pulled up, these gentlemen here, the list and

18 started going through it. Why doesn't every

19 regional POW, I mean, start doing something like

20 that?

21 MS. WILLIAMS: Okay. So at a regional

22 office, whenever they're doing POW status


59

1 verification, they go through DoD's Web site, so

2 there's two different Web sites that DoD mandate,

3 the Manpower Web site, and then the other one is

4 Femara (phonetic), so they go through both of

5 those Web sites.

6 By the time it comes to me, they've

7 exhausted all other means available to them to

8 verify POW status. And so then once I get the

9 request, and I make them give me all the evidence

10 that they use, because I need to make sure that

11 they've actually gone through this protocol, then

12 that's when I actually look at the master list

13 that was prepared -- provided to us by DoD.

14 So to answer your question, they do go

15 through DoD twice before they come to me.

16 MS. JOHNSON: But do they do that in

17 the outreach also or just when somebody comes

18 into the office. That's when they verify. They

19 don't bother to look at the list and see, well,

20 is this person in my area or, you know, just --

21 MS. WILLIAMS: No, and that's only

22 because -- so it's only when someone is claiming


60

1 POW status, but in actuality, the list that I

2 have is not available to them, because it's a

3 controlled item, because it has all of the PII.

4 And even though they're VA employees, you would

5 think -- but no, it's not available to them.

6 Now, I will say this, one of the

7 things that I requested for my management to do

8 that I think would be more feasible, would be to

9 break the list down by state and just post it on

10 my shared Web site and only allow the

11 coordinators to have access.

12 In doing that, it will shorten the

13 process that they have to go through for POW

14 status verification, but the one caveat would be,

15 it will allow shortcuts to be taken as well.

16 Because in actuality, to do POW status, is really

17 not simple, and even when we -- when they come to

18 me and I email them back, and I say, you know,

19 Benefits Assistance Service will need to

20 substantiate POW status for, then they have to do

21 a memorandum of unavailability, and with that

22 document, they have to list every step that


61

1 they've taken, and it has to go through their

2 entire chain of command again, come all the way

3 up to Washington, D.C., be reviewed by

4 Compensation Service, and signed off by their

5 director.

6 MS. JOHNSON: So to deny them their

7 status, you have to go through all that steps,

8 but to give them the status, somebody just has to

9 say, yes, that's a POW.

10 MS. WILLIAMS: No, you have to go

11 through all of those steps for approval.

12 MS. JOHNSON: Okay. All right. So

13 how are they faking it? I don't understand how

14 they're faking it.

15 MS. WILLIAMS: So let me give you an

16 example, two weeks before coming here, I received

17 an email from a spouse, and in her email, she

18 said to me that her husband was a POW, and that

19 VA accused him of being a fraud, and stripped his

20 benefits away from him, and he hadn't received

21 benefits in over 48 months.

22 So she gave me his information, she


62

1 gave me his Social, so I looked in the system to

2 just familiarize myself with the case before I

3 reached back out to her. So when I looked in the

4 system, I saw there was an open investigation

5 with OIG.

6 So my first thought was to contact

7 OIG, because I did not want to reach out to her

8 with this investigation, going in, misrepresent

9 the agency or myself, so I went to OIG, spoke to

10 the person who did the investigation, and what it

11 turns out was, this individual, he submitted a

12 DD214 to VA and his claim was denied.

13 Well, a year later, he came back with

14 an onion scan --

15 DR. HAIN: With what?

16 MS. WILLIAMS: An onion scan DD214, I

17 don't know how he was able to get this, but onion

18 scan DD214 confirming his POW status. So once VA

19 got that, he was service-connected for various

20 disabilities at 100 percent.

21 Later on, someone was looking through

22 the file, and when they were looking through the


63

1 file, they came across the original documentation

2 that he submitted, and that person contacted OIG,

3 so sometimes it's not even at VA that we don't

4 pay attention, but whenever the -- we try to err

5 on the side of the veteran, so whenever we get

6 documentation that looks official, we accept that

7 documentation.

8 And I mean, the fact that he had an

9 onion scan that was fraudulent was mind-blowing

10 to me because, one, you don't see a lot of those

11 DD214s --

12 MR. MOORE: Excuse me, what did you

13 say he had that was --

14 DR. HAIN: Onion scan copy.

15 MR. MOORE: Is that, like, just a

16 carbon copy, you mean?

17 MS. WILLIAMS: Yes. And those are

18 treated like gold in VA, because we rarely see

19 them, so to get one, you really don't question

20 the authenticity of it, because you rarely see

21 it, and I would think that it would be hard to,

22 you know, reproduce in this day and time, but he


64

1 did.

2 MR. MOORE: It was fraudulent?

3 MS. WILLIAMS: Yes. And so, you know,

4 she had --

5 MS. JOHNSON: You're going through

6 that much trouble to cheat?


8 MS. WILLIAMS: What came of that case

9 is, I didn't contact the spouse back, but she

10 sent me another email telling me she was going to

11 go to the press. The fact of the matter is, it's

12 an open investigation. My hands are tied. I

13 can't do anything until they close the

14 investigation.

15 COL. KUSHNER: How did you ascertain

16 that the onion scan was fraudulent?

17 MS. WILLIAMS: Now that, I do not

18 know.

19 COL. KUSHNER: Oh, you didn't --

20 MS. WILLIAMS: Oh, no, I did not. You

21 know what it was? The person who was looking

22 through the file, they found what he originally


65

1 submitted, and when they compared the DD214,

2 there was several differences. That was the red

3 flag. And so once they notified OIG, they

4 actually sent an investigator to their house, and

5 he was interviewed, and at the conclusion of the

6 investigation, they concluded that he was a

7 fraud.

8 And VA, we stopped payment, we

9 actually -- now they owe VA money.

10 COL. KUSHNER: Do you get the money

11 back when that happens?

12 MS. WILLIAMS: We try to. So what

13 they do is, we'll send you a demand letter

14 telling that you have a debt, and then they'll do

15 things as far as putting a stop on your income

16 tax, but clearly, this man is not going to be

17 filing an income tax.

18 So, you know, if you're working, they

19 can garnish your wages, so there are avenues that

20 we attempt to take.

21 COL. KUSHNER: But he doesn't have any

22 wages.


66

1 MS. WILLIAMS: Exactly, so in that

2 case, more than likely, we will not get the money

3 back.

4 DR. HAIN: What's next, Mr. Chairman?

5 CHAIR CERTAIN: I'm thinking we're

6 about finished.

7 DR. HAIN: No, I was just asking, what

8 was next on the agenda, so everybody can make

9 their plane.

10 CHAIR CERTAIN: Right. We've done

11 opening remarks, 2017, we haven't had a break

12 yet, we voted on the next meeting, we've got an

13 approved date now, and now it's just a matter of

14 just getting our site finalized, and that'll be

15 Leslie's issue, and there will not be a first

16 draft on today's committee report.

17 We're just open discussion now and

18 we'll quit at no later than 11 o'clock.

19 MS. WILLIAMS: Oh, if so, if you have

20 not signed your form for the honorarium, if you

21 can please sign it and give it to me, so that way

22 I can have them process these activities. So I


67

1 have some individuals, but I don't have --

2 DR. HAIN: The East Coast here signed

3 up.

4 MS. WILLIAMS: So I have Dr.

5 Certain's, Dr. Hain, Dr. Quarles, Dr. Kushner, I

6 mean, you doctors on it.

7 MR. CARSON: We went to school. I

8 don't hear that the lawyer's name is mentioned.

9 The politician's name isn't listed.

10 MR. MOORE: I guess it's time for a

11 network.

12 MS. WILLIAMS: Oh, actually, Dr. Moore

13 --

14 DR. SNEED: Mr. Chairman, before you

15 guys leave, Ms. Thompson wants to get a group

16 picture, so I'm telling her to come down now.

17 CHAIR CERTAIN: Oh, good. Let's do

18 this. But first, everybody check the network.

19 COL. KUSHNER: Leslie?


21 COL. KUSHNER: One of the great

22 services you provided in the last meeting was you


68

1 mailed this form to us.

2 MS. WILLIAMS: That will happen again

3 at this meeting. I will.

4 (Whereupon, the meeting in the above-

5 entitled matter was concluded at 10:06 a.m.)

6

7

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In the matter of:

Before:

Date:

Place:




----------------------- Court Reporter

80

Advisory Committee on FormerPrisoners of War Biannual Meeting


05-19-17

New Orleans, LA

Robert G. CertainChairman

department of veterans affairs + + + + + veterans … - fpow...9from to start with. 10 so just...

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