captain karl david hogs junior who's been name is still on because he wrote a book about his p t s d experience it is compelling and in tennessee kentucky and indiana he's very well known now the veteran community because of the extraordinary depths of hill so to speak in his experience with p t s d and his recovery and what he went through and he developed this entire program called the ladder and he speaks extensively now because he's an author and many veterans have read his travails his story and his recovery and i think that is important that as we add money address this issue as comprehensive as it is that we get real live veterans involved that have been through it especially those that have dealt with it in amazing ways that he has dealt with it in terms of restoring his life to very productive level even though as he told me he was in a place where he did not want to be even in a little room he wanted to be in a totally dark room where he could just completely withdraw from the world for days at a time it was that bad with p t s d so this is compelling and i provided the materials and i understand that your staff is really looking at it because i think the more we can engage people like him and not assume that staffers as competent as they are people that have not been there can even fathom what these veterans are going through and so i raise that issue with gratitude that you're considering his work and others like him that could make mighty contributions to addressing this problem because this problem as you and i talked earlier today is not just combat combat related incidents but it's no combat he actually was involved in a training crash where he was successfully ejected but the copilot was ejected into a pole which completely dismembered his body as he watched and these challenges are enormous and even today stories of e mails and sexual abuse and all the different contributions to p t s d and i just want you to address what we're doing to make sure first with this fresh story that females have full access to p t s d benefit as males and that we also give attention to non similarities i think this is a generational issue i was down in university of florida and some of the young veterans asked how many of them are combat veterans and most of the hands went up in the dialogue i suggested to them that they were all down into what college campus we we all know college campuses we all know one of the things we're doing is the university of south florida cleveland state san diego state has think is we try to reach out to these veterans of having someone who is actually been there is invaluable versus the people who work for that they haven't been in this condition and that's why i hope you up on the mental health care issue if i could mr womp comments and questions where are we in terms of research and implementation of best practices of how to deal with  tell you that in the last several years we've hired something on the order of additional mental health professionals we've added to the workforce so we now  last several years and we have embarked on a program to train our mental health professionals to treat patients with p t s d in these cognitive related therapies so i think there's great progress being made in standardizing treatment and in making treatment available to veterans that is truly evidence based and the other part of that we're doing now i think a very effective job of consistently in the same fashion screening all of those people that are returning from iraq and afghanistan for p t s d in two thousand and nine we screened over two thousand six thousand veterans in the primary care setting and that's growing every day right now we've got three hundred ninety seven thousand veterans who are receiving care for p t s d within the v a and sixty nine thousand of these are veterans i believe we are making great progress in standardizing evaluation and therapy do you think dr betts all that we need to do a lot of research in this area or are you using money within the v a medical accounts to  test out different approaches we certainly do mr chairman need to do a lot of research in this area as the secretary mentioned our budget in two thousand and eleven for mental health research is going to be eighty two million dollars this represents fourteen percent of the total research budget and a large part of that is devoted to mental health research p t s d research some of the most important the process of now evaluating these groups as they have come back and we are learning a lot about the antecedents of mental illness that occurs in in combat veterans and about the things that are responsible during that combat experience for for some of those issues so yes we need to devote a lot of money we are devoting a lot of money to p t s d research in mental health research in general are you working with the national institutes of health of the national institutes of mental health they doing any research that has direct application to the v a and how we can help our veterans mr chairman there are grants coming from the national institutes of health that do look directly at these issues it's not a large amount of money but there is money from both the nasa of health and national institutes of mental health that is devoted to the types of problems thank you for that because we did not get that bill passed until the middle of last year we agreed to work with and not have that implemented at the very time you're trying to kick off the twenty last year they qualified for the benefits last year but the policy was they would not get their first checks and till august or september this year can you give me some sense that the v a is really focusing on this i can think of few people in this country that are more deserving of our nation's support than children who've lost mothers or fathers in military service i know no one would agree with that more than you but since they will sense of confirmation there that we're going to get started on time and get those checks out rapidly when the program kicks in you have any estimate as to how many children of military families actually were in college last year that would have qualified last year for this funding i don't know at the top of my head i believe we have that information  is in two thousand and ten we have been seeing an increase year after year in the total number of veterans in the united states someone it indicated that perhaps two thousand and ten as a first year that number is level out and because of the passing of our war two veterans many of our korean war veterans and other veterans the total veterans population is actually decreasing now i don't know what certainly the rock and afghanistan wars impact  on pushing those numbers up where are we demographically in terms of this year maybe more important than this year where we go over the next five to ten years in expectation the total number of american veterans i have  what i would offer though is even though the overall population twenty three million today twenty year decline we are very aggressively outreaching to the veteran population and the fact that as i indicated earlier we processed nine hundred seventy seven thousand claims and get a million new ones in return so just whatever that larger population number is we are still reaching out to veterans and  eight point one million veterans who are enrolled today i don't think those numbers are going to go down we'll continue to see the success of our outreach programs and our numbers i think are going to grow over the next several d the fact that veterans are living longer as most americans are adds more expense than we might have had a decade or two decades so you don't you don't see anything happening population of veterans my focus is eight point one million who are enrolled with us are demonstrating we are being successful and i am very happy with the and so i see that our enrollment numbers are going to be a different dynamic you're ok good thank you mr secretary looking across the concerns of the disabled american veterans we've touched on many of their concerns that they shared with me today but two that i wanted to raise in closing and i hope i hope i'm as chairman to finish here in five minutes and maybe even stick my head in energy and water nuclear hearing across the hall there since i represent oakridge but one thing they raise it  want you to be sensitive to is that when we increase dramatically funding the feeling from certain veterans groups is that the money doesn't trickle down low enough to actually benefit them directly off and that's the bureaucracy that you inherited which is a necessary part of delivering a big government program like v a benefits but the real sensitive as you can and your staff is making sure that there's an accountability function of the money getting to the veterans particularly the disabled american veterans as it goes and they also are concerned about see box because you and i talked in my office about how certain things even with increased funding are not happening or can't happen or won't happen as fast as you would like to see and i come from one of those areas in chattanooga tennessee of somewhat degraded service because we're two hours by car from any impatient facility and so we've made great progress at our outpatient clinic in the past and we're in line in twelve for funding for a super seebach which is really needed and where we are one of the highest service areas without a hospital immediately available in the transport is difficult dangerous mostly done by volunteer veterans bands and there was a wreck a few years ago and people died and so really important and i just want you to speak to what you're doing to hurry the money into these programs to build the super sci box as quick as possible i did not want to mess up your timeline looking at or try to accelerate or expedit but i do very interested that larger box in these investments in the outpatient clinic so that you get is many functions of care to the veterans as possible especially to avoid long travel construction cycle it is part of our plan to do this and i will look to ensure that these stays on track regarding the distribution of funds we use two or three rounds so i'd like to recognize you for whatever time you'd like to have sectarian ask any questions you might want to ask very much mr chairman it's an honor to serve with you as chair i'm so proud of your leadership in this and for veterans in this country and it i'm one of the issues i'm involved in is child nutrition and the whole issue we're doing on child nutrition the school feeding program was started by harry truman you know order to grow healthy kids so they could qualify to get into the military and we're back that today that  incredible percentage of american youth cannot qualify to be in the military because of obesity and so i think the we're going to try to raise healthier children and for healthier soldiers and healthier veterans and appreciate your leadership in it i just have to you've discussed a lot of the questions about backlogs and how do we get people off the streets we're doing a wonderful job of building in our communities locally you know paid for locally homeless shelters and we really have full services in those shelters which are really helping people get back into recovery but one of the things we've found is this the veterans coming in to roll in the universities a old had difficulty in community getting with a call center because a call center is and different time zones and i know i mentioned this to you in your my office if you considered extending the call center hours to accommodate the west coast veterans address this time differences in this large country of ours will do better thank you because i do appreciate what you've done to clean up the ministry to backlogs and i think you're being very management wise in that and appreciate that leadership the other areas which is really it's one that the chairman is sick and tired of me hearing him airing about this guy i think the whole committee is that's why they all left because they know it bring it up  but when ford close which was the largest military training base in the united states in fact to this date the largest military base to ever close in the history of this country twenty eight thousand acres and is about thirty three thousand people and what we've tried to do is with all that land at the d o t owned in has transferred back to the community is build a national cemetery because the monterey peninsula which is where california government began it's where the old is proceed on the united states still operational exists and so we have this history of military and everything there and to this day with an able post grad school in the defense language institute and bunch of other service  programs going on we've been trying to convert this base into a national cemetery because there is one over in the san joaquin valley which is within seventy miles as the crow flies they're not eligible because it's a geographical restriction you have the authority to look at this seventy mile radius and suggest that we squeeze it in making instead of a round circle on the lip tickle circle which would take in the entire coast of california and from san francisco and certainly that's where the people are they want to come because a cemetery in the san joaquin valley is has nose support services it's essentially the closest community is a truckstop not even an incorporated community anyway it's as did a town hall meeting last night and one of the questions a woman that she says my husband died twelve years ago i have his ashes in in my closet and i'm just wondering can i bury him in monterrey because i don't want to go over to santa now and that's the thing i hear over and over again so what i'm asking is that we cannot build a national cemetery there until you have fully filled the one in existence that's going to take a long long time and this property's radio replied to have this plan b the state option but california as you know is not building cemeteries i wish they were i wish they were doing what your home state is nine a think state cemeteries the california chose not to go that route regardless of who the governor is not a partisan issue it's just they've decided that their priority is in the housing of soldiers in their retirement homes in the rest homes and they'll put their money and you a lot of that money federal money into that initiative not into maintaining state cemeteries so we've doing a plan c which was to try to raise the money locally for the state to having a lot of problems because commies so flat but i would really appreciate if you could look at this a lot of a lot of talk in washington about bending the curve that we bend that circle and that's what i want to know we've been that circle we qualify and would really appreciate your help on that mystify sure you i'll i'll the encouragement was to have work with california create a state summit as you've indicated that's probably not going to happen so let me go back take a look at the and see whether there's a solution we can come to he was chairman thank you sam and let me just correct the record on one point i'll never get tired of hearing you fight for the veterans of your your district and state and my mentor and this public service died how proud he was that he was going to be buried in arlington cemetery and i know those same deep emotions exist among so many veterans when it comes to being buried and  talked about have given unprecedented increases over the last three years out of the subcommittee to the v a health care system anecdotally i sometimes hear from individual hospitals that while we were passing ten eleven twelve percent per year increases nationally that the individual hospitals allocation only going to one two three or four any information right now very specific or general to tell me over the last three years maybe compared to the total increase if it's been ten or twelve percent what are the individual hospitals on average been getting and their increased allocations and if they're not getting ten or twelve percent national increase then where is that extra money going and if you'd like to follow up with greater five point three percent increase twenty two thousand and nine to two thousand and ten i'll be happy to give more detailed information and some of the  here thank you mr secretary mr chairman the secretary i think as pointed out while the budget increase on average or the average distribution in two thousand and ten was ten percent that's an average the money if you're a distributes the money where the work has been and so if a network has been growing in terms of its work it's going to really receiving probably more than that average and if a network has been growing less than the average then they're going to receive less than that ten percent the same thing would apply to a medical center there are medical centers in our system whose work is not growing because work is actually declining and they would be the medical centers that you might hear saying that we only got one two three four five percent when the national distribution on average was ten percent so i think the general answer your question is that it's related to the workload of those individual medical centers now the networks don't hold on to any money they have a modest reserve but all of the money that they get as part of the very distribution is distributed out to five point seven percent increase but there was another almost four percent that was related to other program monies it got to the medical centers i think the general point is that the money goes to the medical centers  it's not kept in washington it's not kept in in the in the networks because they they have nothing to spend it on particularly except to take care of veterans and that the disparities that one into that region reflecting the increase in population the very distribution is based on historic data and i would have to turn to todd and paul but i think it's about eighteen months is that correct and varies based on a rolling average of workload prior to that so yes there is a delay and that requires a network to give some cognisance to that when they're distributing the money  chairman there are several ways they would they would cope with that in the network that i came from in my prior life network twenty three in minneapolis we had a fund that we called new workload we set aside money each year and would funding criminally throughout the year each one of the medical centers for their new workload and i know that there are a number of other networks that that function in that fashion there is a reserve in every network and the opportunity for medical centers to come back and look at their reserve i know that each network reviews monthly their workload and their funding so that there are opportunities throughout the year to see that the funding is not  being not adequate for the new work for the opportunity to provide additional resources i'm not aware of at this point in time any network or facility that is having difficult there were demands right now  directors are heard in april probably the first time in this department and directors coming up to give a mid year execution brief on the funds we've provided them so that i can hear  program funding it's always well intentioned for high priority causes but is that more difficult to use versus formula money because you're not sure either visit individual hospital isn't sure whether it will receive that program in money beyond one year how do you hire new doctors and nurses and make commitments with one year program if you don't know some of that program money speaking program money comes into your bundles not always but very often it does in two years gives you an opportunity to have your a kick in if you will to help fund that  new initiative so i think you know sitting in this position now one of the things that i want to do as much as i can to do is to ensure that there is two years worth of funding with most of these new initiatives the world health money which while we anecdotally as members of congress hear about individual cases where someone did not receive the care he or she deserved my experience overwhelmingly is that our v a employees whether they're in the v a system i want to not just thank you i want to thank the two hundred thousand employees that you represent for the hard work they do every day and the difference they are making in the lives of our veterans and government important but i think more importantly it's the workforce that comes to work every day trying to do the right thing they are responsible for as i mentioned earlier nine billion dollars of education on the national level so thank you for sharing some of the tremendous things that the v a is doing even as we work together to face the challenges that are still out there thank you for being here and subcommittee was stand