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40–524 PDF 2008

S. HRG. 110–536 

HEARING ON NOMINATION OF JAMES B. PEAKE 

TO BE SECRETARY OF THE DEPARTMENT OF 

VETERANS AFFAIRS 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED TENTH CONGRESS 

FIRST SESSION 

DECEMBER 5, 2007 

Printed for the use of the Committee on Veterans’ Affairs 

( 

Available via the World Wide Web: http://www.access.gpo.gov/congress/senate 

(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

DANIEL K. AKAKA, Hawaii, Chairman 

JOHN D. ROCKEFELLER IV, West Virginia 

PATTY MURRAY, Washington 

BARACK OBAMA, Illinois 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

JIM WEBB, Virginia 

JON TESTER, Montana 

RICHARD BURR, North Carolina, Ranking 

Member 

ARLEN SPECTER, Pennsylvania 

LARRY E. CRAIG, Idaho 

KAY BAILEY HUTCHISON, Texas 

JOHN ENSIGN, Nevada 

LINDSEY O. GRAHAM, South Carolina 

JOHNNY ISAKSON, Georgia 

WILLIAM E. BREW, Staff Director 

LUPE WISSEL, Republican Staff Director 

(III) 

C O N T E N T S 

DECEMBER 5, 2007 

SENATORS 

Page 

Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii ........................... 1 

Prepared statement .......................................................................................... 3 

Burr, Hon. Richard, Ranking Member, U.S. Senator from North Carolina ....... 4 

Murray, Hon. Patty, U.S. Senator from Washington ........................................... 5 

Brown, Hon. Sherrod, U.S. Senator from Ohio ..................................................... 7 

Tester, Hon. Jon, U.S. Senator from Montana ...................................................... 9 

Hutchison, Hon. Kay Bailey, U.S. Senator from Texas ........................................ 9 

Webb, Hon. Jim, U.S. Senator from Virginia ........................................................ 11 

Craig, Hon. Larry E., U.S. Senator from Idaho .................................................... 17 

Specter, Hon. Arlen, U.S. Senator from Pennsylvania ......................................... 74 

WITNESSES 

Inouye, Hon. Daniel, U.S. Senator from Hawaii ................................................... 13 

Dole, Hon. Bob, Former U.S. Senator from Kansas .............................................. 15 

Peake, James B., Lieutenant General U.S. Army (Ret.), M.D., Nominee to 

be Secretary, Department of Veterans Affairs ................................................... 18 

Prepared statement .......................................................................................... 21 

Response to pre-hearing questions submitted by Hon. Daniel K. Akaka .... 22 

Response to written questions submitted by: 

Hon. Daniel K. Akaka .................................................................................. 39 

Hon. Christopher S. Bond, U.S. Senator from Missouri ............................ 42 

Physicians for Human Rights ...................................................................... 42 

Hon. Richard Burr ........................................................................................ 43 

Hon. John D. Rockefeller IV, U.S. Senator from West Virginia ............... 44 

Hon. Patty Murray ........................................................................................ 48 

Hon. Barak Obama, U.S. Senator from Illinois .......................................... 50 

Hon. Jon Tester ............................................................................................. 52 

Hon. Arlen Specter ........................................................................................ 53 

Hon. John Ensign, U.S. Senator from Nevada ........................................... 54 

Response to additional written questions submitted by: 

Hon. Daniel K. Akaka .................................................................................. 55 

Hon. Jon Tester ............................................................................................. 56 

Questionnaire for Presidential nominee ......................................................... 57 

APPENDIX 

Rodriguez, Ciro D.; Gonzalez, Charles A.; Smith, Lamar; Cuellar, Henry, 

U.S. Members of Congress; letter to Hon. Daniel K. Akaka, Chairman ......... 85 

Melia, John, Executive Director, Wounded Warrior Project; letter to Hon. 

Daniel K. Akaka, Chairman, and Hon. Richard Burr, Ranking Member ....... 86 

Mitchell, Harry E., U.S. Member of Congress, 5th District, Arizona; letter 

to Hon. Daniel K. Akaka, Chairman .................................................................. 86 

(1) 

HEARING ON NOMINATION OF JAMES B. 

PEAKE TO BE SECRETARY OF THE DEPARTMENT OF VETERANS AFFAIRS 

WEDNESDAY, DECEMBER 5, 2007 

U.S. SENATE, 

COMMITTEE ON VETERANS’ AFFAIRS, 

Washington, D.C. 

The Committee met, pursuant to notice, at 9:39 a.m., in Room 

SD–G50, Dirksen Senate Office Building, Hon. Daniel K. Akaka, 

Chairman of the Committee, presiding. 

Present: Senators Akaka, Murray, Brown, Webb, Tester, Burr, 

Specter, Craig, and Hutchison. 

OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN, 

U.S. SENATOR FROM HAWAII 

Senator AKAKA. Aloha. The hearing will come to order. 

Today’s hearing is to consider the nomination of James B. Peake 

to be Secretary of Veterans Affairs. 

Dr. Peake has a long and distinguished career, which our colleagues, Senator Inouye and Senator Dole, will describe in detail 

when they introduce the nominee. 

For now, I just note the unusual combination of combat service 

as an infantry officer in Vietnam after his graduation from West 

Point, followed by medical school and a highly successful career as 

an Army physician, culminating in his service as the Army Surgeon General. 

Dr. Peake, you have a tremendous challenge facing you, and I 

know you know that. Heading VA is never easy. Indeed, it may be 

one of the most daunting tasks in or out of government. Doing so 

in a time of war is dramatically more difficult. And taking over, as 

you will, assuming your confirmation, when there is only a little 

more than a year left in the current administration only compounds a demanding situation. Your ability to articulate clearly 

your priorities will be critical to your success. 

I recognize that you come to this nomination with a wealth of experience, even though little of that experience has come from working directly with VA. I am confident, however, that you have a 

strong sense of empathy for those served by VA and a deep commitment to VA’s missions, and that these traits will serve you well. 

As you suggested in your answers to my pre-hearing questions— 

and I want to tell you I really appreciate your responses—VA has 

a strong and dedicated workforce. Things are not perfect within 

VA; few human endeavors are. But I am satisfied that VA is 

2 

staffed by people who seek to do what is right by veterans. What 

the Secretary must do, with the backing of the Congress, is give 

those employees the leadership and the tools—especially the resources—they need to carry out their jobs. If confirmed, you will 

appear before this Committee early next year in connection with 

VA’s 2009 budget. It will be vital that you be prepared at that time 

to inform us whether the proposed budget is truly sufficient for the 

coming fiscal year. 

A time of war puts tremendous strain on VA. Not only must the 

Department strive to continue to meet the needs of those from 

prior conflicts who already depend on VA, but it must quickly 

adapt so as to address the needs of those injured or disabled in the 

current conflicts. Each war brings different challenges, as you 

know—different demands, as well. In the current conflicts, VA is 

having to respond to relatively new challenges, such as the significant number of veterans suffering from Traumatic Brain Injury, 

alone or in combination with other debilitating injuries, in addition 

to wresting with conditions that followed prior wars, as well, such 

as Post Traumatic Stress Disorder. 

One area that needs special and immediate attention is the process by which an injured servicemember moves from DOD to VA. A 

great deal of work has been done on that front—especially over this 

year—and much is being done now. I am hopeful that, if you are 

confirmed, your long experience in the Army will enable you to continue to improve on those efforts. Returning servicemembers, especially those who are seriously injured, must not be made to struggle as they work with both DOD and VA. We must strive for, and 

we must achieve, a truly seamless transition. 

Another area that is demanding attention and a focused effort is 

the systems—both DOD’s and VA’s—for compensating servicemembers and veterans for in-service injury. It is no exaggeration 

to say that VA’s current compensation system is broken. The frustrating lack of timeliness; the need for fundamental rethinking of 

the overall compensation system (as recommended by the Veterans’ 

Disability Benefits Commission and others); and the challenge of 

coordinating DOD and VA’s systems, are all areas that must be addressed quickly and effectively. This Committee, indeed, the full 

Congress, stand ready to work with the administration on this effort. If you are confirmed, this must be one of your highest priorities. 

In closing, I note and commend your strong commitment to 

avoiding even the appearance of any conflict of interest, not only 

with respect to your most recent employer, QTC, but also with 

those organizations where you served in an advisory capacity, as 

well as in connection with your stock portfolio. I personally harbored no concerns about your integrity, but I understand the worries of some that your brief time in the private sector might somehow have led you to favor corporate entities with which you were 

associated. I trust that all fair-minded individuals will appreciate 

the steps you have taken to preclude even an appearance of any 

conflicts of interest. 

I look forward to your testimony today, your responses to questions from Committee Members, and to any post-hearing questions. 

3 

It is vitally important that the position of Secretary of Veterans Affairs be filled as soon as feasible. 

Now I would like to call on our Ranking Member, Senator Burr. 

[The prepared statement of Hon. Daniel K. Akaka follows:] 

PREPARED STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN, U.S. SENATOR FROM HAWAII

Aloha. The hearing will come to order. Today’s hearing is to consider the nomination of James B. Peake to be Secretary of Veterans Affairs. 

Dr. Peake has a long and distinguished career which our colleagues, Senators 

Inouye and Dole, will describe in detail when they introduce the nominee. For now, 

I just note the unusual combination of combat service as an infantry officer in Vietnam after his graduation from West Point followed by medical school and a highly 

successful career as an Army physician, culminating in his service as the Army Surgeon General. 

Dr. Peake, you have a tremendous challenge facing you. Heading VA is never 

easy. Indeed, it may be one of the most daunting tasks in or out of government. 

Doing so in a time of war is dramatically more difficult. And taking over as you 

will, assuming your confirmation, when there is only a little more than a year left 

in the current Administration only compounds a demanding situation. Your ability 

to articulate clearly your priorities will be critical to your success. 

I recognize that you come to this nomination with a wealth of experience, even 

though little of that experience has come from working directly with VA. I am confident, however, that you have a strong sense of empathy for those served by VA 

and a deep commitment to VA’s missions and that these traits will serve you well. 

As you suggested in your answers to my pre-hearing questions, VA has a strong 

and dedicated workforce. Things are not perfect within VA; few human endeavors 

are. But I am satisfied that VA is staffed by people who seek to do what’s right by 

veterans. What the Secretary must do, with the backing of the Congress, is give 

those employees the leadership and the tools, especially the resources, they need to 

carry out their jobs. If confirmed, you will appear before this Committee early next 

year in connection with VA’s 2009 budget. It will be vital that you be prepared at 

that time to inform us whether the proposed budget is truly sufficient for the coming fiscal year. 

A time of war puts tremendous strain on VA. Not only must the department 

strive to continue to meet the needs of those from prior conflicts who already depend 

on VA, but it must quickly adapt so as to address the needs of those injured or disabled in the current conflicts. Each war brings different challenges, different demands. In the current conflicts, VA is having to respond to relatively new challenges, such as the significant number of veterans suffering from Traumatic Brain 

Injury—alone or in combination with other debilitating injuries—in addition to 

wresting with conditions that followed prior wars as well, such as Post Traumatic 

Stress Disorder. 

One area that needs special and immediate attention is the process by which an 

injured servicemember moves from DOD to VA. A great deal of work has been done 

on that front, especially over this year, and much is being done now. I am hopeful 

that, if you are confirmed, your long experience in the Army will enable you to continue and to improve on those efforts. Returning servicemembers, especially those 

who are seriously injured, must not be made to struggle as they work with both 

DOD and VA. We must strive for, we must achieve, a truly seamless transition. 

Another area that is demanding attention and focused effort is the systems—both 

DOD’s and VA’s—for compensating servicemembers and veterans for in-service injury. It is no exaggeration to say that VA’s current compensation system is broken. 

The frustrating lack of timeliness, the need for fundamental rethinking of the overall compensation system as recommended by the Veterans’ Disability Benefits Commission and others, and the challenge of coordinating DOD and VA’s systems are 

all areas that must be addressed, quickly and effectively. This Committee, indeed, 

the full Congress, stand ready to work with the Administration on this effort. If you 

are confirmed, this must be one of your highest priorities. 

In closing, I note and commend your strong commitment to avoiding even the appearance of any conflict of interest, not only with respect to your most recent employer, QTC, but also with those organizations where you served in an advisory capacity as well as in connection with your stock portfolio. I personally harbored no 

concerns about your integrity, but I understand the worries of some that your brief 

time in the private sector might somehow have led you to favor corporate entities 

with which you were associated. I trust that all fair-minded individuals will appreVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00007 Fmt 6633 Sfmt 6621 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
4 

ciate the steps you have taken to preclude even an appearance of any conflicts of 

interest. 

I look forward to your testimony today, your responses to questions from Committee Members, and to any post-hearing questions. It is vitally important that the 

position of Secretary of Veterans Affairs be filled as soon as feasible. 

STATEMENT OF HON. RICHARD BURR, RANKING MEMBER, 

U.S. SENATOR FROM NORTH CAROLINA 

Senator BURR. Good morning, Mr. Chairman, my colleagues. I 

thank you for scheduling this hearing in a very timely manner to 

consider the nomination of General James Peake to be Secretary of 

Veterans Affairs. A number of my colleagues on this panel have 

said that it is important, especially now, to have a permanent leader at the helm of the Department of Veterans Affairs. With that in 

mind, I hope this Committee can schedule a markup as soon as 

possible after this hearing. I think we can move this nomination to 

the floor and, hopefully, quickly have a confirmed leader at the 

helm of VA. 

General Peake, I have examined your application. I have examined carefully the Committee papers. I am convinced that you have 

really prepared for this job for a lifetime. In fact, I do not think 

you could have been better prepared for this job if you had actually 

planned it for a number of years. Your dedication to service to this 

Nation in uniform goes back to 1962, when you entered the military at West Point. After graduating from West Point, you led 

troops in combat in Vietnam. There you were wounded not once, 

but twice. 

Your bravery, your valor have been recognized with military 

medals and commendations too numerous to mention. But, I will 

highlight just a few: two Distinguished Service Medals, the Silver 

Star, the Bronze Star for Valor, and two Purple Hearts. 

Of course, as if your attendance at West Point and your dedicated combat service were not enough, you decided not only to stay 

in uniform but to go to medical school and to serve an additional 

32 years in the military as a physician. Today, you are a board-certified thoracic surgeon, and a Fellow of both the American College 

of Surgeons and the American College of Cardiology. 

Your dedication to duty and medical skills were obviously no secret to your fellow medical colleagues or senior military leaders. In 

2000, you were selected to be the Army’s 40th Surgeon General. 

Those experiences alone, in my mind, qualify you for this job. 

You understand life as a soldier on the ground. You have experienced the challenges of recovery from wounds suffered during war. 

And you have led the next generation of men and women who followed you into service. 

Mr. Chairman, VA is an agency dedicated to ‘‘care for him who 

shall have borne the battle and for his widow and his orphan.’’ I 

believe we have found the man to lead the VA who not only understands combat service, the needs of our injured military personnel, 

and America’s veterans; but a man who has spent the better part 

of his life taking care of those men and women and, more importantly, their families. 

Dr. Peake, I fully intend to support your nomination to be the 

next Secretary of Veterans Affairs, and it is my deep hope today 

5 

that every one of my colleagues on this panel will, in fact, show 

their support and we will act very quickly. 

Senator Dole, I welcome you today and thank you for the introductions, and I know Senator Inouye will be here. 

Mr. Chairman, I thank you for this hearing and for an expeditious consideration of General Peake’s nomination. 

Senator AKAKA. Thank you very much, Senator Burr. 

Senator Murray? 

STATEMENT OF HON. PATTY MURRAY, 

U.S. SENATOR FROM WASHINGTON 

Senator MURRAY. Well, thank you, Chairman Akaka, for holding 

this hearing. General Peake, welcome. Senator Dole, it is good to 

see you again. 

Mr. Chairman, I think we all know that this is a very critical 

and serious time in VA’s history. Our troops are fighting overseas, 

and we see more veterans coming home and entering our system 

every day. We know we are facing unprecedented challenges as we 

try to provide the level of care that all of our heroes have earned. 

I think it is no secret that you all know I think too many leaders 

at the VA have done the agency and our veterans a disservice over 

the last years and that we have seen too many apologists for the 

administration’s policy rather than being strong advocates for our 

veterans. Our veterans have earned the benefits the VA is supposed to provide them, but we have seen them come home to long 

waiting lines to see a doctor, bureaucratic ineptitude, VA claims 

backlogs of months, and many other serious challenges that we 

have all witnessed over the past several years. 

I do not think we should dwell on the mistakes of the past, but 

I really think we have to learn from them, and I think we have an 

opportunity to do that as we decide who will be the next Secretary 

of the VA. In fact, I think whether to confirm General James Peake 

may be the most important decision we make on how our veterans 

issues are dealt with over the next year. 

I often say, that no matter how Americans feel about this war 

today in Iraq, they uniformly believe that we have an obligation to 

take care of our men and women when they come home; and they 

are ready and willing to stand up and do that today. And I want 

you to know that I stand ready and willing to work with any Secretary who is committed to truly fighting for the best interests of 

our veterans. 

So, Mr. Chairman, I very much look forward to this hearing 

today and to hearing from General Peake. General Peake has had 

a very distinguished career and an impressive history of service to 

his country. For most of his nearly 40 years in the military, he has 

been devoted to improving medical care for our wounded servicemen and -women, including a stint as Army Surgeon General. He 

has held numerous positions within the Army, including Commanding General of the Madigan Army Medical Center in my home 

State of Washington. But, we all know a strong resume is not 

enough. We have to have a leader at the VA today who has the fortitude, the backbone, and the courage to stand up to the administration, to all of us; to be honest, and up front about our veterans’ 

current and future needs; and to get us on the right course to carVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00009 Fmt 6633 Sfmt 6601 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
6 

ing for these heroes who risk their lives for our country. I hope 

today we will find that General Peake is the VA Secretary that our 

veterans deserve. 

Mr. Chairman, our VA system is uniquely positioned to recognize 

and treat the specialized injuries, medical conditions, and mental 

health challenges that are caused by combat and military missions. 

Our local VA doctors and nurses are some of the most caring and 

compassionate people I know, and I know they are dedicated to giving our veterans the best care possible. I was, in fact, out in Yakima, Washington, last week at a VA clinic. It was packed to the 

gills with veterans who had come to tell us about the serious challenges that they were facing. And I was most impressed by our VA 

officials on the ground—Sharon Helman from Walla Walla, Max 

Lewis who headed our VISN—who came to that hearing with a 

button on that sent a message to every veteran in the room, and 

it is the first time I have seen that happen. I shared with General 

Peake right before this hearing the button, and, General, when you 

put it on, I will know you have gotten the message. It says ‘‘Business As Usual’’ and has a slash through it. And I think the message sent to the veterans at that meeting is that people were going 

to sit up and take notice and make sure that their needs were met. 

And, General, when you put the button on, I will know you are the 

right man. So, I am glad you have it. 

But I think, seriously, that our servicemembers really deserve 

better than what they have been getting from Washington, DC, and 

I hope that with a new VA Secretary we can change that attitude 

and really get back, on a bipartisan level, to making sure that the 

men and women who serve us are served well. 

Mr. Chairman, we know that Congress has together worked to 

solve some of these problems. We have a lot of huge challenges 

ahead of us. Thanks to recent advances in battlefield medicine, our 

troops, as we know, are surviving incredible injuries that would 

have been fatal in earlier conflicts. And I know some of those advances were overseen by General Peake. However, many more of 

our servicemembers are coming home with devastating and debilitating wounds that are creating a lot of new challenges for our VA. 

One of our biggest challenges is to ensure that our veterans are 

not waiting months or even years for compensation. As of earlier 

this year, the VA had as many as 600,000 disability compensation 

claims waiting to be answered. I heard at that Yakima hearing last 

week from a number of veterans who say they are at the end of 

their patience fighting for their own disability claims. We know the 

claims system is old and antiquated and needs to be fixed. Both the 

Dole-Shalala Commission and the Veterans’ Disability Benefits 

Commission have studied this issue and brought us recommendations, and in many ways their suggestions are similar. But, there 

are some key differences, and, General Peake, if you are confirmed, 

you will have to work with us to address those differences and help 

us move forward to reform this system aggressively. 

Mr. Chairman, I am also particularly concerned about the challenges we face as we try to meet the mental health needs of our 

returning servicemembers. According to the VA, a third of all of 

our Iraq veterans who are enrolled in the system have sought 

treatment for a mental health problem. That is an astounding staVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00010 Fmt 6633 Sfmt 6601 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
7 

tistic. But we also know it is probably too low, because many of the 

veterans are not asking for care, because today, we still have a 

stigma surrounding treatment, or because they fear that a mental 

health diagnosis is going to hurt their military or their civilian careers. 

We know that as our troops are deployed overseas for the third, 

fourth, and now even fifth tour of duty, the risk of suffering from 

PTSD and other mental health conditions is increasing. Just a few 

weeks ago, as I shared with the VA Committee, CBS News reported on a tragic result of not treating mental health conditions. 

CBS found that veterans are twice as likely to commit suicide as 

other Americans. And perhaps, I think, the most disturbing to me 

in that report was that the risk is highest among 20- to 24-yearolds, as high as 4 times that of non-veterans. 

Now, the VA has taken steps to address that tragic situation. 

Congress has taken steps as well. A lot more needs to be done. The 

VA and the Defense Department have to focus their efforts on 

fighting the stigma of mental health treatment and improve screening, improve outreach, and improve care. 

Finally, thousands of our servicemembers are suffering from 

Traumatic Brain Injury, which we know is the signature injury of 

this war. That means many of our soldiers are going to fight subtle 

injuries that are going to hurt their ability to work and communicate with their families and friends. There is still a lot we do not 

know, so, it is very critical that we continue to do research, to identify, prevent, and treat TBI so we can better care for our veterans 

suffering from this devastating injury. 

Mr. Chairman, General Peake has already answered, as we 

know, a number of questions from us. I look forward to hearing his 

testimony today. I believe absolutely we have got to have a Secretary who is willing to roll up his sleeves and get to work because 

we cannot wait another year to start to deal with these many challenges in front of us. 

So, General Peake, thank you for your willingness to take this 

on. I look forward to the hearing today and to your answers and 

responses to our questions. 

Thank you very much. 

Senator AKAKA. Thank you very much, Senator Murray. 

Senator Brown? 

STATEMENT OF HON. SHERROD BROWN, 

U.S. SENATOR FROM OHIO 

Senator BROWN. Thank you, Mr. Chairman. General Peake, 

thank you for appearing here. I look forward to working with you. 

And, Senator Dole, nice to see you. And, Dan, good to see you, too. 

I, of course, echo what Senator Murray just said about the importance of this agency. It is one of the largest in our Government. We 

clearly are not prepared for the next 20, 30, 40, 50 years with these 

injuries that Senator Inouye was talking about on the Senate floor 

one day—who survived and who did not survive these wars—and 

what all three of you have given to this country; and how so many 

of these young men and women will be with us for many, many, 

many years and will demand and deserve such a high level of care. 

8 

Senator Murray also talked about the backlog. My State, with a 

veteran population of a million veterans, has a backlog of over 

14,000 claims—and as General Peake and I were talking on the 

street one day in front of the Russell Building—some 5,000 of those 

claims have been pending for over 180 days. And I know of his interest in dealing with this backlog. The President’s request underfunded the VA, and we are fighting to get the funding with, so far, 

pretty good success. 

Two other concerns. I am concerned about the culture of privatization that has in some cases led to bad contracts, misused taxpayers’ funds, of which there has been a lack of accountability. The 

GAO found that not only did the VA not save jobs, it did not save 

money in its efforts at privatization in many cases. Four-fifths of 

the blue-collar jobs targeted for outsourcing to private contractors 

are held by veterans. So, for this agency to outsource jobs to private contractors, and cut the number of positions that veterans are 

now holding working for the VA, simply does not make sense. A 

large share of them are minorities. A large share of them are disabled vets with service-connected injuries that are using these jobs 

to return to gainful employment and financial independence. 

I offered successfully an amendment on the Senate floor on the 

VA military construction bill which reaffirmed existing laws, ensuring the VA must conduct public-private competition before transferring Government functions performed by more than 10 employees. 

And you will hear more about that, and I think that is a very important part of your responsibility. 

Last, I have done a series of roundtables with 15 to 20 veterans 

at each around my State—probably a dozen of them since I took 

office in January—and one was particularly troubling. In Cleveland, at the VA hospital, about 15 young men and women who recently had left—mostly Guard and Reserve soldiers, but some were 

regular Army, regular Air Force—had recently left active duty, and 

were back home trying to reintegrate into the community; going to 

school, going to work. Almost every single one of them said that 

when they left the military they were not told—this is not your responsibility, except we have talked about the transfer from DOD to 

VA—many of them were told very little about education benefits, 

and health benefits, especially; that once they said they weren’t 

going to re-up, the military—their commanding officers seemed, 

frankly, to lose interest in them—they were told to turn in their 

equipment. They came home, and then they struggled. 

There is a program at Cleveland State, one of the best, one of 

the only in the country, that really works to get veterans in the 

classroom and have special classes for them as they integrate into 

society. But there is not enough information coming from their 

commanding officers, coming from DOD, helping them integrate 

back into society and giving them knowledge of the access to veterans’ services. I hope that that will be one of your top priorities 

as people struggle after serving their country to get back on their 

feet, disabled vets and non-disabled vets alike. It is something we 

absolutely owe them, especially education and health benefits. 

Again, thank you, General Peake, for being here, and thank you, 

Mr. Chairman. 

Senator AKAKA. Thank you, Senator Brown. 

9 

Senator Tester? 

STATEMENT OF HON. JON TESTER, 

U.S. SENATOR FROM MONTANA 

Senator TESTER. Thank you, Mr. Chairman. I appreciate you 

holding this hearing. I want to thank the two Senators, Senator 

Dole and Senator Inouye, for being here today. I especially want to 

thank Jim Peake for being here, and thank you for your service to 

this country, and thank you for wanting to do this job. You have 

a distinguished military career. That goes without saying. You 

seem to be a man of good moral character. That is very, very important. 

If you get confirmed to this job, you have an incredible opportunity to impact the VA in a very, very positive way. Challenges 

for the VA are great, and they will continue to grow. It still takes 

too long for veterans to get an appointment with a VA doctor. That 

needs to change. It still takes an average of six months for a disability claim to get resolved. That absolutely needs to change. Too 

many PTSD claims are denied or given an unacceptably low rating, 

and the claims that are appealed by our veterans take, on average, 

two years to resolve. We all know that these are unacceptable. 

Fixing these problems will be an enormously complicated process, and they will require substantial time and attention and sometimes money. I look forward to hearing much about General 

Peake’s strategies for handling these issues. I hope that despite his 

extensive background in the private sector he agrees to address 

many of these issues without relying too much on privatization of 

the VA. The private sector needs to be involved in some of the 

areas in this country, particularly in the rural areas and the specialty care areas; however, as the American Legion has said, I believe the VA system is a system worth saving. 

Finally, Mr. Chairman, I hope to hear more from General Peake 

about the particular needs of rural veterans. Montana being a rural 

State, and the fact that many of the veterans that live in rural 

areas do not live as long as veterans that live in urban areas, it 

is critically important. I look forward to hearing him expand upon 

the questions that he answered, the pre-hearing questions about 

rural medicine for vets, telemedicine, and how we can improve 

rural health care. Clearly, the needs of vets in Montana and in all 

areas of this country go well beyond just telemedicine. 

As I have said, Mr. Chairman, General Peake seems to be a very 

good man. He has a solid military record. Really, the question is 

whether he can deliver the urgent leadership necessary to implement the solutions that will make the VA work better for the men 

and women who have put their lives on the line for this country. 

I want to thank you very much once again for being here. Thank 

you, Mr. Chairman, for holding this hearing. I look forward to your 

comments and the questions that follow. 

Senator AKAKA. Thank you, Senator Tester. 

Senator Hutchison? 

STATEMENT OF HON. KAY BAILEY HUTCHISON, 

U.S. SENATOR FROM TEXAS 

Senator HUTCHISON. Well, thank you, Mr. Chairman, very much. 

10 

First, I want to say that the two people who are sitting on either 

side of you have more credibility with the veterans community and 

for this country as the greatest patriots I know, and that they are 

here with you means a lot to me. 

Secondly, I think at a time when we know that the biggest problem we have is making sure that our veterans get the health care 

they need, having a physician for the first time to be the head of 

Veterans Affairs I think was a very wise choice by the President. 

So, I, of course, have visited with you; and with your distinguished 

record, which Senator Burr has enumerated, I certainly intend to 

support your nomination because I believe you can make things 

happen. 

I want to talk about the three issues that are of greatest concern 

to me. As you know, I am also Chairman of the Military Construction and Veterans Affairs Subcommittee of Appropriations. The 

claims processing, as has been mentioned here before—a wait of 

177 days for a disability claim to be processed is unacceptable. This 

Congress, in a very bipartisan way, has passed appropriations 

through my Committee that would specifically target hiring more 

claims processors. In fact, we specified this year in our appropriations bill, which I hope honestly, Mr. Chairman, that we can pass 

free-standing, because it has been agreed to, but has not yet moved 

to the President, we specified $124 million to hire an additional 

1,800 claims processors. If we can get that bill through, I will be 

looking to you to expedite the hiring of those claims processors and 

trying to change the system. 

Senator Dole and Secretary Shalala, who headed the Commission 

that we all know was so vital for the recommendations that it 

made for improvement in veterans health care, both said that the 

entire system needs to be restructured. So, that is something that 

I think should be first on your agenda, and we would certainly 

want to hear from you on that subject. 

Secondly, I want to say something good about the VA because 

our veterans do deserve the very best care. But I hear complaints, 

complaints, complaints, and yet the good things that the VA does 

are largely unnoticed, and they never seem to be remarked on by 

Members of Congress or the groups that could talk about it, and 

that is the electronic records system. The VA is state-of-the-art. It 

is the very best. After the Katrina disaster in Louisiana, not one 

veteran missed a medical treatment or a medicine because the electronic transfer happened, and wherever the veteran was, that veteran went to a veterans’ facility anywhere in the country, and they 

could be treated. That is remarkable. And I want to give many of 

those sitting on the front row here who have been with the Veterans Administration and previous administrators and Secretaries 

credit for that because it is phenomenal. 

However, the Department of Defense is not up to speed in making sure that the people who are leaving active duty because of injuries are having the smooth, seamless transfer that we all expect 

to go into the veterans system. It could not be too complicated for 

the Department of Defense and Veterans Affairs to have the same 

system for electronic transfer of records. So, I think that is an area 

where you can take the accomplishments of past Secretaries and 

11 

the Department and transfer that into a success by working with 

the Department of Defense and having that seamless transition. 

The third area that is very important to me and has been on my 

Appropriations Subcommittee, as well, is the research. We all know 

that the wounds of today’s veterans are different from those suffered by the two wonderful, valiant men sitting at the table with 

you, and you, yourself, from Vietnam, theirs from World War II. 

The injuries are different today. We have more brain injuries, more 

traumatic impact injuries because of these IEDs. We have more 

Post Traumatic Stress Syndrome, or at least we are treating it. It 

could be that we had it before and we did not do enough. I think 

that is probably likely. But today we do know about it, and General 

Patton’s word is wrong on this subject—as we all agree, I think— 

and that is, we have got to treat the injuries of today. 

Research is doing so much more in that regard. The prostheses 

and the use of arms and legs that are missing or partly missing 

has taken phenomenal step in the right direction. But we need to 

continue that to make sure that we are doing the very best for 

these veterans, to have the most normal lives possible. 

The Post Traumatic Stress Syndrome—we have mental health 

centers now that have been designated as centers-of-excellence for 

mental health for our veterans’ treatment. We now have the traumatic injury centers in different areas of our country. This is all 

very good. Gulf War illness research, which is very important to me 

and I think is something that has been overlooked in the past, 

though not in the recent past; because the Veterans Administration 

has gone forward to see what the effects on the brain from coming 

in contact with chemicals does. And they are finding that maybe 

there is a connection between these debilitating sort of Lou 

Gehrig’s disease symptoms that are connected with some contact 

with chemical weapons. 

So, I hope that these three areas, which are major priorities certainly for me and many Members of Congress, will be addressed by 

you. And I think you can take some very good successes in the Veterans Affairs Department, and add to those with the help of the 

Dole-Shalala Commission recommendations and with veterans like 

Senator Inouye, who are in this Congress, and all of those on this 

Committee who have really focused on this and made sure that we 

did improve the service and increase the appropriations for this 

very important need. 

So, with that, I look forward to hearing your remarks and supporting your nomination. And hopefully, Mr. Chairman, we can do 

this, so that we can have not an Acting Secretary but a Secretary 

who is going to hit the ground running and make things happen 

in the next year for our veterans. 

Thank you. 

Senator AKAKA. Thank you very much, Senator Hutchison. 

Senator Webb? 

STATEMENT OF HON. JIM WEBB, 

U.S. SENATOR FROM VIRGINIA 

Senator WEBB. Thank you, Mr. Chairman, and, General, welcome. I would like first to express my appreciation to you for your 

service, and particularly your service as a young Army officer. The 

12 

West Point class of 1966 has really been memorialized, I think, as 

having taken the most casualties of any of the West Point classes 

in Vietnam. As high as 10 percent of that class was killed in Vietnam, as I recall, a very difficult period during the war when you 

and others served. I have a great deal of appreciation for that. 

I, as you know, am going to want to hear from you about your 

views and your ability to affect the views of the administration 

when it comes to a proper GI bill for the people who have been 

serving since 9/11. And, it is rather fortuitous that Senator Dole 

and Senator Inouye are sitting with you this morning, because 

when I have been speaking about the need for a GI bill that properly recognized the service of people since 9/11 and assists those 

who are readjusting, I continually come back to the World War II 

GI bill, which was an amazing piece of social legislation, as well 

as a piece recognizing properly the service of people. It gave people 

a true chance at a first-class future in a way that very few other 

programs in this country have. 

I have three quotes I would like you to think about before you 

and I have a dialogue. This is, as I say, very fortuitous. I did not 

know that Senator Dole was going to be here, but this is what he 

said before this Committee in October: ‘‘I think the World War II 

GI bill was the single most important piece of legislation when it 

comes to education, how it changed America more than anything 

I can think of, and we ought to take the same care of veterans 

today.’’ 

And then I asked my staff—when I was trying to be able to explain why this is important and why this Montgomery GI Bill is 

not addressing the ability of these people who have been serving 

since 9/11 to have a first-class future. I asked my staff to take a 

look at the advantages our colleagues in the Senate who were 

World War II veterans were able to obtain through their use of the 

World War II GI bill. This is a chart that was put together, and 

Senator Inouye, who is a cosponsor of our GI bill, S. 22 that I introduced, is one of the people on here. But, if you take a look at this, 

you can see the institutions that those who served in World War 

II were able to attend on the World War II GI bill and what that 

would cost today and what percentage of that would be able to be 

paid for by this present Montgomery GI Bill, and you see the problem. 

Senator Lautenberg, who also is a cosponsor of the bill, was able 

to go to Columbia on a full ride. Today it would cost $46,874 to go 

to Columbia. The present GI bill, the average participation rate of 

$6,000, would take care of not even 13 percent of that. This is what 

we are looking at. 

The U.S. military is doing a very good job in terms of managing 

its career force. What it is not doing is understanding the difficulties in transition of the people who are leaving. Not everybody who 

comes in the military, as you and I well know, even under a volunteer system, comes in because they want to make it a career. They 

come in because they love their country; they want to serve for a 

while; maybe they want a soldier, they got a family tradition; these 

sorts of things. And, we are not taking care of these people. 

And just out of fairness, I put myself on here. I would not be sitting here today, or it would have been a much more difficult jourVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00016 Fmt 6633 Sfmt 6601 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
13 

ney for me to be sitting here today, without the help of Uncle Sam. 

You know, this country put me through undergrad at the Naval 

Academy. I do not know what the number is that we can put on 

that. In fact, they get a little shaky when you ask them how much 

it really costs to put each individual through. And then, because I 

had been wounded and was on a voc rehab program, I was able to 

go to Georgetown Law School. And that is the same benefit that 

the World War II veterans had. They paid my tuition, they bought 

my books, and they paid a monthly stipend. Today that would cost 

$51,000 a year, and this Montgomery GI Bill would pay for 11.6 

percent of that. 

If we put the other chart up, this is you and me, General. Our 

country put you through school—put you through medical school; 

put me through school—put me through law school. We have got 

some really tremendous young men and women out there who have 

stepped forward at a time when a lot of other people have dealt 

with this situation intellectually, and we owe them absolutely the 

best transition that they can get into civilian life. It will reduce 

things like Post Traumatic Stress. It will give them something affirmative to bring back to the community. And I hear from DOD 

that they think this will affect retention. I do not think they are 

being creative enough. I think this will broaden recruitment. I 

spent a lot of time doing manpower issues in the Pentagon. I have 

got 5 years in the Pentagon, as you know—one as a Marine and 

the other 4 as a defense executive. And the word, the signal word 

when I was in the Pentagon was that the best recruitment tool you 

have is a proud veteran back in the community, someone who believes they have been treated right and is proud of their service. 

And this is the kind of thing that would help that. 

So, I am looking forward to hearing your thoughts on this during 

your testimony. This is a time in the administration, toward the 

end of an administration, where I do not know how many minds 

you would be able to change. But at the same time, I hope we can 

have an honest broker in there; and from your own background I 

am really strongly hoping that you can help us make this happen. 

Thank you, Mr. Chairman. 

Senator AKAKA. Thank you very much, Senator Webb. 

And now I would like to ask for the statements of our two Senators who have honored us by being present here today. I want to 

begin by saying they have so much in common. Both of them 

served in World War II. Both of them were badly injured. Both of 

them were in the same hospital. Both of them were distinguished 

Senators in the U.S. Senate. And they are here today to speak and 

introduce Dr. Peake. And being here long enough, I am struggling 

as to who to ask to speak first. If we go by age, I know who should 

speak first. And so, what I will do is I will ask Senator Inouye and 

Senator Dole to decide who will speak first. 

[Laughter]. 

STATEMENT OF HON. DANIEL INOUYE, 

U.S. SENATOR FROM HAWAII 

Senator INOUYE. Thank you very much, Mr. Chairman. I am honored to join my dear friend Bob Dole, Senator Bob Dole, in presenting to the Committee the President’s nominee for the position 

14 

of Secretary of the Department of Veterans Affairs. I would like to 

thank General Peake for agreeing to serve. Our country needs the 

General, and I am certain no one is more proud of you than your 

wife, Janice, and your children, Kimberly and Thomas. 

This Committee carries the tremendous responsibility of ensuring that we live up to our enduring obligations to our veterans. The 

President’s nomination of Dr. Peake sends a strong message that 

this administration is serious about transforming the care of 

wounded warriors to ensure that our veterans get the world-class 

care they deserve. 

I am confident that there is no one more qualified to accomplish 

this task than Dr. James Peake. As the son of an Army nurse and 

a career Medical Service Corps officer, he grew up in a home where 

service to country was paramount and where respect for soldiers 

and their families was expected. He graduated from the United 

States Military Academy, as noted, in 1966. After completing airborne, ranger, and pathfinder training, he served as an infantry officer in the 101st Airborne Division in Vietnam. He was decorated 

three times for valor and earned a Silver Star. And many of you 

know that he was wounded in action and received two Purple 

Hearts. Dr. Peake attended Cornell University Medical College and 

later specialized in cardiothoracic surgery. He dedicated the rest of 

his 38-year career to caring for soldiers and their families. 

In the year 2000, he assumed the highest position within the 

Army Medical Department when he became Surgeon General of the 

U.S. Army, and I have had the honor and privilege of knowing Dr. 

Peake since 1980, when he was assigned to Tripler Army Medical 

Center in Hawaii. He was then the Chief of Surgery and later became Deputy Commander. 

As Army Surgeon General, Dr. Peake led the Army medicine 

transformation. He had a vision, a foxhole-to-hospital view of the 

entire medical system, with the goal that nine out of ten soldiers 

wounded on the battlefield would survive. That was a very ambitious role when considered that during the time of Bob Dole and 

myself, we were lucky if you had more than 75 percent. 

Training every combat medic to be an emergency medical technician was critical to realizing his vision and was his emphasis on 

joint medical evacuations, establishing forward surgical teams, and 

placing mental health, nursing, and physical therapy at the brigade level. 

In December of 2001, projecting the potential for a large number 

of amputee patients from the global war on terror, Dr. Peake directed the development of the Amputee Patient Care Program. 

Today, the VA and the Department of Defense work very closely in 

this program to meet the needs of our patients. The VA social 

workers, benefits counselors, vocational educational rehab counselors, and researchers have been detailed to Walter Reed in support of the care of our patients. The success of this program is due 

in large part to Dr. Peake’s ability to anticipate the need for 

change and to lead people towards a common vision. 

The time is right for change in the Veterans Affairs Department, 

and what we need at the VA is someone who cares, someone with 

a mission focus, someone who has managed large organizations, 

and someone who can build bridges with the Department of DeVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00018 Fmt 6633 Sfmt 6601 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
15 

fense, someone who can work with the bipartisan nature of the 

Committee to do the right things for those great men and women 

who are taking their places in history as our new combat veterans. 

Dr. Peake is uniquely qualified to meet these challenges. Dr. 

Peake has the distinction of being the first physician and the first 

general to be nominated as Secretary of the Department of Veterans Affairs. His time as an infantry officer gives him a warrior’s 

perspective on how we should care for our wounded. As importantly, his 40 years of distinguished military service gives him the 

wisdom and credibility of a proven leader. 

Very shortly, I will be returning to Hawaii to participate in the 

events commemorating the December 7th attack on Pearl Harbor, 

the Day of Infamy that led to the largest generation of veterans 

this country has seen and a generation that is aging. This generation reminds us of the importance of the VA and the vital services 

the Department of Veterans Affairs provides. 

I am confident that with this appointment the VA will meet the 

considerable challenges ahead, not just for our aging veterans but 

for all veterans. And so, Mr. Chairman and Members of the Committee, I thank you again for the opportunity to join my dear 

friend, Senator Dole, in presenting this great American, Dr. James 

Peake. 

Senator AKAKA. Thank you very much, Senator Inouye. 

Senator Bob Dole. 

STATEMENT OF HON. BOB DOLE, FORMER 

U.S. SENATOR FROM KANSAS 

Senator DOLE. Well, Senator Inouye, we did not know many generals. We were lieutenants. But, it is nice to be seated next to these 

big shots. It is probably a first for both of us. 

We are very proud of General Peake, and what really impressed 

me was the fact that his mother was a nurse, because our mothers 

are wonderful and we forget about that from time to time, until 

you end up in a hospital somewhere. And if you go to Walter Reed 

or a VA hospital and there is a young man or a young lady injured 

there, either there is going to be the spouse there or the mother, 

just as they were back in our days in World War II. 

You all know his background: he is dedicated to service—a must 

for somebody to take on a 1-year job. I have often thought the VA 

Secretary ought to be like the FBI. It ought to be somebody we find 

out there, regardless of politics, who can serve for 10, 15 years uninterrupted. You know, maybe a lot of these problems would be 

cleared up in the process. 

I remember being a service officer after World War II for the 

American Legion and the VFW and the DAV in my little home 

town. So, you know, we have had problems. There are always problems. We have got 25 million plus veterans, and there are problems. And veterans have rights to appeal, which extends the time 

they get their benefits, and they certainly should exercise that 

right. Sometimes we talk about how many days or months or how 

many cases. A lot of them are because the veteran does not think 

he got a fair shake the first round and he appeals the case, as he 

should. 

16 

You know, I think there is a great positive story to be told about 

the VA. It must be the largest medical organization in the world. 

When you stop to think about it. How many hospitals—107? 

Dr. PEAKE. 153. 

Senator DOLE. 153. And I do not know how many amputations 

a year, how many different cases they have. As Senator Hutchison 

pointed out, they have certainly got the best IT system, I think, in 

this country, and probably everywhere. But, you know, when I see 

a piece called ‘‘Waging War Against the VA,’’ and you find some 

outstanding people like Tammy Duckworth, who is a friend of 

mine, and others—Tammy said she owed her life to Walter Reed. 

So, you know, they do a lot of good things, and they take care of 

a lot of good people. I know it is easy to focus on the negative, and 

it is going to happen. Let’s face it. We are all normal Americans. 

We like to complain from time to time, and sometimes we are not 

treated fairly. If you are veteran and not treated fairly, you know, 

that should not be tolerated, as Senator Murray pointed out. 

There are mistakes being made. I do not know what percent of 

the personnel in the VA system are veterans. A lot of these people 

who are taking care of you have been there, and they are certainly 

doing their best to make certain the veteran gets the care. And 

that is another plus as far as General Peake is concerned. I hope 

he does take a look at the GI bill. I would not be around and I do 

not think Senator Inouye would be around—there are 8.5 million 

of us that took advantage of it in World War II out of 16 million. 

It does not have to be 4 years. It could be whatever. And it did become, for me, the most important thing that ever happened; because once you get a college education, you want your children and 

everybody else in your family to have the same opportunity. 

One thing that has occurred to me—this is a little off the point— 

I think the universities and the colleges ought to participate, too. 

There ought to be a little discount on the tuition or some way they 

can participate. They are not going to be overwhelmed with veterans from Iraq and Afghanistan, but certainly they can make a 

little contribution, which would lower the tuition cost in some 

cases. But, anyway, I would be happy to work with Senator Webb 

trying to figure out a good bipartisan approach to this. 

I did a little checking around to see how other people described 

General Peake, and the words and phrases used to describe General Peake have been: tough, smart, hard-working, focused, fair, 

compassionate, pragmatic, thoughtful, measured. He is someone 

who listens, he has a vision, and he demands and expects results. 

That is what we are looking for, somebody who is demanding; 

somebody who expects results; and somebody who is going to respond to this Committee and the Members on this Committee and 

the veterans groups that are working with veterans and others 

around the country. 

I think the fact that you are willing to do this for one year—it 

is a short time—there are many things you can do. I do not know 

of anybody in the Congress that I have ever known the 351⁄2 years 

I hung around in the House and Senate that did not want to help 

veterans. We all want to help veterans. We just need the guidance 

and the facts to make certain that the deserving veterans, you 

know, are getting whatever they need. Whatever you think of 

17 

President Bush and whatever you think of the administration or 

the war—I remember the President telling me and Secretary 

Shalala to do ‘‘whatever it takes.’’ And that is where we are, and 

that is the responsibility. Whatever it takes—whether it is dollars, 

whether it is education, or whether it is whatever other concerns 

the Committee may have. 

The general is going to have a tough, tough assignment. We are 

talking about, as you know, not just the Afghan and Iraqi veterans 

but, the Vietnam veterans—they are getting a little older—and the 

Gulf War veterans. People forget about the sacrifices made by the 

Korean veterans—that we lost 37,000-plus young men and women. 

And then there are still a lot of us around from World War II. I 

think we are down to about 5 million out of 16 million. 

I want to thank Senator Brown for his participation in the Honor 

Flight program where they bring these old guys back here, and 

women—the women are not old; the guys are old. They charter airplanes, and they put them on a plane from Ohio. You have had 

many. They fly them back here without any cost to the veteran. 

They tour all the memorials, and they end up at the World War 

II Memorial. It is a very emotional, important time in their life. 

You can see the tears rolling down their cheeks. It is the greatest 

thing. I have had letters from some of these men who just said that 

nothing like this has ever happened. They thought they were forgotten. And just that little visit—and Ohio I think is the leading 

State; North Dakota is right behind. North Dakota is running out 

of veterans, they have had so many trips. And it does not cost them 

one dime; it is all raised locally. Like Spokane would raise money— 

they could not make it in one day, though, Spokane and back. But 

it is something you get on your website—Honor Flight. It is a great 

program. 

But, anyway, General Peake is going to look after all of us older 

veterans, as well as all the others, and I want to thank him for taking on this responsibility. I sort of got involved in the process of— 

I am not that close to the White House—but in this case I wanted 

to have some input. I recommended some people. And I know that 

they have really worked at it. I talk sometimes two or three times 

a week with people who were doing whatever you would call it at 

the White House, looking at different candidates—and General 

Peake just rose to the top. They had other well-qualified men and 

women, but General Peake was the choice, and I think the right 

choice. So, Senator Inouye and I are honored to be here today, and 

I hope we do not hurt you too much. 

Senator AKAKA. I want to thank you both very much for your 

statements today in support of Dr. Peake. 

Senator Craig? 

STATEMENT OF HON. LARRY E. CRAIG, 

U.S. SENATOR FROM IDAHO 

Senator CRAIG. Mr. Chairman, thank you very much, and I will 

be brief. 

I have had the great opportunity to visit with the general. 

Let me speak in as precise a way as I can so we can hear from 

our new Secretary. I have worked over the years and have spoken 

out about seamless transition. I now see an opportunity with a 

18 

leader who understands this—with a foot having just stepped out 

of DOD and into VA. I believe, after having visited with him, the 

vision to make that transition in a way that brings medical records 

and personnel records fluently and consistently through the process 

so that we get into the 21st century with our men and women in 

uniform as they transition out of defense, out of active service, into 

a veteran’s status, in a way that can be called seamless. If this Secretary can accomplish that, I believe he will accomplish a great 

deal. 

Lastly, Senator Dole, you spoke of a relationship in education 

and a responsibility this country has in working with veterans. Let 

me recommend you look at—and I will send it to you—a program 

that I helped the University of Idaho initiate over 2 years ago 

called ‘‘Operation Education.’’ They have since programmed it and 

sent it out to colleges and universities across the country. And it 

is simply this: an Iraqi or an Afghan vet who wants to come to the 

University of Idaho, with all of their veterans benefits, can come, 

and we will match whatever is necessary to make their stay there 

work. We have reached out to private sector folks and to foundations and to the university foundation. 

For example, if they are married, then we find a job for the 

spouse. We provide daycare to the children. A combination of 

things that has brought, I think, the opportunity of that veteran 

coming out of Iraq or Afghanistan and using those benefits, we 

simply add to the benefits and leverage the benefits into a full benefit. That is what the public and private sector ought to be doing 

in cooperation. 

I recommend it to you. I will send it to you. I think you would 

enjoy looking at it. It is working very well. It is called ‘‘Operation 

Education.’’ Thank you. 

Thank you, Mr. Chairman. 

Senator AKAKA. Thank you very much, Senator Craig. At this 

time I would like to ask Dr. Peake to stand for the administration 

of the oath. 

Would you raise your right hand? Do you solemnly swear or affirm that the testimony you are about to give this Senate Committee on Veterans’ Affairs will be the truth, the whole truth, and 

nothing but the truth, so help you God? 

Dr. PEAKE. I do. 

Senator AKAKA. Thank you very much. 

Dr. Peake? 

STATEMENT OF LTG JAMES B. PEAKE, USA (RET.), M.D., NOMINEE TO BE SECRETARY, DEPARTMENT OF VETERANS AFFAIRS 

Dr. PEAKE. Well, Chairman Akaka, Senator Burr, ladies and gentlemen of the Committee. Senator Akaka, thank you so much for 

scheduling this hearing expeditiously. I deeply appreciate the confidence of the President in this nomination, and I am honored and 

I am humbled to be before you today seeking your endorsement to 

become the next Secretary of Veterans Affairs. 

I want to thank Senator Inouye and Senator Dole for their wonderful words of introduction. I have held each of these great leaders 

in such high esteem over so many years, each of them representing 

19 

service to this Nation in the military, wounded in battle, a full career of public service to follow. Their endorsement alone underscores the responsibility that I know comes with this job. 

As has happened so often in my Army career, my wife, Janice, 

is taking care of our family. My son, Tom, is graduating with his 

master’s degree down in Texas, and she and my daughter are off 

to be with him. She has been my mainstay on this whole journey 

you have heard about, and I could not be more fortunate. 

With the career I have had, though, there is also an extended 

military family, and there are a number in the audience today. I 

would like to introduce one special member of that Army family, 

and that is Mr. Rick Bunger. Rick was my radio-telephone operator 

when I was a platoon leader in Vietnam. He is a veteran, came 

home, went from rodeo bullrider to successful businessman, and he 

has traveled from Arizona to be with me here today. I never 

dreamed that in front of this Committee that cares so much about 

veterans that I would have the opportunity, Rick, to thank you 

publicly for your service. But with your permission, Mr. Chairman, 

I do that now for the record. 

I want to thank each of you on this Committee for finding the 

time to meet with me individually. I was deeply impressed and appreciate your individual commitment to our veterans and to the 

mission of the Department of Veterans Affairs. I listened carefully 

to your concerns. They ranged from the very real challenge of the 

transition from DOD to VA care—the attendant issues of sharing 

information between the Departments, the importance of the continuity of care which that will help—to the very nature and the 

quality, of the care in the VA itself—and not just the quality, but 

access to that care, access that is timely and with minimal bureaucracy. 

The special challenges of rural health care as it relates to access 

for our veterans was an issue that I heard from many of you and 

of the special challenges that this poses, particularly for mental 

health. I appreciate the universal concern that PTSD and Traumatic Brain Injury may be less apparent than some of the horrendous physical wounds that we are seeing fresh from the battlefields; but that these injuries are, nonetheless, real, and are likely 

to become the signature injury of this conflict. 

The great advances in prosthetic devices that allow our amputees 

the opportunity for maximal functioning need to be matched with 

the same kind of advances in dealing with mental health issues of 

our veterans and of their families. That means research, developing 

the base of mental health providers, ensuring access, addressing 

stigma, developing practice guidelines, measuring the outcomes, 

and providing support to address the co-morbid conditions. 

You spoke to me about Gulf War illness. Even now, 15 years 

later, we do not have clear answers for those who returned from 

Desert Shield and Desert Storm with unexplained illnesses. I know 

and share your concern that this not be forgotten, that we continue 

to care for these men and women and continue to seek the answers 

to the questions of why; not just for them but for future veterans 

as well. 

I appreciate your concerns about the VA infrastructure, ensuring 

that VA forecasting is done well to ensure that we make the right 

20 

investments, to have the appropriate physical and human infrastructure to care for the evolving demography of our veteran populations. 

I heard clearly the dissatisfaction with veterans waiting excessive periods of time to have their claims adjudicated; of the importance in reducing the backlog of claims, while at the same time ensuring consistency in our rating processes. While I am gratified 

that the VA has nearly 3,000 new claims people on board and in 

training, I look forward, if confirmed, to moving forward to making 

the system less complex, more understandable, and better supported with the tools of information technology. A veteran should 

not need a lawyer to figure out what his benefit is, and he should 

not need a lawyer to get it. 

Every single one of these issues that I heard from you is important. Each one is complex, and each needs both short-term and 

long-term approaches as we honor our commitments to those who 

have served—those who have served before and to this new generation of combat veterans. It is important we get it right for them 

now. And as you said, Senator, it is not business as usual. 

Well, the issue today I guess is why me—given the challenges I 

have outlined, the size of the organization, the complexity of the 

mission. You have seen my bio. My father and my mother, both 

buried at Arlington, were in the military. I was raised in the Army, 

chose a career, 38 years cared for soldiers and their families. I have 

spent time in medical centers and in troop units. I have been in 

combat zones and on disaster relief missions. I have worked in the 

joint and interagency arena, engaged with many stakeholders in 

military medicine, and appreciate the importance of working collaboratively with the veterans service organizations and the military service organizations. Fifty percent of our Army medical force 

is in the reserves. I spent a large amount of my time, and energy 

really, over multiple assignments, with and for these men and 

women who truly live up to the moniker of ‘‘twice the citizen.’’ I 

know they have unique veterans issues. Fifty percent of Army Medical Command personnel are civilians, so I have dealt with a large 

civilian workforce. 

I have learned that one cannot micromanage large organizations. 

One needs to delegate and trust subordinate commanders. I do believe in accountability, in facts, in data-driven decisions. I have 

learned by asking questions and by challenging assumptions, and 

I will do that if confirmed at the VA. I will do that to try to make 

a difference in those issues about which we spoke in your office, 

and which I have heard from you today: to make a difference for 

our veterans, for those who served in World War II and Korea, 

whose needs may be different from the needs of my generation; the 

Vietnam veterans generation, my colleagues and my friends who 

are now finding an increasing need for VA services; to make a difference for this next generation of combat veterans returning from 

Afghanistan and Iraq, who have immediate needs that are quite 

different from those whose last battle was 40 years ago. 

I know these young men and women, too. I have been responsible 

for training many of them; for helping build the system that is returning them from the battlefield despite serious wounds; for investing up front and providing them the best prostheses; for trying 

21 

to understand the mental health issues longitudinally, from the 

front edge of the battlefield. I care about them. I appreciate the 

debt that we owe them. I believe we must look proactively to their 

needs today while shaping the system for their needs of the future. 

I thank this Committee for your unwavering commitment to the 

Nation’s veterans, and if confirmed, I look forward to working with 

you with that same personal commitment. 

Mr. Chairman, I thank you so much for this speedy hearing, and 

I look forward to your questions. 

[The prepared statement of Dr. Peake follows:] 

PREPARED STATEMENT OF LTG JAMES B. PEAKE, (RET.) M.D., 

NOMINEE TO BE SECRETARY OF VETERANS AFFAIRS

Mr. Chairman, Senator Burr, Ladies and Gentlemen of the Committee. Senator 

Akaka, Thank you for scheduling this hearing so expeditiously. 

I deeply appreciate the confidence of the President in this nomination and am 

honored and humbled to be before you today seeking your endorsement to become 

the Secretary of Veterans Affairs. I want to thank Senator Inouye and Senator Bob 

Dole for their kind words of introduction. I have held each of these great leaders 

in such huge esteem for so long, each of them representing service to this nation— 

in the military, wounded in battle, and a full career of public service to follow—their 

endorsement, alone, underscores the responsibility that I know comes with this job. 

As has happened so often in my Army Career, my wife Janice is taking care of 

our family. My son, Tom, is graduating with his Masters Degree down in Texas and 

she and my daughter are traveling to be with him. She has been my mainstay on 

this journey that brings me before you and I could not be more fortunate. With the 

career I have had, there is also an extended Military family. There are a number 

in the audience today, but I would like to introduce one special member of that 

Army family, and that is Mr. Rick Bunger. Rick was my Radio-Telephone Operator 

when I was a platoon leader in Vietnam. He is a Veteran who came home, and went 

from rodeo bull rider to a successful businessman. He has travelled from Arizona 

to be here with me today. I never dreamed that, in front of this Committee that 

cares so much about veterans, I would have the opportunity to thank him for his 

service, but I am delighted to do that now for the record! 

I want to thank each of you on the Committee for finding time to meet with me 

individually. I was deeply impressed and appreciate your individual commitment to 

our veterans and to the mission of the Department of Veterans Affairs. I listened 

carefully to your concerns. 

They ranged from: the very real challenge of the transition from DOD to VA care; 

the attendant issues of sharing information between these Departments; the importance of the continuity of care to the very nature and quality of that care across 

the VA system; and not just quality, but access to that care—access that is timely 

with minimum bureaucracy. 

The special challenges of rural health care as it relates to access for our veterans 

was an issue that I heard from many of you, and of the special challenges this poses 

for mental health in particular. 

I appreciate the universal concern that Post Traumatic Stress Disorder (PTSD) 

and Traumatic Brain Injury (TBI) may be less apparent than some of the horrendous physical wounds that we see fresh from the battlefields, but, that these injuries are nonetheless real, and are likely to become the signature injury of this conflict. The great advances in prosthetic devices that allow our amputees the opportunity for maximal functioning need to be matched with the same kind of advances 

in dealing with the mental health issues of our veterans and of their families. That 

means research, developing the base of mental health providers, insuring access, addressing stigma, developing practice guidelines, measuring the outcomes and providing support to address the co-morbid conditions. 

You spoke to me about Gulf War Illness. Even now, 15 years later, we do not have 

clear answers for those who returned from Desert Shield and Desert Storm with unexplained illnesses. I know and share your concern that this not be forgotten, that 

we continue to care for those men and women and continue to seek answers to the 

questions of why, not just for them, but for future veterans as well. 

I appreciate your concerns about the VA infrastructure, insuring that VA forecasting is done well to insure that we make the right investments to have the appropriate physical and human infrastructure to care for the evolving demography 

of our veteran populations. 

22 

I heard, clearly the dissatisfaction with veterans waiting excessive periods of time 

to have their claims adjudicated; of the importance in reducing the backlog of 

claims, while, at the same time, insuring consistency in our rating process. While 

I am gratified that the VA has nearly 3,000 new claims people on board and in 

training, I look forward, if confirmed, to moving forward with making the system 

less complex, more understandable, and better supported with the tools of information technology. A veteran should not need a lawyer to figure out what benefit is 

due, or to get that benefit. 

Every single one of these issues that I heard from you is important. Each is complex and each needs both short-term and long-term approaches as we honor our 

commitment to those who have served before; to this most recent population of combat veterans; it is important that we get it right for them now. 

The issue at hand today, is ‘‘Why me?’’ Given the challenges I have outlined, the 

size of the organization, the complexity of the mission . . . . You have seen my bio: 

my father and my mother, both buried in Arlington, were in the military. I was 

raised in the Army. 

I chose a military career and for 38 years I cared for soldiers and their families. 

I’ve spent time in medical centers and in troop units; I’ve been with them in combat zones and in disaster response operations. 

50 percent of our Army Medical Force is in the reserves. I spent a large amount 

of time and energy over multiple assignments with and for these men and women 

who truly live up to the moniker, ‘‘twice the citizen.’’ I know that they have unique 

veterans issues. 50 percent of the Army Medical Command personnel are civilians, 

so I’ve dealt with a large civilian work force. 

I’ve learned that one cannot micromanage large organizations, one needs to delegate and trust subordinate commanders. I do believe in accountability, in facts, and 

data driven decisions. I have learned by asking questions and challenging assumptions. If confirmed, I will do that in the VA. 

I will do that to try and make a difference in those issues about which we spoke 

in your offices: to make a difference for our veterans; for those who served in World 

War II and Korea whose needs may be different from the needs of my generation 

of Vietnam veterans, my colleagues, my friends, who are now finding an increasing 

need for VA services; to make a difference for this next generation of combat veterans returning from Afghanistan and Iraq who have immediate needs quite different from those whose last battle was 40 years ago. 

I know these young men and women too. I’ve been responsible for training many 

of them, for helping build the system that is returning them from the battlefield 

despite serious wounds, for investing up-front in providing the best prosthesis, for 

trying to understand the mental health issues longitudinally beginning at the front 

edge of the battle field. I care about them. I appreciate the debt that we owe them. 

I believe we must look proactively to their needs today, while shaping the system 

to meet their needs of the future. 

I thank this Committee for your unwavering commitment to our Nation’s veterans. If confirmed I look forward to working with you with that same personal commitment. 

Mr. Chairman, I thank you again for this speedy hearing. 

I look forward to your questions. 

RESPONSE TO PRE-HEARING WRITTEN QUESTIONS BY HON. DANIEL K. AKAKA TO LTG 

JAMES B. PEAKE, (RET.) M.D., NOMINEE TO BE SECRETARY OF VETERANS AFFAIRS

Question 1. What do you believe are the most important problems and challenges 

currently confronting VA? In the next year, which of these problems and challenges 

will you focus on and how do you intend to address them? 

Response. Problems & Challenges: 

• Transition: The transition from active duty servicemember to veteran of our 

current generation of returning, combat experienced, men and women is an important current challenge. The challenge is broader than just those with severe injuries 

found unfit for service. We must be proactive for those who need support from the 

VA in readjustment to and reintegrating in civilian life. We must anticipate and 

prepare for the fact that some of these Veterans who initially did not recognize or 

claim a disability will have legitimate claims that require timely and accurate adjudication. 

• Mental Health/Traumatic Brain Injury: Understanding, appreciating, and intervening appropriately for those with mental health issues, particularly PTSD; and 

understanding the relation of the spectrum of Traumatic Brain Injuries and levels 

23 

of associated impairment will be both a short and long term issue for this newest 

generation of Veterans. • Access to Care: Insuring access to care with compassion, timeliness, quality, 

and without hassle whether our Veterans live metropolitan areas or in the rural 

areas of our country. • Backlog of Claims: Addressing the time required to execute the claims process 

to provide benefits, through reproducible, thorough and accurate ratings. 

Approaches to address these issues: 

• Creating clear expectations within the VA as to standards, attitudes, and Veteran focus supported by an investment in training. • Crossing the information and cultural gaps and barriers with DOD. • Measuring the outcomes against standards and a culture of accountability. • Process analysis and re-engineering supported by information technology/automation tools. 

Question 2. Some believe the Secretary of Veterans Affairs should be an independent advocate for veterans; others believe that the Secretary should be the executor of the Administration’s policies relating to Veterans. What is your view of the 

appropriate role of the Secretary of Veterans Affairs? 

Response. As a member of the President’s cabinet, I appreciate that I am a part 

of the administration. But, I believe I am in the administration with the responsibility to not only advocate for Veterans, but to insure that our Veterans receive the 

best of care; that they have their benefits provided in a timely fashion, and that 

the many programs that serve them produce the outcomes that make a positive difference in their lives. I recognize that this means appropriately forecasting the 

needs and advocating for the funds to meet those needs while making sure that the 

funds provided are well used. 

Question 3. What do you believe are the differences and challenges in heading a 

civilian department versus a military organization? As a result of any differences, 

do you anticipate that you will have to alter or modify your leadership style? 

Response. Within the departments, there are more similarities than differences, 

i.e., a highly skilled work force, men and women who care deeply about the mission, 

many of whom have had long careers in the department. The civilian component of 

the DOD is larger than some might realize. In fact, 50 percent of the US Army Medical Command work force was made up of civilians during my tenure. The span of 

control with the VA is more diffuse than the military; the locations within the VA 

are relatively fixed compared to the deployable assets and characteristics of the 

military. Another difference is in the nature of our VA beneficiaries, spread throughout the land where advocacy groups have become partners in the delivery of services 

as well as within the department and with Congress in the shaping of these services. 

I do not anticipate a fundamental difference in my leadership style which I would 

characterize as integrity based, mission focused and recognizing that the only way 

to succeed is through the men and women at every level who do the real work of 

the organization. To accomplish this I will make focused efforts on communication 

to insure clarity of intent; to insure that those men and women know that I value 

them and count on them; and to let them get to know me. In the Army I had the 

advantage of having been a general officer for 8 years before I became the Surgeon 

General and was known. Though many in the VA do know me, it is not at the same 

level. I will similarly need to reach out to and communicate with the VA’s partners, 

the VSO’s; to this Committee, and to those on the House side if I am to be an effective leader for the VA and for Veterans’ issues. 

Question 4. How have your previous experiences prepared you for heading the second largest Federal department? What lessons did you learn as Army Surgeon General that you plan to apply to leading the VA? 

Response. I believe that there are several areas of my experience that are relevant: 

Because of the mission of the Department of Veterans Affairs—Caring for those 

who have borne the battle... and their widows and orphans—I do believe my 38+ 

years in the Army, with service in the line as an infantry officer and in medicine 

as a physician, 38 years of taking care of soldiers, provides a personal background 

of caring, understanding and empathy that will keep my decisions true to the mission. 

My management experience includes 10 years as a colonel with executive responsibility in medical teaching centers, in command of the Army medical forces in 

Korea, and as the Chief Consultant to the Surgeon General during Desert Shield 

and Storm. This was followed by 12 years as a general officer in command of progressively larger and more complex organizations with subordinate units geographiVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00027 Fmt 6633 Sfmt 6621 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
24 

cally dispersed and with, particularly in my 4 years as Surgeon General, the important, direct interface with Congress, the joint and interagency community, and the 

Army staff. The lessons that I have learned in this journey, not just as the Surgeon 

General, are the importance of data driven decisions, measurement of outcomes and 

the notion that if something is measurable it can be improved; and that this approach supports a culture of accountability. 

Leadership of units from a platoon in combat, to a team around an operating room 

table, to a department of surgical specialists many more senior than I, to the combat 

medical units of the XVIII Airborne Corps with active and reserve units up and 

down the east coast, to leading more than 50,000 men and women of 11 major subordinate commands is valuable and relevant experience that that has emphasized 

the importance of listening, of valuing people, and of communicating while maintaining a clear focus on the mission. Visibility and accessibility are important as a 

leader. I believe my progression over the spectrum of leadership described provides 

a foundation to apply this experience to the much larger VA. 

Question 5. What is your management style? Are you a ‘‘hands-on manager’’? Do 

you rely on significant delegation? Do you seek to achieve consensus with those on 

your management team before making a decision or do you generally gather relevant information and input, and then make a decision? 

Response. The only way one can get anything accomplished in an organization 

much larger than even an infantry company, let alone an organization the size of 

the VA, is through delegation. But, with the delegation must come accountability 

supported by data. I do my homework on issues and ask questions to understand 

the issues. In that sense, I am a hands-on manager. As the ‘‘intent’’ of policy is communicated, my expectation is that those many operational decisions made at levels 

below the Secretary are made consistent with that ‘‘intent.’’ In decisionmaking, I 

welcome all input, encourage the dissenting view, and seek outside critical thinking. 

I am always impressed that a product can be made better. However, with that 

input, I will make decisions with or without consensus. As a corollary, when there 

is not full consensus, I recognize my increased obligation to communicate my rationale; engaging and seeing the decision to success (ownership); and in changing course 

if I am wrong. 

• If confirmed, do you expect to visit various VA facilities in order to accurately 

capture what is occurring in the field? 

Response. I look forward to visiting the facilities, meeting with the men and 

women of the VA and finding the venues to meet with those we serve. My Army 

experience supports the importance of ‘‘visiting the troops’’ in the field as well as 

‘‘walking around’’ one’s own headquarters. 

Question 6. As I am sure you are aware, many veterans have raised concerns 

about your coming to VA from QTC—a private sector firm that has significant business relationship with the Department. Two Questions: 

• What will you do as Secretary to ensure that you have no dealings whatsoever 

with QTC or with any efforts on QTC’s part to continue or expand the company’s 

dealing with VA or on any other matters involving QTC and VA? 

Response. If confirmed, I will terminate any connection with QTC, will have no 

ongoing or residual financial interest in QTC, and will recuse myself in any matters 

related to QTC. 

• What Plans do you have with respect to QTC when you leave the position of 

Secretary? Do you expect to return to the firm? 

Response. I have no plans to return to QTC, if confirmed; and, more specifically, 

I will not do so. 

Question 7. Secretary Nicholson was accused, rightly or wrongly, of being out of 

touch with the needs of veterans. Are you satisfied that you are attuned to the 

needs of America’s veterans? If not, how do you plan to improve your understanding 

of the needs of America’s veterans? 

Response. My whole life has been with soldiers. My mother was an Army Nurse, 

my father a Medical Service Corps officer. Those who came over to our house included active duty career officers and their families and those who had worked for 

or with my father but who were out of the Army, sergeants, privates, officers alike. 

Many of those had served in WWII and in Korea. As a surgeon throughout the 70’s 

and 80’s I had the great privilege of taking care of many in that last ‘‘Greatest Generation’’ who were dual eligible for DOD and VA care. As a commander myself, I 

know the faces of soldiers and their families and have dealt with their needs. As 

a medical commander, I’ve been involved with the medical and family needs of those 

injured. As the Chief Medical Director of QTC, I talked with veterans in our facilities or on the phone and dealt with their C&P examination issues. 

25 

Though I do have what I believe is a solid understanding and empathy for our 

veterans, I know that I will gain an even better perspective, should I be confirmed, 

as I proactively engage Veterans Service Organizations, our own dedicated work 

force, and the veterans themselves who seek the spectrum of VA services. 

Question 8. If you were able to have a one-on-one meeting with every VA employee, what would you say? If confirmed as Secretary, how will you implement this 

message in terms of policies and actions? 

Response. First, I would tell them how privileged I feel to be joining their team; 

that I believe deeply in the mission; and that I believe in them. I would want them 

to know of my background both in the military and in regards to my rather long 

association with the VA through the Special Medical Advisory Group; through working for the last year with the VBA; and even with my experience with a VA Cemetery as the commanding general at Fort Sam Houston. I would talk about our opportunity to look to the future of this next generation of combat veterans returning 

from Iraq and Afghanistan, getting it right for them and their families while simultaneously honoring our commitment to the WWII and Korea generation, and addressing the men and women of the Vietnam era (my generation), who are now finding more need for our services. I will commit to each of them my dedication to the 

mission, to them, and to creating the environment for their success as, together, we 

serve the needs of veterans and their families. 

I will use the chain of command, all of the command information channels available and will find the personal venues to deliver this message. Policies and actions 

will be consistent with this message. 

Question 9. How many staff do you plan to bring with you to VA? Do you anticipate asking the White House to allow you to replace any political appointees, including any confirmed by the Senate? 

Response. I am impressed with the quality of the VA senior leadership. I have 

no preconceived plan to replace any political appointees and have not been in a position to assess the need to bring in additional staff. I am aware of the potential for 

an Assistant Secretary for Acquisition and look forward to the support of this Committee in moving forward with that position. 

Question 10. The President noted in his introduction that you are the first physician and first general to serve as Secretary. While he was certainly correct about 

your credentials compared with prior Secretaries, there have been other generals, 

including perhaps the most famous of all, Omar Bradley, who headed the VA before 

it became a cabinet department in 1989. It is correct, however, that you are the first 

physician to head either the Veterans Administration or the Department of Veterans Affairs, and I think that there may be at least one compelling reason why 

a physician has not previously been picked for the job, namely, the potential conflict 

between the Secretary and the Under Secretary for Health, relating to VA’s health 

care mission. 

By law, the Under Secretary is a health care professional responsible to the Secretary for ‘‘the operation of the Veterans Health Administration.’’ The Secretary, on 

the other hand, is responsible for ‘‘the control, direction, and management of the Department.’’ This difference suggests that the Under Secretary for Health, like the 

two other Under Secretaries with respect to their Administrations, is expected to exercise direct operation control of VHA and that the Secretary’s role is to supervise 

the Under Secretary, but not to be directly involved in the operation of the VHA. 

If confirmed, how do you anticipate working with Dr. Kussman or whomever is 

the Under Secretary for Health to ensure that this division of responsibility is recognized and honored. 

Response. The VA is extremely fortunate to have Dr. Kussman as the Under Secretary for Health—its ‘‘Top Doc’’. He has assembled a very talented team of professionals. If confirmed, I will seek to complement Dr. Kussman’s efforts and initiatives 

in leading his administration, not to compete. With my medical background, I anticipate being able to more quickly make the decisions that he might bring to me since 

I do not anticipate needing ‘‘Medicine 101.’’ As I execute my responsibilities as Secretary, I would anticipate that my guidance to him will be well informed because 

of my medical background and my military background. If anything, I anticipate a 

greater synergy supported by our common medical background and our long association. 

I would note also that Dr. Kussman, Under Secretary Cooper, and I all share the 

background of being flag officers. Again, common backgrounds offer synergy rather 

than competition for authority. 

Question 11. Please describe how you intend to work with the Deputy Secretary. 

Will the Deputy Secretary be VA’s Chief Operating Officer? 

26 

Response. Gordon Mansfield is one of my heroes. I am delighted that he will continue as the Deputy Secretary. He will continue as the VA’s Chief Operating Officer. 

Question 12. Please describe how you intend to work with the General Counsel. 

Will the General Counsel be a key member of your management team? 

Response. The General Counsel will be a key member of the management team. 

Ethical and Legal behavior are the hallmarks of a quality organization. The General 

Counsel is a major compass in this regard as well as one who will provide the detailed advice on specific policies, legislation, and initiatives. The General Counsel 

will have open-door access to me to ensure the communication necessary to provide 

that advice. 

Question 13. Please describe how you intend to work with the Inspector General. 

Are you comfortable with the IG’s dual responsibility, to the Secretary as the head 

of the Department, and to the Congress? 

Response. I understand the Inspector General function from my military experience, appreciate their uniquely privileged role, and am comfortable with that role. 

The IG can be a very powerful force in maintaining the VA as a learning organization, identifying systemic issues that we can fix internally or acquire the support 

to fix externally. Their work will not sit on the shelf, but will be used to make us 

better. 

Question 14. Please describe how you intend to work with the three Under Secretaries and with the Assistant Secretaries. 

Response. We will, on a regular basis, meet as a group; we will have dedicated 

one-on-one time. The Under Secretaries have unique responsibilities to exercise direct operation control of their respective administrations and the Secretary’s role is 

to supervise the Under Secretaries. I owe them guidance, objectives, and resourcing 

with the support of all of the assistant secretaries will be dedicated to their success. 

Question 15. Are you satisfied with the current alignment of Assistant Secretaries 

or do you anticipate proposing any changes to the number of Assistant Secretaries 

or to their responsibilities? 

Response. The addition of a proposed Assistant Secretary for Acquisition is the 

only Assistant Secretarial position change of which I am currently aware. I do not 

have any preconceived notion of other changes that might be required. 

Question 16. How do you plan to work with the Veteran Service Organizations? 

Do you anticipate meeting with VSO representatives on a regular basis? 

Response. I appreciate the unique roles of the Veterans Service Organizations and 

the Military Service Organizations and will work collaboratively with them as we 

develop policy, as we seek insights from their members, as we work with them as 

partners in the service delivery. I look forward to meeting with them on a regular 

basis. 

Question 17. What are your views on the situation that was described in the 

media reports earlier this year about Walter Reed Army Medical Center and on earlier problems with the medical holdover detachments at Fort Stewart and Fort 

Knox? In hindsight, what might you have done as Army Surgeon General to prevent 

or mitigate the problems that surfaced at Walter Reed, Fort Stewart, and Fort 

Knox? 

Response. Regarding the Walter Reed issues, I do not have first hand knowledge 

of the details having retired in 2004. However, it is unacceptable for soldiers to be 

housed in inadequate barracks. What was reported as a lack of caring for those 

wounded warriors who moved to outpatient status was disturbing as was the failure 

to bring these issues through the chain of command. I know that the Army has responded with a concerted effort to reestablish appropriate chain of command and 

accountability for those soldiers remaining at Walter Reed in an outpatient status 

and keeping them focused on their individual mission of medical improvement and 

rehabilitation. I also believe a valuable service was done in highlighting the convoluted and complex nature of the DOD Physical disability system, the overlap of 

the VA disability system, and the need, as highlighted by every group who has examined this recently, for revision, simplification, and modernization to accommodate 

for medical and societal changes. I was gratified to read, though often as an addon comment, the recognition of the very high quality of inpatient care, of the amazing success in bringing soldiers home from the battlefield when, in prior conflicts 

they would have died. 

Regarding the Fort Stewart issue of medical hold-over care, I was intimately engaged. The situation that the press highlighted included inadequate barracks, slow 

processing times, and medical resources that were not adequate to meet the demand. The majority soldiers who had reported to a mobilizationsite medically unfit. 

Others had suffered some condition in their train-up that made them nonVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00030 Fmt 6633 Sfmt 6621 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
27 

deployable. The first group was large and a result of policy (changed as a result of 

this experience) that kept soldiers who reported unfit to mobilizationsites on active 

duty for medical board disposition. I had not anticipated this category of soldiers 

to be large and had not expanded capacity to meet the demand. 

My response: Within 24 hours of becoming aware of this issue I dispatched a general officer led team to meet individually with each of the 500 Soldiers at Fort Stewart. Questionnaires were used to collect and categorize their issues. The team also 

met with leaders on the installation; Division Commander, garrison commander, 

and other key leaders. I coordinated with the Amy staff and other Army leaders to 

have their subject matter experts available to assist this team to resolve those 

issues outside of the medical arena. In addition to Fort Knox, the team followed the 

trip to Stewart with trips to Fort Benning, and Fort Campbell, again meeting with 

Soldiers at each installation and their family members as well. Assessing the teams 

input, we immediately looked at policy issues that needing changing, new ones that 

should be instituted, or resource related issues of more people, equipment or facilities. Immediate changes reduced the normal TRICARE access to care standards for 

appointments; for MRIs and other diagnostic imaging procedures, and for surgical 

procedures. I pushed greater use of the community assets (purchased care) while at 

the same time bringing in VA, public health service staff and borrowed staff from 

other Army locations. I worked with Army leadership to approve mobilization of additional personnel in anticipation of increased numbers of injured/wounded Soldiers 

returning from both Iraq and Afghanistan and justified additional funds for contract 

providers, physical disability advisors and other support staff. We reduced the ratio 

of case managers to patients, the ratio of soldiers to disability benefit advisors, and 

ensured that hospitals assign primary care physicians who would directly oversee 

this population of patients. I approved the establishment of a unique contract that 

would allow quick access to healthcare professionals to include mental health specialists. 

Strict reporting requirements were enacted for the medical facilities and they 

were held accountable to the new standards. The medical holdover population was 

modeled and forecasts allowed resource distribution and monitoring of our progress 

in resolving the needs of this population of Soldiers. 

Each soldier was mandated to have a case manager to stay with the soldier 

through their hand-off with the VA. I supported the development of the Community 

Based Healthcare Organization medical concept of operation. This initiative continues allowing soldiers to return home and receive their care locally but under the 

management of the community based organization with National Guard leadership. 

Prior to this and before the war, the issue of the disability system was on my 

scope. I had insisted that ‘‘The Compassionate and Efficient Disposition of the Unfit 

Soldier’’ be placed as a key performance process on the Balanced Score Card Strategy Map for the United States Army Medical Command. In hindsight I could have 

recognized that the peacetime processing standards (a problem already) were inadequate to support a surge that potentially would come of wartime. I might have anticipated the impact of the flawed policy regarding the retention of soldiers unfit at 

the time of mobilization and fought harder to change it prospectively. I might have 

worked harder to create the imperative to reengineer the disability system. Though 

I was one of the outspoken champions of DOD/VA sharing, I could have pushed 

harder for advances that were more aggressive than the 50 VA caseworkers that 

we welcomed into Army hospitals or been more aggressive in staff sharing beyond 

the 4 cardiac surgeons that I detailed to the VA. 

Question 18(a). What difficulties confronting wounded, injured and ill servicemembers transitioning from the military to the VA health care systems are the result of DOD policies and practices? Of VA policies and practices? Of some combination? 

Response. If confirmed, I look forward to detailed briefings on the current status 

of policies and practices and the result of pilot programs that, I understand, are ongoing. Already addressed, as I understand from what I have read and in general 

discussion, are the establishment of specific standards for living quarters for wounded warriors, an expanded and aggressive case management approach; a strengthening of the chain of command for care and oversight of the wounded warrior; the 

beginning stages of the recovery coordinators as suggested in the Dole-Shalala report; information exchange as wounded warriors are moved into VA facilities for the 

next stages of their care. Each of these was an area that needed strengthening and 

focus. The VA has moved to expand the polytrauma capability with an additional 

polytrauma center planned as well as polytrauma expertise identified within each 

VISN. I am told that VA has pushed the limits of their authority to provide medical 

support to family members who are supporting their wounded warriors. The pilot 

program in the national capital region that began in November will provide lessons 

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in the single physical and VA rating for Medical Evaluation Boarded servicemembers. The incentive for the servicemember to move from one system to the 

other—or rather the incentive not to move from one system to the other—is only 

partially addressed by these measures and is not completely within the purview of 

administrative change. 

Question 18(b). If confirmed, what do you believe you will be able to do to enable 

VA to change the current situation and to ensure that separating servicemembers 

are made aware of the benefits and services that are available to them? 

Response. I believe that the different demographics of separating servicemembers 

require targeted approaches. The wounded warrior with recognized combat related 

injuries is one group. The active duty servicemember with an active duty unit affiliation with its full time chain of command who elects to separate from service prior 

to retirement is another. The retiring servicemember who may become dual eligible 

is a third group. The reserve (to include National Guard) servicemember, demobilizing and returning to civilian life while remaining in the reserve force, subject to 

call-up represents yet another group. Coordinating access for these unique groups, 

crafting and delivering a common message with the responsible service, appropriate 

counseling, the processes to deliver those services, and measuring the success of the 

engagement are steps that I would champion, if confirmed. I am fully supportive 

of web based access to assistance and would explore other methods to ease communication for veterans/families in need of assistance. 

Question 18(c). Will your Army background be a plus or a minus in dealing with 

the relationships between VA and the Navy and the Air Force? 

Response. I believe my background will be a plus. My joint experience at senior 

levels dates from my time in command of Army medical forces in Korea while serving as the Joint Surgeon with staff oversight for both armistice and wartime health 

care planning. As the first lead agent for TRICARE, I worked closely and collaboratively with Navy and Air Force medical commanders in our region as well as with 

the VA leadership in Washington State and Oregon. As Surgeon General I believe 

my relationships with my fellow Surgeons General was positive and I have sustained those relationships with those who have moved into the senior leadership positions within the Services since my retirement. 

Question 19. Currently, the VA/DOD Senior Oversight Committee, co-chaired by 

Deputy Secretaries Mansfield and England, meets on a weekly basis to deal with 

joint VA and DOD issues. In part, the SOC has been addressing those Dole-Shalala 

Commission recommendations that can be corrected administratively. If confirmed 

as Secretary, what would be your priorities for the SOC? 

Response. I am aware of the eight ‘‘Lines of Action’’ which, I believe, address the 

high level key areas. If confirmed, a first priority will be to gain an in-depth understanding of the level of progress within each of these ‘‘Lines of Action’’ and formulate my own assessment of progress, priorities, or potential areas for addition. 

Question 20. If implemented as set forth in the draft legislation presented by the 

White House, the disability reforms recommended by the Dole-Shalala Commission 

would create a multi-tiered disability system. 

• How would you ensure that any changes to the current disability system are 

fair, equitable, and uniformly administered for all veterans? 

Response. With the system as it is today, I have heard concerns that there is unfairness, inequitable and non uniform decisions that occur from time to time and 

across different geographic areas. Working with Congress and the administration to 

revise the disability system offers the opportunity to simplify the process, create a 

way ahead for an equitable and uniformly administered system while meeting the 

needs of each of the tiers that might be identified. 

• Do you believe that a disability system that treats veterans of different generations differently is desirable? 

Response. The demographics of the Veteran population in the United States represent a spectrum. The needs at different parts of this spectrum may be quite different. The geriatric medical requirements of the World War II generation are quite 

different from the acute needs of the recently returned young Veteran; just as the 

social needs of the older Veteran who may be leaving the active work force is different from the vocational and rehabilitation needs of the your Veteran who aggressive assistance in re-entering that work force. In between is the Vietnam generation 

who’s medical and life circumstance may require yet a different focus. It is important that we provide the support and care needed that is appropriate to the Veteran. 

• Do you believe that veterans of prior conflicts should be given a lower priority 

in claims processing than veterans of current conflicts? 

29 

Response. I believe that the VA should strive, through, process improvement, automation tools, training, and the expanded claims work force that the Committee 

has supported, to do ‘‘today’s work today and to standard’’ for all Veterans. A quality 

system must have the ability to identify and deal with uniquely urgent or emergent 

situations by exception. 

• Do you believe that claims resulting from combat versus non-combat injuries or 

diseases should be prioritized differently? 

Response. I believe the first priority for the VA is to those who have sustained 

service-connected disabilities whether injury or disease, physical or mental, and to 

those veterans in need. I understand that the term combat injury within the DoleShalala commission context is, according to their guidance, broadly understood to 

include training for combat whether in or out of a combat zone and with the opportunity for Secretarial discretion to be more inclusive if warranted. 

Question 21. I understand that VA has solicited an outside bid to carry out two 

technical studies that are being sought as a result of the recommendations of the 

Dole-Shalala Commission. Once these studies are completed, do you believe that the 

Secretary has the authority to implement changes to the disability compensation 

schedule generally? Do you believe that the Secretary has the authority to distinguish between multiple systems of compensation and how they are to be applied to 

different groups of veterans? 

Response. The change to the disability compensation schedule requires congressional approval. I do believe that legislation is required to change the disability system itself. If confirmed, I pledge to work closely with Congress, the Department of 

Defense, and the Veterans Service Organizations to create and manage the change 

necessary to meet the needs, both short-term and life-term, of this newest generation of combat veterans while insuring that we meet our enduring obligation to 

those of the ‘‘Greatest Generation’’ and of my generation who have served before. 

Question 22. The Disability Benefits Commission recently released a report on its 

two-and-a-half-year analysis of the benefits and services available to veterans, 

servicemembers, their survivors, and their families to compensate and provide assistance for the effects of disabilities and deaths attributable to military service. 

That report contains 113 recommendations. In your view, how should VA analyze, 

and, if appropriate, implement the recommendations? 

Response. Though I have not studied each of the 113 recommendations, I appreciate the work that went into developing such a detailed report. VA should analyze 

each of the recommendations and consider its value and validity in the scope of the 

larger revision and changes which are being considered in the disability system. I 

believe this is an area where the Senior Oversight Committee can add value, urgency and leadership and I will support their efforts at the big picture look and in 

ensuring appropriate improvements are implemented in a timely manner. For those 

recommendations which VA has the current authority to implement, an overall implementation plan with timelines should be developed based on a prioritization of 

the recommendations. 

Question 23. The relationship between VA medical centers and medical schools 

has endured for more than 60 years and has been credited with improving quality 

of care for veterans. These affiliations draw the best and brightest physicians and 

help VA fulfill its research and educational missions. I am concerned, however, 

about the viability of the relationship. Please share your philosophy regarding the 

overall value of academic affiliations, including the role affiliates play in staffing VA 

facilities. What is your assessment of how Army medical interacts with academic 

medicine? 

Response. The academic affiliations are one of the enduring strengths of the VA. 

I believe that a robust teaching environment and high quality research affiliations 

are contributing factors to the excellence of the Veterans Health Administration. As 

with any relationship, it is healthy to continue to reexamine the outcomes of the 

relationship to ensure the basis remains sound; that our Veterans benefit from the 

care of the affiliate, that the research is of high quality and supporting the Veterans’ needs; that our Veteran population is providing needed access to those in 

training, and that our changing demography of Veterans warrants the maintenance 

of the affiliation. The relationship of Army medicine with academic medicine is less 

interdigitated. Army Graduate Medical Education programs are individually accredited, but often work with civilian academic institutions for specific rotations. The 

Army training of ancillary medical specialties is, except for degree producing programs, done largely without affiliation with outside academic medical centers. 

Question 24. Many veterans, especially those with complicated health issues, rely 

upon the specialized services of VHA. Many of these services, like spinal cord injury, 

blind rehabilitation, and prosthetics, are unique to VA and are unmatched by the 

30 

private sector. In an era of declining budgets and decentralization of funds, please 

describe your views on VA’s responsibility to maintain capacity in these programs. 

Response. I fully support the continued excellence of VHA in these highly specialized areas of expertise and service. 

Question 25. Post Traumatic Stress Disorder is a major concern for the Committee, both in terms of compensation and health care. 

• As a combat veteran, what is your experience with veterans and PTSD? 

Response. In combat I had members of my platoon who handled the same level 

of exposure to the horrors of war quite differently; from a single soldier becoming 

overtly combat ineffective; to another providing effective fire in an ambush and then 

continuing to fire round after round, even after the action was completed; to the majority of my soldiers who were able to perform their duties even in the face of the 

same combat stressors. Personally, I experienced some of the symptoms of Post 

Traumatic Stress, but at a level that would not be classified as a disorder. In fact, 

it is part of what I believe is a ‘‘normal’’ range of adaptation. As long as two years 

after I returned, I would sometimes startle at an unexpected loud noise or have an 

occasional dream about combat. I was fortunate that these faded with time for me 

and did not affect either my professional or social life. 

• Do you personally know veterans who continue to suffer from PTSD or veterans 

who were diagnosed with PTSD, but who are now no longer suffering from the condition? 

Response. I do know Veterans who continue to suffer from PTSD. On a personal 

basis I know Veterans who have had PTSD symptoms, who now are coping well and 

are not disabled. I do not know if they had been formally diagnosed with PTSD 

meeting the DSM IV diagnostic criteria. I believe that this spectrum of mental 

health issues is treatable and we will learn more as we continue to do scientific inquiry. 

• Under what circumstances, if any, is it possible for a non-combat veteran to suffer from PTSD? 

Response. The circumstance in which an individual experienced, witnessed, or was 

confronted with an event, combat or otherwise, that involved actual or threatened 

death or serious injury, or a threat to the physical integrity of self or others and 

whose response involved intense fear, helplessness, or horror might cause that individual to suffer from PTSD. 

• VA has significantly decreased its in-patient programs for veterans with PTSD. 

What do you view as the role of in-patient treatment for PTSD, in particular for 

veterans with co-morbid substance use disorders? 

Response. I am not aware of the extent of the reduction of in-patient programs 

or of a backlog in access to these in-patient programs. I am aware that significant 

advances in outpatient and community-based programs for mental health treatment 

and support have enjoyed success and popularity, not only in the VA, but nationwide. If confirmed, I will look carefully at the balance between the various treatment modalities for PTSD and the co-morbid substance abuse disorders to ensure 

access to the right care in the right location. 

• Please describe the priority that you believe VA should place on providing care 

to veterans with PTSD, and how would you ensure that priority is manifested in 

budget requests and programmatic planning? 

Response. Care of our Veterans with PTSD and with related symptoms short of 

PTSD is, rightfully, a very high priority. I am aware of the recent increase in mental health workers recruited by the VA and, if confirmed, I would continue to support this initiative as well as exploring the issues of access in rural areas of the 

country. I will work with Congress, OMB, and the experts of the mental health community to identify new programs and emerging treatments and in programming the 

resources to support them. 

• What are your views on the need for more research into the best treatments 

for PTSD? 

Response. I believe that PTSD will be a hallmark condition of the current conflict. 

I am proud to know that the VA has been at the forefront of research in this area. 

I believe that there is still much to learn and that it is the VA’s obligation to remain 

at the forefront of this learning. 

Question 26. Last year VA suffered on, of the biggest losses of personally identifiable information in history. Fortunately, the data was recovered and there have 

been no reports of any personally identifiable information being compromised. Secretary Nicholson testified last year that he intended for the VA to become the ‘‘gold 

standard’’ for IT security within the Federal Government. If confirmed, what priVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00034 Fmt 6633 Sfmt 6621 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
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ority will you put on efforts to ensure that veterans’ personally identifiable information is protected? 

Response. The protection of personally identifiable information will be a high priority for me. Though I have not been briefed on the details, I understand that, subsequent to the noted event, many specific policies, procedures, and safeguards for 

information integrity have been put in place. A major information management restructuring and centralization has occurred, and investments have been made in 

hardware and security applications. If confirmed, I will work to ensure accountability through oversight and compliance monitoring. I understand that a specific 

office with this function has been established. 

Question 27. The Dole-Shalala Commission recommended that a corps of welltrained, highly-skilled Recovery Coordinators be swiftly developed to ensure prompt 

development and execution of patient-centered Recovery Plans for every seriously 

injured servicemember. The Commission’s recommendation called for members of 

the Commissioned Public Health Service to perform this role. On October 31, VA 

and DOD announced an agreement to provide ‘‘Federal recovery coordinators’’ for 

seriously injured, ill, and wounded servicemembers and their families. Under the 

current concept the ‘‘Federal recovery coordinator’’ will be VA employees and the 

program will apply only to those injured, ill or wounded in combat. Two questions: 

• Do you believe the care coordination role is one VA should be performing prior 

to a servicemember’s separation from the military? 

Response. The complexity of the conditions and the complexity of the systems can 

be bridged by a coordinated effort from the beginning in laying out a recovery plan 

and monitoring it’s execution in conjunction with the patient, the patient’s family 

and with the agencies involved. As the care coordinator’s role evolves it must involve the VA while the servicemember is still on active duty. 

• Do you believe that this program should be focused solely on those seriously injured, ill, or wounded in combat, or should it include others who are seriously injured or ill from service elsewhere? 

Response. If confirmed, I will endeavor to insure that the broad inclusion of the 

‘‘combat related’’ description is operative and that appropriate additional exceptions 

have a clear and easy process for approval. 

Question 28. VA’s vocational rehabilitation and employment program is one of the 

smallest, yet most important, programs within the Department. It is the linchpin 

for helping veterans who incur service-connected disabilities, achieve a fulfilling and 

gainful future. I am deeply committed to making sure that this program lives up 

to its full potential, especially when individuals who have sustained serious injuries 

in combat are involved. What are your thoughts on the role that vocational rehabilitation plays in terms of the total rehabilitation of an individual recovering from severe combat-related injuries? 

Response. I agree with the importance of vocational rehabilitation in support of 

the critical objective of making our Veterans self-sustaining, proud, and independent 

financially, socially, and emotionally. I believe in finding the right incentives to get 

them into these programs and keeping them in these programs through the point 

of their transition to gainful employment. If confirmed, I will strongly support these 

programs for Veterans who need help in being productive citizens. 

Question 29. There has been significant discussion for at least the last decade 

about the need for DOD and VA to create a bi-directional/interoperable electronic 

health record. In 2003, the President’s Task Force to Improve Health Care Delivery 

for our Nation’s Veterans recommended that the VA and DOD develop and deploy 

such a record. 

• What involvement did you have with this effort while Surgeon General? 

Response. As the Surgeon General, I invited the President’s Task Force and personally briefed them on Army medicine to include being a champion for DOD/VA 

sharing. I was a vocal supporter of the development of a longitudinal, queriable patient record that would capture a servicemembers care from MEPS Station to VA 

Cemetery. 

• Based upon your experience, do you believe that, to achieve this goal it is necessary for DOD’s and VA’s electronic health record systems to be combined or to 

simply have the ability to share data? 

Response. I do believe this is an obtainable goal that does not necessarily require 

a single system. More important is the harmonizing and adoption of a common 

health care lexicon and standardization of processes. 

• Do you believe the current problems in the area can be resolved in a timely 

manner so that VA doctors can have access to complete medical history, including 

military health records? 

32 

Response. Timely is yesterday! So my answer is that we need to move as quickly 

as possible with initiatives that do share digital data and records as we advance 

to the interoperative use of computable data as an achievable goal, while making 

up any short term shortfall with paper, and personal communication. We must ensure, even without perfect electronic transfer that providers have the information 

needed to provide outstanding care appropriate to the continuum of care. 

• As a former practicing physician, what medical information do you believe VA 

health care providers need from DOD? 

Response. I believe that VA physicians and the other health care providers within 

VA need the most comprehensive medical information that DOD can provide that 

is relevant to the patient’s current active medical conditions. It would be impossible 

to list here the full spectrum of the specific data elements that might be required 

to do this. I would point out that I do not see this information flow as one-way from 

the DOD, given particularly: the service to those dual eligible Veterans; the potential for a Veteran to return to active service after care in the VA; and what our rehabilitative services might achieve in returning someone who had been unfit back 

to duty. 

Question 30. VA currently uses the criteria of 170,000 unserved veterans within 

a 75-mile radius for purposes of establishing new national cemeteries. In the past, 

the Senate has supported this standard and has authorized new cemeteries based 

upon VA’s recommendations. Do you believe this should continue to be the standard 

practice? In the absence of a VA recommendation, do you believe Congress should 

legislate location of new national cemeteries? 

Response. I understand that the stated goal is: by 2011, to have 90 Veterans within 75 miles of a national or State veterans’ cemetery. It is my understanding that 

Congress has been extremely supportive of this strategic direction—five new cemeteries are targeted to open in 2008 because of your support. If confirmed, I will continue to work closely with our National Cemetery Administration and Congress to 

insure the resources are available for new cemeteries and to insure the standards 

are maintained that mark the lasting tribute that commemorates Veterans’ service 

to our Nation. 

Question 31. What is your view of the correlation between combat service and 

homelessness? 

Response. I have read that up to one-in-four of single male homeless people are 

Veterans. It has been estimated that nearly 200,000 Veterans may be homeless on 

any given night. Risks include poverty, lack of family support, precarious living conditions. 

I am told that, currently, there is little information to suggest that combat service, per se, has a direct link to homelessness. But, deployments with disruption of 

family lives, the effects of traumatic events of combat, may very well contribute to 

homelessness and is a correlation that truly needs investigation. 

• Do you believe that VA has a particular obligation to aggressively address 

homelessness among veterans? 

Response. Yes 

• Public Law 106–377 funds the Interagency Council on Homelessness and 

makes the Secretary of Veterans Affairs a rotating chair of the Council. What do 

you see as VA’s role in working with other departments, agencies, especially HUD, 

to address the needs of homeless veterans and their families? 

Response. I believe homelessness is a multifaceted problem that involves individual economics, skills development, mental health and social well-being. If confirmed, I look forward to supporting the inter-agency/interdisciplinary approach to 

understanding and supporting homeless Veterans. 

Question 32. VA has a history of significant waiting times for care—a problem 

from which specialty care particularly suffers. What are your thoughts on the priority that should be accorded to reducing waiting times? In your view, how long 

should a veteran be expected to wait for a non-emergent health care appointment? 

Response. Excess waiting times result in patient dissatisfaction in any health system and so must be a priority in a patient-centered, and, in our case, veterans-centered, care environment. In some cases excess waiting times can have an impact on 

the course of an illness or in extended period of patient distress. In other cases the 

Veteran him or herself may choose a visit time outside of specified standards for 

their own convenience and without compromising care. The waiting time standards 

should address this spectrum. I understand that the VA standard for a non-urgent 

specialty care appointment is within 30 days. This is consistent with the DOD 

TRICARE standard for non-urgent specialty access and is reasonable with the caVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00036 Fmt 6633 Sfmt 6621 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
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veat that the referring provider can decrease that time depending on the clinical assessment. 

Question 33. The active-duty military has become increasingly more reliant on the 

Reserve components to accomplish its missions. What will you do, if confirmed, to 

ensure that governmental services, including pre-, during, and post-deployment 

services, including transition services, are equally available to National Guard and 

Reserve veterans? 

Response. The ‘‘pre-, during... services’’ are largely within the purview of the 

Department of Defense. I believe in their recently instituted annual Personal Health 

Assessment and reserve health readiness initiatives. Where needed and feasible the 

VA should be supportive of these DOD efforts. Regarding the ‘‘post-deployment services, including transition services,’’ I will, if confirmed, work to make VA an integral 

participant from emphasis on the Benefits Delivery at Discharge program, to educating demobilizing Guard and Reserve veterans about their benefits, to encouraging their access to VA services in their immediate 24 months of post deployment 

presumptive period currently authorized, and to working with the reserve component leadership through DOD collaboration. 

Question 34. In your view, how long should a veteran have to wait to have his 

or her initial claim for compensation adjudicated? 

Response. I am aware that the VA has as its strategic goal to provide claims decisions in an average of 125 days. I know also that this goal has been very difficult 

to achieve for many reasons. However, I believe VA can and must do better. VA’s 

compensation claims process is complex and the evidence gathering often involves 

obtaining information from DOD, VHA, other Federal agencies, and private providers. I believe the recently introduced Disability Evaluation System pilot, a joint 

VA and DOD initiative, holds great potential for servicemembers undergoing a Medical Evaluation Board Proceeding. I am committed to working with all involved parties and the Congress to streamline the disability compensation claims process for 

all Veterans. 

Question 35. VBA has come under fire for the lack of timeliness of its claims’ processing. While VBA has made progress in improving timeliness and accuracy of disability claims processing, further improvement is needed. VBA has turned its attention to decreasing the amount of time it takes to process a claim, but that improvement seems to be at the cost of a decrease in the quality of its decisionmaking. Do 

you have any views on how a more balanced approach can be reached? 

Response. The nearly 3,000 additional personnel for the Veterans Benefit Administration dedicated to claims processing will help in the short term and as they become better trained (as I understand it, a major focus of Admiral Cooper) and experienced, the accuracy will improve in addition to the timeliness. 

However, I support the observation by multiple recent groups looking at this problem, that a simplified disability system with updating of the rating criteria on a goforward basis offers the best opportunity to have clear, fair, and reproducible ratings 

that are supportable by modern rules-based information technology tools. 

Question 36. Accurate forecasting of usage of veterans benefits is essential in 

planning for resources to administer those benefits. What do you see as the Secretary’s role in insuring that VA forecasts the need for additional staffing resources 

so that Congress could appropriate those resources in a timely manner? 

Response. I believe that the Secretary must use actuarially supported data combined with real information from practice patterns and collaborate with the DOD 

using their best data to provide accurate forecasting and appropriately identify the 

resources to support those forecasted needs. 

Question 37. As one who knows first-hand the value of educational benefits under 

the GI Bill, I am deeply committed to making sure that this important benefit is 

available to today’s veterans. I recognize that this benefit is not just a readjustment 

benefit in today’s all-volunteer force. It also serves as a recruitment and retention 

tool. 

• What are your thoughts about the delicate balance between these in aspects of 

the benefit? Do you believe that one outweighs the other? 

Response. From my years in the military I appreciate the value that soldiers place 

on their educational benefits. For many, it is a way to take an economic burden of 

education off of their parents, for others, the GI Bill represents the only route to 

additional schooling past high school. It is perhaps most important as a motivator 

for service for those who enlist not specifically seeking a career. For the servicemember returning from combat, it can be a powerful readjustment benefit as described in the Bradley report of 1956. Education can produce a better adjusted Veteran and one who is better positioned to resume life as a productive citizen. I absoVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00037 Fmt 6633 Sfmt 6621 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
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lutely share this Committee’s belief, and appreciate your history of action, in investing in those who have served this Nation in uniform. 

• How do you see the VA working with DOD on GI Bill issues, such as the size, 

scope, and details of benefits under the various GI Bills and in reaching out to eligible individuals to ensure that they are aware of and use their benefits? 

Response. The forum for such collaboration exists with the DOD/VA Joint Executive Council. If confirmed, I would support a focused look at this subject, and would 

work with Congress and DOD and our Veteran Service Organizations to take the 

results of that work into an effective update of our GI Bill programs. 

Question 38. There has been increasing pressure in recent years for VA to contract for services in local—especially rural—communities where VA facilities are not 

easily accessible. Mental health is one area of particular emphasis in this regard. 

What do you believe is VA’s responsibility for meeting the needs, including mental 

health needs, of rural veterans? If confirmed, what emphasis would you place on 

this issue? 

Response. Rural Health is a topic that has come up on several occasions in my 

pre-hearing meetings with the Committee Members and so I appreciate that emphasis is needed. I believe that Veterans in rural areas may be well served locally, if 

care is available, but that the VA has an obligation to monitor the quality of that 

care. I also appreciate the challenges of making this care part of the continuum of 

care expected of a quality health system. If confirmed, I will ask early in my tenure 

for an update from the recently-created Department of Rural Health, explore the 

various interagency opportunities, and the potential for leveraging technologies such 

as Telemedicine/Telepsychiatry, to better serve remote Veterans. 

Question 39. There are a number of issues about the current GI Bill that I find 

troubling. 

• One aspect that especially concerns me is that there are individuals who are 

serving in combat, placing their own lives in harm’s way, who have had to make 

a monetary contribution in order to establish eligibility for GI Bill benefits. What 

are your thoughts on this issue? 

Response. It is my understanding that the Montgomery GI Bill was enacted by 

Congress in 1984 and designed for a peacetime active duty service and supported 

a contribution that put skin-in-the-game. If confirmed, I will work with DOD and 

this Committee to re-examine this premise in light of the current conflict and the 

sacrifices of today’s servicemembers and Veterans. 

• I am also very concerned that there are individuals who are serving with the 

National Guard and Reserves and who may have completed multiple deployments 

in combat zones but who stand to lose eligibility to valuable educational assistance 

benefits if they separate from their unit. What are your thoughts about these individuals and the portability of their benefits? 

Response. I do not yet have a detailed understanding of the full scope of this 

issue. However, my sense is that once these valuable educational assistance benefits 

are earned, they ought to follow our servicemember. If confirmed, I will follow up 

on this issue to fully understand the issue and make appropriate corrections within 

my authority or recommendations for change. 

Question 40. All Federal agencies have certain responsibilities to maximize contracting opportunities for veteran-owned small business and especially service-disabled veteran-owned small businesses. In general, it appears that VA has a better 

record than most other Federal agencies. However, some have raised concerns that 

to meet the goal of increased contracting with these businesses, there has been increasing reliance on partnerships between large corporations and small service-disabled veteran-owned businesses, in which the involvement of the SDVOB is really 

only on paper. In your view, does the VA have an obligation to ensure that contracts 

with small service-disabled veteran-owned businesses truly involve and benefit 

these firms in the actual contracted activity? 

Response. I am aware of the VA’s emphasis on Veteran-owned and, especially, 

service-disabled veteran-owned small business as preferred contractors. Given the 

magnitude of some of the programs and projects it may be unrealistic to expect successful performance by any small business—veteran-owned or not—in the prime 

contractor role. I whole-heartedly endorse our government providing preferential 

treatment to our own Veteran small business owners and particularly those servicedisabled small business owners. If confirmed, I will work closely with our contracting office to insure we have clear outcome objectives that include development 

of these veteran-owned small businesses (coaching, teaching, mentoring, investing 

and rewarding) and consider that such metrics may be applied to the large corporaVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00038 Fmt 6633 Sfmt 6621 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
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tions who may be better positioned to function as a prime, but with a specified level 

of subcontracting to the veteran-owned concerns. 

Question 41. I have long advocated strategies for recruiting and retaining highly 

trained medical professionals within the VA health care system. Just a few years 

ago, I supported legislation to create a more competitive pay system for VA physicians and dentists, as well as other legislative initiatives targeted at nurse recruitment. Despite these efforts, VA continues to face a growing nursing shortage, as 

well as vacancies for specialty care physicians. In your view, what should VA do to 

improve personnel recruitment and retention at VA health care facilities, particularly of nurses? What more can VA realistically do to improve recruitment in areas 

where there are fewer specialty care physicians overall? 

Response. The recruitment of all health care personnel, including physicians and 

nurses, remains a challenge in U.S. health care. While I do not know all of the programs that are currently in place to support the recruitment and retention of VA 

physicians and nurses, I do believe that the VHA’s reputation as a high-quality 

health care system is a strong recruitment incentive. Generally, VHA will have to 

continue to ask for authorities to allow it to match market pay and performance incentives that are offered in the community sector. Not to do so would jeopardize the 

quality of health care providers that treat Veterans. Additionally, I would look to 

ensure that the practice environment for our providers is supportive, collaborative, 

and an inducement to retention. 

Question 42. Many in the newest generation of veterans are technologically savvy. 

Veterans can submit claims for compensation over the Internet. However, such applications are treated as e-mail copies of the application and are not integrated into 

the claims process. Do you believe that VA has a role in improving the use of technology for the processing of initial applications for compensation and to aid in the 

timeliness and accuracy of claims adjudication? 

Response. Yes, I believe that the VA should quickly adapt an e-commerce model 

that enables those increasingly technologically savvy Veterans with a positive, secure, and easy experience. 

Question 43. For some medical conditions that occur after service, the scientific 

information needed to connect the medical condition and the circumstances of service may be incomplete. When information is incomplete, Congress or the Secretary 

of Veterans Affairs has the authority to presume disabilities and diseases as serviceconnected for the purposes of compensation. If confirmed as Secretary, what would 

be your approach for evaluating whether a presumption is warranted? 

Response. I am aware that there have been recommendations made by the President’s Commission on Veteran’s Disability Benefits and by the Institute of Medicine 

on presumption. I am also aware that this is a critical policy decision that determines benefits for millions of Veterans. If confirmed, I will study these recommendations and others in formulating my approach. 

Question 44. As you know, women constitute an ever-growing segment of the 

Armed Forces and consequently, the overall veteran population. What do you see 

as the primary challenges to appropriately treat and serve women veterans in VA 

facilities? Are there aspects of your experience working with women in the military 

that can translate into innovative solutions for improving care for women veterans? 

Response. I believe the challenges include facilities, culture, and expertise in 

women’s health issues that have not traditionally resided within the VA. Military 

medicine has traditionally cared for all family members, with delivery of babies 

being one of the most common admissions in that system. Even with that base, we 

had adjustments to the deployment culture as more women came into the force. I 

had a specific consultant on women’s health issues to focus on our active duty 

women. The importance of ambience, a sense of caring, of attention to the privacy 

needs and sensitivities to security are important in addition to the expertise and 

availability of equipment and services to address the physical and emotional needs 

of women Veterans. These capabilities need to be planned for prospectively as the 

number of women veterans grows to the anticipated 10 percent of the veteran population by 2020. 

Question 45. A major issue in recent years has been the proposal for mandatory 

funding for VA health care, with many veterans’ organizations calling for the guaranteed funding of the systems each year at a level set by law. What do you see as 

the benefits or drawbacks or both to such an approach to funding for health care? 

Response. I appreciate this to be a very complex issue and one for which I will 

require detailed briefing to provide a more informed response. I understand that 

VA’s position has been that annual actuarial projections, rather than pat formulas, 

are the most rational way to project the resource needs for Veterans health care. 

36 

I do have an open mind on the subject and intend to carefully study it before forming an opinion. 

Question 46. At the present time, military recruiters are actively recruiting 

servicemembers from countries in the Pacific Islands, such as the Federated States 

of Micronesia. Some veterans benefits, such as vocational rehabilitation services, VA 

home loans, and health care are not normally provided outside of the Untied States. 

In your view, what obligation does the government have to provide non-citizen disabled veterans benefits and services needed to compensate for and overcome the disabilities which they incurred after being recruited into United States military service? 

Response. I believe that all disabled veterans should receive the benefits earned 

through their service, regardless of citizenship status. I have been informed that VA 

has legal authority to furnish hospital care and medical services to any veteran residing outside the United States without regard to the Veteran’s citizenship if such 

care and services are necessary for treatment of a service-connected disability. VA 

may also provide vocational rehabilitation programs outside the United States to assist veterans in becoming employable and obtaining suitable employment. The law, 

however, does not provide for independent living services outside the Untied States. 

I have also learned that VA guaranteed home loans and grants for Specially Adapted Housing for seriously disabled veterans cannot, by regulation, be made to veterans living outside of the Untied States and its territories. This is, in large part, 

because of problems in administering this type of benefit to veterans in foreign 

countries where there is no VA presence. If confirmed, I will ask for this area to 

be reviewed. 

Question 47. In 2004, a blue-ribbon panel completed an exhaustive review of VA’s 

vocational rehabilitation and employment program. In its findings, it made more 

than 100 recommendations. Of those, VA reports that 88 recommendations have 

been implemented to some extent. I remain concerned, however, that there are far 

too many eligible veterans who do not apply, complete the evaluation process, have 

a rehabilitation plan developed, or complete their plan. No one seems to really know 

why there is such a low completion rate when measured against the number of veterans who apply and who are determined entitled. What priority do you believe VA 

should place on determining why the successful completion rate for individuals in 

this program is so low? 

Response. I have not had the opportunity to review the blue-ribbon panel review 

noted. However, I do believe that the VA should place emphasis on outcomes, not 

just participation, in all of our programs. If confirmed, I will review the panel recommendation and the results of our vocational rehabilitation and employment programs. 

Question 48. Restructuring and downsizing in several VA health care facilities 

have led to contracting with community providers for care. Also, a large number of 

existing VA community-based outpatient clinics are run by non-VA providers. What 

do you believe is VA’s responsibility for monitoring care furnished by contract providers and how might that monitoring be carried out? 

Response. As VA works to provide access to meet the needs of Veterans, it is incumbent on us to maintain the same high quality standards that we have within 

the VHA. 

Appropriate monitoring of claims, appropriate contracting; appropriate retrieval of 

health records to compliment the continuity of care are all mechanisms that might 

be used to meet this obligation. 

Question 49. There is legislation currently pending in Congress that would provide 

World War II Merchant Mariners with a tax-free annual pension of $1,000 a month, 

a payment based upon neither disability nor financial need. 

• What is your opinion about VA providing certain groups with entitlement to a 

monetary payment that is based neither on being disabled nor in need? 

Response. The VA administers the entitlements determined by law and I do understand that there are some historic precedents for such groups. However, I believe 

the priority should be given to those Veterans with service-connected disability or 

Veterans in need. 

• Should VA provide such special compensation to a group without doing the 

same for similarly situated groups? 

Response. The first priority of the VA should, I believe, be to those with serviceconnected injuries or disease whether physical or mental, and to those Veterans in 

need. The VA should administer what other benefits are legislated by Congress to 

the best of our ability with the resources applied to insure our first priority commitment is fulfilled. 

37 

Question 50. Under the Uniformed Services Employment and Reemployment 

Rights Act of 1994 (USERRA), employers—including the Federal Government—have 

certain responsibilities to re-hire individuals who are seeking to return to their jobs 

following a period of active service. It is particularly troublesome to me that an individual who has been sent into battle by the government would need to do battle 

with that same government for the right to regain a job and its associated benefits. 

However, it does happen and it happens far too often. Indeed, according to Department of Labor, more than 30 claims of violations of USERRA were lodged against 

the Department of Veterans Affairs in fiscal 2006. This should be embarrassing to 

the agency. If confirmed, what steps do you believe you can take to ensure that VA 

follows USERRA? 

Response. I believe that the legal protection of employment for those men and 

women who have left their jobs to serve this country is yet another important contribution made by this Committee. I know that among our deployed reserve soldiers, 

it is a concern that is often on their minds. I also agree that the Federal Government and perhaps, most particularly, the Department of Veterans Affairs ought to 

be the positive example. 

If confirmed, I will look into the practices that would have the Department of Veterans Affairs out of compliance with the law and make corrections where that occurs. 

Question 51. Public Law 106–117 contains a provision mandating that VA provide 

non-institutional extended-care services to veterans who are enrolled in the VA 

health care system. While most veterans would prefer to stay out of nursing homes, 

GAOI confirmed that VA is nowhere near full capacity on the non-institutional side 

of long-term care. 

• What is your view of the value of noninstitutional long-term care? 

Response. I believe that non-institutional care can provide a high quality of life 

enhanced by societal and family interaction when so enabled. 

• Do you have any personal or professional experience in this area? 

Response. My personal experience in this area was with my mother-in-law who, 

because of Alzheimer’s disease required progressive nursing home care and with my 

father who, until his death, eschewed a nursing home, but was enabled by home 

health and a capable caregiver to remain in a home setting that was much more 

satisfying to him. As a cardiac surgeon, I often worked with the social workers to 

find intermediate care for recovery and rehabilitation, but realized the quicker one 

could transition the patient back to non-institutional environment, the more likely 

it was that my patient would be productive and enjoy a higher quality of life. 

• If confirmed, what steps will you take to promote VA’s development of non-institutional extended care? 

Response. First, I was gratified to understand that more than 90 percent of VA’s 

medical centers provide home and outpatient long-term care programs and that 

about 50 percent of VA’s total extended care patient populations receives care in 

non-institutional settings. I fully support VA’s patient-focused approach and these 

programs, and, if confirmed, I will review the metrics of success and the incentives 

to support this program with our Veterans. 

Question 52. VHA has had considerable success in using electronic health records. 

What are your views on how technology might be used to address problems that 

arise from VBA’s reliance on paper files? 

Response. I believe that this is a very important axis of advance. I understand 

that much work has been done toward the goal of automating VBA processes, but 

that the paper service medical records of the past have limitations on digitization 

potential. On a go-forward basis, this constraint should be eliminated and with a 

simplified disability schedule, decision support information technology should provide a valuable tool in addressing these problems. 

Question 53. In 1941, Congress passed legislation which, in recognition of the difficulty of using official military records to establish the disability of veterans who 

were disabled in combat areas, provided for a relaxed evidentiary standard in the 

case of claims from veterans who served in combat areas. It has recently come to 

my attention that VA defines ‘‘combat’’ very narrowly when applying this standard, 

requiring a veteran claimant to produce proof of direct combat with an enemy. I 

have introduced legislation which would recognize service in a combat zone as ‘‘combat’’ for purposes of VA claims. Do you see this as an appropriate response to this 

issue? 

Response. If confirmed, I will review the details of the definitions related to combat. My understanding within the Dole-Shalala description of ‘‘combat-related’’—a 

38 

disability acquired while training and preparing for combat—does not have to be 

sustained in the Combat Zone to qualify. 

Question 54. Recently, it came to the Committee’s attention that there may be 

thousands of Reservists who have returned from mobilizations longer than 20 

months, including extended deployments in Iraq or Afghanistan, to find that while 

their length of service qualifies them for Chapter 30 benefits, due to Army procedures, their orders fall short of the 730-day threshold, and thus, they are ineligible 

for full educational benefits. A specific example is the 1/34th BCT from Minnesota, 

which returned from Iraq in July after a 16-month deployment. Although almost 

4,000 members of the unite had served 22-months on active duty, roughly half had 

orders that called for active duty service for up to 730 days and half did not. Thus 

despite all having served equal lengths, only half are eligible for Chapter 30 benefits. 

It is the Committee’s understanding that the Department of Defense has elected 

to pursue a remedy in this specific case through the correction of military records. 

They have also indicated that they are working with the VA to establish a mechanism for the processing of claims for affected individuals in the most expeditious 

manner possible. 

If confirmed, I ask that you have appropriate officials work with DOD in an effort 

to avoid problems such as this in the future. Also, please let the Committee know 

if you believe a legislative remedy is necessary. 

Response. If confirmed I will insure that we work with DOD to address this problem and to find the solution to avoid such problems in the future. 

Question 55. VA research not only makes a major contribution to our national effort to combat disease, but it also serves to maintain a high quality of care for veterans through its impact on physician recruitment and retention. The Administration has made efforts to limit the types of VA research to those conditions associated 

with combat. What is your view of limiting the scope of research performed in VA 

facilities? 

Response. The many different age groups and an increasing gender mix of Veterans expand the scope of research that is relevant to Veterans issues. Our first priority in the use of our discretionary research funding is to insure we are the experts 

in service-connected medical issues, but the influence of those conditions over a lifetime allows our researchers latitude in the scope of their inquiry. 

Question 56. Through VA’s vocational rehabilitation program, VA assumes certain 

responsibilities for the provision of employment assistance to veterans who complete 

a plan of vocational rehabilitation. This assistance can take a variety of forms. I believe it would be desirable that VA cooperate and coordinate with the department 

of Labor’s Veterans’ Employment and Training Service so that duplication of effort 

can be minimized. If confirmed as Secretary, what will you do to involve both DOL 

and DOD in efforts to ensure that employment-related issues are addressed 

seamlessly and without duplication of effort? 

Response. If confirmed, I pledge to work diligently with both DOL and DOD to 

have a collaborative environment supporting the very important outcome of employment for our returning Veterans. 

Question 57. What is your view of the VA’s CARES process and VA’s Capital Plan 

overall? How will you involve senior Veterans Health Administration leadership, 

Congress, veterans service organizations, affiliates, and other stakeholders in the remaining decisions related to the implementation of the Capital Plan? 

Response. I believe in the importance of an overarching strategic planning process 

for long-term restructuring of capital assets and investment to meet the projected 

future needs. I have not had the opportunity for detailed briefings on execution of 

the CARES recommendations. I do note that those recommendations were based 

upon data only as current as 2004. In moving forward, I appreciate the importance 

of engaging senior Veterans Health Administration leadership, Congress, Veteran 

Service Organizations and other stakeholders to insure that our investments support the projected needs and demographics of our Veterans while addressing the realities of the significantly aging capital infrastructure. 

Question 58. Diagnosis for substance use disorders (SUD) in veterans from the 

current war continue to increase. In your view, does combat play a role in increasing 

the likelihood for developing an SUD? Does VA have a particular responsibility for 

treating SUDs? 

Response. I am aware of recent studies from our current conflict that support the 

role of the stress of combat in the development of substance use disorders. There 

is documented co-morbidity with PTSD that is well recognized. VA does have a responsibility to treat substance use disorders as they do any health issue that prevents a Veteran’s reintegration into society. 

39 

Question 59. VBA has had some success in the past with improving the efficiency 

of claims processing by consolidating certain services into fewer offices. What are 

your views on the pros and cons of such consolidation? 

Response. I appreciate the importance of the issue of the claims backlog and the 

time required to process a claim in an accurate and timely manner. I support exploring new models of claims processing, measuring the outcomes, and adopting best 

practices. I have not been briefed to the extent that I have formed an opinion on 

the pros and cons of consolidation in this claims environment. 

Question 60. Under the VA’s vocational rehabilitation program, there is authority 

for a program of independent living services for individuals who are severely disabled. However, there is an annual cap of 2,500 enrollees in this program. Concerns 

have been expressed that this enrollment cap may be adversely impacting the provision of services to those most severely injured in combat. Do you believe that this 

cap is appropriate or should these services be available to all who need them? 

Response. Independent living services must be available to all service-disabled 

veterans who can benefit from them. I need to learn more about this issue. If an 

annual cap is keeping any disabled veteran from participating in the program, I will 

work with Congress to resolve this issue. 

Question 61. Under current policies, there is a protracted period of evaluation and 

multiple reviews of decisions concerning seriously disabled veterans seeking independent living services. If confirmed, will you look into what steps might be taken 

to shorten the evaluation period and reduce the layers of review? 

Response. If confirmed, I will look into what steps might be taken to streamline 

the evaluation of independent living decisions. 

RESPONSE TO WRITTEN QUESTIONS FROM HON. DANIEL K. AKAKA TO LTG JAMES B. 

PEAKE, (RET.) M.D., NOMINEE FOR SECRETARY OF VETERANS AFFAIRS

Question 1. In response to a pre-hearing question, you described different subsets 

of separating servicemembers—those with combat injuries, those with an active 

duty affiliation who elect to leave service prior to retirement, retiring servicemembers, and finally those in the National Guard and Reserves who are demobilizing while remaining in the reserve forces. Please expand on what you see as VA’s 

response to each of these groups—what priority should be accorded to each and 

what should be the focus of VA’s outreach and message to each? 

Response. I believe the VA has the same responsibility to the servicemember who 

becomes a veteran from each of the groups and that is a speedy and accurate adjudication of their claims, effective and efficient and compassionate delivery of their 

benefits, including the highest quality of health care. The difference in response is 

in finding the effective ways of reaching them, educating them on their benefits, assisting them in their access to the VA. The soldier separating from active duty without an unfitting condition has a period before discharge to plan his/her future, access to DOD support services, and the link to the VA system with the Benefits Delivery at Discharge (BDD) program. The retiring servicemember has a similar circumstance, but with the potential of dual eligibility for health care if there is service-connected disability. Again, the opportunity for education can be targeted and 

directed while on active duty. The reserve soldier who is demobilized may be eligible 

for VA benefits. Reaching this group for education, for screening, for helping them 

with service-related frustrations of getting back to their civilian jobs requires a different focus from the active component and it requires working with a different 

chain of command—both National Guard and Reserve. The family support structures are more of a challenge in the reserve component, yet are increasingly important as it is the family unit that needs to understand not only benefits, but issues 

of warning signs for service-related mental health issues such as I understand is 

being done for the active component families. Regarding the message, it is the same 

for each—‘‘we value your service to country, we care about you, and support your 

successful transition back to the civilian world as a productive citizen of this great 

Nation. If you have been disabled by your military service, we want to insure you 

get the best in rehabilitative care for the most productive and rewarding life possible.’’ 

Question 2. You stated in a response to one of my pre-hearing questions that, as 

Army Surgeon General, you were a supporter of the development of a viable patient 

record that would capture a servicemembers’ care from a MEPS facility to a VA 

Cemetery. At the same time, you also noted that you believe that a DOD-VA electronic health record system is an achievable goal that does not necessarily require 

40 

a single system. Do you believe that these responses are contradictory, and if not, 

if confirmed what will be your priority for solving this problem? 

Response. I do not see these as contradictory responses. The important thing is 

that information is collected as close to the point of origin of that information as 

possible, that it is available to those who need it when it is needed and that it can 

be trended. That does require common standards, common definitions, and common 

protocols, which means very close cooperation and shared decision making in these 

areas. In a perfect world, a single system would seem desirable, but with that also 

comes vulnerabilities and acquisition challenges as well. As noted, this has been a 

particular interest of mine for many years and, if confirmed, the issue of common 

computable information will be a very high priority. I will quickly ask for updates 

from VA and DOD to find the best way to pursue this goal. 

Question 3. You also noted that, even without a perfect electronic transfer, it is 

important that providers have the information needed to provide outstanding care, 

appropriate to the continuum of care. At this point, how encumbered is VA by 

DOD’s lack of a complete digital record system? 

Response. I know that the DOD has moved forward with computerized records for 

the ambulatory environment since I retired in 2004. I do not have current information on their progress, but do understand that there is agreement for both data and 

image sharing to be accomplished by October 2008. If confirmed, I would ask for 

detailed briefings on this area. 

Question 4. As I have stated many times, members of our Armed Forces serve at 

the call of our Nation 24 hours a day, 7 days a week. Recently, the Veterans’ Disability Benefits Commission presented its report and, in that report, agreed with my 

view, concluding that there should be no distinction between combat and non-combat injured servicemembers. Do you believe that there should be a system of compensation for those injured in combat or training exercises that is different from 

those injured under other conditions? 

Response. I believe that those injured in combat or training exercises should be 

treated the same. I understand the Veterans’ Disability Benefits Commission also 

supports an affirmative Line of Duty determination as a requirement for benefits, 

and I agree with that as well. I favor finding a way forward for a clear and simple 

to understand definition of benefits and look forward to studying the recommendations of the Scott Commission, the studies that I understand have been commissioned by the VA, the Dole-Shalala Commission and working with the Committee 

to provide assistance and support needed to those with service-connected disabilities. 

Question 5. In response to one of my pre-hearing questions, you noted that you’ve 

been told that VA has pushed the limits of the department’s authority to provide 

medical support to family members who are supporting their injured and ill family 

members. Historically, VA has provided only limited direct care to veterans’ family 

members. I see at least two areas where it might be appropriate to change that— 

first, as part of the direct care of the veteran, such as providing counseling and 

other mental health care services to family members of veterans with PTSD; and 

second, as your answer suggested, when the family member is spending time in a 

VA facility or with VA caregivers in connection with the care of their family member. Please give me your initial thoughts on what you see as VA’s role in this area 

and then, assuming your confirmation, please provide the Committee, within 60 

days, recommendations for any legislation that might be needed. 

Response. My initial thoughts are that the family is a unit when it comes to 

health—particularly to mental health. The spouse who becomes a caregiver for a severely injured/disabled veteran can best serve that role if mentally fit and that fitness can be challenged by this new role. VA should be able to be supportive. If confirmed, I will provide recommendations to the Committee within 60 days. 

Question 6. In your view, do the majority of individuals who are entering military 

service today regard that as a career decision, that is, as a career from which they 

will retire? 

Response. I believe that there are many factors motivating men and women to 

join the service today. One is the potential for a career from which they might retire. But, I believe that, while there may be an increased predisposition for a career 

in the volunteer force, most do not have that as a fundamental career commitment. 

In the Army it was clear that we recruited the individual, but retained families. 

Question 7. In response to my question regarding GI Bill educational assistance 

benefits, you did not elaborate on the value of these benefits as a ‘‘retention’’ tool. 

Do you see such a benefit? 

Response. I do believe that educational assistance is valuable as a retention and 

a recruiting tool. 

41 

Question 8. In response to one of my pre-hearing questions, you made reference 

to the so-called ‘‘Bradley report of 1956.’’ To what extent has that report influenced 

your views on VA and veterans benefits and services? 

Response. The Bradley report of 1956 does highlight some of the same challenges 

for veterans that we see today. In that regard it is useful as a part of the background information that I will continue to read and consider as I further develop 

policy and recommendations for the way ahead. I appreciate the need to keep in 

mind the historical and societal context in which any report was written. It does 

remind us that the challenges to these newest of combat veterans are not without 

precedent. I appreciate the value that report gives to reintegration support. 

Question 9. With respect to VA adopting an e-commerce model for filing claims, 

would you support the move away from a requirement for an actual signature on 

a piece of paper to some form of an electronic signature and will you take steps to 

do whatever is necessary to move VA in this direction? 

Response. I do support this approach, note that industry successfully uses it, and 

I will do what is necessary to move VA in that direction to include a focus on security and oversight. 

Question 10. In response to questions concerning the Dole-Shalala Commission 

Recovery Coordinator recommendation you responded, ‘‘As the care coordinator’s 

role evolves it must involve the VA while the servicemember is still on active duty.’’ 

Under the recently announced pilot, VA will be responsible for providing these coordinators. While I agree that VA should be involved in the process, do you believe 

that VA should be performing these services for servicemembers still on active duty? 

Response. I believe the Recovery Coordinator, though housed in the VA, is really 

a joint asset and must be supported by and supportive of both agencies. I will seek 

ways to insure this function serves the intended function of coordinating all resources according to a recovery plan. I am anxious to learn from the pilot program 

and adjust accordingly. 

Question 11. Do you believe that PTSD can be cured? 

Response. I am dubious of the word ‘‘cured,’’ in general. I do believe there are people who, at some point, meet the six criteria for the DSM IV diagnosis that, ‘‘with 

treatment lead full and productive lives and whose response to the stressor causes 

no impact on their social or occupational life.’’ In that case, a specific criterion for 

the diagnosis is gone and one could declare the patient cured. We must continue 

to do research to learn more about this particular mental health issue, the likelihood of recrudescence and the ways to prevent or mitigate that once a diagnosis is 

made. Also, we need to understand better the interventions for those at risk before 

the diagnostic criteria are met so that we prevent PTSD. Our focus must always 

be in supporting and enabling the veteran to be a full and productive member of 

society. 

Question 12. In your responses to pre-hearing questions, you addressed the decision-making process and the importance of reliable data upon which decisions can 

be made. Do you believe that all decisions can be quantified in some manner based 

on some data element, or do some decisions have to be made without such underlying data? 

Response. Where things can be measured, I favor understanding the data in support of decisions. I also appreciate the real problem of ‘‘paralysis by analysis’’ and 

I do not intend to use the quest for perfect data as an excuse for not making a decision. There are some decisions which are based upon a philosophical principle—just 

doing what is right—that don’t necessarily require a lot of data-driven analysis to 

decide. 

Question 13. Given VA’s post-conflict and long-term responsibility for providing 

prosthetic services to veterans, do you believe that VA should consider assuming responsibility for the Center for the Intrepid at Brooke Army Medical Center and to 

operate it as a VA Center for Excellence in prosthetic recovery, rehabilitation, and 

research? 

Response. If confirmed, I would be willing to look at that. However, my first inclination is to find the right way to work jointly with the DOD. Ultimately, those patients will be at least a shared responsibility of the VA’s, and to insure we have 

the excellence of the continuum of care and the excellence of progressive research 

in this military related area of rehab, I favor partnership. In fact, when I directed 

the establishment of the Army’s Amputee Center of Excellence, I insisted that we 

invite governance participation from the VA. 

Question 14.A. I have attached a letter from Senator Bond with some additional 

questions for you. I believe you have already answered his first question. 

42 

RESPONSE TO WRITTEN QUESTIONS FROM HON. CHRISTOPHER S. BOND TO LTG 

JAMES B. PEAKE, (RET.) M.D., NOMINEE FOR SECRETARY OF VETERANS AFFAIRS

Question 1. Answered, as noted above. 

Question 2. What are your budgeting and staffing plans to address the increase 

in PTSD and TBI patients amongst the veteran population and the impact on homelessness, for both the newest wars and prior wars, now estimated at more than 

52,000? 

Response. I have not had detailed briefings on the budget. I understand that VHA 

has made specific expansion of mental health workers to deal with these issues. I 

note that the Secretary of Veterans Affairs is one of the rotating chairs of the Interagency Council on Homelessness. I believe homelessness is a multifaceted problem 

that involves individual economics, skills development, mental health and social 

well-being. If confirmed, I look forward to supporting the inter-agency/interdisciplinary approach to understanding and supporting homeless veterans. I will also 

quickly assess the budget for mental health/TBI. 

Question 3. What are your detailed budgeting and staffing plans to address the 

backlog of PTSD claims? Would you consider expediting the process by establishing 

a presumption of service connection for PTSD claims for veterans deployed to Iraq 

and Afghanistan where the service record supports evidence of PTSD symptoms. 

Response. I have not had detailed briefings on the budget. I am aware that nearly 

3,000 new claims personnel have been hired and are in various stages of training. 

If confirmed, I will further review the budget and the pros and cons of this presumption, as well as other potential alternatives for expediting claims processing. I am 

particularly interested in getting assistance to those in need and, as quickly as possible, engaging them to keep the reaction to combat stress from becoming a disabling condition. 

Question 4. What are your plans to address the significant disparity among the 

number of Iraq and Afghanistan war veterans diagnosed by VA with PTSD (52, 

375), compared to the much smaller number of Iraq and Afghanistan veterans receiving disability compensation for PTSD (19,015)? 

Response. I am not familiar with the detail behind these numbers. If confirmed, 

I will aggressively investigate this disparity and propose solutions to address unfair 

practices. 

Question 14.B. Attached are also some question from the Physicians for Human 

Rights. 

RESPONSE TO WRITTEN QUESTIONS FROM PHYSICIANS FOR HUMAN RIGHTS TO LTG 

JAMES B. PEAKE, (RET.) M.D., NOMINEE FOR SECRETARY OF VETERANS AFFAIRS

Question 1. During your tenure as Army Surgeon General, from 2000 to 2004, 

what involvement, if any, did you have in the development or approval of the BSCT 

(Behavioral Science Consultative Teams) program at Guantanamo and other facilities, which employed psychologists as interrogators in a military intelligence program using abusive tactics? 

Response. Personnel were assigned to join these teams which were not under my 

command authority. To my knowledge medical personnel did not act as interrogators. 

Question 2. What efforts did your office take to address the credible evidence of 

physicians and other health professionals serving as ‘‘safety’’ officers during abusive 

interrogations? Also, did you support the utilization of personnel within your command to provide sign-off on whether a detainee was physically or mentally ‘‘capable’’ 

to undergo SERE method interrogations? 

Response. I am aware that medical personnel, not in a patient care capacity for 

the prisoners, provided medical advice to the interrogators in support of humane 

treatment of prisoners. I supported this policy. Care of prisoners was performed by 

different competent medical personnel assigned for this task. I was not briefed specifically on ‘‘SERE’’ method and cannot comment. 

Question 3. Military medical personnel who practiced torture and other abuses of 

POWs and enemy combatants may well suffer lasting medical and psychological effects. These individuals who participated in torture or abuse may have unique problems with the potential to lead to significant social consequences. If confirmed, what 

steps will you take to ensure that the Veteran’s Administration is prepared to adequately address the medical and psychological needs of these veterans? 

43 

Response. I am not aware of any medical personnel who practiced torture. Torture 

is illegal and is not supported by the military. As with all of our military personnel, 

exposures to the activities of war create the potential risk to psychological health. 

Our medical personnel in the combat support hospitals, for example, are exposed 

daily to severely injured U.S. and coalition servicemembers. If confirmed, I will keep 

the mental health sequellae of war to include PTSD, substance use disorders, and 

other potential co-morbid conditions as a focused area of treatment and research 

inquiry. 

RESPONSE TO WRITTEN QUESTIONS FROM HON. RICHARD BURR TO LTG JAMES B. 

PEAKE, (RET.) M.D., NOMINEE FOR SECRETARY OF VETERANS AFFAIRS

Question 15. Dr. Peake, you retired from the Army having attained the highest 

rank and position possible for a medical doctor—wearing three stars on your shoulders and serving as the Army Surgeon General. You had authority over and responsibility for the entire Army medical system. What lessons did you learn while serving in that position that you believe would help you to serve as an effective Secretary? 

Response. I have learned that the only way one can get anything accomplished 

in an organization much larger than even an infantry company, let alone an organization the size of the VA, is through delegation. But, with the delegation must come 

accountability supported by data. I have learned to do my homework on issues and 

ask questions to understand the issues. As the ‘‘intent’’ of policy is communicated, 

my expectation is that those many operational decisions made at levels below the 

Secretary are made consistent with that ‘‘intent’’. In decision making, I will welcome 

all input, encourage the dissenting view, and seek outside critical thinking. However, with that input, I will make decisions with or without consensus. I recognize 

that without clear consensus, I have an increased obligation to communicate my rationale; engage and see the decision to success (ownership); and the responsibility 

to change course if I am wrong. 

Question 16. For many years, there have been serious concerns about the backlog 

of claims at the Department of Veterans Affairs, the length of time it takes to process claims, and the accuracy of VA’s decisions. Have you thought about a strategy 

for how you would address these enormous challenges if you are confirmed? 

Response. I understand that Admiral Cooper has been able to expand his claims 

workforce and has put in place an aggressive training program. If confirmed, I will 

be anxious to see the results of that. I also believe that a key to the future is automation and decision support tools for those who have to adjudicate records. Getting 

the right information up front, (and with this newest generation, working right now 

with DOD to do so) is important. The DD–214 that is now shared electronically is 

an example. Simplifying the disability system is also part of the road to more accurate and efficient claims processing and adjudication. 

Question 17. Earlier this year, Secretary Nicholson started a new initiative at the 

Department of Veterans Affairs to provide priority claims processing for all OIF/ 

OEF veterans’ disability claims. Although all claims are important and deserve 

prompt attention, do you share the view that we should provide a higher priority 

to veterans of the current conflicts who are transitioning to civilian life and seeking 

disability compensation for the first time? 

Response. I am a believer in putting the systems in place to do ‘‘today’s work 

today.’’ This includes resources, processes, people, equipment, and time. If those resources are not calibrated to the demand, managers must prioritize. Up to 60% of 

claims, as I understand it, are reopened claims of veterans who are already getting 

benefits. We need to move these along expeditiously and to standard, but I do believe that those who need access to the benefits to reintegrate into society, to rehab 

from fresh battle experience and service-connected wounds ought to have priority 

while we develop the resources, human and otherwise, to meet all of the claims in 

line with that ‘‘today’s work today’’ philosophy. 

Question 18. 

• Dr. Peake, if confirmed by the Senate, your tenure as Secretary will likely last 

just about one year. That’s not a very long time to serve in any post. Why did you 

agree to leave the private sector for this temporary, one-year position? 

Response. I can think of no higher calling that serving the country and particularly having the opportunity to care for our veterans. It is an extension of what I 

have devoted my adult life to doing. I consider it an honor and a privilege as well 

as a responsibility of citizenship. 

44 

• More importantly, with such a limited tenure likely at the helm of VA have you 

given any thought to what you would like to accomplish in that time period? 

Response. We are a Nation at war. We have the best of this nation, our young 

men and women, in harm’s way and returning as our newest generation of veterans. 

I will do my very best to set the azimuth for their future as veterans while working 

the more immediate issues of transition that insures continuity of care for those 

who need that; open the access to those whose health needs become apparent after 

transition; and remember the rehabilitation/reintegration missions as ones whose 

outcomes are jobs and economic self-sufficiency. 

The issue of PTSD is an important one, as is the issue of TBI. We must get the 

best of science to help us guide the way we deal with this for our veterans—both 

our newest veterans and those who have served in prior conflicts. 

Question 19. Dr. Peake, DOD continues to struggle to implement a fully-operational electronic health record. And we, in Congress, have been pushing DOD and 

VA to create a complete interoperable health record between the two agencies. 

• First, how well do you think the Army has progressed in its implementation of 

an electronic health record system? 

Response. I have not had a recent update on the electronic record for the military 

health system—to clarify it is a joint system. I do know there were some technical 

and cultural challenges and particular segments, some specialties for example, 

found it more difficult to adopt. But, having a longitudinal, queriable patient record 

that is accessible to all who need it for the care of the trooper is the right objective. 

• Second, do you think an interoperable record between VA and DOD is attainable? And why do you think we continue to struggle to attain that goal? 

Response. I do believe it is an obtainable goal and one we should fight to obtain. 

It is not just about hardware and software. I believe it has to do with developing 

the standard lexicons, the common processes that promote interoperability. It means 

creating a common information culture, the forums for shared decision making. 

With the centralization of IT at VA (a cultural shift in itself) the opportunity may 

be enhanced. 

Question 20. North Carolina has a number of VA medical centers and outpatient 

clinics throughout the state, yet I am told that VA medical examinations for disability compensation claims are only provided at the Winston-Salem VA outpatient 

clinic. • Are you aware of any reasons why it would be appropriate to require veterans 

to travel, in some cases up to four hours, to the Winston-Salem clinic when other 

VA facilities are closer to them? 

Response. I have not been briefed on the issues of access related to the North 

Carolina VA network. I have heard repeated concerns about timeliness and ease of 

access from Members of this Committee. If confirmed, I will review this matter and 

respond. 

• Do you believe that veterans may be better served, and that VA may even save 

money on travel reimbursements for scheduled examinations, if a wider selection of 

VA examination sites were available? 

Response. The C&P examination can be quite complex. It is important that the 

quality of the examination is maintained. That focus will reduce rework, reduce remand rates, and provide a more timely and accurate adjudication. If confirmed, I 

will work with VHA and VBA to find creative solutions to the quality and access 

issues inherent in this question. 

• Do you commit to examining this issue, specifically for North Carolina veterans, 

but also nationally, if you are confirmed? 

Response. I do. 

RESPONSE TO WRITTEN QUESTIONS FROM HON. JOHN D. ROCKEFELLER IV TO LTG 

JAMES B. PEAKE, (RET.) M.D., NOMINEE FOR SECRETARY OF VETERANS AFFAIRS

Question 21. The press reports on PTSD and mental health issues among our returning veterans are compelling. In private roundtables with West Virginia veterans, I believe that many more veterans may come forward with such concerns 

over time. Given your career in the military, you have a unique ability to understand and appreciate the stigma that soldiers and veterans may face in seeking 

mental health care. Can you share your views and possible strategies to help combat 

the stigma veterans face in seeking mental health care in the VA, and with the public? 

Response. I will start with an anecdote. Immediately after 9/11, with the Pentagon housing the remains of an airplane and having visited all of the wounded 

45 

from that attack, it was clear to me that mental health of the pentagon workforce 

had to be addressed proactively. I assembled my mental health team in a crisis action mode and with their recommendation, supported and resourced flooding the 

pentagon with mental health workers available in-clinic, outside of clinic on-call, 

outside of clinic walking around and visiting EVERY organization and office; outside 

of clinical settings, but in easily-accessible locations; and mental health workers located in the primary care areas that service the military and military dependent 

workforce. The approach was with medical professionals, but without medical 

records developed except for those referred for more advanced and in-depth therapeutic assistance. The senior army leadership, specifically General Shinseki, our 

Chief of Staff, and General Keane, our Vice Chief of Staff, personally, and forcefully 

encouraged the Army Staff leadership to ensure that EVERY person availed themselves individually on in-group sessions of this mental health access. 

This was not done in response to someone acting ‘‘crazy’’ or having a traumatic 

response; rather, it was done proactively—effectively saying to people that they 

could normally expect to have been affected emotionally by the event and that it 

was ok and expected that they would avail themselves of the support, and that they 

could expect to be better. It worked! It is hard to prove the negative, but after a 

year, there were no suicides in that group of workers and there were a number of 

people who had, without fanfare, received longer-term treatment while the majority 

went back to work even while the pentagon was rebuilt. This anecdote has colored 

my thinking on this subject. 

It prompted me to aggressively support an employee assistance program type of 

system that became Army One Source (now evolved to Military One Source). It provides a hotline for help; it allows up to 6 counseling sessions without medical 

records and without reporting (unless a serious mental health issue is surfaced); 

family and servicemember alike have access. 

• What will you do to reach out to Guard and Reserve soldiers who may be less 

likely to seek VA care, and may have more difficulty with the paperwork and eligibility? 

Response. I believe the VA must work with both the active duty and the reserve 

chains of command to insure we reach the Citizen Soldiers with meaningful engagement before they demobilize to educate them about benefits and the processes to get 

them. Particularly, we need to team with the DOD to have all of the Reserve Component Servicemembers who have deployed complete the Post Deployment Health 

Care Reassessment (PDHRA) and be proactive to assure the resulting follow-up 

plans are executed. In parallel we to need move forward with simplifying the disability system and the processes by which it is administered. 

Question 22. As a follow up, Dr. Peake, I wanted to share estimates according to 

the DOD Task Force on Mental Health from June of 2007. 

• Among active duty soldiers, it estimates to be up to 38% with general mental 

health needs 

• For Marines, it estimates 31% will have general mental health 

• Among, National Guard & Reserve soldiers it is higher, with as many as 49% 

facing general mental health issues. 

The report also suggests that psychological concerns are significantly higher 

among soldiers with repeated deployments, and the numbers of such soldiers is 

growing. This is a stark summary of the problem we face. How do you intend to 

approach this once confirmed as the VA Secretary? How will you work with us on 

the major issues of resources and reforms to meet the stunning needs of our soldiers? 

Response. I am familiar with the study and agree with the sense of the magnitude 

of the problem. If confirmed, I will work to strengthen and build upon the ongoing 

collaboration between the departments. It will be important to distinguish those 

among the groups above that truly have a Post Traumatic Stress Disorder diagnosis. 

As you rightfully point out, these numbers above include general health needs. 

Many of these can benefit from early recognition and early intervention and their 

negative effects can be significantly mitigated or even eliminated. Others will require more extensive intervention and may be compromised in their employment or 

life skills even with intervention. We do not want to treat these all the same. I will, 

if confirmed, give strong support to research as we continue to advance the science 

of mental health issues as military sequellae. I look forward to exploring innovative 

ways to engage the family unit of veterans who do not have the benefit of the DOD 

initiatives that might come out of the study. If confirmed, I will work within the 

administration, with the stakeholders represented by veterans, veterans service organizations, military service organization and the best researchers to identify the 

programs, resource the programs, and measure the outcomes. 

46 

Question 23. Traumatic Brain Injury (TBI) is a serious issue for veterans from 

Iraq and Afghanistan. The severe cases of TBI are getting real attention, but what 

about the moderate cases and the potential long-term effects? What research will 

VA engage in to study this problem? 

Response. I have not had detailed briefings on the specific VA research initiatives 

in TBI, but am aware of the high interest in this area and the expansion of the 

polytrauma centers and polytrauma network that has a focus on the problem of TBI. 

I also am aware that both the Dole-Shalala Commission and the Marsh-West Independent Review Group both highlighted this issue. If confirmed, I look forward to 

proactively engaging with Colonel (promotable) Loree Sutton, a military psychiatrist 

who is tasked leading DOD’s study of TBI, specifically, and ensuring active collaboration in her efforts and access to VA experts of our polytrauma team. 

• How can we track veterans who do not have problems now, but may develop 

problems over time due to multiple exposures to TBI during combat? 

Response. I believe this represents a long-term epidemiologic problem that must 

be studied in this population. Sports-related concussion (akin to ‘‘mild TBI’’) does 

have a body of evidence that suggests mild TBI recovers generally well, but again 

I do believe long-term studies are needed. In the meantime, perhaps we should be 

referring to that as concussion rather than Traumatic Brain Injury, which seems 

to take on an ominous connotation with servicemember and family member. Work 

is being done on cognitive testing, but again, I support research to tell us what productive screening might be useful as we look to problems over time. 

Question 24. I realize that VA faces funding problems, but how can we justify a 

ban on Category 8 veterans, many who many be uninsured according to a private 

study this fall, and earning as little as $28,000 per year? Rather than using administrative authority to bar enrollment, shouldn’t we work together to get the funding 

we need to provide VA health care for such veterans? 

Response. My understanding is that the Category 8 designation was established 

in 2003 as the system was overwhelmed and the core mission of excellent care for 

those veterans with service-connected disabilities and those veterans in need would 

be compromised. If confirmed, I will look forward to working with you to consider 

approaches to understanding the needs of non-service-connected veterans for health 

care coverage that is affordable and looking at the means testing that is currently 

in place with the ‘‘Category 7’’ veterans. It is essential that the core mission of specialized care and care for those service-disabled veterans and veterans in need, not 

be compromised. 

Question 25. In 1990, there were only 1.2 million female veterans, by 2010, there 

will be 1.8 million female veterans. The number of female veterans is on the rise, 

as the number of male veterans is declining. Some estimate that by 2010, female 

veterans will be about 10% of the veteran population—that is less than 3 years 

away. 

A VA task force notes that of the more than 263,000 veterans seeking VA care 

from Iraq and Afghanistan, 12% (or over 31,000) are women veterans. How will VA 

expand its outreach and adjust its services to provide care and meet the needs of 

the rising number of female veterans? What needs to change at our Vet Centers and 

in our medical centers to accommodate our female veterans? 

Response. I believe the challenges include facilities, culture, and expertise in 

women’s health issues that have not traditionally resided within the VA. Military 

medicine has traditionally cared for all family members, with delivery of babies one 

of the most common admissions in that system. Even with that base, we had adjustments to the deployment culture as more women came into the force. The importance of ambience, a sense of caring, of attention to the privacy needs and sensitivities to security are important, in addition to the expertise and availability of equipment and services to address the physical and emotional needs of women veterans. 

These capabilities need to be planned for prospectively as the number of women veterans grows to the anticipated 10% of the veteran population by 2020. I am pleased 

to know that there is a specific organization with a focus on women veterans’ issues, 

and, if confirmed, will work within VA to insure this area has focus and resources. 

Question 26. Staffing at VA Medical Centers and Vet Centers is vital to quality 

care. What is your philosophy on staffing centers, routing directors of VAMC, and 

replacing leadership? 

Response. I am pleased to know that the Senate has recently confirmed Mr. Michael Hager as the new Assistant Secretary for Human Resources and Management. 

If confirmed, I look forward to working with him to get a detailed understanding 

of our personnel management programs and alternatives for the future. My experience in the military suggests that there is an advantage to movement in leadership 

positions, but not as frequent as dictated by military life. Managing the human reVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00050 Fmt 6633 Sfmt 6621 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
47 

source with developmental opportunities and progressive responsibility allows a career path with a future and also affords a succession planning bench to insure the 

future of the VA leadership. 

Question 27. The attached news article published in June of this year reported 

concern that of an upcoming $90 million contract for information technology asset 

management software being directed to a particular company without the benefit of 

competition. If the press report is accurate, it is an indication of serious problems 

within the Department with regard to contracting procedures and compliance with 

the mandates of the Competition in Contracting Act including the requirements for 

full and open competition. As a new Secretary, how will you ensure that this particular procurement is properly competed and that all Department procurements 

meet statutory requirements for competition? 

Response. I have not been briefed on this particular contract and do not know if 

the press report is accurate. However, I do believe in full and open competition. It 

is my understanding that this Committee has supported a new position, an Assistant Secretary for Acquisition. I strongly support this new position and believe that 

focused leadership and development of the acquisition workforce of the VA will improve what we ultimately are able to do for our veterans. Regarding this particular 

procurement, if confirmed, I will ask for a detailed briefing to address your concerns 

and take corrective action as required. 

[Federal Computer Week Article follows:] 

Federal Computer Week, Vendors claim VA contracts unfair 

Industry alleges agency decisions give IBM wired advantage to win 10-year contracts. By Jason Miller, Published on June 11, 2007. Editor’s note: This story was 

updated at 11:08 a.m. June 11, 2007. Please go to Corrections & Clarifications to 

see what has changed. 

Several industry sources said two Veterans Affairs Department contracts for information technology asset management software and services worth $90 million over 

10 years appear to be wired for IBM. VA issued the contract solicitations through 

NASA’s government-wide acquisition contract (GWAC). 

Industry sources, who requested anonymity because they did not want to damage 

their relationships with VA, pointed to several unusual decisions the agency has 

made in the past few months and to specific instances in the agency’s request for 

proposals to support their suspicions. 

Those sources alleged that VA’s decision to use NASA’s Solutions for Enterprisewide Procurement (SEWP) GWAC and to require integration with IBM’s Maximo 

Software Suite are among the most troubling aspects of the procurement. 

Industry sources said IBM is the only vendor on SEWP IV that provides software 

that easily integrates with the Maximo Software Suite. They also said other resellers in the market could compete on the contract if it were awarded through the 

General Services Administration’s Federal Supply Schedule or FedBizOpps.gov. 

‘‘VA is looking for an agent-based solution as they say in the RFP, and Maximo 

is the only one’’ on the Solutions for Enterprisewide Procurement, said an industry 

executive. ‘‘All I’m looking for is full and open competition.’’ 

Industry sources said BDNA, CA and EMC Software are among the vendors that 

could compete in full and open competition. 

A VA spokesperson denied the contract is wired to IBM, and said the agency 

wants as much competition as possible from SEWP vendors. VA officials in July 

2006 mandated all software purchases must go through SEWP, the spokesperson 

said. 

But because IBM is the only vendor on SEWP to provide these services, the industry sources said the procurement is unfair. 

The spokesperson said VA is trying to ensure competition. ‘‘In addition to requesting information, the RFI affords vendors the opportunity to establish required relationships with resellers to further enhance competition,’’ the spokesperson said. 

Another red flag, industry sources said, is VA’s request for 205,000 software licenses. On IBM’s SEWP listing for Maximo, IBM quotes a price for 205,000 licenses, 

a price available only to VA. 

‘‘When IBM created their SEWP IV offering, isn’t it striking that they had the 

insight to know that it should be 205,000 assets, and only VA could use it,’’ said 

another industry executive. ‘‘And then there is an RFI that aligns directly with 

IBM’s offering. Maybe if I was a little more naive, I would believe it was an accident.’’ 

An IBM official said VA is simply adding new modules to applications VA already 

uses. 

48 

The VA spokesperson said the agency specifically asked for Maximo because the 

other applications, including the IT asset management software, will run on IBM’s 

Maximo. 

Under the services contract, which is estimated to be worth $54 million over 10 

years, several vendors could provide integration, operation and maintenance support 

services. 

However, several industry sources said VA is trying to direct the procurement to 

IBM, which according to procurement experts isn’t necessarily illegal. 

‘‘Agencies go out of their way consistently to hide the fact that they are buying 

very large dollar amounts of goods and services by using indefinite-quantity, indefinite-delivery contracts to limit competition,’’ said Bill Shook, a procurement attorney 

at Kirkpatrick & Lockhart Preston Gates Ellis, who is not representing any party 

in the dispute. 

RESPONSE TO WRITTEN QUESTIONS FROM HON. PATTY MURRAY TO LTG JAMES B. 

PEAKE, (RET.) M.D., NOMINEE FOR SECRETARY OF VETERANS AFFAIRS

Question 28. VA disability reform—oversight of changes: 

In the pre-hearing questions you answered for this Committee, you pledged to 

work closely with Congress, DOD and the VSOs to create and manage the change 

necessary to reform the Disability Compensation Schedule. You also talked about 

bringing accountability to the VA, if confirmed, in these pre-hearing questions. 

As you know, the Veterans’ Disability Benefits Commission, which was chaired by 

General Scott, recommended we establish an executive oversight group to ensure 

that the commission’s recommendations are implemented quickly and effectively. 

From what I can tell, the Administration’s draft legislation doesn’t include an 

oversight function to monitor the implementation of the action steps included in the 

bill. Given the monumental task of reforming the VA disability system, do you think 

establishing an oversight group is important—and if confirmed, will you do so? 

Response. If confirmed, I will look at the Senior Oversight Committee (SOC) that 

might be re-chartered quickly as an initial oversight group leveraging what I understand to be established and effective working relationships. As the strategic plan is 

developed, it might be best to charter a new oversight group with more focused 

membership and expanded to other agencies as appropriate. I would work with the 

Committee to confer on the most satisfactory oversight approaches. 

Question 29. Family members: I’m sure you would agree that veteran families are 

very much on the front line of this conflict, and often sacrifice to care for their loved 

ones. What more can the VA do to help veterans’ families and give them the support 

that they need when assisting their loved ones? 

Response. I believe the family unit is a social and an economic entity. The other 

family members of the veteran are also affected by the veteran’s experiences with 

injury—physical or psychological. A healthy family caregiver and supporter is important to the veteran and to the family unit. The ability to provide appropriate 

medical support, particularly mental health support, including medications and the 

ability to support the family engagement in the therapeutic process in the form of 

finances, housing, and transportation when it is needed are potentially ways in 

which VA might support veterans’ families. 

Question 30. Mental health providers: How do you plan to address VA’s workforce 

shortages in the mental health field, particularly as they relate to rural areas? 

Response. If confirmed, I will work to quickly get a sense of the scope and demography of the problem. I am aware that there has been an expansion of the mental 

health workforce and a targeting of outpatient clinics. Though I am not familiar 

with all the programs the VA might have in place now, I believe there is a range 

of options to explore to expand mental health access that is a particular problem 

in the rural areas. These might include salary incentives, training subsidies in exchange for remote location service, tele-medicine as a tool, call centers, contract providers, and targeted educational programs for health professionals of other agencies. 

Question 31. PTSD: Dr. Peake, do you believe that PTSD is a legitimate illness 

that has the capacity to impair the daily functioning of our men and women in uniform? 

Response. Yes 

• Do you believe that extended deployments, as well as multiple deployments increase the risk of developing PTSD? 

Response. Rather than the deployment itself, it is the repeated exposures to specific ‘‘stressors’’ that are more problematic in increasing the risk of PTSD. Deployment itself can be stressful with family separations, unknown durations, austere livVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00052 Fmt 6633 Sfmt 6621 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
49 

ing conditions and may have an impact on mental health that is not necessarily 

Post Traumatic Stress Disorder. 

• As a career military officer, what is your feeling on sending troops back into 

theatre who suffer from PTSD? 

Response. I do not favor sending dysfunctional troops into a combat zone where 

they can be a danger to themselves and to their fellow soldiers. I believe the military supports this philosophy. However, I do not believe that everyone who carries 

a diagnosis of PTSD is dysfunctional. Rather there is a spectrum of symptoms, individual resiliency, and response to treatment that offers opportunity for individualized consideration. Blanket determinations can increase the stigma about which we 

are all concerned. I also believe that there are many different environments within 

the theatre that are less stressful and with greater levels of support for the servicemember than others. It is a decision that commanders must make, but with the best 

medical advice. 

Question 32. Dual Diagnosis: As you know, PTSD is a risk factor for the development of substance abuse disorders and many veterans have both. What will you do 

as Secretary to address the problem of dual diagnosis disorders? 

Response. If confirmed, I will support research to find the best ways to deal with 

the co-morbid conditions. I am aware of recent reports documenting an increase in 

post deployment alcohol abuse and recognize the potential long-term adverse outcomes that can result from employment impact, family distress, and homelessness. 

I will look for ways for the VA to be proactive by understanding programs in place 

now and what new programs might be needed to deal with this new generation of 

veterans. I look forward to establishing a constructive relationship with DOD to insure a common message on substance abuse, education of the servicemember and 

family, so that signs can be recognized early. I recognize that it is difficult to help 

someone who does not recognize a problem or who does not want to be helped. 

Question 33. Waiting times: General Peake, as you found out in your meetings 

with Members of this Committee, waiting times for veterans to see doctors are a 

big concern among our constituents. If confirmed, what will you do to tackle this 

problem? 

Response. If confirmed, I will ask for a detailed review and include the Inspector 

General who, I understand, has some disagreement with VHA. I am particularly interested in stratifying the problem to understand if it is access in general, or in specific areas, so that we focus on solutions that will have as quick an impact as possible while we evaluate a more comprehensive approach. 

Question 34. Guard and Reserve Mental Health Problems: A recent Army study 

found that Guard and Reserve soldiers suffer from mental health problems at twice 

the rate of active duty soldiers. Given this discrepancy, how can the VA change to 

better reach out to Guard and Reserve soldiers, many of whom live in rural areas 

far away from VA facilities? 

Response. I believe the VA must work with both the active duty and the reserve 

chains of command to insure we reach the Citizen Soldiers with meaningful engagement before they demobilize to educate them about benefits and the processes to get 

them. Particularly, we need to team with the DOD to have all of the Reserve Component Servicemembers who have deployed complete the Post Deployment Health 

Care Reassessment (PDHRA), and be proactive to assure the resulting follow-up 

plans are executed. In question 30 above I have described potential approaches to 

providing increased mental health services access, but providing a proactive outreach, perhaps even past the PDHRA, is worth exploring as part of a preventive 

program for psychological wellness. In parallel we need to move forward with simplifying the disability system and the processes by which it is administered. 

Question 35. Mental Health: Given the attention in the media about mental illness in our servicemembers, why do you think a stigma still exists with respect to 

these illnesses in the military and what can be done to overcome this stigma? 

Response. The DOD Task Force on Mental Health devotes a considerable amount 

of work on this continuing problem. They identify the need to create a culture of 

psychological health with a number of specific recommendations that include revising regulations that give the appearance of mental health issues leading to adverse 

career outcomes, while finding ways to protect the servicemember and the unit if 

the mental health issue would compromise the mission. Educating and inculcating 

mental health throughout military life is another of the recommendations that includes training leaders, training family members and training medical personnel. 

After 9/11 I supported additional mental health providers to be incorporated into the 

primary care environments, as well as having them circulate throughout the Pentagon and visiting every office space on a periodic basis to provide non-stigmatizing 

ease of access. Imbedding mental health workers in military units is another recVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00053 Fmt 6633 Sfmt 6621 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
50 

ommendation. Promoting early recognition and intervention in alcohol abuse; facilitating command referral are all important recommendations. Stigma is not restricted to the military. It is an area that I believe needs to be explored in relation 

to reemployment of our returning Reservists. I have heard anecdotes of the returning servicemember being asked if he or she is ok mentally after having been to war. 

This may represent a concern of companies, about functionality or about assuming 

liability; in either case, it sets up the stigma issues that the military is trying to 

actively combat. If confirmed, I look forward to working on this important subset 

of the larger mental health issues facing our returning servicemembers and newest 

veterans. 

Question 36. Procurement: Dr. Peake, I assume that as Secretary of Veterans Affairs, you will be committed to ensuring that Department procurement policies will 

be formulated and executed to acquire the best products and services available at 

the lowest cost to the government. These principles ensure that both agency beneficiaries and the taxpayers at large receive the best services and the best value that 

the market can provide. To that end, I would be grateful if, upon your confirmation, 

you look into the Department’s use of non-competitive inter-agency agreements to 

contract for human capital management systems and services in order to avoid 

using open competition that would also examine solutions available from the private 

sector. In particular, I am concerned with the announced purchase of a staffing system from the Office of Personnel Management and a position classification system 

from the Department of Health and Human Services. In both cases, I believe private 

sector solutions were available that were superior and more cost effective. If confirmed, will you look into this? 

Response. If confirmed, I will. 

RESPONSE TO WRITTEN QUESTIONS FROM HON. BARAK OBAMA TO LTG JAMES B. 

PEAKE, (RET.) M.D., NOMINEE FOR SECRETARY OF VETERANS AFFAIRS

Question 37. Congress has voted to hire additional claims workers to ease the 

backlog at the VA. What other immediate steps would you take to ensure that veterans receive quality, timely decisions about benefits? 

Response. If confirmed, I would support the investment in training to make these 

people as productive as possible as rapidly as possible. I believe there are wait-time 

barriers to the speed of adjudication that have been put in place to offer support 

to the claimant. However, I believe some of these time frames if waived by an informed claimant could significantly speed up the process. I believe the opportunity 

for information technology support in records maintenance and decision support 

tools is great and I would invest in them. Fundamentally, I believe that the disability rating system is in need of revision and simplification and I would work with 

all stakeholders and Congress to find the way forward in this important area. 

Question 38. In your view, in the lead-up to the war in Iraq, did the Administration adequately plan for the needs of our returning veteran population? What is 

your view on the appropriate role of the VA in planning for a possible military conflict? At what stage should the VA be involved with the Pentagon in anticipating 

and planning for the needs of returning servicemembers? What surge capacities 

should exist within the VA in order for the agency to be able to adjust during future 

military conflicts? 

Response. I cannot speak for the VA pre-war planning; however, the military did 

expand its medical reception and evacuation platforms in anticipation of an acute 

surge. Reserve medical personnel were mobilized to support the backfill of active 

duty medical personnel who had deployed. Anticipating an increased number of amputees, the amputee centers of excellence at Walter Reed and Brooke Army Medical 

Centers were put in place and the burn unit was expanded at Brooke and a network 

of burn units across the country was coordinated. As the nature of war wounds 

evolved and the deployments have become protracted and repeated both systems 

have worked to adjust to the current picture of returning veterans. I believe the VA 

should be engaged as early in the planning process as casualty estimates are made. 

The ability of the VA to surge should be carefully examined in light, not only of supporting war returning veterans, but in the event of ‘‘war’’ here at home from terrorism to natural epidemics, to disasters. If confirmed, I will review existing surge 

capacity and review recommendations for the future. 

Question 39. In your pre-hearing responses, you stated that the Secretary must 

use actuarially supported data combined with real information from practice patterns, along with collaboration with DOD, to provide accurate forecasting for the 

VA’s budgeting needs. Given past VA budget shortfalls, what do you believe are the 

51 

current weaknesses in VA’s budget planning process, and what actions would you 

take to correct these weaknesses? 

Response. I have not had detailed briefing on the budget process. If confirmed, 

I recognize that we are going quickly into the ‘‘budget season’’ and I will quickly 

need to assess this process and will take action if weakness are found. 

Question 40. If you thought that the VA required an appropriation on the scale 

of several billion dollars more than what the White House was willing to request 

from Congress, would you take your case straight to the President? 

Response. Yes. 

Question 41. During your time as Army Surgeon General, what warning signs, if 

any, did you receive about the woeful conditions and shortfalls in care at facilities 

like Walter Reed? In hindsight, were there preemptive actions you should have 

taken in that role in order to prevent our soldiers from having to wage a second 

battle at home to receive benefits and care? 

Response. I left the Army in September of 2004. We had not had the huge number 

of returning wounded at that point and, for example, we did not have patients in 

‘‘building 18’’. I visited Walter Reed frequently and was focused on the high quality 

of inpatient care (which, by all accounts, was maintained, and even with the problems in outpatient care, board processing, and housing, was lauded by even the 

harsh critics). Warning signs that I should have picked up on might have been the 

burden on the staff, the experience at FT Stewart where, though not returning 

wounded, similar problems with outpatient access and disability processing were experienced. Prior to this and before the war, the issue of the disability system was 

on my scope. I had insisted that the compassionate and efficient processing of the 

soldier who is medically unable to return to duty be placed as a key performance 

process on the Balanced Score Card Strategy Map for the United States Army Medical Command. In hindsight, I could have recognized that the peacetime processing 

standards (a problem already) were inadequate to support a surge that potentially 

would come of wartime. I might have anticipated the impact of the flawed policy, 

since corrected, regarding the retention of soldiers unfit at the time of mobilization 

and fought harder to change it prospectively. I might have worked harder to create 

the imperative to reengineer the disability system. 

Question 42. With regard to Walter Reed and other military treatment facilities, 

you mentioned in your pre-hearing responses that you might have pushed harder 

for improvements that were more aggressive than the 50 VA caseworkers that you 

welcomed into Army hospitals. As VA Secretary, in addition to the new pilot program of joint DOD-VA disability evaluation, what other aggressive changes would 

you pursue to better integrate and coordinate DOD and VA care for our wounded 

warriors? Given the stream of returning wounded servicemembers, is there a ‘‘right 

size’’ for a VA presence at DOD medical facilities? 

Response. The Recovery Coordinator program suggested by the Dole-Shalala Commission is in its inception. Working closely with DOD to make this a valuable joint 

asset with a focus on an overarching recovery plan for each wounded warrior and 

family and someone who can ‘‘bureaucracy bust’’ to insure it is effectively implemented can be a major step forward. There is significant variability among DOD 

medical facilities in the number and types of wounded warriors seen. If confirmed, 

I will explore with DOD optimal staffing to support the education, outreach, and 

benefits counseling not only for wounded warriors, but for servicemembers, active 

and reserve, leaving the active force. 

Question 43. You have said you would recuse yourself from any future VA decisions or dealings that involve QTC. More broadly, what do you believe should be 

the appropriate role for private firms like QTC in performing core VA functions? 

When is it appropriate for a firm like QTC to perform VA functions; and how do 

you judge the right balance of using outside firms while avoiding any weakening 

of this important federal agency? 

Response. I believe the correct focus ought to be on the veteran, insuring access 

and high quality for him or her, and mindful of their families. If provided within 

the VA facilities we must insure that the service is first rate and timely. If VA facilities are not available within reasonable access standards and services can be purchased, whether from another agency or from commercial vendors, a high quality 

acquisition and contracting function can contract for and provide contract oversight 

to insure high quality. As the demographics of our veteran population changes, we 

must keep them in our focus. A balance that must be made is in measuring and 

then maintaining the surge capacity needed to respond to crisis of the variety discussed earlier. If confirmed, I look forward to strengthening the acquisition and contracting function. 

52 

Question 44. What areas of VA specialty care should be expanded, and in what 

ways? Do you believe there should be a priority for certain areas of specialty care? 

Response. VA is known for its focus and excellence in many areas such as spinal 

cord injury, Post Traumatic Stress, polytrauma rehabilitation, and blind veterans 

programs. VHA has led the way in using data for quality improvement and as the 

veteran population has aged, the clinical and research has moved to look at aging 

issues. If confirmed, I will review the current areas of specialty focus and their quality markers. I do anticipate that this next generation of combat veterans will define 

new areas that need to be created or refocused on a young population fresh from 

battle—a population that will include a significant increase in the number of women 

veterans. I want to insure that our way ahead will include the prosthetic support 

that will keep these new, highly-enabled amputees at the cutting edge of assisted 

functionality as they age. As our research into PTSD and TBI gives greater understanding of these potentially signature injuries of this current war, I believe specialty focus throughout the VA will be important to apply those lessons learned for 

the benefit of the veteran. The specialty must, beyond just medical care, include understanding the best way to motivate, encourage, enable a veteran to be as independently productive and self sufficient as possible. 

RESPONSE TO WRITTEN QUESTIONS FROM HON. JON TESTER TO LTG JAMES B. 

PEAKE, (RET.) M.D., NOMINEE FOR SECRETARY OF VETERANS AFFAIRS

Question 45. As you know, the Wounded Warriors legislation, which is expected 

to be attached to the Defense Authorization bill, contains language that would allow 

the VA to raise the rate of travel reimbursement given to vets from 11 cents a mile 

to 28.5 cents per mile. The VA provides this benefit to veterans in recognition of 

the fact that the cost of travel can actually be prohibitive to receiving needed care. 

However, the current price of gasoline appears to be having an adverse impact on 

VA patient care despite the existing benefit. As you know, federal employees receive 

48.5 cents per mile when they travel on official business. Now that you have had 

the opportunity to review the matter, do you view the 17.5 cent increase as sufficient, or do you believe that vets should get the same deal as federal employees? 

Response. It is clear to me that the 11 cent a mile rate is inadequate reimbursement for travel given the cost of gasoline. If confirmed, I will have the opportunity 

to review this in detail to include the way that this benefit is administered to reasonably reimburse for the veteran’s cost. I support the rate increase to 28.5 cents 

and commit to reviewing the need for increases in the future. 

Question 46. At your confirmation hearing, I asked your opinion of raising the 

mileage reimbursement rates for veterans who must travel to a VA facility for care. 

What is your opinion of this legislation? Do you think it will adversely impact your 

budget? Do you think that it is time to recognize the costs borne by the veterans 

who travel, in some cases, great distances to VA? 

Response. I believe the mileage reimbursement should be raised. I have not seen 

the legislation. The additional cost will have a budget impact, but if appropriately 

administered I would not anticipate that to be a show stopper. It is the policy now 

to provide the veteran reimbursement for travel. I agree that should continue with 

realistic reimbursement adjusted for the increased cost of gasoline for those veterans who are required to travel beyond a reasonable distance. 

Question 47. I am extremely concerned about the pace at which the Office of Rural 

Health is moving. As I understand it, the ORH is staffed by only two people, even 

though 6 million veterans in America live in areas considered rural. What criteria 

will you use to determine how best to staff the ORH? What is your vision for the 

ORH’s role in the VA? How will you use the ORH to improve the lives of veterans 

who reside in rural or frontier areas? 

Response. I have heard from many Senators on this Committee and others about 

their concerns of rural health for veterans. I was pleased to understand that an Office had been established, but was surprised to learn that it had only two people 

to deal with this problem. If confirmed, I will assess the expertise, the size, and the 

authority of this office. I will review, for currency or cause, to be created a strategic 

plan for moving the ball forward in relation to serving Veterans in rural areas. I 

have committed to you that I will accept your invitation to visit your state and see 

and hear, first-hand, the issues around the rural veteran. 

53 

RESPONSE TO WRITTEN QUESTIONS FROM HON. ARLEN SPECTER TO LTG JAMES B. 

PEAKE, (RET.) M.D., NOMINEE FOR SECRETARY OF VETERANS AFFAIRS

Question 48. Veterans are an important constituency to me and I have long supported providing them the benefits they deserve. They served our country with 

valor, courage, and bravery. Many times there is a disagreement on whether veterans should be granted benefits. How do you see the current system for the adjudication of claims for VA benefits? Is it working efficiently, and what role do you 

see your office playing in ensuring that veterans who are entitled to benefits actually receive them? 

Response. Though I have not been in position for detailed briefings I am aware 

of the chronic excessive time periods for adjudication of claims, and understand that 

many of these claims are resubmitted. I also understand the concern that there is 

inconsistent rating of claims for the same/similar disabilities. Having walked 

through several VA Regional Offices, I see serial processing, periods of required 

waiting, little in the way of automation of what is largely a paper-based system and 

legalistic communication to veterans that is prone to confuse. Acquiring the appropriate information to adjudicate the claim, whether military history or medical history, seems to be a rate limiting step. I also am aware that the number of claimed 

conditions has increased significantly, which increases the complexity of the claim. 

I understand that Admiral Cooper has been able to expand his claims workforce and 

has put in place an aggressive training program. If confirmed, I will be anxious to 

see the results of that effort. I also believe that a key to the future is automation 

and decision support tools for those who have to adjudicate records. Getting the 

right information up front, (and with this newest generation of veterans, working 

right now with DOD to do so) is important. The DD–214 is an example that is now 

shared electronically. 

Question 49. I am aware that the VA had proposed a regulation that would require all attorneys practicing before the VA to pass a written accreditation exam. 

I believe this is unnecessary and counterproductive, especially considering the 109th 

Congress passed S. 3421, the Veterans Benefits, Health Care, and Information 

Technology Act of 2006, that eliminated the Civil War era policy prohibiting veterans from hiring lawyers to assist with claims for benefits until after the VA administrative process has been completed. Has the VA moved forward with this proposed regulation? If not, what does the VA plan on doing in relation to this issue? 

Response. I have been advised of and, if confirmed, will support the final rule 

being proposed by the VA that will not contain an attorney examination requirement. 

Question 50. If you are confirmed, you would be the first doctor to head the Department of Veterans Affairs. How do you think your experience in this field will 

impact the entire Department? How will this affect the role of the current Under 

Secretary for Health, Dr. Michael Kussman? 

Response. Because of the mission of the Department of Veterans Affairs—Caring 

for those who have borne the battle... and their widows and orphans—I do believe my 38+ years in the Army, with service in the line as an infantry officer and, 

particularly, in medicine as a physician and 38 years of taking care of soldiers, provides a personal background of caring, understanding and empathy that will keep 

my decisions true to the mission. 

The VA is extremely fortunate to have Dr. Kussman as the Under Secretary for 

Health, its ‘‘Top Doc’’. He has assembled a very talented team of professionals. If 

confirmed, I will seek to complement Dr. Kussman’s efforts and initiatives in leading his administration, not to compete. With my medical background, I anticipate 

being able to more quickly make the decisions that he might bring to me since I 

do not anticipate needing ‘‘Medicine 101’’. As I execute my responsibilities as Secretary, I would anticipate that my guidance to him will be well-informed because 

of my medical background and my military background. If anything, I anticipate a 

greater synergy supported by our common medical background and our long association. 

Question 51. The key to any successful organization or agency is the manner of 

leadership from those at the top level of management. How do you intend to execute 

the mission of the VA, and how do you intend to ensure there are open lines of communication to all employees and veterans themselves? 

Response. I do not anticipate a fundamental difference in my leadership style 

which I would characterize as integrity based, mission focused and recognizing that 

the only way to succeed is through the men and women at every level who do the 

real work of the organization. To accomplish this I will make focused efforts on comVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00057 Fmt 6633 Sfmt 6621 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
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munication to insure clarity of intent; to insure that those men and women know 

that I value them and count on them; and to let them get to know me. 

The only way one can get anything accomplished in an organization much larger 

than even an infantry company, let alone an organization the size of the VA, is 

through delegation. But, with the delegation must come accountability supported by 

data. I do my homework on issues and ask questions to understand the issues. In 

that sense, I am a hands on manager. As the ‘‘intent’’ of policy is communicated, 

my expectation is that those many operational decisions made at levels below the 

Secretary are made consistent with that ‘‘intent’’. In decision making, I welcome all 

input, encourage the dissenting view, and seek outside critical thinking. I am always impressed that a product can be made better. However, with that input, I will 

make decisions with or without consensus. As a corollary, when there is not full consensus, I recognize my increased obligation to communicate my rationale; engaging 

and seeing the decision to success (ownership); and in changing course if I am 

wrong. 

Visibility and accessibility are important as a leader. I will use the spectrum of 

means to communicate with the men and women of the VA. That will include email broadcast, video broadcasts, a column in the magazine that is published bimonthly, and group sessions when I travel to visit the VA organizations in the field. 

Question 52. It is my understanding that as centralization occurs, the VA is finding unique problems involving inconsistencies in hardware, software, and processes. 

How do you intend to ensure that there is a smooth transition to a centralized system under the Office of Information Technology? 

Response. Though I have only had the opportunity for a brief courtesy visit with 

Major General (Ret.) Bob Howard, the ‘‘CIO’’ for VA, I was impressed with his evolving organizational structure, as well as the challenges in this major effort. The challenges are not only technical with hardware and software, but cultural. There are 

many legacy systems in the VA that have devolved as local modifications have been 

done. VISTA, one of the stars in the VA IT portfolio, particularly has the legacy 

MUMPS platform and will need to migrate to a new operating environment. Documentation has not always followed the local modifications, and clear and consistent 

IT policies have, apparently, in the past, not been the rule. If confirmed, I will take 

an active role in monitoring and resourcing this process and working to insure that 

the users of the IT tools are getting what they need to do their jobs effectively and 

efficiently. That secretary-level engagement and championship of the user will help 

with the cultural adaptations that are important to the success of this venture. I 

also believe in shoring-up the VA acquisition workforce so that these large and expensive programs have the best and brightest in support. 

RESPONSE TO WRITTEN QUESTIONS FROM HON. JOHN ENSIGN TO LTG JAMES B. 

PEAKE, (RET.) M.D., NOMINEE FOR SECRETARY OF VETERANS AFFAIRS

On November 5, 2007, prior to your hearing, we had the opportunity sit down in 

my office and discuss some VA issues that are important to me and the people of 

Nevada. These questions are a follow-up to our discussion. 

Question 53. During this meeting we discussed the construction of the new veterans medical complex in North Las Vegas and your views on the VA’s CARES process. My understanding is that this complex is now scheduled to be completed in 

2010 and start receiving patients in 2011. This is almost two years later than first 

planned. Can you provide my office with an update of how this project is progressing? Additionally, what will you do as Secretary of the VA to ensure that additional delays and cost overruns do not occur? 

Response. If confirmed, I will provide an update shortly after my appointment. As 

Secretary, I will require routine updates on our major construction programs as part 

of monitoring a strategic capital program and will demand accountability for ongoing projects, as well as realistic forecasting and programming for future projects. 

Question 54. You emphasized in our meeting that you understood the difficulties 

of making sure veterans living in rural areas receive quality health care from the 

VA. Can you provide a status update of the Community-Based Outpatient Clinic 

(CBOC) in Fallon, the Henderson CBOC, and the Elko Outreach Clinic? Additionally, as Secretary of the VA, what are your plans to ensure that veterans in rural 

areas receive quality health care? 

Response. If confirmed, I will obtain and provide a status update on the Fallon, 

and Henderson CBOCs and of the ELKO Outreach Clinic. I have heard from many 

Senators on this Committee and others about their concerns of rural health for veterans. I was pleased to understand that an Office of Rural Health has been estabVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00058 Fmt 6633 Sfmt 6621 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
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lished, but learned that it had only two people to deal with this problem. If confirmed, I will assess the expertise, the size, and the authority of this office. I will 

review for currency or cause to be created a strategic plan for moving the ball forward in relation to serving Veterans in rural areas. I have committed to visiting 

rural areas to see and hear first-hand the issues around the rural veteran. 

Question 55. Earlier this year we learned that in 2006 the VA paid out annual 

bonuses to senior officials in the amounts ranging from $7,000 to $33,000. This was 

of particular concern given that at the time the VA had a backlog of 500,000 veterans’ claims and that approximately a year ago the VA was forced to request emergency funding based on its own budget forecasts being short billions of dollars. I am 

fully aware of the need to attract and retain the highest caliber employees in government service, and I am not opposed to awarding reasonable financial bonuses to 

federal employees in recognition of superlative performance. However, I also believe 

that the individual performance being recognized with a bonus must truly be superlative and the amount of the bonus awarded must not be excessive. In light of the 

reported bonuses I committed to the people of Nevada that I would continue to monitor this situation and would raise your concerns in upcoming hearings and meetings with department officials. What are your views on issuing bonuses for those 

in government service and what will you do in your tenure to attract and retain 

the best, brightest, and hardest working individuals? 

Response. I do not have first-hand knowledge of the incentive program for the VA 

although I did read of the concerns in the newspaper. I am very pleased to know 

that the Senate has recently confirmed and the President has appointed Mr. Michael Hager as the new Assistant Secretary for Human Resources and Management. 

If confirmed, I look forward to working with him to create a measurable, realistic, 

and transparent bonus program for the VA executive leadership. The bonus program 

is only one incentive and perhaps not the most important in attracting and retaining the best, brightest and hardest working for government service. If confirmed, I 

would work to acknowledge their individual contribution to the mission, to provide 

the sense of personal, as well as corporate accomplishment in service to our veterans. 

RESPONSE TO ADDITIONAL WRITTEN QUESTIONS SUBMITTED BY HON. DANIEL K. 

AKAKA TO LTG JAMES B. PEAKE, (RET.) M.D., NOMINEE TO BE SECRETARY OF VETERANS AFFAIRS

Question 1. Recent media accounts have highlighted the issue of substance abuse 

among returning veterans. What additional steps should VA be taking, in coordination with DOD, to address this serious problem? 

Response. I am aware of recent reports documenting an increase in post deployment alcohol abuse and recognize the potential long term adverse outcomes that can 

result from employment impact, family distress, and homelessness. If confirmed, I 

will support research to find the best ways to deal with the co-morbid conditions. 

I will look for ways for the VA to be proactive by understanding programs in place 

now and what new programs might be needed to deal with this new generation of 

Veterans. I look forward to establishing a constructive relationship with DOD to insure a common message on substance abuse, education of the servicemember and 

family so that signs can be recognized early. I recognize that it is difficult to help 

someone who does not recognize a problem or who does not want to be helped. Creating the supporting environment and de-stigmatizing receiving assistance with 

substance abuse will encourage early intervention. 

Question 2. What specific policy changes, if any, would you support to improve access to rural health care for our Nation’s veterans? What would be your preferred 

approach to provide care for veterans in areas in which VA coverage is inadequate 

or non-existent? 

Response. I have heard from many Senators on this Committee and others about 

their concerns regarding rural health care for veterans. I was pleased to understand 

that an office had been established, but learned that it had only two people to deal 

with this problem. If confirmed, I will assess the expertise, the size, and the authority of this office. I will review for currency or cause to be created a strategic plan 

for moving the ball forward in relation to serving veterans in rural areas. I have 

committed to visiting rural areas to see and hear first hand the issues around the 

rural veteran. I am willing to look at models that partner with other agencies, 

which leverage telemedicine, expanding VA services where feasible or that purchases care where needed and ensures the appropriate oversight for quality and inVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00059 Fmt 6633 Sfmt 6621 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
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tegration of that medical care information into the VA system of health for the purpose of continuity of care. 

Question 3. Current education benefits provided to our veterans have not kept 

pace with the rising cost of education. What principles would you apply to reforming 

and updating GI Bill benefits? What level of educational benefits do you believe we 

owe to those who have worn the uniform? 

Response. From my years in the military I appreciate the value that soldiers place 

on their educational benefits. For many it is a way to take an economic burden of 

education off of their parents, for others, the GI Bill represents the only route to 

additional schooling post high school. The current GI Bill was formulated in a 

peacetime environment. I believe with this current generation of combat veterans 

engaged in a shooting war, their required contribution for eligibility should be reevaluated and ways to meet a greater level of their educational costs should be explored. I would consider partnerships with educational institutions that might support our veterans, as well as assistance with tuition, subsistence and educational 

materials if a full-time student. 

Question 4. An increase in unexpected surgical deaths at the VA Medical Center 

(VAMC) in Marion, IL recently revealed major lapses in the VA’s health quality assurance mechanisms, as well as its credentialing and privileging processes. It has 

become clear—although it took 6 months after the fact—that at least one physician 

involved in these deaths should not have been practicing at all. What immediate 

steps would you take as Secretary to institute safeguards so that such tragedies 

don’t occur at other facilities? 

Response. I understand that an extensive series of investigations is ongoing regarding Marion and that a wide review of credentialed providers systemwide has 

begun. If confirmed, I will review in detail the findings from these initiatives to understand if there is a lack or shortfall in procedural safeguards and process or an 

oversight function that needs to be strengthened to insure compliance, or both. Consistent application across the entire VA system is needed so that tragedies do not 

occur at other facilities. I have spoken earlier with Senator Durbin on this issue, 

discussed its importance, and have committed to taking aggressive action to meet 

this goal based upon the investigations. 

Question 5. As you know, recent media accounts suggest that the military has 

been improperly and inconsistently using the diagnosis of a pre-existing personality 

disorder as a basis for administratively separating servicemembers who may have 

been suffering instead from other service-connected psychological injuries. When 

such a diagnosis occurs, it can result in a loss of benefits or access to VA care for 

treatment, such as PTSD counseling. I have worked in the Senate to stop this unfair 

practice and review the military’s current policies. Until comprehensive reform 

takes place, what degree of latitude and authority will you exercise as Secretary to 

ensure any servicemembers who may have been discharged with a personality disorder can still access VA mental health care? 

Response. I have read of such allegations in the press, but have not been briefed 

by VA or DOD on them. In my personal experience, I have not seen intentional use 

of discharge for personality disorder to avoid a ratable psychiatric diagnosis, but recognize that such an error can be made. I do understand that the Secretary has a 

level of case-by-case authority for waiver in such circumstances. I favor providing 

mental health assessment and assistance to servicemembers to mitigate the potential worsening of a mental health condition and to correct, where indicated, a missed 

diagnosis. If confirmed, I would err on the side of the veteran to provide this assistance. 

RESPONSE TO ADDITIONAL WRITTEN QUESTIONS SUBMITTED BY HON. JON TESTER TO

LTG JAMES B. PEAKE, (RET.) M.D., NOMINEE TO BE SECRETARY OF VETERANS AFFAIRS

Question 6. I understand that the VA has committed to eliminating the wide disparity in disability compensation provided to Iraq and Afghanistan veterans diagnosed with PTSD. However, I have received reports that the level of disability compensation for PTSD cases in Montana is far below the national average, and that 

fewer than one-quarter of Montanans are diagnosed at 50 percent or above for 

PTSD—also far below the national average. This data suggests that VA is far from 

eliminating these disparities. Can you commit to examining why Montana’s rate of 

PTSD diagnosis and compensation is so far below the national average? Will you 

also work to eliminate the wide disparity in PTSD-related disability compensation 

awards among regional offices? 

57 

Response. I share the commitment to improving consistency in rating. I know that 

other Senators share your concerns on rating disparity. Simplifying the claims system, supporting it with decision support automation, and enhancing the training of 

those who do the rating are some approaches. If confirmed, I will examine the issue 

of rating disparity in general and particularly the issue of PTSD and will work to 

eliminate such disparities. I will also examine this issue specifically as it relates to 

Montana. 


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Senator AKAKA. Thank you very much, Dr. Peake. 

I want the Committee to know I intend to have two question periods here of 5 minutes each. I will begin with this question, Dr. 

Peake. 

If confirmed by the Senate, you will have just a little over one 

year in which to leave your mark on the Department of Veterans 

Affairs. As Secretary, what do you hope to leave behind as your 

legacy? 

Dr. PEAKE. Well, Mr. Chairman, I am not much of a legacy guy, 

because everything is done with a team, but I will tell you what 

I believe I can add to this is: the ability to reach across and work 

with the Department of Defense as we work out this transition 

issue for the new generation of veterans. I believe I can bring my 

network of experience and colleagues and acquaintances to really 

come to common understandings and cross the cultural issues that 

we have on both sides of the two Departments. 

I believe that understanding this issue of PTSD and TBI is an 

important one, and how that relates to this transition is something 

that I can bring an experience to bear on as well. So, I look forward 

to the opportunity of working with DOD and making that happen, 

and with this Committee to make sure that the things that are put 

in place are executable on behalf of the veteran. 

Senator AKAKA. Dr. Peake, early in fiscal year 2005, when the 

Congress was debating the status of VA funding, then-Secretary 

Nicholson—despite his personal knowledge that budgeted funds 

were not adequate to furnish timely care and service to the numbers of veterans coming for care—wrote a letter saying that VA had 

sufficient funding. In response to a pre-hearing question, you indicated that, if confirmed, you would have the responsibility for advocating for veterans. 

If you become aware in the coming year that funding is not sufficient for VA to keep up with the demand or that something is slipping, will you come to Congress and request additional funding? 

Dr. PEAKE. Mr. Chairman, I would. I would work hard with the 

administration, with OMB, and be able to come forward, if I needed to, to get additional funding. 

Senator AKAKA. It seems as though, Dr. Peake, the problems 

identified at Walter Reed earlier this year are directly related to 

those which occurred years earlier at Fort Stewart and Fort Knox 

while you were Army Surgeon General. Poor living conditions for 

the medical hold and holdover detachments, an overwhelmed chain 

of command, poor case management, and difficulties with a complicated, out-of-date disability process were noted. 

In your response to pre-hearing questions, you stated that in connection with the initial problems of Fort Stewart, you immediately 

mobilized a team to respond to these concerns, mandated a case 

manager to stay with each soldier through the hand-off to VA, and 

worked with the Army leadership to garner and allocate resources 

to solve the problem. 

In your view, why did this fairly comprehensive action plan not 

translate then or later to Walter Reed? 

Dr. PEAKE. You know, Senator, I ask myself what I could have 

done differently as part of that, as well. When I saw that soldiers 

were living, again, in unsatisfactory conditions, there was a sense 

65 

of—or at least a perception of—a lack of caring for those who had 

transitioned out; patient care. I was concerned as well. And when 

I look back at the Fort Stewart issues, our quick response did, in 

fact, do some of the things that would have helped if we had carried those forward with Walter Reed. 

I am 3 years from retiring from the Army, so I do not have direct 

knowledge of what was going on at Walter Reed; but I can tell you 

that when I was the Surgeon General, we had not seen that large 

number of returning wounded from Iraq and Afghanistan at that 

point. At Fort Stewart, we had a policy issue that kept soldiers who 

had just reported to the mobilization station on active duty, even 

if they were unfit, and that policy, ultimately, was reversed. 

So, part of this is getting the policies right, and then following 

through with actions to correct the things that one can correct. 

Senator AKAKA. Thank you very much. 

Senator Burr? 

Senator BURR. Thank you, Mr. Chairman. 

Again, Dr. Peake, welcome. We are truly blessed that we have 

got somebody of your caliber, your experience, your expertise, that 

would consider this role for one year at a very difficult time. Senator Akaka and I were sent a letter by Senator Bond asking us to 

ask four questions. I am going to ask for unanimous consent to 

send those in writing to you, but I would like to ask one of them 

in public for the record, if I may. 

Veterans groups have been raising concerns about the impact of 

PTSD and TBI on our servicemembers deployed in the Iraq and Afghanistan wars. What did you do, as Army Surgeon General, to 

prepare for the long-term outpatient treatment and disability benefits for PTSD and TBI patients observed by Army medical personnel during your tenure as the Army’s senior medical officer? 

Dr. PEAKE. My record on mental health in this particular environment goes back to 9/11 when we had an airplane in the building 

with us over there at the Pentagon. What we did immediately was 

create an operation called ‘‘Operation Solace,’’ where we were very 

concerned about making sure that people had access to mental 

health counselors. We brought them into the building. We flooded 

the building with them—had them walking around—so that we 

tried to avoid any appearance of stigma, so it was not medicalized 

there. We had the senior Army leadership like General Shinseki 

stand up and really direct the Army staff to make sure you get 

your people out, because it is the right thing to do—to get them 

seen by these mental health providers. 

We put mental health providers into the primary care system because we expected and my experts in this area expected the potential of somatization of mental health kinds of problems. And I 

think that was a very, very successful intervention, if you will, for 

a population of about 20,000-some people there in the Pentagon. 

In the early days of Iraq, we invested in putting a mental health 

assessment team into the combat zone—earlier than we have ever 

done that kind of thing before—because I was very concerned 

whether we had the mental health assets right there. Because, if 

you take care of it at the front end of the battle area, the idea is 

that it would improve the returning veteran and returning soldier, 

66 

so that they do not have the problems that, potentially, we would 

have to deal with. 

I think there is a lot to learn about PTSD we do not know about. 

The VA, I know, is one of the leading experts in all of that, but 

there is still a lot to learn about it. And so, what I wanted to do 

is set the base for that. Ultimately, during my time, there were two 

teams that went over, and we reported out fully because we did 

discover problems. We did discover things that we wanted to do differently. We did identify the number of people that at least had 

some of the stressors that might lead to PTSD. 

We invested in surveys to try to understand—anonymous surveys, to try to understand what the soldiers were saying about it 

as well. It led to published papers in the New England Journal of 

Medicine. Recently, the follow-on was just in the end of November—a follow-up. It led to the post-deployment health assessment. 

We wanted to get that up front as far as we could, so we started 

looking at that, and putting it into Kuwait on hand-held computers, so that the soldiers could get into that early on. 

Then, the post-deployment health reassessment has just been restudied, and we find even a larger number of veterans and soldiers 

that are reporting at the second go-round that did not report at the 

first go-round. 

I guess the point I am making, sir, is that I have been involved 

in looking prospectively at mental health to try to understand what 

things are needed now. I think that there is a lot more to do. I 

think we are learning that we can be proactive. I do believe this 

is treatable and that we can intervene, and I look forward, if confirmed, to working on the VA side of the house and walking across 

to the DOD to make sure that there is a continuum in this treatment of what we are understanding better of the mental health 

consequences of war. 

Senator BURR. Dr. Peake, I thank you for that thorough answer, 

and, Mr. Chairman, I see the clock. I will wait for the second round 

for my questions. 

Senator AKAKA. Thank you very much, Senator Burr. 

Senator Murray? 

Senator MURRAY. Mr. Chairman, thank you very much. I know 

you are waiting to be called ‘‘Mr. Secretary,’’ but I am curious. Do 

you want us to call you ‘‘General’’ or ‘‘Doctor’’? 

Dr. PEAKE. Ma’am, I am comfortable being called whatever people are comfortable calling me, to be perfectly honest with you. 

Senator MURRAY. Okay. Well, thank you very much. I have tried 

to listen closely to your answers so far. I did want to follow up on 

the Chairman’s question. He referenced a situation where we had 

a previous Secretary who was not forthcoming with knowledge 

about the budget, and that is a really critical issue for our Committee. I have often said that the VA Secretary has to be a truthful 

advocate for our veterans, not an apologist for any administration. 

And nowhere is this more important than in the Secretary’s dealings with the annual budget process. And I know, as the former 

Army Surgeon General, you are no-doubt familiar with that annual 

budget process and the conflicts that you are inevitably going to 

face. 

67 

There will be times when, in order to get resources for your 

troops, you will have to stand up to pressure from this administration to keep spending down. We know that is going to occur. 

Can you share with this Committee an example from your time 

as Army Surgeon General when you bucked your chain of command 

and advocated for increased funding? 

Dr. PEAKE. I can give you an example of a time when I garnered 

resources that weren’t in the budget as we went through the hearings. I tried to explain what I couldn’t do with the budget that I 

had, and what I talked about at that time was the opportunity that 

we had to do some things if I had only had the resources to be able 

to do them. And what came of that was a notion of a venture capital fund that came with no year money. It was not huge amounts 

in terms of perhaps the VA budget, but for me it was significant. 

They gave some $30 million for each Surgeon General to have as 

an incentive fund to do the right thing, in terms of investment, 

that would allow us to be more efficient. 

I was counseled that I should not be talking about venture capital in front of the Congress, but in my testimony that is what I 

did. I will tell you that I do believe in working within the system. 

I will tell you, as I said in my written remarks, I understand I 

am part of the administration, but also I have a responsibility to 

the administration and to this Committee to lay out the issues as 

I see them, openly and honestly, and fight for the resources to do 

my job—which is to take care of veterans. 

And so, if confirmed, ma’am, I will be working with this Committee very closely to try to do the right thing by our veterans. 

Senator MURRAY. If you are confirmed, you know that you are 

going to get pushback from OMB on funding requests that you may 

see inside the VA as inadequate for the needs of the veterans. How 

do you reconcile the role of being a loyal member of the President’s 

Cabinet and your role as the top advocate for veterans as the VA 

Secretary? 

Dr. PEAKE. Well, I am aware that there is, I understand, about 

$4 billion more than what was in the President’s budget that is 

coming forward. I would be advocating getting that bill forward 

and getting it passed. I mean, we will be able to use that money 

to do good things for our veterans. 

Senator MURRAY. Can we count on you, as a Committee that certainly cares across the aisle on both sides, to be honest with us 

about what the real needs are? 

Dr. PEAKE. I will be honest with you about the real needs, Senator. 

Senator MURRAY. Dr. Peake, I want to ask you about a story that 

I saw in the Washington Post this past Sunday that was very disturbing. It was about a young woman, First Lieutenant Elizabeth 

Whiteside. I do not know if you saw the article? She apparently 

served in the Army for 7 years, had exemplary service, and when 

she was in Iraq, according to the story, she presented herself to a 

psychiatric nurse and said she was suffering mental health problems that were related to stress from serving in the combat zone. 

From the story, it said she, ultimately, fired her weapon into the 

ceiling and shot herself in the chest, and is now, as we know, being 

68 

treated at Walter Reed where her psychiatrists are saying she was 

insane at the time of the incident in Iraq. 

Major General Erik Schoomaker, I understand, has recommended dismissal of the charges, but the Army is apparently 

proceeding anyway, and this is forcing Lieutenant Whiteside to 

choose between accepting a less than honorable discharge and the 

loss of all of her veterans’ medical benefits or a court-martial where 

she could be sentenced to life in prison. 

In your experience, General Peake, are psychiatric findings routinely ignored by military authorities, as has apparently occurred 

in Lieutenant Whiteside’s case? 

Dr. PEAKE. Ma’am, I cannot address this particular case because 

all I know is what I read in the papers also. I will tell you my experience is that oftentimes the process needs to work its way 

through. I do not know that it has been decided that she is going 

to be court-martialed. I did not get that from the newspaper, actually. But my experience is that the medical evidence is fully considered; and, it generally is—again, in my experience—accepted and 

appropriately weighed, and that the right decision will be made by, 

ultimately, the line chain of command, which has the legal responsibility. 

Senator MURRAY. Well, in her case, to use it as an example, she 

is going to either be court-martialed or she is going to be dishonorably discharged and lose all of her veterans’ benefits. 

Dr. PEAKE. I am not sure that is true, actually. From what I 

read, that is not exactly how I interpreted it. But, again, I am not 

sure—I would rather not comment on a specific case that I do not 

know. 

Senator MURRAY. Clearly, this goes to the issue at-hand before 

all of us: in recognizing Post Traumatic Stress Syndrome; what occurs, what happens; and having that be part of understanding 

rather than something that is used against somebody. Maybe you 

could share with us, as Secretary of the VA, how we could move 

forward and correct injustices that appear like this. 

Dr. PEAKE. I completely agree with you about the issue of looking 

at mental illness and not taking unfavorable action against an individual because of a mental illness, just like you would not because 

of a traumatic injury. If there is some problem about a veteran who 

may have a question of their access to the system, I believe those 

kinds of things are potentially waivable by the Secretary, and I 

would look favorably at ensuring that veterans who need care get 

care. 

Senator MURRAY. Can you just tell me if someone like Lieutenant 

Whiteside is court-martialed, what kind of mental health care they 

would expect to get? 

Dr. PEAKE. Ma’am, I would need to understand the legal issues 

specifically, and I would be happy to get back to you for the record 

about the particulars. 

Senator MURRAY. Well, let me ask a more general question. 

Dr. PEAKE. Sure. 

Senator MURRAY. How do we get to a point where we recognize 

Post Traumatic Stress Syndrome, the impacts of that, and use it 

in a realistic way, so we are not punishing people for a real wound 

of war? 

69 

Dr. PEAKE. I agree with you that these are real wounds of war. 

I tried to make that point in my opening statement, and I think 

they need to be treated that way. It needs to be, and I believe it 

is, treatable. I think it is the kind of thing that you can make interventions and really make a difference in people’s lives. I think we 

owe the soldier and the veteran that intervention. 

Senator MURRAY. Okay. My time is up and I have more questions, but I think that the case is that we hear a lot of rhetoric 

about people talking about Post Traumatic Stress Syndrome in a 

better way. I am delighted to hear the rhetoric, but there are real 

live case issues that keep coming in front of us where the rules, 

the attitudes, and other things go against everything we are trying 

to do in trying to make mental health care wounds recognized and 

treated in an appropriate manner. 

Thank you. 

Senator AKAKA. Thank you, Senator Murray. 

Senator Hutchison? 

Senator HUTCHISON. Thank you very much. 

I would just like to ask—I so appreciate what you said in your 

opening statement about Gulf War illness and the need to know— 

not only for the people who have come back with these debilitating 

illnesses and symptoms, but also for our future veterans. And I 

wanted to ask on that and the research on prostheses, what would 

you consider the priorities for the Veterans Administration on 

these research projects for the injuries of today? 

Dr. PEAKE. I think, Senator, that at the front-end we are doing 

a lot of things with the prostheses; and giving our soldiers and our 

veterans the best in terms of the prostheses, at the beginning. We 

need to know where this is going to go for the future, because these 

veterans are going to someday be, you know, my age, and the opportunity for the advances in prosthetic care to continue are absolutely there. And, I think that between DOD and the VA, we ought 

to be, absolutely, the leaders in that. And, as the veteran moves 

through his or her life with a prosthesis, they ought to continually 

get the best that is available. I think we need to continue to do the 

research to make sure that that happens, as well as the investment 

to make sure that that happens. 

Senator HUTCHISON. On the issue of the electronic records and 

melding the Department of Defense with the Veterans Administration, there are committees that are working on trying to make this 

happen. Do you think that in your year, if you are confirmed—and 

I certainly hope you will be before the end of this year—in your 

year, can you give me a confidence that you believe that can be accomplished by pushing it and making it a priority? 

Dr. PEAKE. Senator, I do believe that we can make substantial 

progress in sharing information. I understand already that there 

are mandates by 2008 to have shared records, to share the images; 

and that there are already timelines leading to that. I understand 

that there have been studies commissioned to look at a common inhospital record, and I would commit to you that, if confirmed. I 

would put this as a very high priority and find the ways to share 

the information between these two departments. I believe that really getting a common lexicon and common processes will go a long 

70 

way at trying to be able to have computable information, and really 

interoperable patient records between the two agencies. 

Senator HUTCHISON. Well, I would say it would be among the 

very top priorities. And I know a lot of work has been done already, 

but it is essential that that be accomplished. And, it seems to me 

that a year would be a reasonable time frame. But, I would like 

to have periodic reports, if you are confirmed—back every quarter—to tell us what the progress is and if there is anything that 

needs to be done here to add to your ability to accomplish that. 

Let me ask you another question on that and the claims processing, because that has also been mentioned. If we had the seamless transfer of electronic records, would that also expedite the 

claims processing for the disability benefits and care? 

Dr. PEAKE. Senator, I think it would. The issue of claims processing—one of the issues, as I understand it—is getting all of the 

information you need finally gathered so that you can make a good 

adjudication of the claim. And the longer that takes, the longer it 

takes for the claim. If we can get all the information—not just the 

medical information, but all of the information about the soldier, 

sailor, airman, and Marine—available right away from DOD and 

be able to share that all electronically. I think an advance has already been made with the DD–214, and that is an important step. 

But it is not all the information that is always required. So, to get 

that and the medical information I think would speed up the 

claims processing significantly. 

Senator HUTCHISON. What other specific things do you think you 

could do to speed up that claims processing? 

Dr. PEAKE. I believe the issue of people and training is already 

being addressed, as you commented in your first remarks. I think 

that is important—making sure that there is quality training that 

is consistent across the system so that you have good inter-rater 

reliability. I do believe that we need to look at simplifying the system. It is complex, as about everybody that has looked at it has 

said. I have commented before, it is a 1945 system—is based really 

on the system that has been put in place back in 1945—and really 

needs to be relooked. And I think there is an opportunity for simplifying it so that the veteran himself and the people that are trying to do the adjudication have an easier time of being able to come 

to the right decision. 

Senator HUTCHISON. Thank you. My time is up, but I certainly 

hope that these priorities can have a game plan very quickly after 

you are confirmed, and I look forward to reports. Thank you. 

Dr. PEAKE. Thank you, ma’am. 

Senator AKAKA. Thank you very much, Senator Hutchison. 

Senator Tester? 

Senator TESTER. Thank you, Mr. Chairman. I also want to once 

again thank General Peake for his willingness to serve in this position. 

I want to talk a little bit about staffing. Over the last 11 months, 

I have had many listening sessions in Montana about staffing at 

the hospital, and particularly at the clinics. And one of the comments that comes up quite regularly, is that the clinics and the 

hospital are understaffed—particularly the clinics—from a recepVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00074 Fmt 6633 Sfmt 6602 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
71 

tionist standpoint, to a nurse standpoint, to a doctor standpoint; 

there are some problems. 

I have of a couple of questions around this. Number one, do you 

think that there is a staffing problem, and understaffing problem? 

My perspective comes from a rural perspective because Montana is 

a rural State. It may also be there in the urban areas, too. Do you 

think there is an understaffing problem in the rural areas? Do you 

think there is an understaffing problem in the urban areas? And 

if there is, how are you going to solve it? 

Dr. PEAKE. Well, Senator, I have not had detailed briefings on 

what the staffing levels are or the staffing formulas. But if confirmed, I will take a look at that very quickly and come back to 

you. 

Senator TESTER. That would be great. How would you anticipate 

solving it if it comes back and says, yes, we are understaffed—we 

need more doctors, nurses, and administrative personnel in the 

field? How would you solve that problem? 

Dr. PEAKE. Well, in terms of the recruiting efforts and the locality adjustments, which those kinds of things are tools that, you 

know, the HR folks would have to be able to expand the workforce. 

We have talked in rural areas sometimes—that workforce is not 

there or is engaged in the civilian community. In those kind of 

cases, we need to take a look at how do we partner perhaps with 

other agencies, perhaps with DOD, perhaps with the civilian community, to make sure that there is access to care for the veteran. 

Senator TESTER. Okay. I want to talk about the Office of Rural 

Health for just a second. The Office of Rural Health is staffed by 

two people, even though, as Senator Dole said, there are 25 million 

plus veterans; there are 6 million, I believe, that live in rural 

areas. Do you believe this staffing level is adequate in the Office 

of Rural Health? And if it is or is not, what is your vision for the 

Office of Rural Health? 

Dr. PEAKE. I have not been over to meet the people in the Office 

of Rural Health, but I will quickly look at rural health. It is an 

issue that has come up while talking to many of the Members of 

this Committee. And I would look to ensure that we have an adequate staff to address these issues. If that is more than the staff 

that is available currently, I would expand it. 

Senator TESTER. Okay. I want to step back a little bit to rural 

clinics, and you said that you did not—and it is reasonable. You do 

not have a firsthand knowledge of what the staffing levels are and 

if those claims are, in fact, true. Are you going to have the time 

to get out to see it? Or how are you going to get the information? 

Dr. PEAKE. Senator, I would do a combination of things to get the 

information and get a feel for this big organization that I hopefully 

will be confirmed to run, and that is getting good briefings from the 

staff. From my time in the Army, you have got to get out and kick 

the tires and see the troops. So, I would make a commitment to you 

to get out and see the people, not only in the medical centers, but 

in the rural health areas as well, and to our outpatient clinics as 

well, because outpatient care has become a huge piece of and importance to the Department. 

Senator TESTER. I look forward to that, and you have a standing 

invitation from Montana. 

72 

One of the things that I heard that was quite disturbing at one 

of the field hearings—in fact, a couple of the field hearings that we 

had, listening sessions—and I have said this before in this Committee—is that oftentimes veterans feel like the Veterans Administration is working against them, trying to outlive them. 

What would you do? It is a delicate balance. Trust me, I know 

that, because you have got some people that deserve the benefits 

that are not getting them; others that claim they should get the 

benefits that maybe should not. How do you change that image? I 

agree with Senator Hutchison when she said there are a lot of good 

things that VA does, and I hear tons and tons of good stuff. But 

we want to solve some problems, so that is why I am talking about 

some of the negatives. How do you change that image where the 

VA will not allow people in and they are trying to outlive them? 

How do you fix that? 

Dr. PEAKE. Well, sir, I would tell you I do believe that it may be 

a perception. I am not sure about the reality of that. My personal 

experience is that the quality of the people in the VA is excellent 

and they do care about the veteran. 

Telling that story and getting out and communicating with the 

veterans themselves is an important piece. To be able to, you know, 

share the message is an important piece of it. And I would be anxious to work to try to get that message out, and not only to get the 

message out, but to make sure there are no pockets of real problems that need to be corrected. Because sometimes it is the anecdote that has some truth to it that, unfortunately, colors the whole 

organization. 

Senator TESTER. Okay. I have run out of time. We will come back 

to that in the next round. Thank you very much. 

Senator AKAKA. Thank you very much, Senator Tester. 

Senator Webb? 

Senator WEBB. Thank you, Mr. Chairman. 

General, first I would say that the sentence that I most greatly 

appreciated in your written testimony was the one where you said, 

a veteran should not need a lawyer to figure out his benefits or to 

get that benefit. You know, you should not have to pay a lawyer 

to get your hearing aid. And, you know, we have had a debate back 

and forth on the extent of allowable legal representation and all 

that sort of thing. But for my part, I would like to say, having been 

around this system for 30 years now, from the time I was a counsel 

on the House side, the veterans groups—in particular, the Disabled 

American Veterans—have done an extraordinary job in developing 

a career cycle service officer program where they really do understand Title 38 and 38 C.F.R., and they are the greatest friend that 

the veterans have. 

In fact, Mr. Chairman, we lost a real friend of the American veterans. We buried Butch Joeckel today in Arlington National Cemetery. He was a very fine Marine during Vietnam, a double amputee, did a long period of service with the DAV. 

I read your written comments with respect to this GI bill issue, 

and I sense that you would philosophically agree with what we are 

trying to do here. I know that this administration has not supported this legislation. Having sat on the Defense Resources Board 

for four years, I can guarantee you I could find the money, you 

73 

know, looking at these huge amounts that are going over to places 

like Iraq and Afghanistan. I know you could find the money for 

this. Do you have any thoughts or any perspectives on how to 

change the mind of the administration on this? 

Dr. PEAKE. Senator, as you know, the Montgomery Bill, I guess, 

was really done in peacetime. 

Senator WEBB. Yes. 

Dr. PEAKE. And things have changed. We are not in peacetime 

anymore, and my sense is this administration wants to do something right by these veterans that are coming home. And I would 

look forward to working with you to try to figure out the right road 

ahead to make a difference, like you showed in your charts and like 

all three of us at this table this morning had as opportunities. 

So, I think that things are different than when the current GI 

bill was put in place, and we have the opportunity to take a look 

at what some new approaches might be. I look forward to working—— 

Senator WEBB. The clock is ticking in terms of people getting out 

of the military, and as I said, I think the U.S. military is doing a 

very fine job managing its career force, and I think it is doing a 

not very good job assisting people who are transitioning out. And 

the presumption—even when we had the Dole-Shalala Commission—the presumption was, since this is a volunteer system it is 

a career system. And as you know, it is an odd beast. Part of it 

is career, but a large part of the American military is people who 

come in with the intention of getting out. They want to check the 

box. I served the country, I honored my ancestors; you know, the 

country was in crisis, whatever their motivation is. A lot of them 

are hitting a brick wall, legitimately. This is not just rhetoric, you 

know, in a lot of these articles. 

So, I would hope that you could work with us to figure out something that makes sense here. It is an affirmative tool to give somebody respect in a community and an avenue toward the future. 

I was listening to the testimony thinking about all the different 

problems in the VA, and you are not expected to be the master of 

the process at this point. But, sort of an analytical prototype came 

to my mind while I was sitting here, and that is, when I was Assistant Secretary of Defense, we had moved into the Total Force 

Concept over a period of years. You would be very familiar with 

this, having been in the Army, where in 1968 the Army was fielding 182⁄3 divisions with about, as I recall, 1.7 million active duty 

people. By 1985, they still had 18 divisions, but they only had 

761,000 active duty. And a lot of the active divisions were stovepiped with Guard and Reserve units, combat support, combat service support, it was not functioning terribly well when you started 

thinking about mobilization. 

Cap Weinberger turned around to me one day—because I had all 

the Guard and Reserve programs; I had that first 120 days of war. 

He basically said, ‘‘I want you to show me where the broken points 

are.’’ And I took a year with our staff; we worked on this for a year. 

We laid out at that time where the break points were in terms of 

moving forward in things like: are we really making the right casualty estimates; where is the medical system; where should the 

combat medical stuff go; what does strategic airlift look like; have 

74 

we really got the right balance; can we train these Guard and Reserve people at the same tempo that we do the actives when one 

out of every five was over the age of 40, as opposed to 5 percent 

on the active side; et cetera, et cetera, et cetera. 

So, I put this report out and a lot of people in the Army were 

rather skeptical, because Weinberger then made me Secretary of 

the Navy. But, a part of this report was, basically, where is the 

breaking point; what can be fixed, and under the present system, 

honestly, what cannot be fixed. You may be in this job for a year; 

then, again, we never know how political futures work, so you may 

be in the job longer than a year. But one thing that I am thinking, 

that with your background you might be able to truly contribute 

a study at the end of this. Some of the stuff is budget, some of it 

is policy, but some of it is just the momentum over the years of 

management policies here in the VA when we have got these backlogs and we have got all these different problems. 

You know, maybe you could ask and work on from your perspective a management analysis of the VA, just from your perspective. 

What are the problems? Why do we have them? And what needs 

to be done—from your perspective or to your successor—to make 

this system work? Because it is not working. 

Dr. PEAKE. You know, sir, in the Army I participated in 

TRADOC for a while and spent time with the ‘‘Army after next’’ 

looking out. I think you do need to have the long-term vision, and 

as I suggested in my remarks, these issues need some short-term 

solutions and they need some long-term solutions. 

Perhaps one of the advantages I bring is that, even though I 

have had no significant exposure to the VA over quite a while, I 

am not an inside guy. And so to come in and to be able to step back 

a little and look and get the wisdom from—— 

Senator WEBB. I think you would be uniquely qualified to make 

that contribution. My clock is over, but I hope we can talk about 

that some more. 

Dr. PEAKE. I look forward to following up with you. 

Senator WEBB. Thank you, Mr. Chairman. 

Senator AKAKA. Thank you very much, Senator Webb. 

Senator Specter? 

STATEMENT OF HON. ARLEN SPECTER, 

U.S. SENATOR FROM PENNSYLVANIA 

Senator SPECTER. Thank you, Mr. Chairman. 

General Peake, I commend the President for your nomination for 

this very important post, and you certainly have extraordinary 

qualifications to undertake what may be the most important job 

right now in dealing with America’s veterans who are coming back 

from the battlefields. My light is on, but I do not know how the 

projection here is. I will move a little closer. Senator Thurmond 

used to say, ‘‘Pull the machine a little closer.’’ [Laughter.] 

Senator Thurmond was on this Committee for many years, and 

he was the quintessential veteran. In fact, it was in this room that 

he had his famous 100th birthday party on December 2, 2002, then 

served another month to be at a ripe old age of 100 years and one 

month when he left the Senate. But this machine is stationary, 

75 

General Peake, so I cannot pull it forward. I have to move forward 

myself. 

The attendance here does not reflect the importance of this Committee’s work—there are so many other hearings going on simultaneously. I just came from the Judiciary Committee where we are 

reauthorizing the Juvenile Justice Act, and people are moving in 

many, many directions. 

The background you bring is really extraordinary. You were simultaneously the Surgeon General and commander of the Army 

Medical Command at the same time. Combat experience, being 

wounded; hard to think of someone who has more credentials for 

this job than you do. 

My concern for veterans benefits comes from the first veteran I 

knew, who was my father, Harry Specter. He was an immigrant 

from Russia and served in World War I, carried shrapnel in his 

legs until the day he died from the Argonne Forest. And I recall 

as a very young child—I think I recall, or I have read the history 

books about it—but the U.S. Government broke the promise to give 

the veterans a $500 bonus, and there was a march on Washington. 

Veterans assembled on The Mall, and President Hoover called out 

the Army. The Chief of Staff was General Douglas MacArthur. 

There is a very famous picture of him on The Mall with his aide 

de camp, Major Dwight Eisenhower. The Army fired on veterans 

that day—one of the blackest days in American history. And in a 

sense, in a metaphor, I say, I have been on my way to Washington 

ever since to get my father’s bonus. I have not gotten it yet, so I 

am running for re-election. There’s a lot of work to do. 

But I would urge you to become an advocate—an advocate for the 

veterans. It is a very rough and tumble process as to what happens 

at the Office of Management and Budget. And when we get the administration’s figures, we have very substantial limitations as to 

what we can do; although, characteristically, the Congress does add 

funding because we are lot closer to the situation than the bean 

counters in the administration. 

I think you are in a very unique position to be the advocate for 

veterans with this experience you bring. 

General Peake, how tough can you be? 

Dr. PEAKE. Well, Senator Specter, I think I can be pretty tough. 

My job is to fight for our veterans, to take care of them, and to 

make sure that we do that effectively and efficiently. As I have spoken with Senator Murray about this, I will come to this Committee 

to work with this Committee to make sure that we have the resources needed to do the right thing for our veterans. 

Senator SPECTER. Well, we will back you up, General Peake. We 

will back you up. If you give us the leadership on the specifics as 

to what you need, this Committee will back you up. The whole Congress will. 

Dr. PEAKE. Sir, I appreciate that, and that is absolutely clearly 

the sense that I have gotten from this Committee, meeting with 

folks individually, as well as the reassurance of that today. 

Senator SPECTER. Well, you have a great staff backing you up. 

I see Bill Tuerk sitting in the front row. Bill was the Staff Director 

when I chaired this Committee for six years; he really knows his 

stuff. There are a lot of other good personnel—I do not mean to 

76 

pick Bill out. Well, I guess I do mean to pick Bill out, especially. 

I saw his work when he was Staff Director here, and we will back 

you up. 

I have questions which I want to submit for the record. My red 

light just went on. Thank you very much for taking this job, General Peake, and thank you, Mr. Chairman. 

Dr. PEAKE. Thank you, Senator. 

Senator AKAKA. Thank you very much, Senator Specter. 

We will begin with a second round of questions, Dr. Peake. In response to a pre-hearing question, you indicated a willingness to 

study the proposal for mandatory or guaranteed funding for VA 

health care. The multi-billion-dollar shortfall in fiscal year 2005– 

2006 indicates that something needs to be done. How and when do 

you propose to look more closely at this issue? 

Dr. PEAKE. Senator, if confirmed, I will very early in my tenure 

get the full set of briefings on this issue. I understand the complexity of this issue, and I also understand the concerns that some 

pat formula, as opposed to really good actuarial forecasting, may 

not give the budget definition that the VA, particularly the VHA 

(because it is the largest piece of that), would need. But, as I mentioned in my comments, sir, I do have an open mind on this, and 

I would really want to understand the issue in detail. 

Senator AKAKA. Thank you. In response to one of my pre-hearing 

questions, you stated the following, and I am quoting: ‘‘Working 

with Congress and the administration to revise the disability system offers the opportunity to simplify the process, create a way 

ahead for an equitable and uniformly administered system, while 

meeting the needs of each of the tiers that might be identified.’’ 

I am concerned that the creation of dual systems of compensation, as some have suggested, is inherently inequitable. In your 

opinion, would the creation of a system of disability compensation 

that offers varying amounts of compensation dependent upon an 

era of service for the same disability be equitable? 

Dr. PEAKE. Senator, almost by definition it is not equitable. However, I do think that there are different needs by the different 

groups of our veterans. And the most important thing is to meet 

those needs. 

We have an obligation to this next generation of veterans to 

make sure that we get it right for their future so it is not confusing. It takes, as I understand it, two to three years to be able 

to get a VSR person that can adjudicate a claim fully trained. That 

alone talks to the complexity of the disability system. What I want 

to do is really understand the results of the studies that are being 

done, to analyze all of the information that has come forward from 

the people that have looked at this—with General Scott’s commission as an example—to really understand what the right direction 

forward is, and then find a way to move that system. It is a big 

system, and there are many, many people that are involved with 

it. 

So, I want to do the right thing, but I do not see anybody being 

disadvantaged from their current position as we would move forward, sir. 

Senator AKAKA. I agree with you that the issue of the transition 

from active duty service to veteran status is a key challenge. I am 

77 

hopeful that if you are confirmed, your background will be helpful 

in the ongoing effort to improve that process. 

You mentioned in response to a pre-hearing question that for injured servicemembers, there is an incentive not to move from one 

system—that is, DOD—to the other, VA. I think that is a crucial 

point in the transition effort. Please expand on what you think is 

an incentive not to move from DOD to VA and what, if anything, 

VA can do in response to that incentive. 

Dr. PEAKE. Part of the lack of the incentive to move is sort of the 

fear of the unknown. Part of it is the ability of the servicemember 

and the servicemember’s family to understand what their real benefits are going to be as they move forward. And that, again, talks 

to the complexity of the system as it stands now. 

The other is the notion of how well we can take care of the families. Because the family unit now is often a working spouse that 

is contributing substantially to the financial well-being of the family, if that spouse stops being a provider and starts being a care 

provider instead of a financial provider, that changes the dynamic 

of the family. Somehow we need to be able to take that into account and give them the confidence that, as they move to the VA 

system, they will be able to get all of the care that is required and 

be able to be supported as a family unit as well. 

Senator AKAKA. Thank you, Doctor. 

Senator Murray? 

Senator MURRAY. Yes, thank you very much. 

In my opening remarks, I talked about the CBS News report that 

was aired recently. I do not know if you saw it. 

Dr. PEAKE. The—— 

Senator MURRAY. On suicide. 

Dr. PEAKE. Yes, I did. 

Senator MURRAY. I was particularly struck by the veterans aged 

20 to 24—whose rates are 4 times higher than civilians the same 

age. Can you comment on that and tell me what you think the VA 

could be doing better? 

Dr. PEAKE. I think this is another one of those issues, Senator, 

that really is part of this transition piece, because what goes on on 

the DOD side and the emphasis there on the family reunion, as the 

deployment cycle support kinds of aspects that help identify people 

that might have a problem, is important at the front end. 

As we move into the VA system, we touch the people that have 

come to us. The question is, how can we outreach? And part of it 

is identifying for the family members what they ought to be looking 

for, and not just family members, but also coworkers. So, part of 

it is getting folks to recognize what the danger signs are. 

My understanding is that the VA is already doing a lot to reach 

out. They’re asking folks, ‘‘Are you okay?’’—you know, all the right 

questions. ‘‘Have you thought about harming yourself?’’ All those 

kinds of things are really, I think, being inculcated—as I understand it from my at least preliminary discussions—into the primary care settings of the VA. So, there is that sensitivity of a safety net to find that individual that might have a problem. 

I believe in the post-deployment health assessment, the post-deployment health reassessment. I would like to work with DOD to 

make sure we have all that information, that we are sharing; that, 

78 

in fact, all of the Reserve soldiers that come back get that second 

follow-up, so that we can identify the ones that we can reach out 

to. We do not want to just be passive and stand in the back waiting 

for somebody to have a problem if there are ways to reach out; and 

that will help de-stigmatize as well, I believe. 

Senator MURRAY. And will that be a priority of your administration? 

Dr. PEAKE. It will be. It is something that I think is a different 

approach to this issue of the panoply of mental health issues. As 

we discussed in your office, ma’am, I think not everything is PTSD, 

because there are six criteria to have that as a diagnosis. But, 

there are things short of PTSD or other mental health issues that 

are amenable to intervention and treatment and improving the 

well-being of our veterans. 

Senator MURRAY. Part of the Joshua Omvig Suicide Prevention 

Act that we have passed requires all of the folks at the VA to be 

better advocates in dealing with veterans who are calling. I assume 

that you will really move forward to make sure that happens? 

Dr. PEAKE. I will. And as I say, my understanding is that there 

is a lot being done from, you know, Mike Kussman and crew already in that arena. But I agree with you that it is one that we 

just need to continually stay on and push. 

Senator MURRAY. All right. Let me change the topic a little bit. 

You are well aware that some of the veterans have raised some 

concerns about your previous employment with the QTC and possible conflicts of interest with the duties of being VA Secretary. 

You answered the pre-hearing questions in a very clear way that 

if you are confirmed, you will terminate all your connections to 

QTC; you will have no financial interest in QTC, remove yourself 

from all matters related to QTC. And we very much appreciate that 

clarification, but I would like to ask you how do you envision being 

able to perform your duties at Secretary if you cannot make decisions about a contract that is worth, as I am told, up to $1 billion? 

Dr. PEAKE. QTC has been in business with the VA since 1998— 

perhaps that figure is over the course of that whole period of time. 

But I would tell you that I have been with QTC less than a year 

when this was announced. I would be happy to work with this 

Committee; however you feel is the best way to deal with this. I 

will have, as you pointed out, no ongoing financial interest with 

them. I will not go back to them. I have made that clear and made 

that decision. I will have no deferred compensation or bonus or 

anything of that nature. 

So, I do not see that I will really have a conflict. We have ways 

to create whatever firewalls are necessary. 

Senator MURRAY. I understand from your statement that you are 

going to separate yourself from any decisions about that, but it is 

a contract that is worth up to $1 billion, so who will make those 

decisions about that? And how will that be done if you, yourself, 

cannot do it? That is my question. 

Dr. PEAKE. I will work with the Office of Government Ethics and 

with the ethics people at VA to make sure that the decision level 

will be at the Deputy, I would assume, but it would need to create 

whatever is necessary to have the appropriate oversight of the contract, which is important, I think, of any contract: is to have approVerDate Aug 31 2005 11:48 Nov 13, 2008 Jkt 000000 PO 00000 Frm 00082 Fmt 6633 Sfmt 6602 H:\PS41451\DOCS\40524N.TXT SVETS PsN: PAULIN
79 

priate oversight and accountabilities. And so, I honestly will work 

however you want to be able to make this very clear, because I 

want no perception of any favoritism. I believe in full and open 

competition, and I would support that. 

Senator MURRAY. Well, you will be out and about and hear much 

of what we hear; and I hear, you know, concerns about the system. 

I hear about providers who do not have the expertise in relevant 

areas. We have providers with poor English skills; evaluations that 

do not focus on the problems that have been identified; absence of 

VA medical records; QTC billing for more time than the provider 

spends with the veterans. And you will hear this as you are out 

there. 

What will you tell veterans when you hear concerns about QTC 

in the field? 

Dr. PEAKE. I will collect those concerns. I would take them seriously, and I would put them into the system to get them resolved 

appropriately through the contracting authorities. 

Senator MURRAY [presiding]. Okay. My time has expired. I do 

have some more questions. Senator Tester, I will turn to you. 

Senator TESTER. Thank you. There are a lot of issues here, but 

when we ended up, we talked about VA working for vets versus an 

adversarial situation with the vets. And I have been thinking about 

that as the other questions go around. I will just tell you that I 

have heard many times in Montana about getting through the 

door, the red tape that is involved, and the lost records that are 

involved, and there are excuses or issues, however you want to 

phrase it, down the line. And I will just say, I think it is really incumbent upon you and us to make sure that the veterans who deserve the health care get it, and that is really the bottom line. 

I want to talk a little bit about contracting and how it applies 

to rural areas and what is your vision for contracting out VA services in rural areas. 

Dr. PEAKE. Senator, what I would tell you is I want, as you said, 

to make sure veterans get the care that they need. My responsibility then will be to look at all of the ways in which we can make 

that happen—to make sure that it is not just, ‘‘okay, you got the 

care,’’ but to make sure that that care is of the quality that Mike 

Kussman runs in the VHA and our system; that it is care that is 

integrated; and that we get the information that is needed so that 

if there is other care that is done within the system, it is integrated 

into the full continuity of care. 

And so, I think that what I want to do is make sure that the 

standards of access and the standards of quality are met, and how 

best to do that, as was pointed out earlier by, I think, Senator 

Dole—the VHA is an outstanding system, and we do not want that 

to go away. I have no philosophy about trying to get rid of the VA 

system if that is what you are asking, sir. But what I do want to 

do is make sure our veterans have access to the care that they deserve and that it is of the same high quality that we have within 

our VHA system. 

Senator TESTER. In areas that are rural/frontier, would you be 

amenable to contracting out to local hospitals for VA services? 

Dr. PEAKE. If we can ensure that the quality is of the nature 

needed and that we can get that information back into our system 

80 

so that we can, in fact, have the quality of continuity for the veteran. 

Senator TESTER. I appreciate that answer. How would you ensure that quality of care? I mean, because it is going to be on your 

shoulders to do that. 

Dr. PEAKE. I think it is certainly something that I would have 

to study and to understand what mechanisms we have in place to 

be able to reach it. But, if we are providing that care and we are 

paying for that care, we have the opportunity to monitor it, whether it is through records or through the claims processing or whatever; and perhaps surveying our veterans to understand what they 

think about their care. 

Senator TESTER. Okay. I had a piece of legislation that was put 

on an amendment on a bill, the defense authorization bill, that 

would increase mileage from 11 cents to 28.5 cents per mile for disabled vets. Currently, Federal employees are receiving 48.5 cents 

a mile. Do you see this increase as adequate? Do you think it is 

a good idea? I am talking about mileage reimbursement for disabled vets to get to clinics and hospitals. Do you think it is adequate? Do you think it is a good idea? Do you support it? 

Dr. PEAKE. I do not know about the specific numbers because I 

have not studied that, sir, but I do understand that the price of gas 

has gone up, and I do understand that it is a burden on the veteran that needs to be looked at and appropriately adjusted. 

Senator TESTER. Okay. We are short on time so I will not follow 

up, but that really did not get to my point, that answer. I need to 

know if you think it should be increased up to 28.5 cents. Would 

you support that? And do you think that is adequate? Yes or no. 

Or, yes, I think it should be 28.5 cents, or, no, it is taking too much 

money from other programs, or whatever. 

Dr. PEAKE. Senator, to be honest with you, I have not looked at 

that as an issue, and I—— 

Senator TESTER. No problem. I want to talk about—— 

Dr. PEAKE [continuing]. I can come back to you. 

Senator TESTER [continuing]. Another problem real quickly, but 

it is not a problem we can discuss real quickly. It has been brought 

up here several times, and that is TBI, PTSD, the whole issue that 

revolves around mental health. And I want to talk about telepsychiatry because you mentioned it in your questions. And I have 

some reservations about it, but I am not a doctor. My question is: 

How familiar are you with telepsychiatry? And what kind of assurance are you going to utilize to make sure that this fits the need? 

Because we are talking about folks, as it has been pointed earlier 

by Senator Murray and others, who need help. And do you think 

telepsychiatry can really give them the kind of help they need, I 

mean functionally, to actually get them through incredibly difficult 

times? 

Dr. PEAKE. Sir, I do believe that telepsychiatry has a role. It is 

not the panacea. There is usually not a silver bullet for any one 

of these things. There is not one thing that will fix everything. But, 

I do believe it is one of the tools that really ought to be in the armamentarium. It is one of the areas of telemedicine that very early 

on has been, I think, demonstrated to be effective in certain circumstances. 

81 

I do not claim to be an expert in telepsychiatry, but I have more 

than just a passing familiarity with it. I do believe that the whole 

notion of telemedicine, as we start to look at the full spectrum of 

that, where it reaches—has the potential to reach into somebody’s 

home and monitor their vital signs and keep them out of emergency rooms—are the kinds of things that we ought to be looking 

at. That is particularly useful in the rural environment. 

Senator TESTER. Okay. I have run out of time long ago, and I 

have got other questions, and I am not going to stick around because I have another meeting at noon, unfortunately; and we have 

been at this a while. But, I wanted in closing to say, I intend—unless something comes up between now and the confirmation out of 

this Committee or on the floor—I intend to vote for your confirmation. I think you are a good guy. I think you have got a tremendous 

responsibility ahead of you, and it is only 13 months or 12 months. 

You can do so much good for so many veterans in this country that 

I really hope that you grab the bull by the horns and really lead 

this agency. I think it is critically important. I think you have got 

a lot of great people in it. I think you have got a lot of great people 

in the field and clinics and hospitals that work incredible hours 

and make incredible sacrifices for service. And I would hope that 

you recognize that and move forward and make this agency all it 

can be, because I think the pressure on this agency over the next 

decade is going to be amazing. And if we are able to respond in a 

way that is appropriate, it can really be a golden time in this country’s history. 

So, thank you very much for your willingness to serve. 

Dr. PEAKE. Senator, thank you very much. 

Senator AKAKA. Thank you, Senator Tester. 

Let me follow up with a couple questions, and I will also ask 

Senator Murray and you, Senator Tester, for any follow-ups here 

before we close. 

Dr. Peake, going back to the transition and your comments about 

the fact that there is an incentive not to move from one system— 

that is, DOD—to VA, and then you touched on an issue that I 

think is at the core of the lack of success in the transition effort: 

the cultural gap between the military services and VA—a gap that 

is particularly noticeable in the context of an all-volunteer military. 

What do you believe that VA might try to do to bridge that gap? 

Dr. PEAKE. Sir, I think the opportunity for the VA to reach into 

all of the military facilities where we do briefings of people that are 

getting ready to leave—to work with at the senior level, to make 

sure that they have welcome reception on the DOD side, to come 

in and really tell the VA’s story and to help people understand 

what those potential benefits are—is really an important thing. It 

is better educating—and that has been brought up a couple of 

places here today—the soldier, sailor, airman, or Marine about 

what the VA really has to offer them, from educational benefits, to 

voc rehab, to their health care. So, getting that message out is of 

number one importance. 

The other is making it easy to do, comfortable for them to put 

in their claim, to establish the linkage, and apply for the appropriate benefit. 

82 

Senator AKAKA. It seems that one of the biggest hurdles that 

must be overcome is identifying the right time for what I call ‘‘the 

hand-off’’ from DOD to VA to occur. For instance, many injured 

servicemembers wish to remain on active duty. What role, if any, 

should VA play in either the decision about whether someone is 

leaving active duty or in working with an injured servicemember 

who may not be leaving active duty? 

Dr. PEAKE. I believe that it is appropriate for the VA and the 

Care Coordinator for the servicemember that is injured to, early 

on, have somebody from the VA be a part of their recovery team. 

I think that the service really needs to make the decision about 

whether they are going to be fit for duty or not. That is really a 

service-specific decision, the way I see it, sir. 

I am very open and would encourage looking at bringing even an 

active duty servicemember into the VA system, and we do that in 

specialized areas now. But for rehab and then, if possible, they 

want to go back to the service and they are capable of going back 

to the service, that ought to be a nice route back—one that is easy 

and coordinated with the services to do that. And then if they are 

not able to recover to that level or to be rehabilitated to that level, 

then we have got our arms wrapped around them as the VA that 

is going to give them the appropriate care for the rest of their lives. 

Senator AKAKA. Thank you very much. 

Senator Murray? 

Senator MURRAY. Yes, thank you, Mr. Chairman. 

I want to talk to you about an issue that is very near and dear 

to my heart, and that is the Walla Walla VA Medical Center. As 

you may have known, it was slated to be closed, and after numerous closed-door meetings with the VA and the Senate VA Committee field hearing that occurred there, the right decision was 

made—to keep that open. The community has been very, very involved with it, and the VA has now approved a 90,000-square-foot 

outpatient clinic to replace an existing facility there. 

I have been told by the VA that the design and construction of 

that outpatient clinic is now going to be delayed by several years, 

and I want you to know that is totally unacceptable, and I would 

like to hear, if you are confirmed, if you will pledge to work with 

me to speed that construction up. This is a vitally needed center. 

The vets there have been told one thing and another for so long. 

They need the confirmation that their country is with them. I 

would just like to hear from you that you will work with me to 

make sure of that, and I would love to have you come out and see 

it personally. 

Dr. PEAKE. Senator, I will commit to both, coming out there and 

visiting with you and holding a hearing in your area if you want 

me to. And I will commit to you that I will work with you to look 

at Walla Walla and what needs to be done there. 

Senator MURRAY. I appreciate that, both for Walla Walla, and I 

want to follow up with you on that, but I also think as Secretary 

you need to be on the ground to hear what we are hearing. The 

world is very different inside of VA’s circle here versus what you 

see on the ground out there, as you can imagine in any agency. But 

I think you need to hear the passion, both from community members who support veterans and are concerned about what is going 

83 

on, and from the veterans themselves—the frustrations they have 

felt. This is why I gave you that button saying, ‘‘it cannot be business as usual.’’ The attitude needs to change. And I would love to 

have you come out to my State. We have a number of very, very 

active places, as you know from having been at Madigan. Come see 

what is happening at Madigan all the way through the VA system. 

I would love to have you join me there once, if you are confirmed. 

Dr. PEAKE. If confirmed, I appreciate the invitation and I look 

forward to accepting. 

Senator MURRAY. Okay, good. One other question and then I 

have a comment. We have heard a lot about this issue of personality disorders discharges, and in the last 6 years, the military has 

diagnosed and discharged more than 22,000 servicemembers because of so-called pre-existing personality disorders. I wanted to 

find out from you what your understanding of administrative discharges from the armed forces are, based on this diagnosis of personality disorder. 

Dr. PEAKE. Can you clarify the question? You have a person with 

an administrative discharge—— 

Senator MURRAY. There is a concern about the process being fair. 

We are hearing from a lot of men and women who have been discharged because of a so-called pre-existing personality disorder, 

and they feel they are not being treated fairly. Are you aware of 

this issue? 

Dr. PEAKE. I am aware of the issue. I would need to understand 

more specifically the individual cases. 

Senator MURRAY. Okay. Well, that is a question I would like to 

work on with you. There is a very strong and real sense of the process not being fair, and I think it is something we need to pay some 

attention to. 

Mr. Chairman, I do have a couple of other questions I will submit for the record. 

I will say this, General Peake: We have had a vacuum at the top 

of the VA for some time that has to be filled. I am likely to support 

your nomination unless something else occurs. I cannot imagine 

that it will. We expect you to take this job and to take it seriously, 

and obviously, being confirmed is a major recognition of an achievement. But, I think where history will really judge this confirmation 

is a year from now; and whether you can begin to turn around an 

agency that for too long has really not gotten into the ball game 

at a time when men and women are at war and we have thousands 

of people returning, as well as those from previous generations, 

who really feel that they have not been given the service they need. 

So, an attitude change at the top will, I think, serve all of us 

well. There are thousands of VA employees who work very, very 

hard, both within the agency here and out in the field, who I think 

are open and ready to take on a new challenge and to make sure 

that they are seen visibly as an agency that serves our veterans 

well, and I think leadership at the top a year from now will be 

judged on what that attitude is. 

So, I look forward to working with you very much. 

Dr. PEAKE. And I with you, Senator. Thank you. 

Senator MURRAY. Thank you. 

Senator AKAKA. Thank you, Senator Murray. 

84 

Thank you, Dr. Peake, for your full and open participation in today’s hearing. Every organization needs an unquestioned leader. It 

is not optimal for the Department of Veterans Affairs to have an 

acting leader for an indefinite period of time. With this in mind, 

I will work to bring your nomination before the Committee and the 

full Senate as soon as feasible, following time for any post-hearing 

questions to be asked and answered. And so I will ask that all 

members submit any such questions before the end of this week to 

move it along. 

With that, again, I want to say thank you so much. I want to 

thank you for what responses you have given. To have your radio 

man here to support you is great. I want to say also please convey 

our aloha to your family, and I wish you well in this process. 

With that, this hearing is adjourned. 

Dr. PEAKE. Thank you, Senator. 

[Whereupon, at 12:08 p.m., the Committee was adjourned.] 

(85) 

A P P E N D I X 

November 2, 2007. 

Hon. DANIEL K. AKAKA, 

Chairman, 

Hon. RICHARD MURR, 

Ranking Member, 

Committee on Veterans’ Affairs, 

U.S. Senate, Washington, DC. 

DEAR CHAIRMAN AND RANKING MEMBER: Recently, President Bush nominated 

Lieutenant General James B. Peake to serve as the next Secretary of Veterans Affairs. As Members of Congress representing the San Antonio area who have worked 

closely with Dr. Peake, we urge the Senate to give him the utmost consideration 

during confirmation proceedings. 

As you may know, Dr. Peake has impeccable credentials that we believe can be 

beneficial at the Veterans Administration (VA). Dr. Peake is the former U.S. Army 

Surgeon General as well as a recipient of the Silver Star, Bronze Star and the Purple Heart. Along with his public service, Dr. Peake has served in the private sector 

as Chief medical director and chief operating officer at QTC Management Inc. 

Dr. Peake began his Army medical career as a general surgery resident at Brooke 

Army Medical Center at Fort Sam Houston in San Antonio. He later went on to 

serve as both the commander of the U.S. Army Medical Department Center and 

School as well as commander of Fort Sam Houston. 

The San Antonio area is in a critical period of expanding services to both our active duty troops as well as veterans. Fort Sam Houston is in the transformation 

stages to become the hub for training of all branches of service’s enlisted medical 

personnel. The Center for the Intrepid, a four-story, 55.000 square-foot facility adjacent to Brooke Army Medical Center, was recently opened to provide advanced rehabilitation for amputees and burn victims. Additionally, San Antonio was recently selected as the home for the newest Level One Polytrauma Rehabilitation Center at 

Audie Murphy VA Hospital. 

Because of Dr. Peake’s familiarity with our community, we believe that he would 

serve with the needs of San Antonio veterans in mind. Although the VA is improving, it certainly is still in need of leadership to better prepare the agency to serve 

the growing number of new veterans while fulfilling the needs of current veterans. 

As Members of Congress from San Antonio, we hope you will closely consider his 

nomination to this important position and we thank you in advance for your prompt 

consideration. 

Sincerely, 

CIRO D. RODRIQUEZ, 

CHARLES A. GONZALEZ, 

LAMAR SMITH, 

HENRY CUELLAR, 

Members of Congress, San Antonio, Texas. 

86 

WOUNDED WARRIOR PROJECT

Jacksonville, FL, December 3, 2007. 

Hon. DANIEL K. AKAKA, 

Chairman, 

Hon. RICHARD BURR, 

Ranking Member, 

Committee on Veterans’ Affairs, 

U.S. Senate, Washington, DC. 

DEAR MR. CHAIRMAN AND MR. BURR: The Wounded Warrior Project (WWP), a 

non-profit organization that serves the men and women of the United States Armed 

Forces who have been injured during the current conflicts, strongly supports the 

nomination of Lieutenant General (Ret.) James B. Peake to be Secretary of Veterans 

Affairs (VA). 

LTG Peake has spent more than 40 years as a soldier and physician in the U.S. 

Army. He has dedicated his adult life to serving our Nation as a platoon leader in 

the 101st Airborne Division in Vietnam, as a thoracic surgeon in the U.S. Army, 

and finally as the Surgeon General of the U.S. Army from 2000 to 2004. 

The situation at Walter Reed highlighted the many obstacles our wounded warriors face. As a wounded Vietnam veteran and physician, LTG Peake would bring 

his personal and professional perspective to the Department of Veterans Affairs. In 

addition, his career-long experience in the military will enhance the cooperative efforts between the VA and the Department of Defense for the benefit of those injured 

in service to our country. 

If confirmed, WWP looks forward to working with LTG Peake in his capacity as 

the Secretary of Veterans Affairs. Thank you and we look forward to his timely confirmation. 

Sincerely, 

JOHN MELIA, 

Executive Director. 

December 4, 2007. 

Hon. DANIEL K. AKAKA, 

Chairman, 

Committee on Veterans’ Affairs, 

U.S. Senate, Washington, DC. 

MR. CHAIRMAN: As you prepare for tomorrow’s confirmation hearing for Lt. Gen. 

James Peake (Ret.) as Secretary of the Department of Veterans’ Affairs, I would like 

to share my concerns and the concerns of some of my constituents. 

In particular, I want to encourage you to consider not only the candidate, but the 

critically important challenges the next Secretary will face, and his or her ability 

to address them. 

I am confident that Lt. Gen. Peake is a well qualified physician, and he has proven himself as a budget-conscious administrator as Surgeon General of the Army. He 

has deservedly earned respect and accolades from his colleagues and Members of 

Congress for this service in the Army. 

However, making the necessary changes at the VA will require more than a few 

minor policy adjustments. The problems are so significant and systemic that I believe the next Secretary will need to lead a cultural shift. The status quo is unacceptable and our veterans cannot afford a Secretary who merely marks time until 

the next Administration. The next Secretary must be an active and effective agent 

of positive change. 

The House Veterans’ Affairs Subcommittee on Oversight and Investigations has 

uncovered some matters of serious concern, including the urgency to fix the 400,000 

disability claims backlog, the continuous inability of the Defense Department to 

share medical records with the VA, and numerous bureaucratic hurdles facing 

servicemembers and their families when they return from war. 

I am proud that this Congress has made veterans’ benefits a priority, but as you 

are well aware, there is more work to be done. In the coming year we will be working to ensure that veterans receive the college education they have earned and deserve by modernizing the GI Bill. We will also be working on legislation to implement the recommendations of the Veterans’ Disability Benefits Commission. 

There is no doubt that these are all serious challenges. Now more than ever our 

nation’s veterans need a Secretary who is committed to working with Congress, in 

a bipartisan way, to ensure that the men and women who have defended our freedom receive the health care and vital assistance they earned. 

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I appreciate you holding these hearings in such a timely manner. Your committee 

has worked tirelessly this year to improve the lives of our nation’s veterans, and 

I urge you not to let up as you prepare for this week’s hearing. Again, thank you 

for your consideration. 

Sincerely, 

HARRY E. MITCHELL, 

Member of Congress, Tempe, Arizona. 

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