>> good afternoon, welcome to the national press club, the place where news happens. i'm the president of the national press club and managing editor of standards and training at axios. thank you for joining us both here anden-on- and online for our headliner event with secretary of veterans affairs secretary mcdonough. we are happy to take your questions, please submit them and i'll ask as many as i can. for our c-span and public radio audiences please be aware that in the audience today are members of the jeep public, so any applause or reaction you hear is not necessarily from the

working press. it is now my pleasure to introduce this distinguished head table. please stand when your name is called. starting on my far right is tom young, commander of the american legion post 20, affiliated with the national press club. breonna camara, vision one patient officer for the v.a. new england health care system. carla van, pentagon correspondent for v.o.a. news. kevin wensing, managing director of wensing enterprises, retired navy veteran and organizer of today's luncheon. we'll get to you in a moment. lawyerie russo, president of stanton communications and co-lead of the headliners team. to my left.

jen dudson, land warfare reporter for defense news and the 115th president of the national press club. lynn deen, assistant director of customer experience for the veterans benefits administration. senior associate of activa resources and consultant to the v.a. richard barbado, client and employment officer of the v.h.a. readjustment services. and max learner publisher of "stars and stripes." [applause] when our guest today was sworn in as the 11th second retar of veterans firns february 8, 2021, he pledged to increase veterans' access to care and benefits and

to improve outcomes for them. he identified three core responsibilities as his highest priorities. providing veterans with timely, world class health care. ensuring that these veterans and their families have access to benefits they have earned. and honoring our veteran with a final resting place that's a lasting tribute to their service. bucek retear mcdonough also faced a host of challenges that would require vast amounts of time and resources. the persistent and worrisome proives veterans' homelessness, untreated mental health issues and an uptick in suicides. structural issues in the v.a. that created backlogs of claims and long waits for benefits. reports of -- repoforts serious side effects from exposure to burn pits common among service members overseas. i.t. problems that landed the v.a. on the d.d.o.a.'s list of

cyber security problems. and just this weekend a report of bombarding -- crew members who bombarded enemies with shells are now reporting memory loss and other issues. mcdonough has a long career of tackling tough issue he was served as white house chief of staff in the obama administration and prior to that was principal depp if i ty national security adviser. he's also served in seen quor leadership and policymaking positions in the u.s. house of representatives. he garage rated -- graduated from st. john's university in minnesota and receive hid master's degree from georgetown university.

his efforts are causing some headway at the v.a. already. according to v.a. times this morning, they set all-time records in v.a. health care and veterans outreaches efforts. as veterans iday approach it is a time to honor veterans for their great various and sacrifice and a time to take stock. by the way, if you are a veteran, please stand up. thank you for your service. [applause] today we are eager to hear from secretary mcdonough about the progress he's made on his stated priorities and what remains to be done. please join me in a warm national press club welcome to secretary mcdonough.

[applause] sec. mcdonough: thank you for the nice enter ducks. great to be here with everybody. good afternoon. nice to see old friends. stake holders, partners, veterans. this year marks the 50th anniversary of america's withdrawal from vietnam. this year and every year we remember the 58,220 americans, american patriots, who were killed or are still missing in that war. we honor the nine million americans who raise their right hands, committed to serve and defend our constitution. as members of the armed forces in that tumultuous period now country's history. one veteran, everett alvarez, ejected from his skyhawk on august 5, 196, shot down over

north vietnam. he landed in the water among a fleet of vietnamese fishing boats where he was quickly taken captive and became the first of 766 american prisoners of war in vietnam. lieutenant alvarez endured over eight years of captivity in the infamous hanoi hilton. mashing the passage of time on the wall, celebrating his own catholic mass each sunday. he chose to hang on to every motivation he could muster. thoughts of home. the strength of faith. trust in his country and a deep sense of duty to his fellow p.o.w.'s. on february 12, 1973, shortly after the united states signed the paris peace accords, lieutenant alvarez was finally freed. service didn't end when he got

back home. he remained in the navy, retired as a commander. continued serving the nation out of uniform as deputy administrator of the v.a. and as an advocate for his fellow vets and families. but my favorite part of commander alvarez's amazing story is what happened while he was recuperating after coming home. he met a wonderful woman, tammy. asked her out on a tate. that date, their first date, was at the white house. at an event honoring commander alvarez and his fellow vietnam war p.o.w.'s. kind of a big date. [laughter] just a few months later, on october 27, 1973, they were married. just last week that means they celebrated 50 years of marriage. so that 50 years of history

sends -- since the end of the vietnam war mark ours veterans' having -- our veterans having continued to make this country strong. commander everett alvarez and tammy are on another date, here, this afternoon. so congratulations and thank you for your courageous service to the nation. [applause] veterans day is saturday. it's a day we remember the millions of brave men and women just like everett alvarez who

fought our nation's wars and stood guard over our country during the periods of restless peace and between -- in between those wars. it's a day to reflect on what veterans and their families have done what they sacrificed for our country and for each of us. because here's the thing. when someone signs up to serve our country in the military, we make them a promise. if you fight for us, we will fight for you. if you serve us, we will serve you. if you take care of us -- if you take care of us, when you come home, we'll take care of you. now our country as a whole makes that promise. i'll say more about that in a minute. at v.a., it's our privilege and it's our honor to keep it. so i'll start as eileen said with an update on what we're doing at v.a. to keep our promise to veterans.

since president biden took office, v.a. has delivered more care and more benefits to more veterans than ever before. when it comes to the ben visits vets have earned and deserve, we're processing their claims faster than ever before. he's an example. just over a year ago, the president signed his historic legislation designed to care for veterans who were exposed to toxins in vietnam and in those 30 years of war, in central command. the pact act. sergeant major kenneth ericson is one of those vets. he served in the army for nearly 30 years. combat tours spanning from the jungles of vietnam to the deserts of operation desert storm. last may, the sergeant major was diagnosed with esoft jeel cancer and he filed for those toxic exposure benefits.

our v.a. benefits team expedite red view of his claim at direction of the president. in less than a week, sergeant major ericson was granted 100% service connection. his benefits were back dated to august 10, 2022, the day the president signed that bill into law. because of that law, sergeant major ericson has one less thing to worry about in what may be the most demanding battle of his life. that's what we mean when we talk about fulfilling that promise. altogether, v.a. processed more than two million claims in 2023, shattering the previous year's record to that point, the highest ever, by 16%. that meant 1.5 million vets and their families and importantly, survivors, received over $163

billion in earned benefits. we're also providing more care to veterans. this year, v.a. delivered more than 116 million health care appointments. exceeding last year's number by more than three million appointments. it's not just more care. it's better care. world class care. study after study shows, we deliver better health outcomes than the rest of the health care system for our vets. which is a big reason why nearly 90% of vets who come to v.a. now trust us to deliver their outpatient care. 5.4 million people including 4.1 million veterans are taking their final rest in v.a. national cemetery, and we've doubled our online veteran legacy memorial program to nearly 10 million veterans.

a digit at platform, keeping veterans' stories alive long after they're gone. now, behind all these statistics are veterans. veterans like commander everett alvarez. and like sergeant major kenneth ericson. they are our neighbors, our friends. they're teachers, zivic leaders, coaches. loved ones. they're continuing to serve america, to defend and to strengthen our democracy long after they take off the uniform. and all our work at v.a. adds up to the single statistic that matters most. veterans' lives improved. veteran's lives saved. by the work that we do together. now that's what we've done. i want to talk a minute about how we've done it and who,

importantly, does it. the v.a. work force has been delivering for vets during a period of rapid change. teaching us vivid lessons that have forever altered the way v.a. does business. first, while the covid-19 public health emergency came to an end six months ago, let's not forget that v.a.'s frontline staff provided world class care through what has been a devastating once in a century pandemic. from the moment that pandemic hit, v.a.'s public servants mobilized around one core mission. saving and improving the lives of veterans, their family, caregivers, and senior vivers. they worked long hours, sacrificed precious time with their families, risked their own lives and by extension, the lives of their loved ones. to serve veterans. because you see, that's the

promise we make. and there are veterans at home today with their families right now, happy and healthy, because the best work force in the federal government. i'm incredibly grateful to every one of them. second, today's service members and vets represent the most deployed force in our nation's history. and our thoughts are with the brave men and women serving in uniform in this period of heightened readiness and urgent security challenges in the meas and around the -- in the middle east and around the world. through this 33-year intense period since september 11, 2001, many have experienced multiple deployments, come home -- came hope gripped by both the visible and invisible wounds of war. all of them, each of them, were

exposed to particulate matter and toxins from burn pits and other sources. months or years later, some have developed and some might yet still develop conditions that follow them home from war. that impact on their lives, in some cases, will continue long after the guns of war are silenced. it's our job as a nation to provide those vets, family, caregivers and survivor, this benefits and care for those conditions. and that's exactly what we're doing. these two developments, these two very important development, the pandemic and our national commitment to recognizing the need to care for burn pit exposure, have catalized a dramatic period of change and reform at v.a. revolutionizing the way we do business. but one thing hasn't changed. and that's keeping the vet, each

of you, at the heart of everything we do. let me share four lessons we've learned during v.a.'s new veteran-cent rick era first. we're -- centric care. first, we're billing our care around veteran's live, not expecting veterans to build their lives around us. if we're going to keep our promise to vets we need to meet them where they are, when they need us, without exception. we reached out to vets and listened to what they wanted. using a veteran-centered design approach we developed tools to ensure vets and their care give verse positive, productive experiences when engaging the v.a. we overhauled v.a. -- overhauled va.gov to make it the digital front door for all services v.a. offers vets. medical appointments, applying

for education benefit, filing a claim. all go through that same front door. and the new v.a. health and benefits mobile app gives vets access to that digital front door, meaning vets with a smart phone can have all their v.a. services right in the palm of their hand wherever they are. so, while a vet is waiting to pick up a kid from school, out on a lunch break, watching a football game, they can refill a prescription, send a secure message to their doc, take a quick telehealth appointment, access travel reimbursement and more. it's working. not perfectly. but it's working. we've seen a staggering 3,000% jump in vet virtual home visits since 2020. nearly 28 million home visits in that time.

by offering care built into vets' lives in the community, via telehealth and alongside focus, processes and technological advance we decreased average wait times in nearly 60% of our facilities. the same is true at v.b.a. where we reduced our average time complete a claim by 15 days in the last year alone. and at the board of veterans appeals we're using telehealth appeals set a single record of 103,000 decisions made last year. as a result, vets trust in v.a. has groan strong -- as grown stronger. again it's not 100% but it's stronger. here's the point. we at v.a. are about shaping solutions for vets that meet them, meet you, where you are. that are adopted -- adapted to you and to your needs rather than expecting you to adapt to

us. second lesson. v.a.'s people. not machine, not computers, not buildings, v.a.'s people keep our promise to vets. from ending veteran homelessness to delivering toxic exposure benefit, none of this happens without the best federal work force in the federal government. they're the most passionate, highest performing public servants in this country. there are folks who want to make a real difns in the lives of vets. lives of survivors. caregivers. and families. and i am proud and i am privileged that they consider me their colleague for this brief period i get to work with them. and we owe it to them to have a work force sized to meet this mission. that can ensure we operate to ensure veteran-patient safety and high quality claims decisions. so this has been a year since the last time i saw you, a year of hiring at record pace.

while retaining our excellent staff. and by the way, not retaining our not-excellent staff. this year we strengthened our partnerships with our unions, and both the veteran health administration and veterans benefits administration have had their highest growth rates in more than 15 years. v.h.a. now has more than 400,000 employees providing health care to veterans. and with 32,000 employees, v.b.a. is bigger than it's ever been. we've also increased employee retention even in one of the -- even in one of the hottest labor markets in modern history. a market with profound health care provider shortages. why are we able to grow our work force in this context? because people want to work for you. for our nation's heroes. people like shelby long, a v.a.

nurse. for her, serving veterans at the bay pines v.a. is a family affair. her brother, a surgical nurse at bay pines. and they're both following in their mom's footsteps, nurse in the bay pines community living center. and navy vet creshawn lloyd, a navy veterans services representative. they were inspired to join v.a. because of the thorough, responsive care his v.s.r. gave him when he was transitioning out of the navy. then there's hector rodriguez, a marine. marine vet. hector was -- went from being homeless on the streets of san diego to working as a caretaker in the miramar national cemetery. thanks to v.a.'s compensated work therapy program.

hector regular lay li goes back to his former homeless camp hoping to insmier and support other vets in crisis. veterans helping veterans. nothing bert. third. v.a. can't and by the way v.a. doesn't do this work alone. each of us has a piece of this puzzle. from the white house to the hill. faith-based and community grouped, veterans services organizations, from private sector to the university we all play a critical role. these partnerships are helping us tackle some of our most pressing prior toins preventing veteran suicide. on ending veteran homelessness. on improving health care access. and more. we just launched the second round of grants under the staff sergeant parker gordon vox suicide prevention program. these grant goes to local organizations.

implementing innovative new suicide prevention programming where veterans live and work. meaning that we're funding local people who know their vets. organizations like nation's finest which provides transitional and permanent supportive housing for vets in rural communities across california, arizona and nevada. this team recently helped a pregnant vet fleeing domestic violence. think of that sentence. pregnant vet fleeing domestic violence. talk about a phrase that should not exist in the english language. they enrolled her in prenatal care at the v.a., connected her with services and provided her with housing. just one veteran of hundreds that nation's fiepest helps every year. and we're -- and working with state, local and other partners we're providing more housing and

wraparound services for vets, homeless vets, at-risk vets. more of them than ever before. as we did last year, we're on pace then this year to exceed our goal of permanently housing 38,000, exceed our goal of permanently housing 38,000 homeless veterans. permanently housing. part of the way we provide more care to more veterans than ever before is through the community care program. succeeding in the community means scheduling appointments faster. we're doing that. it means paying our bills more quickly. we're doing that too. it means recording records of care into our community so we can recognize the full promise of v.a.'s health care system. allowing providers and gentlemans to work together to piled joint plans of treatments. medical intersessions. a psychiatrist seeing a vet for ptsd and t.b.i. can see the

vet's neurological records. then the team can huddle up with the vet and their loved ones co-discuss coordinating care. along with neurologists, social workers, pharmacists an any other team member involved in that vet's care. that's the integrated treatment that improves outcomes. and that's what v.a. promises. if we're not getting the records of the veteran care in the community back, we decrease that efficiency. we increase costs. and most importantly, we reduce effectiveness for the vets. so we have to see our community partners as just that. partners in our quest to provide integrated care, integrated veteran-centric care to high quality outcomes. now, as i stand before you in this august room, national press club, i have to underscore our partnership with the press. we cannot keep our promise to

vets without you. the journalists who tell veterans' stories. journalists like the one who is still working, actually, in the back, patricia chime. patricia's stories make v.a. better. because they trust -- vets trust patricia's reporting. veterans, v.a. employees and other stake holders, knowing they trust her, talk to her when they see that something is not working. the way it should or maybe not working the way we tell them it's working. so her reporting and her stories help us better understand what veterans experience in war, what they're going through at home, and how we can better help them, often times bringing something to our attention that we didn't even know was happening. a couple of months ago, patricia noticed a software issue on

va.gov website, the one i was just bragging about, preventing some vets from sub nairgt claims appeals. she asked us for a comment. alerlted to the problem by patricia, we were able to immediately fix the bug, reach out to vets who were impacted, alert congress to the issue. and prevent similar issues from happening again in the future. as i said, patricia is here, so i'll speak directly to her. your work is having a direct and positive impact on the lives of sleets. you make -- on the lives of vets. you make us better, to serve better, holding us to account. you and your mates like leo. leo shane. quill lawrence. ben kesling. jordy heckman. orion donovan smith. are helpings serve veterans for a better than we ever could on our own.

and as i lean -- and as eileen just mentioned, just yesterday, investigative reporting from david phillips in the "new york times" uncovered the unseen t.b.i. risks faced by soldiers and marines who operated heavy artillery weapons in the fight against isil. in syria. if you haven't read it york must. because of his reporting, v.a. will be reaching out to those vets who served in the field artillery units to ensure they're receiving the care they need, importantly, the care they have earned. those vets served in syria and iraq. making them eligible for that care around the pact act. several of the vets profiled in the piece are characterized as having received less than honorable discharges.

we all them o.t.h.'s, other than honorables. v.a. cannot change a vet's character of discharge, vets are not automatically disqualified from v.a. services because of discharge status. are not. in fact, over the last 10 year, v.a. has granted benefits or care to 73% of the veterans with other than honorable discharge status who have presentedto us. so. to those vets in that heart break story, and any vets watching today, we want to serve you. please apply now. please reapply. if you've been denied before. and we need everybody's help. every single person in this room's help, communicating with

vets so they get the care they need. and the benefits they deserve. fourth and finally, we've seen again and again that earning veteran's trust is critical to everything we do. trust means many things. it means making it easier for vets to get care and benefits, ensuring their v.a. services are are -- their needs are met and ensuring they feel respected when they come to v.a. there's no greater privilege than having that trust. there's no higher bar to meet and there's no bigger problem than when we lose it. since v.a. began measuring trust in 2016 through something we call the v signal, those three measures of trust, and the veteran experience, ease, was it easy to get your appointment? effectiveness -- was it effect sniff and did you feel respected? ease, effectiveness, emotion. each one has increased. the v.a. currently has 184

active surveys bringing in more than 2 million responses over the loss of this v signal allowing us to hear directly from vets about your experience at v.a. and all of this information is released to the public through our quarterly v.a. trust report and at va.gov/trust, tying trust metrics with our performance. three of the v.a. teammates who helping in intensive survey process that helps us ensure the veteran experience and trust in v.a.'s care benefits join me at this lunch today. they all work in frontline veteran experience roles. helping v.a. measure and learn how to build better trust if our patients. from our customers. from the people we work for. breonna camera went into health care because her dad was sick.

when she was in high school. her grandpa was an army vet but didn't trust v.a. care when he left the military. and that's her passion. making damn sure other vets have a good experience with v.a. linda feems. comes from a long tradition of naval service. while she didn't serve she often says there's seawaterrer in her family's blood. her son joined the navy as a rescue swimmer and that is when lin decided working on -- that's when lin was working on digitizing v.a.'s paper records. she went on to lead the very first veteran experience project on machine learning. today she brings her experience to help make -- help v.a. make data driven decisions to our claims process decisions.

richard barbado served as an army officer in the 82nd air force dwig. he fought in the initial invasion of iraq and in the years after, we've lost 40 paratroopers he served with to suicide. including a best friend. many of them rest today across the river in section 60 at arlington national cemetery. richard came to v.a. to honor them. he said this has never felt like work. it's a mission. i wake up every morning because of this mismtion you see why i'm so excited and humble to be part of this team. they share a deep devotion to keeping our promise to vets. that characterizes their colleagues as well. and boy, do they demand high

standards from us, their teammates. now our mission is far from over. there are enormous challenges ahead, not least meeting the demand of millions of veterans who have filed claims under the pact act and who will qualify to be enrolled in v.a. health care. i know that with v.a. teams, teammates leading the way, publicker have -- public servants like breonna, lin, richard, v.a. will continue serving vets every bit as well as you have served us. and as we look to the future we're not trying to build a v.a. that goes back to some old number. instead we're going to do better for vets. we're going to continue to be better for vets. this future v.a. isn't because of me. it was well under way without me. because 450,000 v.a. employees in your communities and neighborhoods across the country who keep vets at the heart of the care that they provide.

so again, to all the veterans hear today and those watch, thank you for everything. to the press club, my thanks for all that you do holding us accountable to veterans. and telling their story in the powerful way that you do. god bless you awful may god bless our veterans, their families, caregivers and survivors. [applause] onow i'll talk some questions. >> thank you. sec. mcdonough: thank you. i tried to filibuster. is there time for questions? >> we'll do rapid fire questions. so thank you for addressing the "new york times" report. i just want to confirm you said that the pact act should cover those impacted by the high explosive shelling. sec. mcdonough: yeah, thank you. it's a really important story. it appeared yesterday. again i encourage you to take a very hard look at it.

remember what the fact act says. if you served during 30 years of war in central command, and you stepped in that a.o.r., you -- that begins your process of eligibility. now, it also -- pact act goes a step further and says if you have any of a series of more than 25 conditions, right, then we presume those conditions to be connected to your service. my point is not that all the conditions that dave phillips reported are covered by the pact act. my point is that having served in central command there's a 10-year window during which our veterans qualify for care. so we want to make sure we see them and we want to make sure that we are in touch with them

to tell them we can see them. we want to make sure they file claims. so that those conditions that they may be experiencing, that we'll work through with them, can get service connected. so i hope that answers the question. >> speaking of the pact act. amidst retention and recruitment challenges, how has the v.a. handled the unprecedented influx of clips? sec. mcdonough: that's a good we. we anticipated and hoped that congress would pass a new law on this. but we weren't waiting. so in may of 2021, president biden, using his own authority and i think you've all now seen reporting about how strongly and how personally he feels about this issue, began connecting three initial conditions to service in central command.

and exposure to burn pits and toxins and importantly just plain old particulate matter. all you guys who were over there, you remember what that was, right? you're in a constant sand storm. so just ingesting that amount of silica is a problem. so. the experience of may, june, july, august, of 2021, showed us that we were going to need more people and to his great good credit, v.b.a. career employee tom murphy said hey, we need to start hiring now. for the three conditions that the president has established and for anything congress establishes coming forward. so we've been hiring at v.b.a. since september, 2021. which is why we have more than 32,000 employees at v.b.a. right now. the claims process is overwhelmingly moved by a simple

entry point which is more people reviewing claims. so that's one way we're addressing this. a second way we're -- meaning we're hiring more people. that's going to take us a little time to train all those people. but we've been hiring them since september20, 21. that means we're adding fully trained people into the claims review process almost monthly now. that's the first thing. the second thing is, we are still looking at the process itself. and figuring out where can we do away with unnecessary steps? where we can avoid unnecessary c.m.p. exams? compensation and pension exams. and where we need them let's make sure we have even more personnel working contract and pension exams. that's the second way we're doing it. the third way we're doing it is we're trying to modernize this process. so we've been undertaking an automation process in our claims

process -- in our claims process at v.b.a. where we use an automated decision support tool. it's still humans that make the decision. and thank goodness we do. because nobody is more empathetic and more likely to make a decision in the interest of the veteran than our employees who have dedicated their lives to veterans. but the automated process can help do what machines do best which is go aggregate data. consolidate that data. bin that kay -- data and then present that to the v.s.r. or the rating v.s.r., rvsr, so they can make a final decision. that process is proving to work well but we're not betting on massive returns on that over the near term. that's a longer term effort for us. so of the ways we're working on

it, please. we regularly, about to report late they are week on this, we are put ought every two weeks how we're doing on claims. we're not hiding this from anybody. we put this out every two weeks on friday morning. you can find that data. we're putting it out there. i want no veteran to be dissuaded from filing their claim. we are going to work through those claims, we're doing it as i said 15 days faster per claim this year than last. still 120-something days on average. but we're getting faster and we will stay at this until we get every one of them done. >> thank you. there's a couple of other questions with the pact act. can you give us an update on whether there's any progress on making constrictive bucolitis a disability rating. sec. mcdonough: i think i have to be careful what i say here.

the way we do this is through rule making. i want to be sure i don't somehow knock off-kilter the act. we're checking this issue and trying to get to the bottom of it. there's three questions here, actually really two. one, how do you diagnose constrictive bronchiolitis. right now it's a relatively new condition and the process by which we condition firm the condition is so invasive, a lung biopsy, as to make it not in the veteran's interest to carry out that action. the second question is, how do we categorize that in the v.b.a. system such that the benefits can be paid to the veteran? let me just underscore that. that's the process that we'll go through in terms of rule making. i'm not going to say anything about it to not compromise it. but what i will say is that veterans can still get their

benefits, their compensation benefits, even as we work through this process. if there's any veterans struggling with that, i want them to be in touch directly with us and we'll work that through. >> can you discuss the impact of the v.a. rule change in rates v.s.p. for special modes of transportation will have on impacted veteran's ability to seek treatment for complications suffering from burn pit exposure. sec. mcdonough: is the questioner in the audience? can you tell us, give me a couple, are we talking about the rural travel reimbursement rates? are you talking about the contract for ambulances and air ambulances? >> the proposed reduction for air and ground ambulances will impact the sustainability.

as well as any complicates -- complications that may arise. sec. mcdonough: got it, got it. let me start if the top. i don't know who is proposing a reduction but it's not us. what we have said is, if you do not have a contract with v.a. to provide the service you provide, we will have no choice but to contract with you at medicare reimbursement rates. ok. that's what the proposal says. this is a proposal that is designed to ensure that v.a. addresses a problem that the inspector general has raised with us several times, including in a very hard-hitting report which i just reread last week in 2018 that report said that there is -- that the way v.a. pays for

emergency ambulance and air ambulance, puts at risk taxpayer interests. so we are going through a process where, because v.a., alone among, as near as we can tell, alone among health care systems in the country pays for each individual ambulance, cash, in that exchange. meaning, but for a number of cases where we have a contract with a provider, we're just paying cash for each run. we cannot find another hospital system that does it that way. which i think is why the i.g. hit us upside the head with it. so we're try through this rule making process to get contracts in each individual market. we at the national level have not set a price and why would we?

we don't know anything about individual markets. those contracts are being negotiated. i hope. in each of the individual hospital systems in the v.a. so i hope we get to the bottom of this and work this out. because getting that really tough i.g. report in 2018 i think should have been enough. you know. i think we've got to make sure we're doing right by our vets, doing right by our taxpayers. >> another one. active duty captain in the air force sent in an email, the captain's father who also served in the air force passed away in 2013 from cancer developed from exposure to toxic burn pits while serving in the middle east. the v.a. declared his death service related in 2018 than & they qualify for benefits. however when the captain applied for the funds last year the v.a. told the captain they did not

qualify due to their active duty status. sec. mcdonough: first of all, thank you for an amazing family of service to that veteran. is the name attached, you don't have to read it but is it attached? >> i can get that. sec. mcdonough: let us reach out to you directly and work the case. i want to make sure i don't misstate it here. let us work the case and we'll get to the bottom of it. >> is there any exception for active duty military people? sec. mcdonough: part of the reason i'm not answering the question is i'm not sure. i queses the -- i guess the question would be -- you know, i'm just not sure. let us get to the bottom of it. >> all right. on to other issues. on friday, it was reported 40,000 low-income veterans and their survivors mayo money because of accounting errors over the past 12 years regarding their pensions.

v. amp officials said they wouldn't collect the debt for now but this follows a series of other issues including disability claims thatting afterred tens of thousands of veterans and delays in implementation of electronic records. why does the v.a. continue to experience these expensive technical issues and what is being done? sec. mcdonough: i may disaggregate the two questions. i think the issue relate reported in the federal times on friday relates to a question of recordkeeping and self-certification for a particularly vulnerable group of veterans who get both different kinds of federal stipends or federal assistance, and also get v.a. pension. and so the question is whether -- not whether there was a technical failing but whether we were closely enough

monitoring the -- the self-certifications about how much those veterans were receiving in terms of federal funding and v.a. benefits. this is what i mean when i say we want to be a v.a. that works to bring services to veterans. not to have them build their life around us. and so i don't think this is a technical failing as much as it may have been a policy execution failing over the course of more than 10 years. and in that scenario we're going to study very closely whether that that set of policy steps that were taken should be, you know, made whole by the veteran. or whether we, if it was indeed v.a. that made the faulty calculations, whether we should

take care of that. so that's what we mean when we say that we're not collecting them for now. we're looking at how we address this and the context of a veteran-centric v.a. and make sure that our programs are built around and into veteran's lives and respond to veterans' needs rather than again being sure that they follow our various -- our various requirements which at the end of the day are ours to implement, not the veteran's. >> there are also other -- sec. mcdonough: sorry, there are definitely other issues. i think you raised three. i volunteered one with patricia's reporting. that is definitely, those are things where, you know, we are going to make mistakes. and when we find them and when

reporters ferret them out, when congressional staff moshes congressional members of congress or veterans themselves identify them for us we're going to fix them. so that's the second batch. the third batch are big, new technology overhauls. like the electronic health medical records. and that is something that we've been going at now for more than a decade. and it has been difficult to implement. some of that is difficulty across a national, very complex health care system. some of it is because, you know, technological advances like a -- an electronic health record have proven difficult, irrespective of the health care system in which you implement it. and some of it is because of technology -- is because the technology is not in all cases

everything you hope it would be. and so we're working through that on ehrm. but again, i don't think it speaks to a fundamental capacity one way or another of our providers. and our leaders at v.a. where i think we are doing really positive things. i just call your attention to, as i said, a v.a. benefits and health care app which is, you know, we've been slowly rolling that out. we're now north of one million users. and the experience, the veteran experience on that, again, not uniformly, not 100% positive. but the ratings including on the public app site are positive. overwhelmingly so. so we'll keep implementing each of these transparently, responsive to the problems that our veterans experience, that our stake holders like the press and like congressional staff and congressional members identify for us.

and by the way v.s.o.'s who are routinely hearing about veteran experiences that are not up to snuff from our v.s.o.'s, and when we do we'll fix it. >> robert card who is responsible for last month's mass shooting in maine, underwent a medical evaluation while training at the u.s. military academy in new york. this army directed that while on duty she shouldn't be aloud to have a weapon, handle ammunition or participate in live fire activity. it also declared him to be nondeployable. why do you believe he was still a reservist and wasn't discharged? and if this is by the book what needs to change? sec. mcdonough: i'm not in a position to comment on the decisions made in another federal agency. one. two, i'm really -- obviously our hearts go out to the victims of this sepsless act of violence in

lewiston. we are in very close coordination through our vision one teammates and through our v.a. hospital in portland to make sure that we're supporting victims, victim's families, first responders, and supporting the state in this response. >> the v.a. four years ago initiated a veteran's legacy memorial project meant to be an online repository of records of every veteran now deceased. it began with veterans interred at national and v.a. grant cemeteries. it has since expanded and includes veterans buried in 87 different countries with records date back to the american revolution. why did the v.a. embark on this snrojt what do you see as its role? what does it mean to you?

sec. mcdonough: it's a really cool project. it means a lot to me because at least in the case of one veteran it's important to me. i've been able to go and add my voice on his site about what that veteran has meant to me. and that is the idea of the veterans' legacy memorial, the v.l.m. it's an opportunity for -- it's develop and deployed and maintained by the national cemetery administration. we'll be communicating about this aggressively this week. please watch this space. but the idea is that it, like our national cemetery, which are national treasures, where our veterans can be assured the dignified lasting resting place commensurate with their honorable service in defense of the constitution and our democracy. this is meant to be a living

memorial where survivors, family members, in my case, former player for my coach, we can update that legacy. so that the country can come to understand the fullness of the work, the sacrifice, the benefits, that our veterans have taken on our behalf. and so, i encourage you guys to check out the veteran's legacy memorial through va.gov. if you have any problems with that, get in touch with pawell.

let me welcome everyone to the virtual planes very excited for today's discussion around securing space and addressing the cyber risk that could not ask for a better group of speakers than than we're privileged to have joined us today before doing