with the secretary's advisory committee on prostatic subspecialties abilities. we spent a great deal of time with bands and i think that group has representatives from many veterans service organization. they address the concerns that they may have. again, and make the offer is that i would be happy to meet with any group to discuss peace. >> thank you. i think it would be in the best interest as we go forward to do what is best for veterans enter your the veteran service organizations and from the veterans themselves and for those who have gone through this process and understand antonelli at it the first two panelists that it would seem like very basic to talk with them and to

have them identify needs and concerns. you've heard wounded warriors saber asking you, congress to please freeze the change. the other point i wanted to bring up was the pilot. you heard paralyzed veterans, the organization mentioned the pilot. have you done a pilot? if so, what were the findings? is that the justification? >> yes, ma'am. i have a number of issues to address on this line. first, to put it in concept and graham are talking about the more expected science committee transfer of the contracting authority only impacts those procurements about $3000, which is the mandated federal acquisition or federal micro purchase threshold. so only 3% of orders we estimate fall in that realm. 97% of workers will stay with purse headaches. as i said, we are doing this to

bring us more in line with federal acquisition regulations and also address many issues eag has mentioned although those were identified previously. i want to assure everybody that if a clinician specifies a specific product for a veteran, they look at the product for that individual. i am not as a cheese contracting person in the veterans health administration, i do not want my officers making decision as as to what those in the veteran gets appended to it. that is a clinician decision. and how we are going to get the product of the clinician specifies for the veterans under the auspices of the federal acquisition regulation. but when the safety authority at 8123, one individual mentioned the broad latitude given by congress to the veteran administration. we are going to do that by properly preparing just

purgation approvals for sole source, citing an paragraph for the authorities granted under 8123. there are seven exceptions in part thanks to full and open competition. exception five is authorized by statute and that is what we will use. we have gone through great pains to ensure success in this transfer. in a little bit of history, starting my summer when was it this process in the direction of the department,.dirtbags and my folks formed a team and that included field personnel, both aesthetics and contracting which we felt was critical. they developed a plan for the transfer, a very detailed plan. as we got into it.more details as we identified other issues. we then worked at their union partners to ensure they did not at issue is we could receive

successfully. there were pilots as part of the plan, which was the best part other than bringing field people into the planning process, the pilots was a great aspect. we did envision six, 11 and 20 ms virginia, north carolina area in the pacific northwest. we piloted beginning in january for about 60 days. those pilots concluded in march. we did learn from those pilots and are implementing changes to ensure that care is not impacted. some of the things we learned is that our staffing models were incorrect in the number of procurements we could do in a day in the contracting we are hiring. we hired additional people to see that we could keep up. we are process for justification approvals by templating that process so they can say more fill in blank with the clinician's prescription. those are the processes. we're slowly implementing and the rest of the veterans health

administration for more visions are starting the process now and the rest of the visions will be coming on in june and july. the goal is to have all of this done by the end of july. there is a contingency plan we have discussed. we still have the legacy procurement system if something does not go right or something unexpected happens we can fall back on. but we don't expect that to happen. >> i would like to add that this has been a very strong collaboration and partnership. prosthetics and sensory services ferry can turn that we can continue to provide the services to the veterans that they deserve and that we have always been able to do. and so are prosthetics organizations that are local medical centers and at division level remained the eyes and ears to all orders stuck on your

prosthetics. prosthetics is managing than on working with contracting officers to achieve the placement of the order assays required to be meeting all of our acquisition requirements and we are, as mr. doule has said as the ability to use 8123 and has been a significant amount of time developing justifications and approvals that allow us to use that and really refract the needs of the individualized rehab needs of our veterans. were very much aware that we customize these products and services that they are select date based on an individual veterans needs and that has been our goal as we have managed this transition. we are coming into a critical

time as we move the transition forward and extend it to other visions. we have very well developed and exact procedures in place to monitor this as we go. we are prepared, i think, mr. doule nist team and our offices as teams to review this very carefully and make recommendations as the way forward based on how this process reflects veterans. >> may have the one i met with the advisory committee on disability is last week they had many of these very same concerns after spending some degree of time, they at least understood what we were doing. they're still very interested in ensuring we to achieve success. i'll let dr. beck comment.

as a veteran myself who made several trips to iraq and afghanistan, both in a military and civilian capacity, very sympathetic to the needs of the veteran population and i can assure you i will do not and that hurts the veterans because they are there for the grace of god and that's the way a look at. >> thank you. my time as way ran however my colleagues on soldier may have a couple of up questions and i will live as much time as you need. my first concern is that procurements it only pertains to those of her three batasuna nisei only 3% of the orders are over 35. how many request you have? >> that is still not an insignificant number. a center planning estimate complaining figures for fiscal year time in which we plan to transfer over with 3% of the orders equals roughly 97,000

orders. >> so i would suggest that because we were talking about 1500 warriors with amputations that probably are in need of prosthetics that that is going to be a small percentage of what you're doing. however, all of those will exceed the $3000 threshold. we heard earlier about a $12,000 land and its $25,000, that doesn't matter because the veterans they prosthetics and state-of-the-art prosthetics. that concerns me committed peace right there. the other thing is he mentioned to you type with your union partners. it seemed to be more appropriate to talk to your veteran partners in the veterans who have gone through this and be more concerned with their thoughts about this beta program that works versus talking to the union partners. lastly the pilot information if i could respectfully request that she would provide us. i think he said he did three,

six, 11 if you could provide us with the findings from this pilot programs, i would appreciate it. i now yield to the ranking member, mr. michaud. >> i decide to follow up, mr. doule on the comment you made for you mention that if contracting officers do not change but the clinician prescribed, but actually and testimony we heard earlier from pda that is not the case, that their testimony state that contract office serves the need to receive the orders to request for the devices is modified and even denied and cases because of the cost. so that is a huge concern. there seems to be a disconnect from what you are hearing versus what the vss are carried because that is not the case. the cost of space that area. it is not the veterans of health

care. do you want to comment on not? >> first of all, contracting officers to house a mandate under federal acquisition regulations to ensure there's a price of the reasonable aspect of the cost provided. i don't know if that is of concern or not. i can't really speak to what may have happened before, but i've put out to the contracting community and that under 8123 at the contracting officer sees the decision console for a specific product will do due diligence to ensure we pay a fair and reasonable price for that product, but we are going to get the product for the individual. so i do not know if it is a concern that again i will take full blame for not bringing the veterans service organizations into the loop in this discussion we can fix that, but i don't post that started the issue they are by that concern was being raised. >> is very clear that some of their statements that is not

uncommon for clinicians to prescribe some pain and it's been modified by contract in officers and primarily because of cost is a big concern that i would have. my other question is mr. boreas taught about older veterans at his desk complaining that there appears to be a new administrative hurdle to prevent their continued to receive care that the da has a short veteran that they may choose their own processes and get veterans who wish to use community-based providers report widespread administrative hurdles at their oppressors to choose and house va care. how would you explain the perception among the veterans in

the community-based providers because there seems to be a disconnect here as well as far as which have told us versus what is actually happening out there. >> yes, sir. i will start. we do have contracts with 600 providers, approximately 600 providers. we do offer choice to our veterans and in our amputee clinics, when we initiate the process for the multidisciplinary care that we provide, we have buyer physicians and are clinician and prosthetist mayor. we also have contracted community partners are prosthetics vendors turn the community are there as well.

the veterans do have that choice is part of our policy and as we become aware of, we will reaffirm that policy with the field based on what we have heard from our veterans today and we are improving the processes. i think the inspector general report pointed out that there's some contract administration initiative that we need to undertake including streamlining the way we do our reviews so they have been in a more timely fashion and that they really clarify their prescriptive elements for fabrication at the lake and we are doing that for the lan and we are doing that. the second thing we are doing is we're making sure that our contracting officers and their technical representatives who have as part of their

responsibility to review those close and certify they are doing that regularly and in a timely fashion. there is guiding that is repaired even now to rinse your field and educate them on that. the third thing we are doing is taking a contracted -- what we call a contracted template where we are developing policy and guidance that can actually go into our contracts so that it is clearly specified for the contracted provider and the va exactly what the requirements are and the timeline. so we have taken the report we have from the aspect or general about the need to improve contract administration to support our veterans seriously and we are making those corrections and has been doing that over the last several months. >> do you feel that with the new changes are providing gets back

to my original question that the clinicians will have final say in what veterans receives versus the contracting officer who has to look at contracts and saving cost, which i believe we have to do. but the veterans have to get the prosthetics they need at a cost a little bit then they should be able to get it if it fits them more appropriately. the concern i have ncsc got to look at saving cost, but not at the cost of providing what are better in speed. and i do have a concern if contracting officers and check the more cost versus the clinician but cannot veterans needs. >> yes, sir. i have a concern with that, too.

and the clinician myself working with another area who provides rehab tech elegies to veterans and it is critically important that what the clinician requests and that of course is done in collaboration and partnership with the veteran. these are choices and decisions about technologies that are veterans make with their clinicians and we are absolutely absolutely -- rehabilitation is not affect this unless we are able to provide the products and services our veterans need and our role in prosthetics and in rehabilitation is to assure that any contracts in the way we put your items and hans says -- not only enhances that provides high-quality and to visualize care. we've done that successfully for a long time and we believe we are able to do that as we move

forward. as mr. doyle has cited, we can certainly work within the framework of contacting requirements in the added authority congress gave us many years ago for 8123 i think is the other piece of sole source procurement that we can do when we need to provide them we are providing highly individualized products and services. >> thank you, madam chair. >> mr. reyes. >> thank you, madam chair. >> you mention the center of excellence. where is that located and how much of the work being done there is medical research as it pertains to prosthetics? >> the son of excellence i spoke about is situated va dod center

of excellence for extremity care. that actually will be a virtual center or as a virtual center. it will have locations in san antonio, texas and in washington d.c. staff will be distributed across our sistan said that some of our staff will be in various centers, both va and dod centers around the country so we are collaborating, coordinating our house for. i think you mentioned research earlier, sir. one of the things you talked about that will be able to do by leveraging the capabilities with dod and va is built to do clinical trial type of evaluations that a number of different centers at the same time that is one of the missions that destroyed the eighth dod center of excellence is research coordination and studying and

reporting on new technology is an outcomes for care. >> how will you ensure that at least for medical research going on is somehow tied back with defeat back being given back by the veterans? e-mails, their experience as with the different types of prosthetics, and the challenges that they have and also pain management, is that all part of that? >> it is. i will comment and i'll ask dr. webster to comment. the participants will be the act did duty service members. they will be able to report to us first hand what their experiences are curious about is

how we will tie in the feet that. we also listen carefully to our veterans as they look at their outcomes of care and successful use of prosthetic limbs and technologies to gain information about where the research needs are. i am going to ask dr. webster to comment just for a minute on what we're doing with pain management. >> thank you. i appreciate the opportunity to be her today and provide this testimony. i would agree it is extremely important to give feedback and information from the veterans and service members at the imputation on what is important in research. we can do research looking at various things but it's not important to the veterans service members have a lot to good. it is critically important and that is done on a routine basis. cap dan pruden and its research

earlier on a panel put together looking at the imputation carousel is prosthetic care will continue to occur as we move forward their research efforts. again, with the center of excellence, several of the physicians on administrative headquarters of being san antonio and the national headquarters region. many of the staff are actually located with in her treatment facilities within walter reid in the center for the intrepid. they are completely integrated with the clinical staff and with the soldiers and veterans who are being treated in those facilities. >> i am curious how the process works. is there like a caseworker that will have the caseload of the particular veteran to make sure

that feed back is coming to the caseworker and not feed back goes into the r&d component? how does the process work? >> i think it can occur both directly from the service member or veteran should the researchers. again, they are co-located in the clinical areas. it can come directly, but there is also opportunities for the feedback to the people who are doing the researchers -- doing the research to come from the case managers, the other providers whether it be a physical therapist or physician can any providers providing care for people with amputations can also provide that input into what is important for research and research initiatives. >> and when will this process be implemented? is that already going on? and if so, are there examples for an example of how that is

working to make sure that the feed back of the battery and is taken account? >> well, the center that we spoke about standing up now and we expect it to be operational by the end of this year. i want to talk about a couple of research projects of the work we are doing and i think that one of them is what is known as the darpa arms, which is the probably mystics fan researcher dignity that is going on and that is the defense agency project for the development of a prosthetic, upper extremity prosthetic arm. and the way that is working and va's participation has fund by the defense department. >> that is the one the medal of honor winner has, right?

>> does he have that armed? we are going to figure that out. were not exactly sure. >> i think that is right because i visited with him in that office and he took a handoff put it back on. i'm not 100% sure, but i think either he or somebody with him referred to it as the darpa arms. >> we'll check on that for you and find out, but one of the things and this is a good example of veteran feet that. in the first study that was done to evaluate the arm, our veterans participated in that study and actually came to va facilities and participated in the study. we participate the second part of the study, which will not be a take on study, were veterans

fulvio to take the arms halls and use it in everyday activities. and so, they will then be providing feeds back on the ironman how it works and what is required next. we do that frequently with technologies. i think the jenny and me, the iowa side are two examples of technologies that va and dod have worked on together and had our veterans and active-duty service members participate in those evaluations. >> so each batter had, so i can understand, is a case unto him or herself and the response ability will be with the va caseworker to make sure all of these things take place?

>> okay, the va has in place a type of case manager for amputees or amputation care and that person is known as an amputation rehabilitation coordinator and that all of our major amputation care sites that we talked about, are seven regional centers, and additional sites spread throughout the country, we have in place the special case manager who is case managing our amputees and providing those services in theme that their needs are met. so it is a case management kind of function similar to the other types of case manager, but it is specialized to address the needs of amputees and many of those case managers are at therapist, either physical or paris or

occupational therapist. >> very good. thank you for your indulgence. i think this may be an area we as a subcommittee can follow up on. >> i was actually going to ask if you'll look like a second round of questioning. so at that, i think we will start a second round of questioning if you have the time and wait until just this afternoon. in the panel with mr. pruden, captain pruden i should say, the electronic contract management system and talk to us about the fact that there requires 300 steps to get the request in. can you comment on not? >> i'm going to ask mr. doyle who is our expert in this area to the contract system.

>> that is new and that will be putting in place as part of the system, which is the part where they are requiring people in this case, prosthetics is transferred over to the contracting office. we have had the management system and va for several years and that is what art contract writing tool and effect. and that is what we will use to write the contracts for the prosthetics that come across to us. as for the 300 steps, i will say that i know it is not the easiest system to use and can be laborious. i would have to say what the individual does he have a came up with the 300 steps. that is a new figure on me however. >> i guess my concern is that we are talking about lightbulbs or tissues or any sort of items that we need to purchase or contract that within the va, that is what dean.

but we are talking about and the whole scheme of things that very small quantity, a very specialized product. and this morning in the testimony i heard the word incident. it becomes a part of the veteran's body. it is not like some isolated product that we use. it is specific to that person. agitate that request or contracting dump it into a system like this seems to me that the opportunity for a lack of timeliness, personalization, you name it, and this thing is rife with the possibilities of the veterans and you heard the their testimonies means i can't walk my daughter down the aisle or put my baby in the created. those are intimately personal. we come in the va or whatever the system on the wii run the

risk of not allowing our veterans to do that. and every day that goes by without a wheelchair or prosthetic, shame on us. shame on this country because if we are ever on our game and had to be where providing for veterans. and so, my concern is that as soon as you take away the personal piece of days, you run the risk of the government yurok receipt and making sure the veteran has exactly what they need, as soon as they need it and it is state-of-the-art so they can get out to the life that they had as best they can and that we maximize for them. that is my concern. our responsibility is to maximize the quality of life for these veterans. when i hear that they think to myself, you will know what it's like to do with government. you won't know how impersonal, even in a hospital or smaller setting with prescriptions or anything else, but this goes

right through it to the veteran's quality of life. my concern is that this was arbitrary and i'll be anxious to see the results of the pilot studies that not enough thought was given to us, not enough consultation with hot. not enough work was done before the change was made. we're not talking about 25 or 30,000 prosthetics. we are talking about a much smaller group and i think the very least government can do is make sure we do it right for these veterans is with that i go to the ranking member if he is additional >> thank you very much. just to additional questions. my first is, does the va have an object that measure to evaluate a prosthetic outcome of the veteran? >> yes, sir, we do. our workload staff on the first understand the project took a

number of orders expected to come over to the acquisition and heavy workloads that jemima and anticipated or assumed a number of people that would be required in procurement staff that. turns out to the three pilots that are staffing model is strong and we are hiring additional people. unfortunately they are purchasing agents coming across from the agent career filled to the contracting field and will be now working procurement, which is probably good for them because there's meshwork rare opportunity as 11 or two versus a purchasing agent 1105. we are now staffing to the love of attitude are a complete per day. that is the match eriksson will be tracking metrics to ensure we don't fall behind on most metrics. if we do start falling behind, at the unexpected does happen because we do approach the

fourth quarter as well, the busiest time of year for contracting folks, we have the legacy system in purchasing agents and prosthetics we can fall back upon. >> what about the individual veteran themselves as far as i do really satisfied if they don't come back to a contact them to see why they haven't come back and at the services they receive from the va? >> all times, it will be the percent sophistry they should have no interaction with the contracting folks whatsoever. as vig mention it comes down to communication between the offices. we are setting up a static size for their joint contract t-man prostatic people working together to make sure we meet the needs of the veteran. again, prosthetics people will be the upfront fees to the veteran, identified what they

need. require that will come to contracting and will get under 8123 of his civic product will get it for them in the product will come back to the prosthetics people for the follow-up aspect with the veteran and i'm sure there will be a way to prostatic folks will buy this now and ensure there is initiative. >> you're talking about delays in getting the win. my question is the veteran themselves. have you done an evaluation -- is the customer veteran satisfied with concern for? and if not, why not? or if they have a combat, have you ever followed up with the veteran themselves to find out whether everything is satisfied or? >> in procurement we have not because we are just getting into the ballgame. >> and prosthetics, we have done a number of surveys over the years. some extensive ones where we

float that using rva chef type surveys, our overall customer service and veterans satisfaction with care as we do for medical centers. we attend two of those surveys over the years. we also do the gallup polls survey in 2009, which the data evaluating what are amputees taught at that time. the ig has actually come arnsberg or general and the most recent report also provides us with veteran satisfaction data. we realize we need to do more in that area and are now looking at a couple of options that we have. one is when it -- is a standardized survey related to patient satisfaction and that the committee on accreditation of rehab facilities use as.

we intend to use that for the amputation system of care will be able to use the veteran satisfaction survey and oliver amputation care clinics. and we're also looking at other ways that we can assess veteran satisfaction. >> can you define this latest survey with the satisfaction. my last question is, do you find it difficult -- this is a special field, to find and higher qualified clinical personnel? >> we have done a lot of hiring in the field of rehabilitation and four worth of taste and a prosthetist over the last several years we have added a

lot of new providers, providers who are highly experienced and very capable. for this profession as they have with physical therapy and occupational therapy and some of those professions, the jobs are extremely competitive. we've done a couple things in our system. when is our orthop taste and a prosthetist or hybrid title 38, so we are able to recognize them for their clinical capabilities and advanced them based on that performance and pay scale. so while it is a challenge, we have been able to attract high-quality providers and filler positions. i'm going to have stopped to miller, currently prosthetist to give us some comments. >> thank you very much for allowing me to testify today. i am an iraqi that and i had the honor of serving both the walter reid army medical center is the

chief of prosthetics there before coming over serving in the va. with regards to her work for us, the va is very kind that it is and that we are able to retract and attain quite a few orthop days and prosthetist because we offer to treat for veterans and they enjoyed and wanted to do. we also offer training and education. we offer the accessibility to the technology to veteran receives them anytime the technology is only available within the va for dod and it types to the said they to crack this anew clinical care. >> mr. reyes, g of any additional questions? >> just a couple of brief points. of the 600 vendors that she mention, are those -- the

contact with our veterans, are they independent of the va or are they through the va? is that like sometimes happens that a patient will be contact did outside of the system and be convinced that maybe this product is something they ought to try it? how to does 600 vendors have contact with our wounded warriors? >> the 600 contract to vendors for our community partners and so their act deemed it their own va facilities. the attend clinics and health in the prescription rationale of the item for that veteran. an attendant care. >> said they would not have independent contact with the veterans themselves?

>> as commissary. they would predate the vendors select day to provide that land come in the veteran than would typically go to their credit facility and how bad design for them independent of what is going on at the va medical center. >> and do those vendors, are they just doing these prosthetics based to be a fax order to say to them independent? >> whenever a prescription is written for that, it is sent about were refers to as the industry standards. so we contract with those providers and certification just like the providers do. >> for a specific product? >> that's correct. >> the other thing is on the surveys, part of why it is think does that reflect the sentiments

and i say this from experience that we've had there not paso, the veterans that are not getting it access to health care or upset about something come and they are very good about taking the surveys and sending them back in. it has been my experience and i say this because i had even some of the members of my family that has gotten those surveys and because they are satisfied they don't return them. they just chuck them. so is there a way or processes that have added to that? another words, if you send out 20,000 surveys and you only get that $8, is there some way to factor in those veterans that don't send it in because they're satisfied? these are multiple pages and they don't want to take the time

or can take the time to answer all those questions. i think that really skews the results for those va facilities. is there some way that can be done? or is that being done? is that being taken into consideration? >> that is a very challenging question is going to answer that a couple of ways. i think that when when any of us to are when we publish surveys or read about surveys, will very often see a statement about the response rate because it's the response rate is very low, if you send out 20,000 questionnaires that only a thousand people respond, then your question or doesn't have a lot of validity because the number of people you sample is the challenge in her gallup poll in every way we do surveys. so that would be the first thing we do and i think her survey

tried to divine surveys that will be easy so people return them. i think we need to do is we develop outcome measures were focused on making them short and easy for the clinicians and for the veterans to fill out and i think that is what were trying to do as the address patient satisfaction, veteran satisfaction and even outcome measures. >> if you just include a postcard that basically says i'm satisfied. i can't or don't want to go through global survey, count me in a satisfactory somehow like that because i believe the results are being skewed because veterans don't want to go through those multiple.

those are short and failing. i've gotten them myself here by me tell you. 16 pages is not sure. >> i don't want to fill this out either, so thank you. >> thank you, madam chair. >> thank you, mr. reyes. before we adjourn this afternoon's hearing, i suggested she would provide as. their shared cynical practice guidelines. so much of the testimony has taken the lead in prosthetic and collaboration between dod and va. if you could provide for the committee for the set committee i should say all of the initiatives are going to ensure that the va of these students work and trying to emulate or catch up to dod prosthetic programs they think that would be helpful for us. >> thank you. yes, we will do that. >> if there is not any further questions i just want to thank

the panel for your interest. this in-line hearing them for your willingness to be here. thank you and i think the both of you, doc or miller and mr. doyle for your service to this country. before we adjourn, so it's a good opportunity for the committee subcommittee to see thank you for all the veteran service organizations for your surveys and sacrifice to this country. in the states is the greatest in the wilderness because of the service and sacrifice that the men and women who serve this country and have served this country come as a thank you very much. but this i ask unanimous consent that all members of site which said just revise extend remarks and include any extraneous materials. but that objection so bordered. thank you told by witnesses and participants in today's hearing for joining in today's conversation. the hearing is now adjourned.

[inaudible conversations]

panegyric what the north koreans in human rights is kind of ridiculous dialect because you can tell them you need to improve your human rights situation in the response he will be in we've had this conversation. the response of the united states have human rights problems, too. i mean, that is not a comparable discussion.

>> now, you look at who makes up america's veterans. unfurnished washington "washington journal" incentives for official at the co2 professor discussed demographics of the veteran population. this is 40 minutes. >> host: we got on this memorial weekend it would be an interesting time to use our america by the segment numbers to look at the status of veterans in the united states. let me introduce you to urge to guess at the table. melissa chiu is that the occupation statistics branch at the texas bureau. meredith kleykamp is a sociology assistant professor at university of maryland. thank you for being here. while most children get started with the percentage of veterans in our population, either char break here that looks at the years 1980 to 2010.

so in terms of overall numbers of veterans, how many are there in america and has the changed? >> guest: overtime between 1880 and 2010, the number of american veterans has decreased from 29 million in 1982 about just under 22 million in 2010. however, the percentage of the population has also increased. in 1981 in six americans have some kind of experience for in 2010. >> host: meredith kleykamp, what is that name at the percentage of americans who are veterans? >> guest: well, over time we have had viewers hear individuals who serve in the military. we do fairly large character outdone in the wake of the tom and in the wake of the first gulf war. i think there is some evidence to suggest that you are in fear population to see the collator has an interest in joining the

military as well. the numbers are primarily driven. >> host: the% >> host: the online d driven. >> host: the online discussion this morning is asking the question, what do we as a society or veteran? since we are looking at things that jobless numbers, homelessness numbers, and might be a good place to start the discussion with our budget issues in the u.s. right now, big debate over all kinds of spending. the question as we honor veterans and those who died on memorial day, what do we owe them as the nation might be a great base to involve you in the conversation. veterans is someone to get into automatic mode. veterans, veterans. active-duty and reserve, 202-737-0002 and all the rest of you out there who don't have military service in your family, 202-628-0205 and will get your calls. you can tweet as as you well know if you watched the program

regularly. this looks like a generation of veterans, this chart from the world war ii to call for our later looks at the difference between the last decade, 202,010. >> guest: she received a number of veterans who served during the vietnam era comprise 7 million veterans and they are the largest group of veterans. however, that number has been on the decline and between 202,010, the number has increased to nearly 5 million the number is projected to win greece. >> guest: the reason that world war ii numbers are so small, lots and lots of people who were served an outboard, but they're all dying off as a generation. >> guest: every single day we lose more and more of our world war ii veterans and those demographic patterns of mortality have implications for who our overall population of veterans honor. >> host: this group of vietnam

era veterans as a percent of the population would have a draft. is that why so high compared to gulf war? >> guest: that is a large part of the issue whether so many vietnam veterans. we just need more people they serve for shorter periods of time, whereas in the volunteer force you see staff in the postwar era we have people who are serving for longer periods of time, which means you need fewer and fear to come in it out. >> host: nextstep, which states have the most veterans in them. here's a map in the united states. the darker the blue, the higher the concentration of veterans. which states have the most percentage? >> guest: that's right. the veterans are more concentrated in the western states, namely alaska, montana and wyoming. but also highly concentrated in certain states of virginia and maine. however with respect to the total number and where they live, the most popular states

have the highest number of veterans. namely california, florida and texas are all states that have over a million veterans. >> host: the next is a >> host: the next is a statistic on women veterans of the past several decades. >> guest: this chart shows since 1980 women veterans comprise a 4% of veterans in 1880 and 7% in 2010. and the next slide shows the composition in more detail. we can take a look at that. the dish is to prevent veterans -- percentage by age. so what is shows is among veterans age 18 to that 34, almost 20% of those veterans are printed for us if we look at those in the older age group, run 3% of those veterans are women. >> host: what is happening to demographics of the military? >> guest: statutorily, the number and percentage of women in the service was capped and

filled us in advent of the volunteer force, women could serve in large numbers and in fact, some that argue one of the main reasons for the success of the volunteer force is the open opportunity for women to serve in greater numbers. >> host: first call from fire at veteran. when did you serve? >> caller: [inaudible] >> host: and what time. what years? >> caller: it was from 1977 to 1983. >> host: tell us what you think this country owes you, if anything, for that service. >> caller: i'm not saying me in particular, but the people in iraq and afghanistan, there are people from the lower economic scale in this country and they serve voluntarily, fight the wars. the thing that bothers me is when they come back to this country they are not rewarded

with a job. they have benefits. i think the country does owe them that much. it's sort of a big discrepancy in that. we have a lot of legal problems in this country and there's a lot of veterans who -- [inaudible] >> host: let's talk about some of his comments. full ceballos is those who serve are from the lower economic establishment of society. is that true? >> guest: in some ways it is true and in some ways it's a little bit of a holdover from the vietnam era. people who join the military tend not to come from the elites in society. they tend not to be the 1% as we see these days, but the requirements about what it takes to serve in the military screens on people from the very poorest backgrounds who might not graduate from high school or meet some of the other

requirements. think the consensus of the military draws from the middle of good socioeconomic distribution. it's not the slightly lower end of that. so what is true, but it wouldn't say that we have sort of a so-called poverty draft where people are being coerced because of economic need to join the military. so i would start with that i guess. >> host: will use numbers to-gu. >> host: will use numbers to respond to this concern about unemployment. this is a set of numbers from the bureau statistics about veterans of employment. if you look at it overall with a .3% which is not very different than the national average. the liquid weekend to parse the number of able-bodied veterans at 7.9%. as a service connected disability 8.5. but if you look at where veterans from iraq and afghanistan, 11.6%. so hired by several points in the national average and one of

our number. if you look at young men who served in iraq and the afghan wars, 18 to 24, the unemployment rate is 29%. what is happening there? >> guest: is a really complicated story. i think it's difficult for veterans coming back to find a job. some of that has been argued to stem from the employers not being very familiar with widescale veterans might bring to the table. some people have suggested employers might be a little bit concerned about the kinds of traumatic experiences soldiers might have faced and how that carries into their lives as veterans. but the reality is that the young veterans, in particular, are having a difficult time finding work -- a more difficult time in their young contemporary peers. >> host: we mentioned earlier legislation and there is a g.i. bill the president to president obama mentioned in that clip.

.. james is a veteran from maryland. good morning. thanks for being with us. >> caller: thanks so much and for c-span and all that you do. personally i find the best thing the country can do for a veteran

in is keep the promises they make to each and every last one of us when we raise our hands and take the oath of service. in other words give a veteran his benefits. if he is a disabled as utter and don't make him fight for decades to get the benefit. they're in my generation which was vietnam. don't make them suffer like we suffered. give them their benefits and let them live. thank you. >> thank you. james brings up disabled veterans and the associated press has statistics. let's put them on the screen before the best answers about how they are treated in society. the total disability claims has risen from about just under 900,000 to 2008. 1.3 million disability claims in 2011. this note 35% of iraq and afghanistan war veterans are

seeking compensation for service related injury. >> guest: i am sure the numbers will continue to rise. stomach while she's looking media can talk a little bit about the disability process. some of the disability claims process i don't claim to be an expert, and in fact my closest contact us through my husband who is currently in your number two of the process to have the claim at adjudicated. it's a long and difficult bureaucratic process. the fda does provide five years of post subornation benefits to access the health care services, but that is sort of say holding pattern until the permanent claims can be established, and i don't know what the numbers are right now in terms of the backlog of the claims but it's

substantial, and it's taking a long time for the veterans to have the claims heard. >> host: it is attributable for the number of casualties or are there any other dynamics going on? >> guest: i would say there was in the claims largely dictated by people separating from service and starting the process of trying to get the benefits from the va. however there are still their veterans that claims with regards to exposure to agent orange. there are new cases of ptsd in the vietnam veterans going on today. so it is not simply a matter of nearly iraq and afghanistan veterans, but i would believe that that is where it is driving. >> host: jam on a twitter says this comment if you look at the list of the legislative proposals i'm not sure about passing on the benefits and less of this 50 to 100% of its connected disabled. you have the statistic about service connected disability.

help us understand what it's like. >> guest: first let me explain that the disability is. so this would be an injury or illness that is incurred or aggravated during the service and the disability is inside of the deer veterans affairs. the chart shows that among veterans in 2010, one in six of our veterans has a service connected disability rating and by age if we look at the next slide, this figure shows that veterans under 65 are more likely to have a service connected disability than the veterans age 65 and over. i do believe he was referring to some of the backlog from claims from the vietnam era, so even though the numbers are lower, the percentage is lower among those that are over, again, there are 7 million vietnam era veterans here so even though the percentage is lower, it is a large number of veterans.

>> host: do you want to add any more? >> guest: i think that is about right even though the percentages may be deferred, we saw at the beginning the number of the veterans versus iraq and afghanistan veterans tends to make the vietnam veterans still the typical veterans. >> host: linda, you are on the air. >> caller: yes, thank you. >> the military personnel there is one law that has been an unintended consequences as an active duty military person in a condominium we cannot foreclose on them from dimond emineth maintenance fees and the maintenance cover water and

sewage. they don't want to see this issue because amending that wall because they don't want to be seen as disloyal to the military personnel. >> i empathize with any individual who might be dealing with the unfortunate consequences of having somebody whose property might need to be foreclosed and isn't able to meet the payment if you are a resident and a sort of a group building like that, but i think phil law more generally were put in place to protect individual video depleting in the service of the country which might have economic implications for the families and to protect them

from having their homes for closed in their absence i can understand the individual frustration, but i think the policy itself is put in place to protect people, to protect our service members. >> host: i want to go back to the graph looking at the women veterans by age in 2010, and again, large number 18 to 34. as i put that on the screen and this came in from michigan asking can you discuss the special needs of women veterans outreach and gender specific services are key. >> i could say a little bit. i think women veterans have different experiences than male veterans in particular cases especially the exposure and experience with military sexual trauma with implications for the mental and physical health. the va has taken great steps to try to increase their attention to the women's veterans as they

grow, but women have different means especially if they've been exposed to military sexual trauma has the support suggests 30% of women in the military. >> we are going to tweet the same time looking at on the air the night before so you can spend some time with them if you like and get better acquainted with the members we are looking at. so if you are on the twitter list you automatically get them and we also put them on the washington journal home page so you can have some time to spend with it and we hope that will increase your understanding and to conversation in a different direction. next is a call from tennessee. arnold is a veteran of which war >> caller: i was in the navy during the vietnam war although

i was never in combat or anything. >> host: if you have to contribute to the program? >> caller: you for asking the question what can the government do for you, do for us and that brought to mind john f. kennedy famous code ask not what your country can do for you but what you can do for your country. i would like to try to do something for my country right now. my name is arnold joseph white and i have a web site where you can read and download for free a book that i rode into the web site is god is love got word of. i open and close my book with this quote. it goes when the power of love

overcomes power, the world will know peace. there is something in my book that has the power to do that and i would like to share this with you. there is another quote came from john f. kennedy. that was from his inaugural address in january back in 61 and this other quote from his address goes a long history of the world only a few generations have been granted the role in defending freedom and it is the our of maximum danger. i do not shrink from this responsibility. i welcome that. we need to try to bring an end to the war if all possible, and i believe we can if we would simply love one another. >> host: next is a call from massachusetts. jim is there and you are on the air.

go ahead, please. >> caller: i have watched the war since the 70's and soldiers get spit on when they come back. no fault of their own basically because of our government. if you want to do the veterans a justice is take some of these people better so-called leaders in government and in the going data mining for all this information how war basically started especially during the bush administration especially when they had meetings over energy companies and everything else. i mean, why are we sending people to go out for the war when i believe this last war was no different than another which was an inside job. basically nobody is going to jail when the steel from the people, steal from the banks.

industrial complex has got an even bigger. they are basically signing on everybody now. we have the patriot act, and nobody feels hopeless because it feels like they have no voice. if you speak of you might be deemed a terrorist. the soldiers are coming back with plutonium poisoning and everything else and i basically called one time to ask the gentleman that said he was going to take care of these soldiers and basically they are not doing anything. >> host: we are going to stop right there. >> guest: we know about traumatic brain injury and other things he mentioned. are we seeking medical conditions that are not familiar with this generation? >> caller: >> guest: i'm not familiar with any chemical exposure or the like. this generation, the signature injury is traumatic brain injury the foley had an official

diagnosis after vietnam. i think the number is about 1400 of veterans have had an education as a result in iraq or afghanistan, but i think that some of these new conditions take awhile to become evident to those who treat individuals, and one of the things that is awareness and some interest in for the brain atrophy as a result of traumatic brain injury and the kind of injuries which seem with sports players and i think that is an emerging area. "the washington times" on the front page today to see the photograph from arlington national cemetery, and this is matthew hernandez for carlos santos in arlington national cemetery it's an interesting time to look at the number of hispanics and other races and

the military so let's take a look at the charts that you have here. >> guest: the chart shows is since 1990's the population has grown in its racial and ethnic diversity. so the percentage that is white or hispanic has decreased about five percentage points between 1990 to 2010. the next slide shows in more detail the racial diversity. the next one shows the spending origin by age for veterans, and it shows that about the younger age groups they're definitely more ethnically diverse a month 18 to 44-year-olds about one in three are not hispanic whereas among those age groups only about one of ten are non-white or hispanic. >> host: here are the percentages for those of you at home may be the camera can get closer as we get these and the veterans groups, 18 to 34.

15% are black with the blue are 13% hispanic or latino and compare that to 55 age group which is 5% hispanic and 11% black or african-american. does that, with any issue? >> guest: in many ways i think it is nothing but a great thing for the country to have a military that demographically reflects the society that it serves. and there may be a difference between the socio-economic representation in the military, but i think it's an encouraging sign that we have racial and ethnic diversity that parallels what we see. >> host: on this memorial day weekend we are looking at the numbers of the veteran population. jason who is a veteran, good morning, jason. >> caller: good morning. yeah, i just wanted to call -- actually, i was calling about

the first caller. as i've been listening it's been kind of, you know, i don't know i guess what i called about has changed. what i really want to talk about was veterans or the benefits they receive when they come out. me, myself, 2000-2004 veteran, and, you know, a lot of my friends that have gotten out over time and a lot of people that i've met going to school there are a lot of people that are having a lot of trouble receiving benefits just trying to get their benefits, and then i also know the policies now are changing. they've been changing a lot. with the chapter 9/11 bill everybody thought there was gold in and now it's kind of making it even harder for the veterans to apply for -- not just apply

for but it's making it hard for the veterans to go to school, and i know that the money than you get from it is pretty good, but it's not -- you can't really live off of it so to speak if you want to become a full-time student it's hard to do that. plus deal only thing you get out of it is an associate's degree and a lot of jobs now require a bachelor's degree. now there's a lot of job offerings for veterans of there, but, you know, there are a lot of veterans. so they can't offer jobs to every single veteran. it's very hard to do so. >> host: what are you studying? >> caller: i'm going for associates right now, but i plan to get a bachelor's and psychology. i've been diagnosed with ptsd myself. i have a lot of anger issues and my wife is a veteran as well, and she's done -- she's done great taking care of me. we have three boys.

you know, we try to do our best. and i have a lot of friends that have ptsd as well. i have to take medication for. it's kind of -- you know, i used to get -- i used to get really angry when it would come to topics like this, but i'm just saying it's really hard for everyday veterans. we are from working class citizens. my parents, working-class people affected by economic hardships just like everyone else, and its, you know, it makes it really hard for everybody else to get back on their feet when they just keep getting knocked down. you get a chapter 9/11 bill comes of and everybody is praising it and it is really good you get a stipend, you get a housing allowance and what not, but in the and it's not really enough to survive. you could have family just a

husband and wife and it's going to be hard for them for the editor in to get the job of of an associate's degree that he's getting with the 9/11 bill. >> host: as he talking about that we will put that on the screen as we talked about it earlier, and we turn to our guest to talk to add a little bit of color to what jason had to say. >> guest: cheese in story in many ways is reflective of the number of a lot of the veterans coming home. we have a lot of policies and programs that are in place that are intended to help but sometimes the rules and the bureaucracy are so sick that it's very difficult for somebody who is coming home, somebody like chasing who might be dealing with some mental health issues from post-traumatic stress injuries. it's difficult for me to manage in my own life, much less manage it when you are dealing with a number of other conditions. the g.i. bill is meant to

provide students with 36 months of tuition with a livingston, which is essentially the pay equivalent to an e for, but many veterans are getting out of ranks higher than that before. so going back a couple of drinks to have the housing around and a stipend, you know, at a level that might have done to, to become a four years ago it's typical for families to manage in particular. >> host: this number looks at the federal educational attainment. jason was hoping to have a bachelor's degree at some point. tell us what this was. >> guest: so, what we find here is that veterans are more likely than the non-veterans to earn a high school degree than to actually have some college education. however, the veterans are less likely to actually complete the degree than the non-veterans. >> host: do you have a sense of why? >> guest: i think it can -- it

can have a lot to do with what kind of institution you choose to attend. >> host: starting the process leader come too? >> guest: family and life can get in the way. when you have the privilege of going to college from 18 to 21 or 22-years-old and you don't have other obligations it is easier to complete the degree that when you have family come a wife and children, sometimes their needs get in the way of continuing the degree. i would also say that different campuses have different levels of attention to service provided to veterans on campus, so i think it's important for veterans to look into the places they would like to attend college. >> host: august of 2011 the employed veterans with a disability works in federal, state, local government. as a, moving from the military service to civilian public service. let me ask that this statistic which looks at the number of the

veterans in the work force by a huge which is the loranne chart. >> guest: they participate at about similar rates. however when you look at it by age under 55 who veterans are more likely. over 55 they are slightly less likely in the labour force. >> host: there are less people the would be in the non-veteran groups to go to school or raising a family, so when you slice of the family it seems like it would affect the numbers somewhat. >> host: 55 and above starts to equalize again because more people are making decisions to retire at that point. >> guest: i imagine so.

that may well be the case and for veterans that serve, have served a career in the military if you enter that 18 or 20-years-old to might be able to retire around 40. so the veteran population may not be retiring early. next is a call from bernie a democrat in the colorado. thank you for c-span. i'm a veteran. i still on the committee in the denver va system in denver colorado building and 840 million-dollar veterans for somebody the would be the largest most complete diagnostic research treatment center in america for the veterans. and i would like to answer some of the questions that you don't seem to be able to answer. we are providing our jubilee the finest health care system, excuse me, i am a little out of

breath, 81-years-old and i was in the korean war. arguably in all of these ancillary services that the veterans are applying for from world war ii, korea and vietnam would you include everything from ideology which is the largest group to a traumatic brain injury, and then specialty care services improved everything that the private sector delivers. we are going to see 77,000 patients in denver in our facility this year. on the disability claims any boots on the ground in the vietnam war met during the period of indigent or range is entitled the disability benefits. it takes roughly six to nine months to deliver the benefits and apply for a benefit because i lost my hearing. in july of 2011i was awarded a

60% disability on march 1st. in the areas was paid to me and check immediately. the full amount was grandfathered, and i will begin to receive a benefit for the rest of my life which is substantial. i'm sorry. i will answer some questions if you have it. >> host: i was going to say thanks because we are four minutes from the program ending. so a new story for veterans in the denver color other region, what can you add to what he had to say? >> guest: dva offers the best quality care for the veterans that anyone can provide. civilian providers may not be familiar with the kind of issues and concerns other veterans populations. they are in many research studies have shown the quality-of-care provided by the va supersedes the in the

civilian society. so i think the story is good for the va in general. it's the bureaucracy that i think is getting the veterans connected with those great services. >> host: the few recent statistics about the moving into the public work force, and you actually surveyed that. >> guest: is we do and this shows in 2010 for the veterans and non-severance and what this shows is that for both veterans and on veterans' committee overwhelmingly participate in the labour force and in the private sector. however, that being said as one of the previous caller alluded to veterans are likely to be a participating employed in the government and that includes federal, state and local. >> host: this blue bar is the veterans versus the orange are. why is that?

as you look at the military to the civilian public-sector job. guess the question of having different pensions works itself out of the white herd discussions about that concern. so there would be a lot of hiring programs. >> guest: would that have a hiring preference? degette a pretty in the federal hiring depending on whether they have a disability and other circumstances. and then i think in many cases it is clear that the veterans have something to bring to the table in the veterans affairs, so in addition to the hiring preference or priority their skills are in the strawhat. go ahead, please. >> caller: can you hear me? great. absolutely. as you mentioned, a veteran. a vietnam-era veteran.

i wore the uniform of the armed services for eight years from 68 to 75. but more importantly fish i met my wife and the regular army and she loves the life. it's referred to as a regular army at my age i'm approaching 62 and at the young age of my colleagues out there. i have to do to other things with two other shows because the interest of light is far too

narrow. it would be great if you have a follow-up show on military families and said you have an all volunteer army. when i served we had a draft. it was more, very much like the world war ii are made and it is today, and it wasn't uncommon for the first sergeant to talk to who's having family problems and say that the army wanted you to have a life. >> host: you're other quick answer. >> caller: the military gap and the civilian gap. there's a report out that says 80% of our civilians have the military life experiences -- >> host: thank you reva sorry to cut you off but we have about 40 seconds left. do you keep statistics on

military families to look at that as he suggests? >> guest: we don't have the statistics today for you, but we might be able to use some of the surveys to produce the data. you can take the numbers and slice them differently than we did. the last product on the military get very quickly. i think it's a very important issue. i would like to see another program for people who are talking about the military gab. i think it is something like 1% of the american population today has served in iraq or afghanistan that means 99% haven't necessarily been directly affected on the war. we'll proceed once again america looking at the number of the size for the veteran population. thank you for your information to the viewers.

there's been a lot of books written and most of it is the people that talk to friends of friends of friends.

they really don't have the information itself. she tried to put me to the test many times and i did my best to meet that.

vice president jo bonner bogden spoke part of the weekend memorial day. he's joined by his wife and joint chiefs chairman martin dempsey at this event hosted by the tragedy assistance program for survivors also known as taps. this is 45 minutes. >> a philosopher who once wrote that friendship and proves happiness and of its misery but the doubling of our joy -- >> we can't hear you -- [inaudible] >> i bet we have some technical folks that can fix that. [laughter] all right.

how's that? not yet? ironclad this is happening with me now. how's that? great. [applause] i wanted to share a favorite quote. a philosopher once wrote that friend should improve happiness and a bates missouri by the doubling of our jury and the dividing of our grief. you are loved. america remembers, and through taps, we are now here for each other. i'm bonnie carroll the president and founder of taps, and this is our family. a family we never wanted to be a part of, but i can't imagine a

more patriotic, more passionate or broader group of americans than to be with this weekend. thank you for being here. [applause] well, we've come together this weekend with a lot of support and a lot of hard work, and i'd like to welcome our amazing partners of the new york life foundation and at operation hero. please, stand-up. [applause] this is our time and we are all married to have special guests with us today to honor our loved ones and offer words of comfort. taps is very proud to be part of the white house joining forces

campaign and to work closely on a regular basis with the first lady and dr. joe biden. we welcome the chairman of the joint chiefs and his wife as friends and tireless advocate for the families of the fallen. ladies and gentlemen, taps families, it is with prada that i introduce our friends, vice presidential latent, dr. bert jul and accompanied by the chairman of the joint chiefs general dempsey. [applause] ♪

>> thank you for the kind introduction. and good morning everyone. i want to welcome all of you to washington, d.c., and i hope you feel right at home while you are here. i am so honored to be with all of you. memorial day is just a few days away, and if i can say one thing to all of you and your families, is thank you. you are our heroes. i have been truly overwhelmed by the bravery and courage of our men and women in uniform and inspired by the dignity and the sense of patriotism that military families like yours exhibit everyday. each of you like our service men and seven and families have dedicated so much to your country, and we are truly honored by your sacrifice. it is our sacred duty to honor the service of those that have sacrificed for our country and

america thinks you. our thoughts and prayers are with all of you. this weekend, on memorial day, and every day. now it is my pleasure and honor to introduce general dempsey, someone along with his wife has done so much to support our military families. general dempsey. [applause] >> thank you. you're free kind but we are here to honor do this weekend as we do or try to do every day of the year. i want to thank the vice president and dr. biden for being here. we get to share the stage with them on many occasions.

many events like this for families of the wounded warriors, and i can tell you that their heart is exactly where you would want to be on these issues so it is an honor to share the stage with you again. i like to tell folks a little about this day in history because it helps us connect to our past so this day in history in 1986, you might recall the phrase hands across america because 6.5 million people from battery park and new york city to long beach california, they were doing it in the name of homelessness and hunger. but i think about that in terms of what taps because what taps does is linking hearts across america. i know you have a special place in your heart for taps. we have a special place in our heart for the founder of taps continues ago tried to link parts across america.

how about we get it around of applause to bonnie. [applause] most americans have not had the life altering experience of being handed a folded flag, but those of you in this room have. in many ways you are the face of the past decade but even prior to that. so, what we want to tell you today is that your example truly does inspire us that we understand and honor your sacrifice and what you've done for your nation and promise you that we will never forget. i just had the privilege to go spend some time with your children, and by the way they are an unbelievable lunch, good-looking kids, now i know why they are so good looking i guess. [laughter] there are some mentors in the

room. each of them as you know has a soldier, sailor, airman, coast guard or veteran mentor, so it is the highlight of my year. i was here last year and buy back again. i told her i won't miss another one of these for as long as she continues to invite me. [applause] so we are with you. i promise you that. ladies and gentlemen, i now have the privilege and honor to introduce a man who epitomizes service, sacrifice and support for the military families. the vice president of the united states, joe biden three [applause] thank you.

i am jill biden's husband, joe as i know here in washington and our household. [laughter] general dempsey, i've been around washington for a long while, and i was one of those folks to call it chairman of the foreign relations committee for a long time. and i have gotten to meet an awful lot of incredible military personnel, and some remarkable women and men who have worn the uniform. they all have different qualities. i want to tell you just for a second about why i like dempsey so much and why i like speed even more. i really mean this. these guys get.

you're not a number, you're not a soldier or a soldier's family. these guys wear it in their heart. i've been with them when we visited bases where some of your heroes have fallen and watch and watch how she responds. i watched the general, he's a tough guy. better watch him. you can almost hear his heart breaking. there's something special about both of them. and i guess you know what, too. but what he says is he will be here as long as he is invited. he really means it. he's not here because it is his job as the chairman of joint chiefs of staff. she is not here because of that. if you saw his family -- by the

way, his children serves. they are in harm's way right now. [applause] >> i watched them talk. we don't have the military history that they do with our son spent a year in iraq. [applause] when he came home, it's going to sound strange to you and maybe anybody but this audience. we felt almost a little guilty because he came home,. because there's so many funerals i attended, so many bases i've visited. and you know, not all losses are

equal, not all losses are equal. what used to drive me crazy, i could be wearing one of those red shirts. not for the military but when i was 29-years-old and got elected to the united states senate out of nowhere on november 7th. and i got a phone call like you guys got, someone walking up to me. december 18th i was down in washington, the first united states senator i ever knew. i was in washington with my staff and i got a phone call that my family had been in an accident, and just like you know by the tone of the phone call you knew, didn't you, you knew when they walked up the past, when the call came, you knew,

you just felt it in your bones something that happened and i knew. i don't know how i knew, but the call said my wife was dead, my daughter was dead in and they weren't sure how my sons were going to make it. there were christmas shopping and a tractor-trailer world cited them in one instant, killed two of them and, well. but i have to tell you i used to resent -- i knew people knew well, they would come up to me and say joe, i know how you feel. [laughter] [applause] i knew they meant well. i knew they were genuine but they didn't have any damned

idea. [applause] that a black hole that you feel in your chest like you're being sucked back in, looking at your kids and most of you had kids here, and it was the first time in my career in my life i realized someone could go out, and i shouldn't say this with the press here -- [laughter] but you are more important. for the first time in my life i understood how someone could consciously decided to commit suicide. not because they were deranged but because they get into the top of the mountain and they knew in their heart they would never get there again. there was never going to be that way again. and by the way, the moms and

dads, no parent should be predeceased by their son or daughter, and i unfortunately have that experience, too. but, you know what? i was -- i don't know about you guys -- but i was angry. man, i was angry. you'll probably handled it better than i did. i really mean it. i was angry. i -- not that it's relevant what religion -- plan a practicing catholic and was a practicing catholic up the time, but i was mad at god. i remember being in the rotunda to go to the plane to go to

identify -- anyway. i remember looking up and saying god -- i was talking to god myself -- you can't be good. how can you be good? you probably handled it better than i did. but i was angry. and i have a great family. this woman literally saved my life five years later. but i have a great family. my mother, brothers, sisters, my best friend in the world. they were all there for me. there's still something gigantic missing, and some of you the loss occurred two years ago, some of you two months ago.

just when you think maybe i'm going to make it you going down the road and pass a field and see a flower and it reminds you when you hear the tuna radio you just look up in the night you think maybe i'm not going to make its because you feel at that moment i got a phone call from a guide was a much older guy than me he was a former governor. [baby crying] that's all right chinese to babies. you don't have to worry about it, for real. what happened was i got this call from someone out of the

blue from a former governor of new jersey. i'd never met him but he said, you know, called to express my sympathies. i know what it's like. i felt like saying you know -- he said no, i know it's like. when i was attorney general i lived across the grain in trenton in the state capital from my office. i was attorney general and i just go home for lunch every day. one day i'm walking across from launch its only a block away the woman that can to help me once or twice a week came running across the green and she said attorney general, your wife just dropped dead. he said i remember what it was like. and i started listening. he said you know what helped me? he said -- and for what it's worth i recommend it to you -- he said start to keep a calendar. keep a calendar. and every day when you go to bed every day when you go to bed market in that calendar whether

the day was one, which is as bad as the day you heard the news or ten. he said you won't have a tan for long time, but measure. just marked down. and he said after two months take out the calendar and put it on a graph and you'll find that you're down days are just as bad as the first, but here's what happens, they get further and further apart. that's when you know you're going to make it. that's when you know you're going to make it when you realize the measure of your progress, you mothers, you father's coming you husbands, wives, brothers, sisters. that's how you know. that's who you know you might make it. and all of you, i don't know all

of you, many of you, kids and grandkids in the of their rooms, you know as well as i do that the need you. you know what most people don't understand you need them more than they need to. you need seven more than they need to. my mother, sweet old wonderful irish lady said something at the time the accident happened and i thought it was the cruelest thing that i cannot identify and -- anyway, she said joey -- she adored my wife and daughter -- she said joey, with everything terrible something good will happen if you look for a good enough. i thought what a cruel thing to say. really, i did. you know you're going to find out? your relationship with your son or daughter, which is already close, is going to be like a bond of steel that runs through

your chest and there's and perhaps you together. you'll find the brothers and sisters they will be each other's best friend their entire life. everybody's friends of their brothers and sisters. there's a degree of difference in death of the relationship you never thought could happen. and i'm going to see something outrageous. i was a good and caring father before the accident -- in the bazaar whey is almost harbor for the parents of our fallen heroes because the parents never expect to have a child predecease them, never. the irony is jill is the most

incredible woman in the world and when she makes up the resources on december 18th and we have a special mass for the grave site and chill on mother's day walked me out to the cemetery for the flower cybercrime, and she brought the favorite flower for my deceased wife and daughter. what happens is that there really is hoping. the aching in the back never goes away, but it gets controllable. when i ask jill to marry me -- i realize this is personal but it's important to you i hope -- i had to ask her by the way five times. [laughter] by the way, that is not a joke. that is the god's truth.

five times. [laughter] finally, five years after the accident, five times. the last time i came back i went to the apartment, came back from africa as a trip as a senator and i said you have now engaged my private. this is the last time i am going to ask. she's at the door, didn't walk in. she's holding the door. i said it's the last time. let me say to you, i'm going to ask you, don't say anything, i'm going to ask you will you marry me. you don't have to tell me when. [laughter] you just have to tell me if. and if you say no, that's it. she looked at me and said yes. then she later told my sister when asked why she finally said yes, she said i still in love with the boys. [laughter]

it is too soon. it is not reasonable, it is beyond their expectations. it is awful feeling of guilt. but just remember to things and keep thinking what your husband or wife would want you to do. keep thinking what it is, and keep remembering those kids of yours are him or her the rest of their life blood of my blood, bone of your bone. folks, it can and will get

better. there will come the day i promise you and it's your parents as well when the faults of your son or daughter or husband or wife brings a smile to your lips before it brings a tear to your eye. it will happen. my prayer for you is that they will come sooner or later but the only thing i have more experience in you is this and i am telling you it will,. you have one at a vantage. how can you say i have an advantage of anything? you have that incredible thing called a military. you are not alone. just sitting around the table people you didn't know before. being able to share what is it like, how do you put them to bed and say your prayers, what do you do when they ask about?

that's why i think that as i said coming in that's why what you've done is so critical. most of us go through what you are going through totally alone. and after a while it doesn't make any easier or harder. after a while you get tired. you feel like you are relying on your family too much. like i can't say to my mom, can't say to my sister who helped me moving to raise my kids i can't say to my brother it's about time, i've got to get if you have somebody to talk to. for what it's worth and i'm no psychologist or psychiatrist but i sought help on how to help my kids and you have that advantage as well.

it became solis for me to talk to people i didn't know but they said they've been through it. i would call to say you can make it. so hold onto each other. hang on to each other. i can't tell you how deeply the five of us on this stage field about the sacrifices he's made for this country. that doesn't tell the black coal by you should know only 1% of du fought the war and much less think god than 1% that fought are going through what you're going through.

we owe you more than we can ever repay. as i said, my prayer is that that smile will come sooner or later but i promise it will come. god bless you all and may god protect our troops. thank you. [applause]

[inaudible conversations] [inaudible conversations] [inaudible conversations]

[inaudible conversations] [inaudible conversations] [inaudible conversations]

>> feature message from the heart. thank you so much to our special guests. [applause] we are honored to have such special friends as the chairman as life and vice president and dr. joe biden. they truly come as you can see from their words and presence

with us here today and their hugs and words of encouragement how much their heart go out to each and every one of us and how much they truly know and understand and bear with us in a support us and we are just so pleased to have been lucky to have them join us today. sit thank you very much against our special guests. [applause] it is now my pleasure to introduce a lady that most of you know. she is a person who has been part of the family since its very inception. she comes and gives us her words of wisdom, words of hope, words of a shared journey and her laughter and humor. she is truly a friend, a dear, dear friend of top and we all

love her so much. it is my privilege to introduce to you now, back to her darcy since. [cheers and applause] >> i will tell you i've never had to follow the vice president. [laughter] forgive me if i'm not a sparkling. how amazing for him to come and share his story. he truly is an american. he truly is. so we have a couple of minutes before lunch i get to fill in while they are picked making the

sandwiches. thank you all for coming, for your courage, for your patience today, for putting up with some of the extra stuff that has to go on when we have this very special guest. the military daughter. i'm a military wife. i am a military mother. and once i live the american dream as you did in that dream was shattered once, twice. and a very long time ago, 36 years ago when our son died, there was no support group, no books. we were told to be strong and when you walked out of her quarters, gross, you will have a smile on your face because it wasn't acceptable to talk about it. i learned early on that the grateful wait for us. i will wait forever for you in a

very, very grateful that now we have a family. we thank you for coming and even though you're going i don't know if i'm going to say. i give it another 10 minutes and then maybe i'm going to go. please give us another 10 minutes. please give us the next hour and the next day because every single person in this room has been where you are now. everyone of us us who wears a red shirt as been where you are now and we didn't believe we would be here again and again. ucs hugging each other. it's a family reunion and that's what this is. this is our family. so my opening speaker will give you a couple ideas on how to survive the service so you can create irregular and a couple. the first is have a little

patience. have a hug. i have goes a lot further than harsh words with each other. hug each other a lot. give yourself permission to be here. you need a pair of track shoes if you've are to read the schedule. however, you don't have to go to everything. pace yourself. sometimes face down or sitting on a chair and am i been sitting for a second. but every workshop you think sounds good and i will tell you on behalf of all the speakers here it returns out to not be the right workshop, get up and go. just go and say that wasn't what i thought it was. it wasn't wearing them today. and every speaker will be okay with that. this is your time. do what you need to do to shield. bring a little patience. you prepare for all of the emotions that we've got. all of them. we come sometime with the heart

is heavy at this year. sometimes we are quite sure we have a heart left. you're going to need a lot of kleenex. or perhaps kleenex is an enough because what i've learned over the years they put a box up there for short people. what i've learned over the years since this is an enough. have you ever notice that it's donated tissue, we actually say may i borrow? you want to bury tissue? yes, thank you very much. here come out of that. but i learned a lot time ago if they will give us one. there you go. hope you're over that soon. [laughter] it's been three or four days. you have to be better by now. did know but the third or fourth day is worse.

we were so numb in the beginning we had no idea what it meant doing. as we go through the weeks and months of early grave, it almost seems as follows for assignment of freston and it does feel worse. so we're right and we need to be. when are we going to do a? soar fear of prior like me, i'm a professional crier. i figured out a long time ago it had to carry 30 or 40 of these packs glued all over me. or every morning go in the bathroom and get the toilet paper. now i loved them. i love them as such. all you have to do -- you know i'm going to do this. you just stick it in your pocket and out you go. now is anyone going to notice? everyone is going to notice that. are they going to say something to you?

no. how do they know that? as we have all seen so much on the back of the issue and none of us say anything to them. look at that, look at that. we don't say excuse me descending on your shoe. so no one is going to say anything to you. if they do look at them and very kindly say very clearly, i'm bereaved. and nobody knows what that word means. so they're going to go okay. [laughter] that's fine. and if they continue the conversation, just look at them in a i'm prepared and i've never had anyone go further than not. [laughter] cry if you need to cry here. laugh if you can and you learn you can do the same. if it's dishonoring are the funds to find joy again bored i hope not. in fact you can do no less.

a few other laugh with your husband or wife or son or daughter or mother or father or brother or sister or aunt or uncle or grandparent or battle buddy or fiancée, if you ever have a laugh at them come you can do less than bring it back. if you know your choices in this world come with oocyte choices, who do marry, what should we do and then we have other choices. do you want to marry them? and then we have other choice is. while a two-week this morning? do i want to breathe today? what am i going to do with this stuff? if we have even more choices and some of you have the choice can i say? cannot do the same group of people that have toilet paper in their pocket? why do you choose to bring what do you?

what do you choose to remember? you can carry anger and hurt and bitterness for the rest of your life, or sometime i want you to always remember they live. you can choose a good memory. you can choose joy. you can choose gratitude. you and i are last beyond any measure we could count because someone walked into our life whether they want to and are reborn into our life, and they snuck into her life. we have no idea how they got cured with all hopelessly and madly in love with them and are she's glad we did? i wouldn't have missed a moment. i think they truly believed in the world are those who have never known love it all and you and i in this room reach beyond measure because you and i lived in we love them and we still do.

we did not lose them. we did not lose them. [applause] they are forever and always rapier, right now. we talk in the present tense in this term because they're still here. it's what makes the tears come down her face and then we hope someday we bring a smile to your face. please stay, family. please turn to each other. please find that hug that is waiting. please find that handsets waiting to reach to yours. go find people wearing shirts. they are believed to have been here long time and taken special training and are willing to reach out to you and to set all night if we need to add to cry and to sing it to dan. not in sadness, but ingratitude.

and gratitude for somebody loves me that much. they died, but i didn't lose them. and neither did you. change the language if they died. it's hard to say, no matter what she believed religiously or spiritually, no matter where you believe they are, they are right here, right now. to wrap around us in the darkness of night. never to be forgotten. choose anger for now. she's depression for now, choose joy for no. choose to breathe one more time because you can do no less than honor our loved ones.

that's what brings us here. relinked not be the death of someone with a. you and i are links to the love of someone we still love is in this room. i want you to spend the weekend telling your death stories. we have workshops. i'd like to tell your death story and tell you are through with it. and if they take months, if they take years, but when you see me in the hall this weekend and which tell me your life story? would you pick a moment that makes your heart circle? if you can't tell me anything else on the color of your country in their eyes. it's been a very long journey for me. and i finally choose joy every single moment. i am forever blessed because i have been loved by a little boy

and an old man, a general. choose joy. so right now is her getting ready to start our weekend, what you just reach out to the person next to you and connect with hands, just hands, wipe your hands off. wipe your hands off. and we now in this room are forever laying to the love of our husbands and wives and sons and daughters and brothers and sisters and moms and dads and grandmas and grandpas and aunts and uncles and best friend and fiancée syntaxes and all of the people who dance across the rainbows ahead of us. we are in this room now a family circle, broken by john at, amended by love. i am so glad you are here as those sorry we'll have to be,

but i choose was. join me on that. welcome home, god's family. you're in the right place. welcome home. [applause]

>> life is incredibly precious and passes by far too quickly. so during your time here come the cell of your unique god-given talents to serve one another as that will be the true measure by which your life will be judged. follow the golden rule. veterans of amputations and prosthetics. va officials and veterans testified at the three-hour hearing chaired a new york republican and marie buerkle. [inaudible conversations]

>> good morning. the subcommittee will now come to order. good morning and welcome to states that committee on health hearing optimizing care for veterans with price tags. our nation's commitment to restoring the capabilities of disabled veterans struggling with combat ones resulting in the loss of limb began with the civil war. restoring these veterans to wholeness was a core and the taste behind the creation of the department of veteran affairs and now continues to play a vital role of the department's mission. prosthetic technology in va care have come a long way from the civil war era. wooden peg legs and simple hooks following world war ii 1945, veterans dissatisfied with the quality of the apostate i care to storm the capitol in protest. congress responded by providing the va with increased

flexibility and launching federal research into the development of new mobility and assistive devices. with these reforms come the va let them in prosthetic care and research guided by dedicated professionals both inside and outside the department who worked tirelessly to provide veterans with the quality care they earned and so much deserved. as a result the model of the va care today for today's veterans include leading-edge artificial limbs and improve services to help them regain mobility and achieve maximum independent. still, the magnitude of the heartbreaking injuries sustained by by service members returning home military service from iraq and afghanistan find the va to keep pace with the rising demands of younger and more veterans but for amputations. prosthetic care is unlike any other care provided by the

department. prosthetic device is particularly prosthetic limbs quite literally become a part of their owner, requiring the integration of latte, mind and machine. the goal is not just to teach amputees to walk or use an artificial arm or hand, but to provide multidisciplinary continuing care to maintain long-term and lifetime functioning and quality of life. which is why i am troubled by the department's proposed changes to press at a procurement procedures. the forthcoming reform vote among other things take prosthetic purchasing authority for an prosthetic and transfer them to the contracting officers. this is alarming to me as we will hear soon is also alarming to many of today's witnesses. i would like to read a quote from captain jonathan pruden, he

wondered where he himself is safe in his testimony that we see no prospect that this plan to change and procurement holds any promise for improving services to the warrior. instead, almost certainly threatens greater delay and pas ability to provide severely wounded warriors needing prosthetic devices and heightens the risk that a fiscal judgment will override a clinical one. i think the members of this committee agree a lot with many in the audience this morning we cannot allow this to happen and this morning we look to the department for assurance that it won't happen. it is nothing short of inspiring to see how far modern type knowledge he and most importantly this. , kurds and resolve over veterans themselves as calm and restoring mobility, dignity and hope to our nation's heroes and they are our heroes and this

nation does send instead of gratitude to make sure veterans have exactly what they need to survive, thrive and have a quality of life. it is vital that we set va prosthetic care in a course that matches the courage and bravery of men and women who serve our nation in uniform. again i think all of you for joining us this morning. i now recognize the ranking member, mr. michaud for any remarks he might have. >> thank you, madam chair and like to thank everyone for attending this very important hearing we are having today. the purpose of today's hearing is to look closely at va's prosthetic services and examines the demand for this service is in the quality of care and access issues, the impact of ongoing procurement reforms and four, if current acquisition and management policy are sufficient as the three office of inspector

general reports have shown, there are numerous concerns including the frequency of overpayment in the nearly quarter of the transaction totaling over $2.2 million in fiscal year 2010. the absence of negotiation price guidance and other controls and the limited information access if current prosthetic limb fabrication and acquisition practices their effect gave. i set it on this committee before, but which seems to be a case that there is a little accountability and management and once again procurement and procedures and policies were not in place or not solid and managing nearly $2 billion worth of prosthetics and sent 30. the va and last year's budget mission and claimed that

$355 million in savings in fiscal year 2012 and 2013 due to acquisitions improvements. but at the va can't follow its own policies and procedures, how much faith can we have been the claim of acquisition saving? i hope the va can help us understand today what accountability we should expect and to make certain that the va does not continue to overpay for prosthetics in the future. taxpayers and veterans reserve the best value for the devices and for management to ensure that the prosthetics incense or a service is a meeting veterans needs. finally, i've come to my attention that va has proposed changes in the procurement of prosthetics and that there is a high degree of concern among some of our witnesses today as

to the effectiveness of these changes. i look forward to hearing from the va on these issues as well. i would like to thank all of the panelists for coming today and want to thank those of our panelists who are veterans for your service for this great nation of ours. i am committed to working with all of you to ensure that our wounded veterans, those who have served honorably and made such great sacrifices they're able to go about their lives more comfortably with these devices and with the best support and services from the va possible. so i want to thank you once again for coming today and thank you for having this very important hearing. i yield that. >> thank you, mr. michaud. as i turn better first panel. join us or john register and jim monier. -- mayer.

mr. register as a veteran of operation desert shield and desert storm and the world class that late, but a ninth gold miners in the armies armed services competition. in 1994, john suffered an injury that but to the amputation of his left leg. undaunted and with the aid of a prosthetic, john went on to many silver medal in the 2000 paralytic paralympic games race at the american long jump record at a distance of 5.41 meters. he now works at the olympic committee where he manages the paralympic academy youth outreach program and the paralympic military program. we also had the privilege of being joined by mr. chen mayor. mr. mayor service infantry men in the united states army during

the vietnam war. he's a combat disabled veteran and a bilateral polyphony amputee. after serving honorably, mr. mayor has devoted his life and career to assisting his fellow veterans, working for 27 years at va and 12 of their veteran service organizations. perhaps most of us played he spent 21 years as an amputee peer visitor and mentor at va and the walter reid medical center. and now at the walter reid national military medical center where he's affectionately known as the milkshake man. gentleman can i thank you for your service to our nation and for your continued service to your fellow veterans and many worthy and diverse today. but you're truly inspired to all of us and it's really an honor to have the where with us today. i very much look for to hearing your testimony. mr. register, you may proceed. >> thank you very much, i know

the milkshake man. thank you for this opportunity to testify on veteran affairs to deliver state-of-the-art care to veterans of the amputations. today i'm testifying on behalf of myself and the board of directors with the nation on third advancement of orthotics and prosthetics on the national association that promotes public policy and interest up orthotic and prostatic providers who serve them. i served fcc's earlier and desert storm injury happened may 17 come in come in its 94, some anniversary is tomorrow at the pentagon, where a friend of mine actually found photos of the accident, so i just have them in my back, so i'm stressing out a little bit right now seeing those photos again. it is remarkable that the

prosthetic care and that's what i'm going to talk about a little bit today. i did go back after my injury and went to the paralympic games in 2000 winning the silver medal. i currently now live in colorado springs and begin my initial carrier at the amputee clinic in denver va hospital in colorado springs for me primary prosthetic care. i thought at the process for two reasons. secondly they understood the hype level activity that i'm accustomed to. this is done in no way to despair the care i received at the denver va. when i first was an amputee, i came to walter reid and also the va hospital right here in the capital region and had outstanding care. in my experience i was treated with dignity and respect. after three ba hospitals have been fortunate to work with finding the process is typical in the prosthetic care. just a few years ago 9% of limbs

were provided by a private prosthetic petitioner under contract with the va. understand has decreased after it has invested internal capacity to say to fabricate limb prosthesis. i've developed a close working relationship with a local process would like to continue seeing him and the process has certified and accredited by two agencies come in the va recognizes and requires. my local prosthetist and time is seven minutes from my house and has assigned the va contract to provide that care. the ongoing care received was high quality and very convenient creed and little disruption for my current job, family and lifestyle. i develop a new prostatic coming out and began to be interested in the new technology in the va hospital when i went to go see them for the cons will in order

to get the lens fitted. the new technology would need a my prosthetic needs and increase and i began to meet the bidding process at the denver pa, driving 70 miles each way to receive prosthetic care and i could have just gone down 70 minutes for my home to get that care done and it was also later realized that was my fourth or fifth visit i could be reimbursed for gas miles. that's something i wanted to get out of my social networks. i traveled to denver numerous times and before i finally received my new plan, which i'm wearing today and i'm really thankful for. every time i need adjustments are servicing the prostatic coming mistake the better part of my day off work and pay my va care at the denver va you can. great care there. not disparaging now. it's just a bit of an inconvenience. i have no complaints about the

prosthetic care they receive. i am very fortunate were invulnerable and not uneducated. i'm not a position to advocate simply and accept what they're told about the prosthetic care in options. veterans day think that the rights they have dished out a choice in the prosthetic practitioner come a choice of technological opposites and seek an option when it's desired by a patient. passing the legislation like h.r. 805 and the veterans bill of rights i think it's critical and i reviewed three reports recently issued by the office of inspector general in that general observations to laugh at the committee. the first is that the 1.8 billion spent iba prosthetics in fy 2010, only 54 million or 3% for some prosthetic limbs and these are of a small portion dollars spent by the va on a category of

prosthetics. the va has a major investment internal and prosthetics capacity and to does not development of the amputee system of care program they should be commended for commitment and focus on important population. the report also notes high satisfaction levels of lower limb prosthetics and blessed the upper extremity and we agree with the oig that the va should improve on this population requested p8 to publish the report on upper limb research associate at the research conference held two years ago. an aop takes issue with the calculation of the different different than what it asserts that the cost of the vat provide prosthesis to veterans and the report says that on average for the average cost is $900, this

is a suspect calculation of the true cause for prosthetic care on what to note the costs the costs are associated with those that went into that report. as the va enhances the capacity is important to recognize the legitimate goal we have provided provided prosthetics are to veterans for decades under the va online with the prosthetics and the preserve quality by allowing their choice and provider relationship between the process, especially myself going to higher-level competition and wanted to have a higher quality of life. and i think the last two points is that it's important to maintain access to local prosthetics to conveniently service veterans and this is way the end double 80 p. the va

addresses concerns with the approval process for fee-based and contract for prosthetic services to meet the needs of amputations. we asked the committee to consider subsequent legislative. passage before the committee that seeks to address the very issue, ahr 805 and injured an amputee bedouin country bill of rights. i want to thank you, none of chairwomen and the subcommittee for examining this issue in a thank you for the opportunity to testify before you. >> thank you very much. mr. mayer come you may proceed. thank you for the opportunity and the kind words in your introduction. i really appreciate that, man. i obviously, like john, i've received a lot of prosthetic care. i received it from the va, for brooke army medical center, walter reid and the air.

in reference to my peer mentoring and peer visiting amputees at walter reid over the years, i have gotten to know the current warriors and their families, their concerns. in short, i think i understand the catastrophic injuries they have overcome through military rehabilitation. i understand being at their bedside and also in that hospital bed myself. as of may 1st, there is 1459 amputees -- i'm sorry, warriors of amputations i should say. but care for those warriors is at the very core of the va's mission. it is clear that the prosthetics today is at a crossroads. dh and he has a chance to regain his leadership role that she referred to in the excellence in

this field of prosthetics provision in amputee care. but the current direction in recent decisions involving prosthetic care suggest that the veterans health administration, vha is about to further compromise the stability to serve these veterans. in 2004, eight years ago, secretary principi testified before the committee to va and his opinion has lost its edge and prosthetics and it wasn't doing enough to ensure the va does that world-class prosthetic care and rehabilitation programs. his primary solution at that time was to build a quote from the center of excellence in amputee research and rehabilitation. secretary principiis worth a few years ago still ring true today, but the number of four years with amputations has since increased by over 900%. in 2006, congress revisited the issue and propose legislation to

create five such senators through the leadership from the vha opposed the bill and legislation guide. in my humble opinion as a result, some of the history that the last to find help leadership position in prosthetics and was eclipsed by dod. since 2006, dod has not established just want, but through amputee centers of excellence, which are holistic and care. the warriors they receive world-class care and when they are no longer in active duty, they're going to have to turn to the va. in my opinion, is the house to ensure the expertise is necessary to continue the level of clinical care the warriors have been accustomed to in the military and the va said minister process guarantees timely care. i want to reference your remarks, not in chairwomen, about transferred unwanted prosthetic purchases within

prosthetic services and the va to acquisition to supply. i totally agree. i think the potential wait times because of lack of knowledge on the supply side about prosthetics as if this were both purchased item, i probably wouldn't be worried about it, but john and i know that when prosthetics are delayed, it's not a wait time. it's an inability to function in my life or to thrive in life. i want to couple that with i understand that va is moving towards decentralizing the funding for prosthetic purchases. this is an issue that was sold over 20 years ago by centralizing her fencing off those funds so vocal va medical direct heirs could not use the money for other purposes. 20 years ago veterans were delayed to the next fiscal quarter for the next fiscal year because the monies were used for other purposes. i would like to summarize by

saying but i think needs to happen but the va right now. it is time for them to suspend the decision -- their decision on vha transfer of the prosthetic purchases to supply appeared also to trap any discussions that decentralizing funding. at the same time his temper full-scale evaluation by more impartial body such as ba staff as the policy planning and post stakeholder codeword on that effort. i kind of list is in a written statement. and have that effort report directly to the oversight of secretary should psyche. to me he has shown he has the ability to take tough issues and decide what's right for the veterans. thanks for the chance to be here. >> thank you very much. i give myself five minutes for questions. i'll start with the procedure entry committee received care both from the dod as well as its

va and you mention it in your opening statement. can you compare and contrast the services? how it should say one west versus the other either positively are negatively? >> yes, i will. i think i want to clarify when i went to the department of defense at walter reid, this was before all of the new bells and whistles at the amputee care because it's extraordinary with the servicemembers have. and so i would've likened ben pretty much the same. they were almost on an equal basis. i have prosthetic limb they made their announcement of ba and the d.c. area. i had no issues going between either one or the other. i think when it came time for understanding a higher level at cavity, i found both lacking in that knowledgebase, so i begins seeking about to become the

world class athlete again in the united states and around the world and that their people were walking for actually running on. that's when i started looking at who needs to begin to align this thing so i can run at maximum time period that i found outside of both the dod and the va system. in fact, some of the expertise is so critical that it went all the way to california from virginia to find one prosthetist who knew how to get me correctly. if i didn't get that person i would not be a silver medalist at eight and that's the point of fact. from that ongoing care right now again, it was more the inconvenience and it is for what i see. but i do see having been down to brooke army medical center in san diego, california and at walter reid that the care is exquisite and these individuals coming through are looking to

get back into the site and go back into their units. that is the same level high activity that i've was lacking and they are now receiving to go back and do those things. antes are back in the fighting going on to higher employment and being with their families and that is what i see as the difference. >> thank you. mr. mayer commie type about the fact that va has lost his leadership position in prosthetics and i would like to know if you can maybe identify or help me understand when and how va lost his premier status and military took that over. >> i'll try it. i had the pleasure of being the first staff committee manager for the first prosthetics advisory committee in the early 90s when secretary dubinsky brand that va.

i didn't have a vote. i just took the nose had organized the agenda. the burning issues of today are already being considered by vha. my quarrel is not with the ps asl employees and their ability. they are professionals. they do a good job. my quarrel is that the more senior ranks of vha management. it doesn't matter who is there. culturally and i understand you motivation because of budget reasons they look for flexibility at the local management level. prosthetics monies and procedures are a very interesting, large target. that is how i would summarize it. >> thank you. mr. register, and your testimony talk about different needs depending on whether it's an upper body or lower extremity. can you talk about that with

less than with less than many as you see them are different? >> i think what on x and opera nor extremities comment the use of getting a hand function back as one is pretty critical. if you look at how that's come and developed over time, it's really amazing to enter crises that the upper bodies have with getting that limb function back. with lower extremities, it's a matter of just walking and functionality of the land. it's kind of comical what is inside of the would've amputees, polyphony amputees would have done a brooke army medical center come for example, below knee amputee senate does have a race going it gives each other were for about an entity is called below the knee amputees paper cuts because they don't have their knee. i think it's a matter of functionality and walking again and getting back up right with

that, whereas with arms we write with firearms in their more mechanical answer is what we're doing. they are more tangible with that. i think that is a difference between the upper extremity of my work chamonix. >> thank you is very much group will yield to the ranking member for us questions. >> thank you very much, madam chair. i want to thank you both for your service to this great nation in coming here today as well. mr. mayer, you recommended that for the strategic plan for vha to participate on the operational control should be centralized in the secretary's office. could you explain a little more of why that should be? >> it is just an opinion based on historical experience. like i said, vha and psa as when

it comes down to these issues, you know, i am just here to tell you, john is right, this generation of warriors are athletes. by day, we wanted to learn how to walk. walking don't get it for these guys for the, climb mountains, going to paralympics. i get out of breath just watching them. if you think complaints within 20 years ago, but a couple months am what these policies affect. and you know who's going to get the complaints. it's going to be members of congress and veterans service organizations. that's my kind of go okay, let them participate, the secretary should seki has done a pretty at this style when it comes to large issues. cool. >> u.s. to mention the department of defense definitely has the superior -- superiority

over the va as it relates to this issue. why do you think that is the fact that it does not go to the secretary for department of defense that appears is that the lower level. why is that? >> i think it's a question of leadership recognizing the clientele and their needs and the fact john said a number of them want to get back in the fight. but they've got to be trained and conditioned and go to the board process to certify they could return to duty. so congress provides the funding. congress still provides the funding. it is the war funding. my only concern about that is given the budget situation, i don't know how much longer the funding is going to let the centers operate at the level they do. but i think the real key is what i call holistic and i don't want to going to the details of trying to name. it's not just the surgical expertise in clinical expertise. it's the merger right together a

physical therapy, outpatient therapy, that is sport challenges and to be one of the best-kept secrets in the military as the outpatient nurse amputee manager for yields at walter reid i watched this individual, steve springer, quietly fix problems, keep track on recovery, dede advocates and never in the way that calls attention to his role, but really calls attention to the warriors come us about the make support. co-locating research instead of being standalone is another big accomplishment. >> rate, thank you. mr. register, how long did it take you get the new technology that permits micro processing control of the prosthetic knee to the va? >> i have done it twice now. the first time was here and the virginia area when i first got what we call this ebay.

that is the micro processing technology that worked pretty well. that process took about a month to maybe a month and a half, maybe six weeks. the current process of going back and forth took three months to get the press he says. in fact, the situation was and was going up and i try and show by example, so i attended the national veterans wheelchair games, which will be in richmond this year. i had a wheelchair made for playing wheelchair basketball, so my chair had come in and he went back up to the va to get into the denver area and travel 70 miles i had to go there to get it. on the way of others in the lobby area waiting for my appointment and i saw an e-mail saying that what company or lake is here. it's in. i said great, luscious put it on. i could walk out of here with

that. he said no, we want to come back again. we have to fabricate and make sure everything is good to go. i could've left that way with three pieces of equipment. my wheelchair, sports chair and my leg. but because the va wanted to ensure the fabrication of my socket was done to marry that with the new asked you that i have was just -- it's kind of funny and ludicrous to me i could not just go on the shelf and put it on the front allen wrench and walk out the door with it. >> thank you. thank you command chair. >> thank you, mr. michaud. >> thank you, both of you will thank you for your service to our country and i also want to congratulate the staff who wrote this memo today for the most acronyms i've ever seen. i counted at least a dozen and i thought the plo was the people's

whatever. but whatever, it's a different organization here. john, why do you think for either one of you will contract this is very drop off. i've been to walter reid on multiple occasions and it is unbelievable two-seat amputees up and about in the care they're getting. is very drop-off wendy's warriors are handed off of the ones that got returned to duty and many of them are. there is a different expect tatian and mr. mayer's ananias generation. it's very drop-off? can you see that? certainly in your case because you're incredibly motivated. >> is that to me? thank you for the question. i think what mr. mayer was saying a spot on. there is a little bit of a drop that happens, but i think it's a much larger issue than amputees.

there's a systematic error from a continuum of care that goes forward. what i am seeing now with the drop by think it has to do, my personal opinion is that there is a center of excellence in the young men and women are coming back to the dod hospitals as units, when we ca killed in action, i know there's going to be six or seven coming back and going to hit this dod hospitals have survived that. those are the ones i'm focused in on. when i see them come back, they are extremely motivated to get back. they don't want the soldiers to leave a fallen comrade or that their buddies on the battlefield. they feel it they lost that ability to fight. once they get those mechanisms and tools to rehabilitate, they're ready to be a kid again. i think on the va site the population has been differing and the activity level hasn't been as high for getting back

into the war fighting situation. so i think that's the draw. i do see on the va site right now with the new "sportscenter" on the sports programs, they're really pushing out into the communities that are increasing the a-level of the veteran patient. so those who come to the va hospital are linked in the paternity programs across the united states and that is in its embassy right alchemists, so the model is changed and that is going to change that dynamic for the va. >> part of it too may be generational. as her older your expectation may be just too and billy. effective and really well, that's a success. a 23-year-old is not a reasonable outcome. reasonable up outcome may be too climbing, snow skiing, whatever it may be. i totally curfew on the upper upper and lower extremity. we just graduated a year ago a young medical student who is not a physician who lost his right

arm with a black hawk helicopter crash in which medical school and graduated and is tougher for him. he's going into emergency medicine that because of dexterity you need with your hands, he can walk, but it's difficult to do a lot of things and that's probably the satisfaction difference you see when you get back to jumping and running like you are coming you feel pretty good about that. but there you have a prosthesis or not. the other thing and you brought up the great point. it's very individual who you relate to. as a physician myself, when you have that with your patient you have great confidence and you work with there in colorado springs and they know to you come your leg in exactly about you. i just want to see for myself and i can speak for most of the committee, i don't care what it costs for you to get the care you need, for a wounded warrior to get the prosthesis they need in a timely faction. mr. maher said it very well.

it's inconvenient. no, it affects how you live. you take one day off for three days off if you can't do something, take care of your family, go to work because of our prosthesis that is not acceptable. 1500 something who lasts one or more extremities. we cannot as a committee in a country cannot do enough for those warriors and those needs are going to go on. mr. mayer can tell you, mr. registered to you what changes you older. things just change and gravity has a great effect on us. >> i am finding that out. >> so we have a commitment to those wounded warriors, not for the great care, but a lifetime of great care. i can speak for the entire committee on that. i think we all feel that way. again, i want to make sure that the care doesn't drop from the

time you the dod because i have seen that facility up there multiple times and it's phenomenal what make it to va. and i have time i realize, but later if you get a chance that what should you get on the answer of why you think the va prosthesis is 2900 your private sector is 12,000. they agree with your analysis. i read your testimony. i yelled that. >> thank you. i now recognize the gentleman from new jersey, mr. runyon. >> thank you both for your service to this country. just talking, mr. register, talking that this contract or fee for days equally satisfied -- but they're coming you know, whether it's a private.here or with the va, treatment equal? >> yes. i have no -- from what i have experienced