the progress we're making it's important to see what's working and what's not working and just simply acknowledge that and try to figure out is there something we're missing here. i also wanted to just mention briefly, and i won't dwell on this long, but it's worth a mention to me. as you know, like other areas in the country, we're struggling with a va hospital that was built decades ago. notwithstanding the heroic efforts of the staff there and the doctors and the nurses and the administrative personnel, it is just a very, very difficult situation. we're very pleased that we're on the priority list and we're making our way to a point at which we hope we can solve that problem and replace the facility. i think today we're like 18th if i'm not mistaken. so i'm aware of the fact that it

just -- it just does take a while. we are hoping to work with you and your staff. maybe there are some things we can do, there's a serious parking problem. it's right in the middle of omaha. so maybe there are some things we can do to move the project forward. i'll wrap up with one last thought. we are seeing some areas of improvement that i wanted to mention again, hoping to keep this on a note of look, you are doing some things that i think are making a difference. the first is in the processing of post-9/11 gi bill benefits. in 2011 we at least, i don't know about other senate offices, we at least received no complaints about delays or problems with education benefits. i don't know what we're doing with education benefits, but at least from our experience

something's working. whatever model, if that could somehow be transferred to the disability claims. and i appreciate they're much more complicated. but that seems to be working. and you've had to ramp that up pretty significantly. so i'm hoping i can hear some thoughts on maybe there are some ideas that would work in other areas of the va system. we are also hearing veterans expressed to us that the expanded access to information via the e-benefits system is something that they appreciate. they feel good about. i think all of us have been optimistic and hopeful. maybe that's a better way of putting it. hopeful that that e-benefits system would pay dividends. we think it is. we think as veterans are getting more used to that it is paying

some dividends and hopefully saving some staff time because people can get information or whatever they're needing there. i'll just wrap up. and again, thank you, madam chair. i do appreciate the opportunity to be here. thank you, you and your whole team, for the work you're doing. my hope is we can advance the cause because there's so much more to be done. thank you. >> thank you. senator brown. >> thank you. chairwoman murray, i appreciate your leadership on veterans issues. thank you, secretary shinseki and all of you who dwakt a big part of your lives. it's nice to see you again. thank you for coming to ohio, those of you that have, and the services you provide for veterans in my state and for all of us. it's a good budget. it shows a strong commitment to veterans i think. when you look at what the advanced appropriations mark is, 140 billion, with the 13 -- the request with the advanced appropriations with the $13 billion increase, it's saying

the right thing and doing the right thing for people who clearly have earned it. it reflects the understanding we have of service to country. i applaud the d.a. for its investments in eliminating the disability claims backlog. we're all of course still very concerned about that. as senator johanns said. we still hear horror stories of 12 and 18 and 24-month delays. we should of course never tolerate them. and i know your views about that, secretary shinseki. and know that we need to continue to push. and with better trained staff and improvements in electronic and other processing efficiencies. i also, on a similar note, disability ratings system, clearly needs substantial improvement. a bum knee in charlotte should be treated the same as a bum knee in cincinnati. and the backlog in disability

ratings in many ways related. fixing both at the same time makes sense. and i know your commitment to wanting to do that. and we expect to see results as we move forward. i'm aware, too, of the funds in this budget to train outreach coordinators and operate targeted clinics and provide other services specific to -- to particularly rural veterans but veterans everywhere who simply don't know enough about veterans' services. people from the va, officials from the va joined me in a field hearing in appalachia, two areas of ohio, of app plachia, ohio, one in 2007, one in 2010. we talked about everything from applying for benefits -- veterans' benefits to the earned income tax credit. so many low-income veterans don't know enough about any of those services. the fact that today i believe there are 30 community-based outpatient clinics, cbox in

ohio, speak to your commitment to going everywhere to reach veterans, not just in the va krirnts in cincinnati and chillicothi and cleveland. but well beyond that. i'm appreciative of that. but the outreach efforts obviously need to be stepped up, targeted. not just the demographic of rural appalachia but certainly other places too. i remain -- last point. i remain concerned about the department's outsourcing of more and more work. the quality of outsourced work is often subpar. this whole political view that outsourcing, you know, whether it's selling turnpikes or selling prisons or outsourcing part of the military, that the work often is subpar. often the costs are significantly greater as we learned from outsourcing. the contractors give political campaign contributions. i'm not saying you're any part of that, to be sure.

but that happens too often. you go places without sourcing that does not lead to good government. i think we also -- i think many contractors lack the dedicated service mentality, if you will, of career civil servants, and it's always popular to beat up state and federal employees. we've gone through that politically in state after state after state in this country and the federal government. but i like the idea, i think an individual's motivation to serve our veterans as a career leads to better service. contrasted sometimes to services provided by companies that are motivated by profits. and some of the most dedicated people that i've ever met provide service to veterans and have made that their career. they could make more money somewhere else. but they want to serve in this whole idea that outsourcing saves money, enhances quality, is pretty illfounded. the va and our veterans simply can't be viewed as simply

another client. we see this at the very basic level of services in places like dayton, and i appreciate very much the secretary's focus on fixing the other problems at dayton. but where laundry was outsourced workers tell me it sometimes doesn't come back clean. i mean, what's the point of outsourcing if that happens? if the va continues to outsource more and more activities, at some point are we going to reach a point where the va's health insurance provider rather than a health care provider? and we never should get close to that line. on a lighter note, thank you earlier this week, i guess today's wednesday. on monday was the first day. and i was lucky enough to be there at the parma community-based outpatient clinic. when the va for reasons that i -- with which i disagreed but probably needed to do shut down the va hospital in rexville. part of the deal was that they would put this cbock in parma. it's terrific. it was crowded the first day. people will use it. it serves an important

population. and i thank you for that. >> thank you very much. senator brown, massachusetts. >> thank you, madam chair. i want to hear the testimony of the folks. so i'll be very brief. i agree with senator burr on the job and the fact you're going to be spending a lot of money. also important we see if there's any duplication, overlap. there seems to be a lot of things happening in that field. and when we have these types of issues, we usually throw everything against the wall, see what sticks. and i want to make sure that we do it efficiently, we don't just keep throwing money out there, but actually we have programs. if they're working let's improve them. if not let's get rid of them. concerns still -- bless you, bless you, bless you. and concerned about obviously the long time frame in filing claims. i will say i'm very pleased with what's happening in

massachusetts with the new blood out there and new people helping. it helps we're in the same building. and we've had some great success. and i've made that public in our veterans hearing that we've had in this very issue. and i know the big elephant in the room is the 1 million returning veterans and the obligations we have to keep them and get them whole. and i'm thankful, i know you've already met with secretary panetta to discuss that va d.o.d. mission to make sure we don't just have a million new veterans come in, that if they're going to be released they need to be released in a thoughtful methodical manner so you're not overwhelmed and really just in so deep we can't get out. so i'll just stop with that. i look forward to hearing the testimony. i am going to be going to the floor, madam chair. i have to speak. but then i'll be back. thank you. >> senator isakson. >> i do will be very brief because i'm anxious to hear from both of you. secretary, thank you for taking the time to come to my office two weeks ago. second, i have two pieces of

good news. one's on the jobs front. you probably have heard about this. but if you haven't, i wanted to make you aware. louis jordan, who is the founder of valujet and airtran, which is now southwest, has created a foundation called gratitude america, which is a web-based platform to match job needs with veterans. and it has a component that trains them with training for the job. so it makes the full circle where if a veteran's looking for a job he can search it on the internet. if he finds a job he likes but he's not qualified, it matches him with the closest training facility where he can get the training. i think it's a great idea, and it's something that's very important. i appreciate louis doing it, and i thought you'd want to know. second is i want to compliment director goldman at the dublin va. i spent a day in dublin, georgia last week. he serves a third of the state, 51 counties. and he is trying to partner with the general -- the commander of robbins air force base to merge the va clinics in perry, georgia and macon, georgia with the base

d.o.d. health care on the base to utilize the facility's advantage of having all the imaging equipment and everything on the active duty base and not have to have redundant cost and staff at two other clinics, which i think is a great idea to make better health care available but also at a lower cost to the veterans administration and the taxpayers. i wanted to bring those two pieces of good news to your attention. thank you for what you do, and thank you for being here. >> thank you. and senator boozman. >> thank you, madam chair. and again, very quickly, i just want to thank the secretary for being here. and the team that he's assembled for your hard work. senator brown mentioned that there's a lot of individuals in the va that are there because they want to be and could have other opportunities. and certainly you're in that category. and you know, you've led soldiers and now you're serving veterans. so we really do appreciate it very, very much. the other thing i would say is senator isakson mentioned, i do

appreciate the fact that you're very willing to work in congress and very approachable, you and your staff. so that's something that is appreciated. so we appreciate all that you guys have done in the past and are looking forward to you doing a bunch in the future. and i yield back, madam chair. >> all right. thank you very much. with that i want to welcome again secretary shinseki. thank you for coming here today to give your perspective on the department's fiscal year 2013 budget and the fiscal year 2014 advanced appropriation request. secretary shinseki's accompanied today by steve marrow, undersecretary for memorial hi undersecretary for benefits, dr. robert petzel, undersecretary for health. we also haveecutive in charge f office of management and chief financial officer, and roger baker, assistant secretary for information and technology. thank you all for joining us today, secretary shinseki. your remarks will of course appear in the record. but we welcome your opening

statement. >> thank you, madam chairman. ranking member burr, distinguished members of the senate committee on veterans affairs, thank you again. and i look forward to these. this is an opportunity to extend the dialogue we have in other fora. but thanks for this opportunity to present, as chairwoman -- the chairman said, the president's 2013 budget and 2014 advanced appropriations requests for va. this committee has a long history of strong support for our nation's veterans, and i can speak to that firsthand, having worked personally the past three budgets with you. the president has demonstrated his own respect and sense of obligation for our 22 million veterans by saying to the congress once again another strong budget request for va. and i thank the members for your unwavering commitment, and i am here to answer your questions but seek your support on this budget request. i'd also like to acknowledge the

representatives from our veterans service organizations who are here today. i will tell you as we develop our budget their insights, their experience is helpful as we put together our arguments for resources. and as we strive to continuously improve our programs. madam chairman, thanks for introducing the members of the panel. i have a written statement which i ask to be submitted for the record. this hearing occurs at an important moment in our nation's history. not the only one. there have been others that i could refer to. i'm old enough to have experienced our return from vietnam and to have witnessed personally the end of the cold w war. we are again in another period of transition, an important one. our troops have returned home from iraq, and their numbers in afghanistan are likely to decline over time. and history suggests, as the

chair indicated, va's requirements from these two operati operational missions will continue to grow for some time, long after the last combatant leaves afghanistan. maybe as much as a decade. maybe even more. we must provide access to quality care, timely benefits and services, and job opportunities for every generation of veterans. and the generation at hand is the one that comes home today from iraq and afghanistan. in the next five years more than a million veterans are expected to leave military service. this generation relies on va at unprecedented levels. through september 2011 of approximately 1.4 billion veterans who deployed and returned from operations "enduring freedom" and "iraqi freedom," 67% have used some va

benefit or service in some way. a far higher percentage than those from previous wars. the 2013 budget requestil the requirements of our mission. health care for 8.8 million enrolled veterans. compensation and pension benefits for nearly 4.2 million veterans. life insurance coverage -- life insurance covering 7.1 million active-duty service members and enrolled veterans at a 95% customer satisfaction rating. educational assistance for over a million veterans and family members on over 6,500 campuses. home mortgages and veteran loans with the nation's lowest foreclosure rates. burial honors for nearly 120,000 heroes and eligible family members and our 131 national cemeteries befitting their service to our nation. this 2013 budget request continues the momentum, and our three priorities that you heard

me speak about over the past three years, increasing access to care, benefits, and services. eliminating claims -- the claims backlog. and ending veterans' homelessness through effective, efficient, accountable use of the resources you provide. access encompasses va's facilities, programs, and technology. it's a broad term, but there's a lot that it encompasses. this 2013 budget request allows va to continue improving access by opening new or improved facilities closer to where veterans live and providing telehealth and telemedicine linkages, connectivity, including in some cases where it's needed, in veterans' homes. also, by fundamentally transforming veterans' access to benefits through a new electronic tool called the veterans' relationship management system, this is an effort to get out our telephones. by collaborating with d.o.d. to turn the current transition

assistance program that we both share, tap into an outcomes-based training and education program that fully prepares the parting service members for the next phase of their lives. and by establishing a national cemetery presence in eight rural areas and better serving rural and women veterans. and i'm happy to provide details later. we expect that more than 1 million veterans will leave the military in the next five years. potentially all will enroll in va. over 600,000 of them based on our historical trend. over 600,000 of them will likely seek care, benefits, and services from va in the out years. regarding the backlog, from what we know now, fy 2013 will be the first year in which -- first year in a long time in which our claims production going out the door will exceed the number of incoming claims.

and the paperless initiative we have been building for the past two years, an automation trial becomes critical to reversing backlog growth and increasing quality. we must not hesitate. stability and i.t. funding is critical to our success. homelessness. from january 2010 to january 2011 alone the estimated number of homeless veterans declined by 12%. we have created momentum and the homeless program. much remains to be done to end veterans' homelessness by 2015, and the 2013 budget is a presentation of how we continue to do that. we're now developing a dynamic homeless veterans registry. i think you appreciate that much of what we understand about homelessness is an estimate of real numbers. we're not able to count everyone out there. but it's a valid statistically valid process. in the meantime, over the past three years we've been building

a registry of former and current veterans by name, so we know who they are, what their issues are, the individual level of concern that has been expressed here, what their issues are, where thez reside, and whether they are migratory and move from one va footprint to the next. so as we think about adjusting the footprint, based on what we see day to day, we want to be careful that we're not doing something that ignores maybe an issue that is going to require help. so building a veterans registry today over 400,000 names of currently and formerly homeless veteran, allowing us to better see, track, and understand the real causes of veterans' homelessness. and in the years ahead we think this information will not only help us more effectively prevent it, that's where we're headed, not just for veterans but

perhaps for other communities as well. where we have partnered in taking on the homeless issue. we look to develop more visibility of the at-risk veteran operation in order to prevent veterans from falling into homelessness. and this budget supports that plan. so madam chairman and members of the committee, we are committed to the responsible use of resources you provide and resources we seek in the 2013 budget. and i know that's been a question some of you have posed. but for both 2013 budget, 2014 advanced appropriations request, we're committed to the responsible use. and again, thank you for this opportunity to appear before this committee. >> thank you very much, mr. secretary. and let me begin the questions by getting this one off the table. it's on the issue of sequestration and cuts to spending. like i said in my opening remarks, i believe that all va programs including medical care

are exempt from cuts, but there is some ambiguity between the budget act and the existing law. and when i asked the acting omb director to address this issue during a budget committee hearing two weeks ago, he said omb has yet to make a final determination. so i'm concerned that by not settling this issue now we are not only failing to provide our veterans with the clarity they really deserve toof. so while you're here i wanted to ask you, do you believe that all va programs including medical care are exempt from any future cuts? >> i think, madam chairman, the answer that the omb director is providing you is the same one that i understand. they are still addressing the issue. for my purposes i would tell you i'm not planning on sequestration. i am addressing my requirements and presenting my budget as you

would expect me to do. i think sequestration in part or in whole is not necessarily good policy. and i think the president would argue that the best approach here is a balanced deficit reduction, and he believes that the budget he has presented does that. and asked that the congress look at that budget and favorably consider it. >> i think we all hope that that is the outcome, but we want to provide clarity to our veterans. they're very concerned about this issue. mr. secretary, last year we talked a lot about mental health care, and i think together we uncovered a lot of serious issues, best summed up by a veteran that i heard from recently who uses the ann arbor medical center, had to wait months and months to get into counseling, but then he had glowing things to say about his mental health care providers once he got in. so in order to address those types of issues, va has to be

certain it has enough resources to not only keep up with the increasing number of veterans who are seeking mental health care but also to bring down to unacceptably long wait time. over the course of the last fiscal year the number of iraq and afghanistan veterans who are looking for mental health care went up by about 5%. that's about 18,000 veterans every quarter. so i wanted to ask you this morning if you believe the increase in mental health funding in the budget request is sufficient to accomplish the goals and keep up with this increasing demand. >> i believe that the budget, if you look at the '13 budget request, i think it's adequate for us to meet what we understand our requirements are in '13. are there issues out there we'll discover between now and ex-kooufgs a budget? i would say if we do, madam

chairman, i'd be the first to tell you. now, you asked us to do a survey, and we did. it was very hastily done. senator burr referred to some of the output, conclusions out of that survey. out of 20,000 of our health care, mental health providers, 319 surveyed, and the results were as described. my question of vha was did you go to the places you thought there would be problems? and the answer is yes because we were asked to go figure this out. so i would say we got a pretty pure response. what i think we need to do is make sure we're going to take another broader look here and make sure we understand across the larger population what our issues are and where there are opportunities for reallocation or as it becomes clear to hire more people. i would offer to the chair, i

took a look at what we've done on mental health over the last four budgets. if we look at 12 to 13, it's rather unimpressive. i mean, it's 5%, and it matches the increase in the medical budget, but between 9 and 13, our increase is 39% in mental health. and if you include the 14 advanced appropes it will go up 45%. >> and that's a result of the number of soldiers who are coming home with the invisible wounds of war, which is dramatically increasing, correct? >> true. but we are -- we're trying to anticipate that there's going to be a larger requirement here in the out years even if we don't have clarity. we're trying to prepare for that. we want to do a larger survey here, as i indicated. and then see what the outcomes are. but let me turn to dr. petzel

for any details. >> thank you, mr. secretary. madam chairman, as a result of the hearing that we had earlier in the year, we have now done two things that are i think important and on point with regard to your question. one is that we've developed a staffing model. it is the only staffing model that i know that's available about mental health. it's in the beginning stages, but it is giving us some information about what the need might be. but i think more importantly we're site visiting all 152 of our medical centers look at the access to mental health services, both the initial appointment and subsequent appointments for be it for ptsd inpatient program, a group program, or individual psychotherapy. and what we're finding is there is -- we do meet the criteria for the first appointment in

most every instance. we're having some difficulty in some parts of the country making the next appointment mentioned earlier into the specialty services. this could be the result of three things 37 one is do we have enough staff out there? have we given enough positions, enough resources? two is are those positions filled? are we filling those positions up in a timely fashion? and the third is are we getting the appropriate level of productivity out of each one of those people? if we do discover as the secretary just mentioned that we do have additional needs that are unmet, i can guarantee you we will be in communication with the committee about those needs and in for discussion. >> okay. i appreciate that. this is a top priority for us this year. >> i would just share that in fy11 we hired about 897 additional mental health of