will help them set of this government. >> why is this. -- why is this the end of operations? >> we have been clear that we will continue to have counter- terrorism. . .

that was my rationale. >> maybe one to extend to the end of the term? >> not in my thinking. >> the chinese that threatened action against japan. >> we are watching that tension

very, very carefully. tensions remain. we are hopeful that the political and diplomatic efforts will reduce the tension significantly. we have not seen anything that would raise the alarm higher than that. obviously we will work very strong to support our ally in -- in that region. >> when we go to china? >> i am not received -- i have not received the invitation yet. >> will general petraeus return to washington to explain to the american public his actions? >> i think we ought to wait and

see about the evaluation and see the outcome of the evaluation. we need to see about a recommendation -- a decision by the president and whether that would be useful at the time. >> he has not traveled much. that is because he has a full- time job. >> do you think anything has been changed with what the people in afghanistan are asking? second, china's rise of the

military in the indian ocean -- >> first of all, i think the elections took place despite the fact that the taliban are trying to disrupt them. there are lower levels of violence then there were during the presidential elections last year. at the end of the day, there was still a lot of effort put in by the taliban to intimidate voters. it undoubtedly had an impact on the turnout. a higher percentage of women in this election than in the presidential election. certainly there were a lot of complaints about the election that will have to be adjudicated, but i think having held the elections, the afghans

were in the lead in terms of security for the elections. i think it is an important landmark that they have had these elections and that we can now move forward and tabulate the results of the election. >> military relationships are strong and growing. we are committed to that. with all of our services -- i was recently there. it has taken on a significant step. it is equal to sell many historic relationships. in the indian ocean, we know it is an important body of water, not just now, but also in the future. we recognize the importance of keeping that relationship as strong as it is. >> you will meet with the

indian defense minister next week. what are the issues? >> i had a very good visit last year. i met with the defense minister and the prime minister. i think, as the chairman said, we are looking to expand this relationship in ways that are mutually beneficial. i am sure they will. they have a big competition going on for a new modern fighter. we will probably have some conversations about that. i think we will also be looking at ways in which we can expand our exchanges, exercises, and further strengthen the relationship that we have. >> they have concerns about the

restrictions you have imposed on india. >> i think that is i on our list, particularly in the context of exports and imports. our exports control and my view of the importance of changing those export controls in ways that better protect the things that are really important and open up trade and allow u.s. companies to sell abroad -- those technologies that are not critical. india certainly is high on our list in terms of countries that i would like to see those restrictions eased. >> thank you. >> do you intend to state for

the july 2011 review? >> i would rather not say at this point. >> to be made up your mind? >> yes, i have made up my mind. >> admiral mullen, yet mentioned that this was a very difficult year in afghanistan. the you think this coming year will be as difficult? >> this year, because we were adding some additional forces, we had a better sense of the difficulty of the insurgency. for me, i go back where i had been for a long time. as long as we have been in afghanistan, we are in our 10th year of war -- it has been the last year or year and a half that we have focused on afghanistan. it is very difficult to predict where we will be one year from

now. my over all this year is that we have the right forces. we have 48 other countries who have forces there as well. there is an opportunity here with the right resources and the right for it -- right focus. i do not underestimate the difficulties or the challenge. being able to predict where we will be this time next year, i think it is too soon to tell. >> i think there's a little historical perspective. i think there have been three phases to the war in afghanistan. the first phase was the operation in 2001, 2002 which i would say we won outright. the taliban were expelled. elections were held.

the constitution were put together. women and girls started to go to school. health clinics were open. a lot of positive things happen. 2003 to 2006, i believe our attention in afghanistan was distracted by iraq. we had a relatively low level of troops there. our casualty levels were very low. when i took this job on december 18, 2006, 187 americans had been killed in action in afghanistan. in 2007 and 2008, were paying much more attention to afghanistan, especially in this building. the reality was, we had relatively few resources. we added another brigade or two.

in 2008, president bush authorized the addition of 1000 more. the reality is we did not begin to resource this war in a way to actually give ourselves -- the act -- the cal then use that. to reconstitute themselves across the border and to re- enter afghanistan. it has really only been, i would say, since the beginning of 2009 with the president's first decision to send 21,000 troops and then in his decision in december to add another 30,000 and to increase civilians -- and i would say h. triple-a of our foreign partner troops. we have actually got the resources in afghanistan to partner with the afghans and have some prospect of dealing

with a resurgent taliban that used that time to reconstitute themselves. while we speak shorthand of a nine-year war, in reality, that war has been in three phases. the third phase of that war began last year. last question. >> your returning to your strategy of this new war. it requires more troops, and a lot of money -- it is clear that the military did not get all the troops they ask for. there are economic problems. with a deadline of next july, why are you sure that the charity is not hobbled and can be successful? >> first of all, i believe that the resources that we requested for the time that we are talking

about did it satisfied the military requirement. the 30,000 that the president approved, another 5000 could not be delivered until the middle or latter part of 2011 anyway, so there was no need for him to make a decision on that. an additional 5000 by our allies. the allies have propped up by 7500 the past year. when you add to that the growing amsf, you have a substantial military force. the other key part of the president's strategy is narrowing the mission. he narrowed the areas that we would focus on in afghanistan to this key districts that mattered in terms of reversing the momentum of the taliban, denied them control of territory,

degrading their capabilities while also enhancing the capabilities of the afghan security forces. i think that is under way. we are seeing a slow progress. but i believe that this is one of those instances where the closer you are to the front line, the better it looks in some respects. we will just have to wait and see. we will evaluate in december. i think we have the inputs that are needed for this effort. we have 46 or 47 international partners. they are playing a critical role. the chairman just got back from meeting with the heads of our nato military partners. i am going to be at a nato

defense minister's meeting. in the june meeting, there was a broad sense of confidence that we were on the right track. >> you believed that a smaller footprint there -- what changed for you that nagy back this larger footprint. >> -- that made you that this larger footprint? >> general mcchrystal's response to that when i raise that skepticism that the size of the footprint mattered less than what you are doing with it. it the afghans see you as an invader, then hardly any foot print will be big enough. if they see you as an ally and a friend and a partner, it is a completely different situation. as i reflected on it, it seems

to me -- first of all, the soviets invaded the country. we were invited in. the soviets killed 1 million afghans. they drove 5 million out of the country and they basically destroyed the country. i would say that the effort that we have underway is diametrically different than that and has to do with a different attitude on part of the afghans. every poll that i have seen shows that support for the taliban is about 10%. the afghans do not want them to come back. they have the presence that they do because of their intimidation efforts and their willingness to kill people. but the same token -- and the numbers vary, but everything i have seen indicates that somewhere between 55% and 67% of the afghans what ice in there. i think it is a totally different situation than the

soviets. thank you. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2010] >> coming up, house republicans released a new policy agenda. after that, president obama addresses the united nations general assembly. on tomorrow morning's washington journal, tom davis will talk about the gop strategy for the november elections. then, kasim reed all the challenges facing cities. then new banking rules will be discussed by steven kaplan. >> this weekend on c-span3,

american history tb -- a look at the personal belongings of george washington and what they reveal about the father of our country. also, curtis mayfield and his impact on the civil rights movement. al west and churchill style compares to today. all weekend every weekend -- american history t v on c-span3. with midterm elections six weeks away, all the key races with pcs and video library. our video library is all free any time. what's what you want when you want. -- watch what you want when you want. >> house republicans laid out their policy agenda for the midterm elections. the call it their "pledged to america." it includes spending cuts and

presents a health-care law. this is about 45 minutes. >> good morning. i want to thank greg and libby and all of the people here for their hospitality. i also want to thank congressman frank wolf who represents this district. the american people are speaking out like never before. they are concerned about the future of our nation and the future for their children. they fear a government who is not listening and does not get it. they think that washington does not really care. we are here today to put forth a new governing agenda built by listening to the american people that offers a new way

forward. before i served in congress, i ran a small business. i learned how government gets in the way of job creation in our country. the policies coming out of washington have created massive uncertainty for job creators. the american people are suffering as a result. in order to create jobs, we need to end the uncertainty for job creators and the spending spree in washington and reform congress itself. the government is out of control in washington and we need to rein it in and began a new drive for a smaller, less costly, and accountable government. these are the things that the american people are demanding. our pledge to america is that the republicans stand ready to get it done beginning today. none of this would have been possible without the work of our colleague from california

who has spent the last six months working night and day to put this project together. kevin? >> thank you. the document we released today finally answers the question, -- finally answers the question americans are asking. will we leave to our question a stronger, healthier, more prosperous country that our parents left us? the future of the country hangs in the balance. across this great nation, mothers and fathers wonder if their children will find the same opportunity for success that existed just a generation ago. can you blame them? as a result of the economic, disastrous policies of the current administration, millions of americans today are out of work and our children will be saddled with a debt that is out of control.

we have a more people depending on food stamps to feed their families than at any point in history. the economy is so dire that one in six americans rely on government assistance for financial support. one in six. the land of opportunity has become the land of shrinking prosperity. americans across this country are outraged and so are we. just as at john hancock signed his name to the declaration of independence so that even king george could read it, i want to say this slowly so there is no room for misinterpretation. our government has failed us. from the billion dollar bill out, the stimulus package that failed to stimulate, to the government takeover of health care -- we cried stop. the democratic majority in washington has refused to

listen. we are here today to tell you that we have been listening and we have heard you. we have heard you loud and clear. we assure you that there is nothing more inspiring ban the common voice of the common man. when you said you wanted a more prosperous, competitive economy, we heard you. when you said you wanted a more accountable government, we heard you. when you said you wanted to repeal the health care bill, we heard you. we know that you want a government dedicated to working for the people and that is why we have written this "plates to america." it is are solid commitment to serving you. this is not about republicans or democrats, liberals or conservatives -- it is about you. this pledge focuses largely on three things -- a plan to create jobs, and economic uncertainty, and make america more competitive. it is a plan to cut wasteful

washington spending and reduce the size of government. it is a plan to reform congress and restore trust in government. the new agenda embodies america's rejection of the notion that we can simply tax, borrow, and spend our way to prosperity. it offers a new way forward that has not been tried in washington, an approach focusing on cutting spending, which is a new idea for congress. to put americans back to work, we seek to eliminate uncertainty for the private sector. the innovators and entrepreneurs to create jobs -- it commits to immediate action to change the way congress works. this place is a governing agenda that can be implemented right now said that the powers to be in washington can bring it up. we are calling on nancy pelosi and harry reid to implement these proposals before congress leaves this fall.

we pledge to you that we will create jobs, and economic uncertainty, and make america more competitive. we will cut washington's wasteful spending and reduce the size of government. we will reform congress and restore your trust in government. we pledged to uphold the model for our country our founders envisioned. a grantor america -- the exception among the nations of the earth. if our current troubles have somewhat dimmed the light to the shining city on a hill, we plan to recharge them. they will not go out on our watch. more than 60% of americans believe that our country is headed down the wrong path. they are right. the pledge is a governing agenda that will turn the country around and put it back on the right track.

we are optimists. we firmly believe that we live in the land of great promise and great possibilities. a land where, until recently, to march showed more promise than our yesterdays. we are not ready to concede the bite for the prosperity of our country. we reduced to believe that that same american dream that shone so brightly fourth for our parents have dimmed for our children. we must reverse our current course of action and it rejects the economically poisonous policy of the democratic majority. we will take back our country. we will restore it for a better pitcher. -- future. this is our pledge to you -- our pledge to america. >> good morning. i am marcia blackburn.

i am from tennessee's seventh congressional district. today we complete one pledge and we begin another. many months ago house republicans committed and pledged to listen to americans all across this country who were speaking out about better ideas and practical solutions. we kept that pledge. it allows us to make another. the "pledge to america" starts with a preamble that reminds us that every american citizen is and dealt with certain rights from their creator. when our governor charts a course that endangers those rights, the people have the right to demand a new agenda from their government. this pledge recognizes that the problems the american people are beyond washington's ability to solve those problems through overspending and hyper

regulation. it has always been the power of the american people to seek and create solutions. this pledge acknowledges that washington has gotten in the way of those solutions and that washington has made the problems worse. our pledge to america is that we will respect the will of the american people and we will return to the principles that have made this nation great. faith, family, freedom, hope, an opportunity. we pledged to honor the constitution and the original intent of the framers. we pledge to advance policies that promote greater liberty, wider opportunity, a robust

defense, and national economic prosperity. we pledge to honor our families, a traditional marriage, and a life, and the private faith based organizations that form that very core of our american values. the pledge to america is built on policies that reflect these principles. we call on nancy pelosi to commit to taking action on these policies today. >> i am from subversion chicago. this is a morning of very distant contract. we have on the one hand and economic plan that has been put upon the united states and its citizens by people in washington who are convinced that they have all of the

answers. their answers have underperformed. a nagging 10% unemployment and a tripling of the national debt over a 10 year period. that is what is. we are presenting what can be. where is the opportunity? where is the optimism? where are the concrete ideas that we can move forward? our agenda is to concentrate on job creation. let's concentrate on ending uncertainty and let's concentrate on making america once again -- making america competitive once again. these are things that speaker pelosi can call today. she can begin the debate this afternoon. number one, make the tax cuts permanent. i represent a district with companies that are currently sitting on the sideline from a job creation point of view because they do not know what their tax rate is going to be. the joint committee on tax,

which is a nonpartisan gatekeeper and scorekeeper in congress on all things tax related, says that president obama -- president obama is a proposal will increase taxes on 50% of small business income. that is not the direction we need to go. make the tax cuts permanent. number two, we suggest moving forward. we would offer a tax reduction on 20% of small business income. that has an encouraging effect where businesses and noted that for the first time in a longtime government will be on their side and not an adversary. the third thing we propose is to rein in the washington, d.c., red-tape factory. this town has created over a period of time one rule after another to the point where small business is really struggling. jeff davis of kentucky has put forward an initiative that

regulates. it regulates the executive in the district in deep. it says this, if there is a proposed rule by a non elected federal agency that would have a bigger than $100 million in back of the economy, you do not diskette to publish that in the federal register. yet to have an up or down vote on that by the elected members of congress. that is congress taking a party back from the executive branch. no longer will our businesses be threatened by a cap and a trade regime that is so controversial they cannot even get it through this congress. we suggest those days need to be gone. finally, taking the play book helped of speaker pelosi's line

bet that the health care has to be passive people would know what is in it. it has passed. the more people find out about it, the less they like it. one of the most outrageous things in that health care bill is the 1099 requirement that says that small business, small business, -- big business, any business -- it features $600 in a transaction over the year, you have to submit that in 1899 to the federal government. that is outrageous. we need to make sure that that is repealed and repealed promptly. the speaker can do that this afternoon. >> good morning. i am from the fifth district of texas. this president and this congress has put this nation on the road to bankruptcy and they are pressing down on the accelerator. it is time to press on the brake

and put us back on the road to recovery and opportunity. the second plant republicans pledge to america is a plan to stop out of control spending and actually reduced the size of our government. we want to put, today, our government on a path to a balanced budget and actually began to pay off the national debt. today, we can act immediately to reduce spending by canceling unspent stimulus funds. the american people note that after an additional 3 million of their countrymen have lost their jobs, the other thing the stimulus as stimulated is the national debt. we can cut government spending to pre stimulus, pre bailout levels saving immediately $100 billion. you cannot spend it bailout --

spend, bailout, anti sure way to prosperity. we would put a cap on new discretionary spending. we would go from the first house without a budget to a house with a binding budget under our pledge. we would actually cut congress' budget. at a time when families are having to cut back, small businesses are adding to cut back. why not congress? if you need to lead -- if you want to lead, indeed to lead by example. every single week, we get to the house floor under democratic rules to increase spending. under this pledge, weekly we will have the boat to cut spending. to reduce the size of government, republicans pledged to end tarp once they're all. no more $700 billion bailout

funds for the administration. and government control of fannie mae and freddie mac, which will prove to be the mother of all bailouts to the taxpayer. at the root cause of the economic crisis, totally ignored, by the president and the congress. we proposed to impose a federal hiring increase on all non security employees. federal payrolls should not increase and cause small- business payrolls to decrease. we will root out government waste and sunset outdated and duplicated programs. the closest thing to eternal life on earth should not be a federal program. we will reform the budget process, one that actually focuses on the next generation,

but not the next election. the practice of borrowing almost 40 cents of the dollar, much of it from the chinese, sending the bill to our children and grandchildren is not just unsustainable, it is unconscionable. with this pledge, republicans will save the american dream as it drowns in a sea of red ink. we will make it bigger and brighter for the next generation. we will not allow the towards of liberty to be mortgaged. it will be handed off to the next generation. >> i am from utah's third congressional district. it is an honor and privilege to be with you. i am a freshman year. i am year to help clean up washington, d.c. i was elected to change the status quo. we have to change the way we do

business in washington, d.c. everybody understands that. we cannot perpetuate the status quo. in order to get the right results, process is paramount. we are taking a pledge today to do a number of things. it starts with requiring that all pieces of legislation be available on line 472-hours -- at least 72-hours said the public can see the legislation and members of congress can actually read the bill. we pledge to adhere to the constitution. the fact you submit your piece of legislation, you have to cite the constitutional authority for that bill. we want to ensure an open and bipartisan debate. we want to make sure that it is harder to increase spending and easier to cut spending. as the freshman year, i have never experienced an open rule.

i never been able to get to the floor of the house and offer an amendment on a spending bill. that is fundamentally wrong. it is fundamentally wrong. we will make sure that legislation is issued one at a time. no more of these big, huge, massive bills that are used for a peace that would not stand on its own. at one piece at a time. these are simple, easy, common- sense things to do, yet they seem like radical new ideas to washington, d.c. i am prelate of the republicans for making this commitment to make these changes. that starts today. thank you. >> my name is bill chastity. i represent the sixth congressional district of louisiana. two years ago the democratic majority said they would put up a health care reform bill that would expand access to quality

health care. those were goals that democrats, republicans, and independents can all agree upon. unfortunately, the bill that was signed six months ago ultimately will not achieve those goals. i say that from the perspective of a practitioner of medicine. i have worked at public hospitals and caring for the insured. might like's work has been making sure that those without insurance receive health care. politicians consistently overpromise and undefined. it is easy to say we are going to give you something, but when that something is something you have -- you do not have funds for, access and quality suffer. if you do not first control costs, ultimately none of the goals are met. i can cite the studies that have been released since the bill was

put out. let's just look at the last six months. we have seen greater than 10% increase in the premiums for small businesses and the regulatory compliance burden of 1099 forms. 81099 form is not a health care costs, but it is part of the bill. it takes away from job creation. people do not want this. when we talk to the american people, they do not want the federal government telling a small businesswoman she has to do 81099. they do not molt the federal government in their personal lives with individual mandates. they do not want the $500 billion in taxes and the over 150 board bureaucracies and commissions required to

implement this. the federal government told us that we defund, reap -- the american people have told us to refine it, repeal, and replaced. we have a plan to lower costs. start off with real tort reform. the cbo says it will decrease costs by $54 billion over the next 10 years. lower-cost for the purchaser of insurance by allowing americans to buy insurance over state lines. make these big insurance companies with market concentrations compete against one another for the benefit of the small business woman or the individual purchasers of insurance. strengthen the patient wears physician relationships by among other things, increasing the use and usefulness of health savings accounts. they put the patient firmly in

control of her health-care dollars. it allows her to make the decisions that are important for her help, but also for finances. we will ensure access to affordable health care for those with pre-existing conditions. we would join the 7% of the american people that desire to banned federal funding for abortions. that health care bill was signed six months ago. the need for real health care reform is more urgent now. it is urgent for the families of the small business paying premiums, it is urgent for the american taxpayer facing huge increases in taxes. it is urgent for the uninsured like those i have had the privilege to treat for the last 20 years. house republicans have listened to, we have heard, and we shall do our best to implement real

health care reform that lowers costs and expand access to high- quality care. those are goals which all agree upon. thank you very much. >> i am matt born very of texas. the first job of the federal government is to protect our country and defend our citizens in a dangerous world. the pledge has a plan to help make our nation more secure. house republicans think it is wrong to try to pass controversy old, domestic legislation on the backs of our troops and we believe that our troops ought to have all the resources they need to do whatever job we have asked them to do without any pork- barrel spending being attacked. the american people have said clearly that they do not want

terrorists to be cobbled with rights equal to or greater than our own citizens. they do not want get a vote detainees brought back here. they do not want them to be released when they should not be. we offer a sensible detention policy that keeps terrorists all of the battlefield and helps keep americans safe. we are committed to standing by our friends and our interests. we will restore full funding for missile defense and push for tough enforcement of sanctions against iran. finally, we believe that the national security of any country depends on its ability to control who and what comes across its borders. we will remove the obstacles that some federal agencies have put in front of the border patrol that prevent it from doing its job. we will ensure that the federal government works with, not against state and local law

enforcement to enforce all of our laws. we will take action to improve the security, to make it harder for terrorists to come here. support our troops, fight the terrorists, stand by our friends, and protect our citizens. house republicans note that the freedoms we enjoy it came at a dear price. preserving them for future generations is our solemn obligation and our pledge. >> hello, i am for the second district of west virginia, just right across the way. i want to thank you for hosting us today. i am very proud to stand with my colleagues and the american people as we pledge to get our country back on track. it is long overdue that we take this action to make congress

accountable to our employer, the american people. we have been listening to our constituents frustration. they are exhausted and they are tired of all of the bickering in washington, d.c. i hear every day to west virginians who are asking for a little common sense. do not spend more than you take in, live up to your promises, and solve our problems. that is why we are pledging to fight on the side of the american people as we work together to address the serious, but not impossible problems that are before us. we have been listing. today, we pledge to ensure transparency and accountability in congress and throughout the government. we pledged to fight efforts to

find the very costly health care bill, to fight to increase domestic energy resources and to fight to oppose a test to put a national energy tax known as cap and trade on americans. we pledged to fight for worker'' rights by making sure that we oppose a card check bill that takes away an individual's right to a secret ballot. we pledged to fight the growth of government and opposed stimulus spending that only puts our nation further into debt. our pledge did not originate behind closed doors in washington, d.c. it originated with the american people who have spoken out against the tyranny they feel and we feel of excessive,

unchecked, and accountable government. today, i ask our colleagues in the house for action today. i ask the american people to join us in our fight. thank you. >> for the last three months, we have listened to the american public. we sat with them and that we stand before them. we heard you loud and clear. this is our pledge to america. it is something we can do right now. we challenged speaker pelosi and leader reid to bring these issues up. we asked the american public to join our fight. thank you. we'll open it up for questions. >> any compromising of the principals or specific things of this? you say you want tax cuts

permanently extended. does that mean you are not open to the idea of a temporary extension of a year or two? >> we believe that part of the uncertainty that is causing employers to refrain from reinvesting in their businesses is that set -- is that no one knows what their tax rates will be tomorrow. we believe you have more certainty in regard to tax rates and regulations, you'll see employers begin to reinvest. extending the current tax rates and making them permanent provides more certainty. we believe the permanency creates more certainty for employers. that is why it is in there. >> on the red ink that you all referenced, had you avoid that? even if you can't enforce this cap, you have a 1.3 trillion

dollar deficit. are you willing to go in and start cutting entitlements? >> if we are going to deal with deficits and be honest with the american people, we have to cut spending and we need real economic growth in america that put more americans back to work, caring for themselves, and caring for their families. it cannot have economic growth in america if you insist on raising taxes on the american people. >> you talk about cutting spending and getting rid of the red ink, but there are not many specifics on how you get to the balanced budget if you do plan to extend all the tax cuts and expand defense spending. just to follow up on the previous question, there are no specifics of what you do about social security and medicare. can you give us some more detail on exactly how you can't fulfill these promises? >> i think it is clear that by

having a spending cap at 2008 levels, we can save $100 billion a year. that is $1 trillion over the next 10 years. when it comes to dealing with the entitlement programs, i have made it pretty clear. it is time for us as americans to have an adult conversation about each other about the serious challenges is -- challenges that face our country. i believe if we were with the american people, they will want to work with us to come to grips with these challenges that face our country. it is about having that adult conversation in an honest, open way that will help get us the answers to lay out the plan that will solve this problem once and for all. >> legislatively, how do you plan to honor their families, a traditional marriage and the

faith based organizations? >> if you look at house republicans over the course of the last few years, you'll see that we have supported those pro-family, a traditional value issues. the point we make in this preamble to our pledge is that we are not going to be any different than what we have been. we are going to stand up for those things we believe in. >> one other thing that is not in here that i have heard is something that you have supported and which is a ban on air markets. why is that not in here? >> the american people are concerned about your marks. that is why we took the position of having an earmarked moratorium for this year. this is in a government agenda

is that we can implement today. we have been earmarked moratorium in place. i think it speaks for itself. >> what are we to think of ideas that are not included in here. for example, such as security -- does that mean it is all the table? >> it is not intended to be a party platform. it is not intended to cover everything under the sun. it is about listing to the american people. as we listen to the american people, these are the things they told us. it is about what needs to be done now -- first steps for real fiscal sanity in washington, d.c., and real steps about getting our economy moving again. >> what percentage of the problems in terms of our deficit is being taken care of by this plan?

>> we intend to take first debts. this first test would be to reduce spending to 2008 levels, saving $100 billion a year, our commitment to put ourselves to balance our budget and pay down the debt. we do not underestimate how difficult this is going to be given the economic circumstances that we face. it is our pledge and our commitment to get ourselves on a path to balance the budget and pay down the debt if we are going to save the future for our kids and our grandkids. yes ma'am? >> thank you, sir. could you speak about the pledge to give a constitutional test to all legislation and talk about where in the constitution it states that congress should act to follow that test for legislation? >> most people in america it

think washington is a vault in far too many things. the health care bill that was passed by the congress and vault and individual mandate. in my view, that discussed up -- that is unconstitutional. cite the specific constitutional authority that allows this to come to the floor. the federal government is too big. it spends too much. it is out of control. molly? [laughter] i thought i had better get over with. >> thank you, mr. leader. you guys are saying that this agenda can happen tomorrow, that nancy pelosi kansas was the congress back and you guys can pass it. it took four months to produce this pledge. is this not, in fact, a government -- a governing agenda? >> it is a governing agenda that

could be enacted tomorrow. there is no reason we have to go home next friday. we could he be here each and every day and in that this agenda because if we enact this agenda, we will eliminate a lot of the uncertainty that employers are facing, we will improve the economy, and get the american people back to work, and begin the process of saving hundreds of millions of dollars in wasteful washington spending. >> are we going to see republicans staged another energy protest on the floor ensuring that speaker policy brings the congress back? >> stake in [laughter] . -- state tenuned. [laughter] >> we listened to all americans as we put this together. our members have done thousands of tel hold meetings, public forums, private meetings to solicit the american people's

ideas and bring them back to washington. we have hundreds of thousands of people go to americansspeakingout.com. everyone in america had an opportunity to participate in this. i think that is why we and build this to our colleagues last night there was great enthusiasm among all our colleagues. they note that this document was put together by listening to the american people. all the way in the back periods >> pinkie mr. leader. what is the proposal for what to do about the 12.5 million undocumented immigrants in this country? >> you are asking about something that is not in the document? >> a lot of americans are debating comprehensive immigration reform. i am wondering what the position is.

>> it is clear that the first test for real immigration reform or to secure our borders and enforce our laws. there's a the two things that are in our pledge to america. >> mr. leader, two things you hear at tea party rallies or is that the country needs a balanced budget amendment and that people are just as angry or angry -- or angrier about what republicans did. and what should they believe this time? . .

or ey give their time, energy and leadership talents in order to improve rkcoiond the lives for everyone in their field. national postdoc appreciation week increases awareness in the

fields they continue to make in scientific research in america and fair employment standards in order to continue pursuing crical life saving research. last year, in september of 2009, over 70 research institutions participated in the first naonal postdoc appreciation day. this year, it provides an opportunity for institutions liheniity cad at boulder, businesses, research organizations and others to honor and support the contributions ofostdoc ste f introducing this resolution and express my support for national postdoc appreciation week beginning the third monday in september. i urge my colleagues to join me in supporting this resolution and i reserve the balance of my time. the speaker pro tempore:he gentleman reserves the balance of his time. the gentleman from pennsylvania. mr. platts: i yield myself such i isdain spo ou

solion 45 epring suort r gnion t eek gig onhehir monday in september, this week, s on pos aciion ed whe le fr cadincoinr. sts, gtlem f lridafos sprshif isesolu.hisoluon podoaleais research conducted by a person who has completed his or her studies normally within the following five years and intendo enerse iazesubjt ar ilu nsaki mho rech iofn cosed mion e hoinuton and expected to produce relevant plitis acrdy. iy thrug apoorsh award. appointments may be called poctesear as ddin tyf po

ty mawondendelyr uner srvisn inl investigator. . it is important if tnid states is to remaintin gll et. to do so, we -- exetive in a global market. to do so must make every effot to ensure that progress and innovation takes place in all fields ofdy today we rnihe accomplishments and contributions postdocs to make to fields of studies and mmies around the world. we encourage the improvement of training and career opportunities in various research fields at all levels of training and stages. i urge my colleagues to join in supporting this resolution and i reserve the balance of my time. the speaker pro tempore: e gentleman reserves. the gentlan from colorado. mr. polis: does the gentleman omennsylvaniveny additional speakers? mr. platts: actually, madam spear, i do not and i will yield back the balance of my time. the speaker pro tempore: the gentleman yields back. the gentleman from colorado. mr. polis: i thank the

gentleman. madam speaker, i encourage my colleagues to join me in supporting national postdoc appreciation week beginning, again, the week of the third monday in september. joine upinisue relu andho son suportorhe wk anth &) at today's hearing on the

v.a. presumptive disability, a decision making process.

today, much of our focus will be on vietnam veterans and agent orange. however, this discussion also extends presumptions from the first gulf war and we are just beginning to hear about exposures to potential toxins connected to the wars in iraq and afghanistan. this committee is also addressing exposures at military installations. this is why it is so important that the way presumptions are created is appropriate and transparent for past and future wars. one issue we will look at this morning is the v.a. secretary's role in creating presumptions under the agent orange act. the secretary is called on to determine on the basis of sound medical and scientific evidence

whether there is a possible association between exposure for all herbicides or currency of disease. the law sets up a balancing test between exposure and disease. the parts of an association exists when the evidence for an association is equal to or greater than evidence against the association. in making the determination, the secretary is to take into account reports from all sound medical and scientific information. as we look at the recent agent orange and decision, we must be satisfied that all scientific evidence was made available to the secretary, and we must understand how it was weighed. for my part, i must be satisfied

that the law, enacted almost 20 years ago now, is working today. while it is clear that there are real and subantial costs associated with this new presumption, that is not the motivation for this hearing or four our larger work of a evaluating the process -- our larger work of a evaluating the process. we made a promise to care for and compensate veterans for service connected injuries. i will never stop inviting for veterans, especially when the issues directly related to the consequences of service. promise to veterans to look closelyt the current recession process, wemus must be sure the process gives the proper authority, consider all

relevant factors in order to determine whether a service- connected perception is warranted. i hope our witnesses will shed some light on these issues. this -- the current secretary and a former secretary will testify about their experiences with presumptive decision making. and experts from the scientific commity will testify on dioxin and what science exists for determining an association between agent orange and heart disease and other diseases common to agent. i thank our witnesses for being here today to help us in this effort. i look forward to your testimony. at this time, i would like to call on our ranki member, senator isaacson for his opening statement. >> thank you very much, mr.

chairman. i want to welcome all of our panelists, in particular secretary shinseki and the former secretary. i want to apologize. i am in charge of the floor from 10:30 until 4:30 in a debate and will have to leave. another senator will take my place. unfortunately, many military personnel have been put at risk over the years by dangerous exposure where they are living, working, or serving our nation. last year, the committee discussed some of these exposures including the drinking water at camp lejeune, the smoke in afghanistan and iraq. today, we will hear about toxic contaminants that were widely used in vietnam to destroy jungles, clear crops and clear parameters. for all that had been put at risk by these exposures, it i important to have a process in place to identify how their health ty be affected and make sure they receive in a fair, has a free, and timely manner the

benefits and services they need and deserve. as we discussed today to prevent -- as we discussed today, presumptions can play a critical role in that process. presumptions can relieve individual veterans of the burden of providing scientifically the potential health effects of exposure. this can create a quicker, easier path to services. the institute of medicine recommended a new approach, one that is more transparent, allows stakeholders' greater input, and identifies exposures and conditions that may warrant presumptions. given a profound impac of the presumptions, i hope to have a productive session today about the current process, where improvements may be needed, and more importantly, how any changes will impact our nation's veterans and their families. i am interested in learning the extent to which medical treatment is beingmphasis for those who may have bent exposed.

take, for example, coronary heart disease. treating their risk factors associated with the disease have proven effective in keeping folks healthy. these goals is to restore the capability of disabled veterans to the greatest extent possible. that goal is -- cannot be achieved if we only focus on the disability process and neglect treatment and prevention. i think our panelists for being here -- i thank our panelists for being here. >> senator rockefeller? >> i apologize because i also have to leaveecause we are hang a hearing to make sure that the full spectrum is

available exclusively for our public defenders, fire, police, emt, the rest of it. they do not have enough. i say we have to give it to our first responders. but i apologize for that. first i want to say that i am proud to be a co-sponsor of the 1991 agent orange lot and i still am. that law directed the secretary of the department of veterans affairs to rely on the institute of medicine studies and other science to determine presumptive coverage based on exposure to agent orange. the standard is a positive association, and if the majority of the evidence is such an

if he worked underground for 10 years, by definition you have black lung. the presumption does not give you that. as a result, very many in west virginia are getting black blanc and dying horrible deaths. i am concerned that the standard is very adequate. i am were concerned that sick veterans n be left out. i believe the underlying and unspoken issue here today that some will talk about and some may not want to is cost. people areoing to say in a

muted ways that it cost too much -- we cannot afford to do that. it comes down to what are our spending priorities for our couny? the vietnam war costs $740 billion and caring for the veterans drafted to fight that war is a fraction of that $740 billion. we did not question then. we do not question now. some will face enormous deficits. of course that is the case. i will not get into that. they are correct. but when we are talking about deficits we also have to present the full picture. i was here when people claim that we had such a huge surpluses that we had to cut taxes except for those of the very wealthy. the bush tax cuts enacted in 2001 and 2003 converted our national surpluses into ficits.

i did n vote f that. people did. it passed. the tax cuts expire at the end of this year. hence the moral choice facing the veterans committee and the united states congress. there is a debate about exteing these tax cuts. if we do not extend these tax cuts to the wealthiest 2%, we will save $700 billion in revenues over the next 10 years. frankly, that is so much more than enough to take care of what it is the secretary i required under law to duke and it needs to do and wants to do. i never believed that tax cuts for the wealthy was fiscally responsible. i believe it is proven fact. others would disagree. given the choice between tax cuts for the rich and paying for the care for our veterans, we on the veterans committee have a fairly clear choice about

priorities and it will test to we are morally. i think the choice is clear -- we spend it on veterans. we must serve our veterans. we had the resources to pull full -- fulfill our obligations to care for them. thank you, mr. chaian. >> senator joe hands? >> thank you, very much. i intend to be quite brief. i do know some thoughts i want to offer. first and foremost, i want to say thank you to the chairman. i appreciate him holding these hearings. i might add, mr. chairman, i have appreciated being on this committee. for me, it is an honor to serve on a senate committee that focuses on the needs of the veterans. i cannot tell you how much i have appreciated serving with the chairman, the ranking members, and try to figure out tough issues to try to help the

families impacted here. sometimes the impacts are very direct. we can identify somebody who has been injured in war, maybe they have lost a limb or what ever. you can look at that and still come to grips with what their disability is. sometimes it is much more interactive than that. but there are unintended consequences that we as a committee and as a congress have to deal with. that is the reality of the situation. i would classify agent orange in that category. millions and millions of gallons of agent orange were used to conduct the war. i suspect at the time those who made that decision but they were making the right choice for a variety -- thought they were making the right choice for a

variety of reasons. we can see the consequences of our horrendous. mr. secretary, i am somewhat in your position as a former cabinet meer. i remember the hearings. i would get called up for some discussion or some action i was taken. i thought i was discharging responsibility given to me by congress only to be caught in this debate. i would imagines, today, you might not imagine that you would get in a debate over the 2001- 2003 tax cuts. the reality of that, i might add, is that the largest revenue in our nation's history occurred in 2007. you can't grow de base, but let me stop there. what i want to focus on is what you have done. i think you have looked at this in every way we have asked you to. i think youave dug deep.

you did the analysis we expected he would do. as chairman rockefeller points out, once you get to that conclusion, your discretion in south. region -- your discretion and. ends. i think as we get to this hearing, we have to focus on that. the responsibility we gave you and your attempt to discharge that responsibility. i will all for this final thought. i come from a state -- the state of nebraska -- where i did not have the option of borrowing money. our state does not owe any money. why? because ouronstitution prohibited borrowing.

i could never balance the budget by borrowing money. there were not many choices available to me. some may argue that is not a good way of doing things. i would argue that what it forced us to do was to make important decisions about priorities. i think this is what this hearing is about. for may, our veterans are a priority. we put them in harm's way. we ask them to risk their lives and, oftentimes, they give their ves. i think i in the end it, we have to prote them from the direct and unintended consequences of those decisions. i come here today with an attitude that i want to dig deep, i want to see the justification that you felt, but in the end, it that is there, we stand here with our veterans.

secretary shinseki, thank you for ing here and for your work in this area. i know you are trying to get to a decent and honorable result board veterans. thank you. >> senator jim laurie? >> as everybody on this committee knows, while the cost of war are never able to be predicted, it is always higher than we ever imagined. it includes lies that are lost, billions in funding to keep our troops saved, and to dismiss that are made in or away lands. it always includes the many years of care seeing and unreseen that our veterans will need. it includes what is often expensive, but absolutely sacred. that is a promise that we made to our veterans that we will care for them when they return. mr. chairman, the veterans that have come forward with these new

presumptive diseases are among those that we made this promise to. this is a promise of remember well when in turn at the seattle medical center when i was in college during the vietnam war. we made this promise decades ago without the thought of budget deficits or agent orange exposure or politics. we made it because their sacrifice wanted it. but for years now, they have had to fight to see it fulfilled. they have had to fight the veterans affairs, they have had to fight doctors, and they have had to bite members of congress. that is unacceptable. i understand the need to tighten our physical -- our fisl belt, but we cannot do that at the expense of our veterans. the department of defense did not offer early intervention, chat service members who were

exposed, or create a registry part affected in veterans. if they became sick, they had to fight to have their disease is recognized by the va. the challenges faced by veterans led congress to pass the agent orange act of 1991. that legislation established a presumptive process to lower the burden of proof for veterans in determining whether a disability or illness is service connected. make no mistake, i believe that veterans that sacrifice so much deserve the benefit of the doubt. that is why it is clear to me that the secretary made the best decision possible given the meditation's on the findings and the limitations of his role under that law. given the lk of tracking data on who was exposed and to what extent, i know we must provide for our veterans at the association can be made. with all of that being said,

this committee does need to know how this process works and how it can be improved. going forward, there is no question we need to make a better effort to identify exposures that could lead to illnesses and diseases and the pentagon and va need to work together to make surwe care for these individuals. the dlc must provide -- d. edie should provide treatment immediately. they should create a registry said that over time we have a better understanding of how these exposures impact veterans. i thank you for theseearings. i look forward to your testimony. >> thank you very much, senator murray. >> congratulations on that night's award he received. it was well deserved. mr. secretary, thank you for your leadership and devoted service. we had an opportunity to speak

in my office about some issues we were discussing to date. i will be bouncing back and forth due to some other issues i am working on as well. i enjoyed that meeting very much. i appreciate you making the effort to reach out and talk to me. as you all know, we have a solemn duty and moral obligation to our veterans. i have been fortunate to serve for 31 years now and am still serving in the national guard. i recognize the sacrifices made by the men and women who decided to volunteer. they do it at a great expense to not only them but their families. making good on our commitment will never change. the veterans administration has a steep climb here. we want to work with them every step of the way. at the same time, the process of creating presutive conditions

is one that should be examined. there exists certain realities beyond the -- beyond medicine. the key stakeholders in bolten -- involved in the process are highly qualified. i am interesting -- interested in learning more about the be a process. -- learning more about the va process. i would ask that this group of distinguished stakeholders continue to review current policies and decision making processes for determining presumptive conditions and implement efficiencies where possible. i want to thank you again for all of your work on this and other issues. although i have some concerns, i think the's an opportunity to improve the process.

as you and others should know, you or more than welcome to provide any information to bring me up to speed, being the new person. dissected newest at this point. banking, mr. chairman. >> thank you very much, senator brown from massachusetts. senator saunders. >> thank you, mr. chairman. i want to thank secretary shinseki and the other witnesses for their participation in today's hearing. i also want to report that secondary -- secretary shinseki is stepping up to the plate on his bold leadership in terms of addressing some very long standing problems facing the veterans committee. i want to express my support for his decision.

based on existing law, there are three new presumptive medical conditions for vietnam veterans. i just want to say to my colleagues this morning that what we are talkingbout today is the ongoing cost of war. this is what war is about. war is more than bullets, guns, and airplanes. war is about making sure it that we take care of the last veteran who served in that war. if we do not want to do that, and do not send them over there. if you make that decision, it is the moral responsibility that we have. we have witnessed over and over again war time decisions that were tools of war, but had an adverse impact on the health of the very young men and women this nation has placed in harm's way. i think we are familiar with that.

we remember the shameful experience that took place after world war ii. many of our soldiers were exposed to atomic radiation. the dod and other officials said, "what you talking about?" history has proven that wrong. we all know the shameful history of agent orange. as we know that with the service organizations themselves had to step uto the plate and sue their own government. how are people getting sick? made progress since then. that is something we should never forget. men and women put their lives on the line. they should not have to sue their own government for the benefits that they are entitled to and that they earn. the agent orange act of 1991, which is the fundamental topic of this hearing, enables the be a to begin treating and compensating veterans exposed

because a positive association. it has been my experience in dealing with veterans, especially those with sious medical conditions, that all they want is a timely access to quality health care. with the nation needed these men and women to go into harm's way, they went. the same veterans came back knocking on the doors of the medical centers seeking health care. they too often down themselves turned away or denied health care because of rules and regulations that would rather split hairs than provide health care. i would never forget as long as i live the hearings -- the hearings on gulf war illnesses. bodies were falling apart. the va was saying that they were not sick. it was a very distracting experience. this debate about a perception descending -- decision making

process rather than making the health care needs of veterans. agent orange was a kick the can down the road issue that is so common inside the beltway that it does not make a bit of sense to the men and women who believe the va is their health care system. secretary shinseki, you have been placed in a difficult position. we owe you an apology. we give you the authority and responsibility to make this decision and then, perhaps, turn around and only question and second-guessed your decision making process. i am compent -- confident that he labored over this decision. the resumption process dates back long before agent orange and has repeatedl accomplished one objected that we can all agree on. it demonstrated the thanks of a grateful nation by addressing health care needs a providing benefits to veterans.

my colleagues of the issue of war, none of us are willing to put a price tag on good health. if cost is a concern, then cost should be discussed before sending servicemembers into our's way. clearly this is about the ongoing cost of war. the cost will be paid by not only this generation, the generations to come. i do not believe any better and should be denied timely access to the va health care system if they believe their condition was due to their service in the armed forces. how can we call these brave service members heroes in one breath and question their integrity and intentions when they come to the va. how many vietnam veterans do you think this nation failed due to an action between 1975 and 1991. i am afraid there are many thousands of them. mr. chairman, i want to

congratulate you for your efforts. i hope we can proceed in addressing this sue. >> thank you very much, senator saunders. senator brown of ohio? >> thank-you for your many years of service and for wt you are doing now, mr. shinseki. it is been 40 years since the last use of agent orange. it has been aong, sad history for our service memrs who have suffered because of exposure to agent orange. veterans were also plagued by foot-dragging in congress, at the va, and that the department of defense. families encountered in difference that are a national disgrace. complicated science is involved in determining resumption of illness due to agent orange.

exposure is changing technological developments. waiting for a casual link after 40 years is another way of telling veterans note. complexity is not an excuse for years of inaction. it is not an excuse for veterans, their families -- like the widow from pike county who tried to get indemnity compensation. her husband who served in vietnam died five years ago from heart sease. her claim was originally denied. the appeal was held up. the regulations had not been approved. the widow wrote to me, "my husband did not hesitate to go to vietnam. i waited for aear per have to come home. when he came home he was never the same. s life was cut short by the after effects of agent aren't -- and it arch. -- agent orange."

i am convinced he made the right decision in adding these decisions -- diseases to the presumptive st. the cost of caring for the veteran is a non-negotiable cost of wars senator sanders said. it is a question of choosing between tax cuts for the wealthiest americans and spending money on our veterans, the clear, moral answer is that you take care of veterans first. it could take years of -- there are lives at stake, lives of men and women who served their country because we asked them to. the committee has been working on a host of exposure issues. we are trying to buy the right balance between evidence and lel of exposure and causation. our troops, and i would add, many citizens of vietnam suffered and are suffering still from agent orange.

th is about where do we draw the line. how did the va, to this -- prompted the decision to add three more presumptions? it is not easy. there are legimate questions about the process of determining the presumptions. i believe the secretary is correct. for more than 40 years of vietnam veterans have waited too long. we must work together to create -- to fix this injustice. >> thank you, senator bro. >> thank you, mr. chairman. welcom assessed -- mr. shinseki.

i would like to say that i have a pretty long experience with this issue beginning as a company commander in one of the more war-torn areas of vietnam. for those of you who are veterans in the audience, the arizona valley -- barry ravaged places -- very ravaged places. devastated villages in populations. i also had the privilege of serving as committee counsel of the house-veterans committee for four years from 1977 to 1981.

on that committee during that time, we had a number of hearings about agent orange. i cancelled several of them. i believe by canceled for as we were attempting to come to grips with how to examine where agent orange was used to was exposed, -- where agent orange was used, and it was exposed, and what we should do about it as a government. those issues ve never been clearly or fully resolved. what we are looking at today -- hear is what we have to look at. we had a duty on this committee to examine these issues.

first, the implementations of the law -- disregards the secretary's decision. i have no question that the secretary's decision was within began bit of law, but we may want to ask ourselves if this is the right way for these decisions to be made in the future with issues of this magnitude. i want to say very clearly, this is not simply a cost issue. i have worked on veterans' issues my entire life. this is not a cost item at all. this is an issue about the credibility of our program. mr. shinseki pointed this out very eloquently. i do not want to get ahead of his testimony. it is also about the accuracy of the scientific process as it pertains to agent orange and service in vietnam. we have struggled with this for more than 30 years -- how we

intersect scientific analysis with actual service inside vietnam. it is also about the use of presumptions. the reason i put the chart up and the reason i ask for this chart to be shadowed to my fellow senators -- to be shown to my fellow senators, we need to know what was in the mind of the lawmakers when this law was originally passed. you look at the first three issues here. those were the three conditions that were written into the 1991 law. we asked the va to give us the number of people o were receiving disability benefits as a result to those conditions today. they come up to a total of a little more than 5000 people. the law banned began -- the law then began to be examined under a broader context -- the context

of dual presumptions. firsthat everyone was presumptively exposed to agent orange. secondly, we have said that in the vietnam veteran that ends up with the systemic disease based on this process that was written into law has, as a result, a service-connected condition with respect to agent orange. if you look at the last three of the items on this chart, d.c. what has happened. -- ec what has happed. we have -- you see what has happened. this hearing is vitally

important for us to examine where we are now and where we need to go in the future. mr. chairman, i thank you again for having the courage to hold the hearings. i appreciate secretary shinse's appearance and the people we will see on the second panel. >> thank u very much, senator web. senator faster? >> i also want to thank you for holding this hearing. this is a topic that is not an easy one for anybody. i also want to commend senator webb for asking some very tough questions about agent orange exposure and about exposure issues generally. i also want to thank you, secretary shinseki, for coming here today and to talk about the steps the va has taken to do right by vietnam veterans and who are now suffering the consequences of agent orange.

i do not anyone here thinks the rules should be changed. they are in place. the funding is in place. we are not going backwds and i do not think we should. i have been to a few democratic policy committee meetings on things like burned pits in iraq. we have heard senator byrd's plea for camp lejeune veterans. we need to -- the bottom line is that there are going to be many more concerns raised about exposure to toxins and toxic substances in the years to come. in the case of granting presented eligibility, need to be sure that exposure compensation is based on sound ience and the right interpretation of the 1991 agent

orange law. i am not a doctor. i am not a lawyer. but i believe the basic responsibility of the governmt and this committee is to care for the veterans. that includes service members who were exposed to toxic substances and become ill as a result. at the same time, we also want to be sure that in this environment, we are careful steward to the taxpayer dollar. i look forward to hearing more about the decision making process in balancing the conclusions reached by the several different studies on agent orange exposure. it will not be easy. it is also why am happy we are having this meeting. >> faq, mr. chairman. -- thank you, mr. chairman. i want to welcome secretary shinseki and other distinguished

members of the panel. i also want to mention that i am glad to see that there will be two witnesses from the university of illinois on the second panel. if i am not here, you'll understand your senator has recognized you. i am also pleased that all of you have come here to give the us your assessment of the possible future of presumptive disability decision making process. your experience d expertise should prove to be invaluable. i know i have witnessed several situations in regard to vietnam veterans. i remember being at the parade in chicago when they were finally welcomed home. that was a very, very heart-

wrenching, moving situation to see general westmoreland stand on the platform and watch those veterans come up and get their respect to the general. it was not a dry eye on the reviewing stand. now we know that some of those who came home with no type of parade, the type of motorde, the type of flags flying, and they were not really given what they deserve. i am hope and pray that we do not do -- that if we do not do something, there will be continued misery for these men and women who gave up all and were fortunate enough to come back. if they are suffering from some disease as the secretary has determined under law, that there is presumptive support for them. we should find a way to make sure that those individuals are given the best care thawe can

possibly give them. they have suffered enough. they do not need to be going to the rancor. i agree with senator sanders. he indicated the cost of war was costly. but there is more than guns, bullets, and tanks. it is the aftermath of those who donned the uniform and dear to go out and face bullets -- dar to go out and face bullets and the other large ships tserve this country. it is my belief that we st take care of the veterans. i am sorry that we had to get to this kind of a meeting, but that is our job. there is no price that we can put on what we can do if those veterans suffer from those

chemicals that were sprayed due out that country. we do not even know what the outcome is for those individuals who are in the war. we certainlyannot use finances and budget shortfalls and other excuses to not support our veterans. i am interested to hear the secretary's it testimony and the other witnesses. rest assured that we will be in the process of taking care of our veterans who have taken care of us. i have told everyone who has donned a service uniform that the only way america can be great and the land of the free, is because those individuals or all lead grave. there is no reason for us to give any more agony to those people who finally come to the

va system. some of themtayed away. they are finally coming back in because they are, now, in desperate need. the onus is upon them and they need our help. let's not abandon them. i look forward to your testimony. thank you, mr. chairman. >> thank you, senator burris. >> think you for holding this hearing. mr. shinseki, thank you for the meeting we held briefly. i have to go to a commerce meeting. i thought i had more time. i have to go where the chairman is. first i want to echo some of the comments. what the challenges we have when we engage in conflict be they small or large is that we failed collectively, democrats and republicans, we failed to

outline what the total cost will be. it is not just fighting the war, it is what happens afterward. what we have in front of us is one of those issues that was not calculated in from the monetary and. i want to say that i support what you have done. i have served in leglative bodies for 10 years when i was in anchorage. there are times when you have to make decisions based on a policy set by the legislative body, which this body did. you did the work and, actually, your predecessors did the work. here we are. you made a decision, which i can tell you in alaska i hear from many vietnam veterans about the issue of agent orange and the work and trouble and paperwork they have to go through just to prove what caused it. we can argue over certain

quantities of individuals who may or may not have, but the simple reason we call them up to serve our country in the war, we have an obligation to provide them with the benefits that they earned and they deserve. i am not a doctor. i am not here to tell you what the science is. that is what you do. that is why you are the secretary of the veterans affairs office. your ability to reach out of the last several months and -- several months to determine the right approach to deal with agent orange -- we he the gulf war to finish. then we have our iraq and afghanistan. we have other issues that we're not fully addressing that we will have to deal with. we have to recognize that we are going to have the bill do that is more significant than we can ever imagine of these conflicts

we have been engaged in. that is the cost of going to war. after our discussion and my review of the efforts you have done, i am not going to sit here and try to second-guess doctors, scientists, and others who have gone through this. you have an obligation to follow the law. you did. many vietnam veterans in my state are appreciative of the steps you have taken for the illnesses that they have as well as the disability component. i want to take you for the work you have done. we can argue. we will. oversight is good. that is part of the process of the committee. oversight leads us to understanding what the next issues are going to be. the next generation of veterans and the costs that are going to be associated will be staggering. this is an increasing cost in the sense of what it will be. all you have to do is look at

the wars we are engaged in today. it is a staggering cost we cannot measure today. i just want to reiterate from my perspective that i think the steps you have taken are positive steps for vietnam veterans. i think the process you went through, at least in my review, was tedious, in depth, and came to a resolution that we hav heard for 70 years. i have only been here less than two. it took only a few months serving in thi office -- people were very quick to talk about this issue aggressively. thank you for being here today. now you, get to say a few words. i will end it there. mr. chairman, thank you very much for the opportunity. >> thank you very much. i want to thank the members of this committee for their opening

statements. i want to welcome our lead witness, secretary eric k. shinseki. secretary shinseki is accompanied by dr. robert gentry to is the principal deputy under the secretary of health. the director of the radiation and the physical exposure service, the secretary is also accompanied by the associate deputy and undersecretary for policy and program management. jack thompson, the va deputy general counsel. secretary shinseki, i want to thank you for joining us today to get your perspective on the department's presumptive disability in decision making

process. -- presumptive disability decision making process. we look forward to understanding the process better after this hearing and deal with it legislatively to try to improve it for the future. i look forward to your testimony, mr. secretary. your statement will appear in the record of the committee. please proceed. >> chairman akaka, senator isakson, other distinguished members of the committee, thank you for the invition to appear here today to discuss my decision to address a presumption for service connection of three new diseases in accordance of the agent orange 1991 law. some of it will be repetitive.

mr. chairman, thank you for including my written statement for the record. i appreciate the generosity by members of this committee prior to testimony. i want to acknowledge the representatives of our service organizations who are in attendance today. their insights are important and have been helpful to me. mr. chairman, you have already intruced the members of the panel. let me make sure that i have positioned to they are. on the far left is the assistant deputy -- the assistant deputy secretary for policy programs and veterans benefits administration. as you indicated, to my immediate left is our general counsel, jack thompson. to my immediate right is the deputy undersecretary for help in the veterans health administration. to the far right, someone from our department of public health

and environmental hazards. congress established many significant presumptions for service connection says creating them as part of the benefit system in 1921 following world war ii one. the department of veterans affairs have also used their statutory authority to establish that-based perception in service. congress passed the agent orange act of 1991, which prescribe a more focused and proactive policy for addressing veterans's concerns. the act was explicit both in the actions the secretary must consider and the standards the secretary must apply in these determinations. the act directs the va to establish a presumption for any disease or the evidence shows a "positive association" for the development of disease in

humans. by law, a positive association exist whenever the credible evidence is equal to or outweighs the credible evidence against an association. the act further specifies that in determining if a positive association exists, the va mu consider a biannual report of the institute of medicine that evaluates the evidence regarding help the banks and exposure to herbicides and all other medical evidence available to the va. it was the report is released, the law allows the va only 60 days to determine whether it be -- whether new presumptions are warranted. the va will ensure that the determinations are made in a manner consistent with the standards. each report is reviewed by a working group of va employees with medical, legal, and

appropriate expertise and by a task force of senior va leaders. the secretary benefits from the advice and the analysis of these groups. the secretary is responsible for determining whether the evidence regarding any disease satisfies the statutory standard. in july 2009, the va receive the most recent iom report. the most significant changes from the 2006 report or the findings of sufficient evidence of a positive association between herbicide exposure and chronic leukemia and a limit suggested evidence of an association between herbicide exposure and parkinsons' disease and systemic or disease. after reviewing the analysis and scientific studies, and a consulting with medical and legal experts at the va, i

determined that the evidence that the positive association standard of the agent orange act. the be a proposed regulations to establish presumptions of service connection to this disease is. the evidence regarding hypertension was less compelling in my view and still didot meet -- did not establish a positive association. i believe that these decisions in all four cases are consistent with that the w. in conducting my review and making my decision, i was aware of the prevalence of systemic heart disease within the general population and the fact that it is associated with a number of factors other than herbicide exposure. i carefully considered whether these factors could be considered in applying the statutory standard.

my determination that there is a positive association between our side exposure estimate are disee was based solely on the evaluation of the scientific and medical evidence according to the statutory standards in the agent orange act. we identified nine studies that were rigorously conducted, some containing reliable measures of exposure that permitted evaluation of relationships that are particularly related to in determining if they situation exists. five of the studies detected a relationship. the studies with the best dose information showed increased risk of the highest categories of exposure. there is sound medical evidence of a biological mechanism of the

disease causation. i took particular note that of all nine studies, all nine studies had control for age. age is the primary determinant of systemic heart disease. it is the one determinate and one risk factor that cannot be moderated. some of the studies showed the association persisting after an adjustment from compounding factors. the iom study also noted that the studies did not adequately control for certain risk factors -- those risk factors were unlikely to explain the increased risk detected. the review brought to my attention at a recent study which was particularly helpful. it was useful because it analyzed numerous prior studies and concluded that those with the best data in comparison were consistent with finding a

significant dose relationship between dioxin exposure and it increased risk of systemic heart disease. in my judgment taking into account the findings, the strong evidence of this response relationship, and the extent to which these studies control for risk factors including age, the evidence for an association betwee herbicides closure encysted and heart disease more than satisfies the positive association standards of the agent orange act. the statute directed that i make a presumption of service standard without regard to cost or independent risk factors. my determination were not made lightly.

no other course of action would have met the intent of the law. veterans and their families have waited decades while science has incrementally revealed the impact of agent orange on vietnam veterans. not only did our actions follow the statues, but i believe our actions on agent orange will be viewed as an indicator of our seriousness of commitment in addressing veterans needs, not only for vietnam veterans, but our veterans of every generation. presumptions will continue to be an important part of the system for the foreseeable future. they are powful tools for promoting efficiency, fairness, and justice. these presumptions are significant for the efforts of the va and congress to assure the fair adjudication of benefit claims at a time when claims are in -- when times -- when claims are increasing.

the most important thing i have learned from this process is the one that senator murray pointed out and that is we must try to be -- we must try to limit exposure earlier. such checking does not get easier or less complicated as time passes. eay ristration and surveillance of those exposed enables better treatment and rehabilitation and allows us to make protective decisions and mitigating -- in mitigating future exposures. early check-in, treatment, because better help for america's veterans. we must do better, and we will. thank you for this opportunity to appear before this committee and thank you for your continued, unwavering support of our veterans. i look forward to your questions.

>> thank you very much, mr. secretary. we appreciate understanding more about your decision. bodman will you please tell me about any concerns -- will you please tell me about any concerns within the va that were raised when you're deliberating on the issues and your decisions? >> by concerns you mean about the dialogue that went on inside our project? >> d v m eight. >> as indicated, we had several groups. there were other independent views i sought. i would say it was an open dialogue. people were encouraged to participate fully. in that kind of environment,

you're going to have to give and take on thdiscussions. i listened to all a bit. all of it was helpful. some of that was more focusing. i would say perhaps the most robust of the debate focused on systemic heart disease. i would say that the vast majority of the medical experts who engaged in that dialogue with me were solidly in support of the positive association. that is as much as i can describe for you about the internal process. i would offer that when i say it 60 days is what the law stipulates, i would say it was a time-constrained process.

the dialogue was important and i had to find a way to make sure that all of the views, including minority views, were shared. the time limits was a bit constraining. i have proposed -- one of my suggestions is that we look at a way to expand the window that the va has to do this. after all, the study is a two- year process of the iom. all of the studies of a book that, we received a report of about 650 pages. 60 days is a little challenging. >> thank you. according to responses to the hearing questions from a witness on t next panel, 8% to 90% of

patients suffering from heart disease have factors such as smoking, lack of exercise, and a diet high in cholesterol. how did this affect your decision? >> mr. chairman, i do not have any data that would refute that. i think it is fair that people my age in this country -- the 60-year group -- heart disease of some kind is a fact of life for all. 80% may be the right number. i would accept that. we are not talking about eight symptomatic heart disease. 8% of people who have this commission, whether it is having

to control with bids through medication or a buildup of plaque in blood vessels, that 80% is a symptomatic. what we are concerned about in systemic heart disease is the 17% who are estimated to have as symptomatic systemic heart disease. symptomatic in the sense that there is pain associated with it in doing a routine activity like climbing a flight of stairs, they are exhausted and cannot do it. this is what we are talking about. it is this a lesser subset that we are focused on with the systemic presumption that we are dealing with. >> thank you. we will have five-minute rounds of questioning. let me call on senator joe

hence. >> mr. secretary, let me go back a ways and lay some groundwork. back when agent orange was so routinely used, how much of it was ultimately used in vietnam? >> senator, this is a great question. i would say our best review of the records says that 19 million gallons of agent orange was disbursed over vietnam. i accept center webb's description. agent orange was disbursed over

all four major regions. areas in the central highlands, northwest of saigon, southeast of saigon -- it was disbursed to help the country. >> typically how would it be disbursed? >> aerosol biplanes. -- aerosol by planes. asking a veteran to prove that he was sprayed -- he may not know. it is distributed by aerosol and, unless you happen to be there, you probably did not know you were in the midsof it. it was due out the country. . .

i would imagine. >> i guess if you were there when it went on, you would probably know it if you could see through the canopy. some areas they were 200-300 feet in the air and you might not see the aircraft, but i think if you look through an area where it was used very clearly, the foliation would tell you. again, in those days, i don't think most youngsters understood or realized wa that meant, you know, in the deployment of fires, artillery fires and bombing, you have effected changes, landscape to look like to moonscape because of the void of trees. i'm not sure youngsters could distinguish between what caused it the facts show that 19

million gallons, if you think to have big 50,000 gallon tanks you pull up at exxon as being a significant fuel supply or supply of liquid, we're talking 19 million gallons which is significant. to this perception in how you will handle it, the last piece of your testimony in response to the question raises a qestion or two for me. do i understand you to be saying that if i walk in and i say, "i have elevated cholesterol" how are you going to handle that versus someone that says, "i have not been able to work for a number of years. i am short of breath. i have pain in my chest."

tell me this. how you manage this presumptions? >-- how will you manage this presumptions? >> we are talking about systematic symptomatic disee. we can begin the process of the health conditions of that over time if it does become of the symptomatic order, we can make decisions of what kind of disabilities are involved. if it is a cinematic, -- if it is asymptomatic, we are not into

that discussion. let me turn the one party to see if there is more that could be added. >> thank you. while 80% of people will have risk factors, roughly 1/3 will have hypertension. 50% will have cholesterol over 200. a third will have bad cholesterol beyond what is acceptable. the risk factors are important. they are not able to be parsed out. what is important, and it comes back to comments made by several senators, is treatment of the risk factors is important when it comes to quality care. if they were exposed to agent

orane or it was recently, we take the risk for disease very seriously. we have measures that are in place that are at par or better than any of our health-care systems in the country for the treatment of lipid and diabetes. we have a program that is focused at getting the veterans to increase their physical activities. all of these are taking very seriously. can we do better? yes. we re trying to do more. >> thank you. that is helpful. >> thank youvery much. >> thank you very much. in his statement, he made some

suggestions to improve the agent orange act of 1991 including new studies in dioxin levels and blood testing to provide an estimate for latency periods for aided orange. -- agent orange. i want to ask you what your thoughts are on those recommendations. how do you think we ought to move forward from here? >>; dr let me call on dr. jesse. >> if we move to the issue of a tribute tributal risk, it becoms difficult.

they have been asked to answer that question. they have said, "we cannot do that." if we go back to causation, which inherently makes sense, it is the wisdom of congress in the 1991 act that moved beyond making that decision. in terms of trying to assign how many veterans might from m ninthight nor might not be affes difficult. we are back in the same position of defining the population. >> how do we move forward? >> the question on measuring levels unfortunately drop as

time goes by. you have some very good levels from 1980 and 1987. at this time, the residual from those exposures in vietnam are now approaching the level of the residual of exposure in the general population. this was seized in this country. the other important point is that we do not know when the damage to the cells actually occurred that develops into clinically significant disease. it could have happened in the 1970's or 1960's. the study shows that increased disease risks correlates with 1980 and 1987 levels. >> here is one issue you asked

about, which was late in say. -- latency. there has been some engagement of latency in the past b. i think it was 30 years. >> in the original perception, pulmonary cancers were given latency periods of 30 years. that was actually withdrawn by congress. if they said there is no sound basis for continuing that. some of the presumptions would be expected to be corrected at the time of high exposure. you cannot put a time frame on it. >> i just wanted to get that discussion out. i think this is a tough

question. this is what we are wrestling with. our best opportunity to set up an outcome differentn the one we are dealing with today -- we ought to be looking. when an exposure occurs, we should be looking for it. it does mean the we have the knowledge that an exposure occurred. while we want to do -- what we want to do is figure out how to identify who was exposed coming get a registry of everyone who is in the unit, in find a way t and find a way to .

you either believe in the efficacy of medicine or you do not. if you diagnose and treat, you influence the outcome of those patients. that is what we are very much into, the prevention model. as these diseases reveal themselves, we treat them and then thebegin to modify the severity. i think that will address the otheruestion about cost. >> that is sending you and i have talked about before, and denial of something at the time. we have a history of that when it comes to war in this country. i hope that is a lesson in alwel think about now. cracks may i follow up?

-- >> man follow up? this is the next comment. we have the opprtunity to change the outcome and not have the agent orange emple repeated. we did know about operation relief. we departed iraq. our opportunities to determine where and what was the exposure of which units -- we are losing the opportunity every day. this is the ough part of the business, i did find that exposure and being willing to do something -- identifying the exposure and being willing to do something about it. >> we have a severe problem in my state on the olympic peninsula with access to our veterans. many lives miles and miles away

from care. there are very jammed facilities. i want to talk to about dealing with some of those folks who are not getting the care that they need. i will contact you. >> i will be happy to have that discussion. >> thank you very much. >> thank you. this is a very difficult discussion, because we ae asking the secretary to play god. i happen to think you are doing a great job, that you are not god. none of us are. in the old days before we knew what we knew today, everyone recognizes that if a soldier was wounded or lost a leg or arm, there is no debate. that was a cause of war. that soldier got all the care and benefits he or she needed. the difficulty is that the world has changed significantly as a

result of chemical exposure. let us not forget that when agent orange was first used, our friends said it was benign and it was not a problem. am i correct? >> to my recollection. >> i am sure the military would not have used this chemical if they had known. at the end of the gameday, a pon our own people. who is smart enough to know exactly the impact? because they were exposed to agent orange, if they combined it to a genetic predisposition. could it have led to another

illness? of course it could have. who is smart enough to make a correlation? i am not. i doubt you are. it is not saying the u.s. soldier put your le on the line. we will give you the benefit of the doubt. we are going to assume that if you come down with an illness that we can relate the exposure in this case to agent orange. we will make the premption. i think that is the right presumption. in terms of agent orange, our history on the subject as the government had not been good protocagainst vietnam vets. one of the things i would like to ask, to the best of my

knowledge -- i was in vietnam a few months ago. it was a hot spot. to the best of my knowledge, i believe that we have really not in a thorough study of agent orange on the vietnamese people to learn from their exposure what it means to americans. i do not think that was an accident. i think in the years afte th war, the attitude was the less we know the better we will be. the lesswe know that means and people come forward and say "i am sick" we ca say "we do not know anything." doesn't it seem strange to the people who were most exposed

have not had a study? this somewhat to comment on that? >> i am not familiar with studies on the people of vietnam. there may have been said these. i m not personally aware of them. i will have a liggett that and provide you with an answer. -- i will have a book at that and provide you with an answer. -- look at that and provide you with an answer. a steady continued through the year 2000 -- a study continue through the year 2000. it lost priority. we have just restarted our efforts to begin the study again. it is looking at the long-term affects of agent orange on vietnam veterans. >> it some mone on the panel could answer my question.

-- if somebody on the panel could answer m question. when we look at the impact of where agent orange was dropped on the vietnamese people to learn their suffering? am i missing something? wouldn't that be a scienfic quest? >> the answer is yes. could it be done is another channel. we are not able to prices leprey identify the veterans that wherere exposed on the bubble on the same as the the average 1a level on the same -- that exposed on the same level as the vietnamese. >> all right. does anybody -- that was the

point i wanted to make. i think we have put the secretary in a difficult position. i think he has done a great thing. we ought to give him the benefit of the doubt. >> thank you very much. >> thank you. in an attempt to clarify the decision process and to clarify may be paying attention to this, one of the set of unknowns we have been working in to bring some validity to this process, i've looked at these studies

that you mentioned in your testimony. you are correct. all of them did and just for age. there is a great variance in the control factors -- and ju adjusr age. there is a great variance in the control factors. i am struck by the fact that i do not know of any extensive study that has looked at vietnam veterans as a whole. it was a study that was begun and interrupted in te year 2000. are you aware of any other studies that have examined vietnam veterans as a whole? >> this is a long-term study of vietnam veterans that i believe

began sometime around 2000 or shortly thereafter. they began to lose momentum. in an ffort to answer some of the questions, we recently read initiated an effort to create that long-term -- we read- initiated an effort to recruit the long term -- we recently read initiat-initiated an efforo create that long-term outlook. >> we were trying to trace the dioxin chemicals. wouldn't there be a way to still examine tissue damage in the sorts of things -- and in these sorts of things we could determine among a control group? >> it is very attractive to look

atthat type of delineation. it is not possible. there are many different numbers out there regarding what the half life of tcbd is. it is very variable from individual to individual. when you look fat tissue damage, if there is no way to say that this damage -- when you look at tissue damage, there is no way to say that this damage was caused from smoking or what. once it is damage, it is damaged. >> let me suggest something else. as we were discussing in the office, when we ere first

looking at this issue in 1978, one of the discussions that we read having on the staff -- we were having on the staff was to take veterans from specific unit that we would know had been in the areas where dioxin had been sprayed and into a comparable study with them as opposed to other -- and do a comparable study with them as opposed to other vietnam veterans. is that something you are considering doing? >> i'll get more into this and provide you an answer of exactly what transpired in the previous study. i think you and i are in agreement. we need an effort to curry create better data.

it is not precondions. we have vetans after suffering from these -- this does not change the conditions. we have veterans after suffering from these diseases. >> when your of looking at disability compensation on this issue, has there been any discussion about these other risk factors as a component of evaluating one's disability? do you measure the overall disability of the individual despite smoking and all the other conditions su were mentioned? >> at this time, i think the inside are helpful. i think it is difficult to figure the contributioof

these various confounding factors. all we know is that tcdd attacks the vast litter -- vascular turture of animals. we know there is a contribution. we do not know to what degree it is more significanthan others. >> youre basically taking the medical condition and assigning it. >> and assigning it to the conditions overall. >> rather than breaking out one component of it. >> that is correct. >> i see. of like to understand your motivations -- i would like to understand your motivations in regards to the 28th report in

the association between herbicides and heartdisease. was this -- where their new studies that came into effect? - where their new studies that came into effect? ere there new studies that came into effect? >> there were two new studies that drove that preponderant of associatioce association to a sr degree. there was no information. >> was a new researc or evaluations? -- was their new research