in addition to vha has diagnosed about 27% of oca patients with ptsd. that rate is relatively high compared to published studies of prevalence which generally range from about five to 25%, but it's not surprising is veterans who have health problems are more likely than other veterans to seek care. the number of veterans who are eligible for vha benefits and extent to which they use the services will affect future costs. about 1.3 million oca veterans have become eligible for health care through the vha, just over half of them have sought the care through march 2011. the number of oca veterans who have ever used vha has grown by about 100,000 per year since 2005. roughly half of those, those have ever used vha, began using it within 12 months of separating from service. their use is typically highest in the months immediately after they enroll in that system. vha spent almost 1.9 billion, or $4800 per oca beijing in 2010, and making the total of $6 billion to treat oca veterans through 2010. although oca veterans were 7% of our veterans treated in 2010,

and the first is that we also, um, had projection withs for the 2011-2020 time frame for vha for all veterans. and the budget would grow -- well, not the budget, but the amount of the costs to treat those individuals would rise from the 48 billion in 2010 to under the one scenario 69 billion, and in the higher scenario which included higher medical inflation and so forth, i think it was 85 billion. so in the lower case we're talking about an increase of about 45% over the next ten years, um, which is a substantial increase in order to be able to provide the health care for all the enrolled veterans. now, we have not, we do not make policy recommendations, and we have not in that paper looked at options for cutting that growth. and we had not looked at efficiencies. so i cannot tell you about that specifically. i mean, you're aware of our budget options, apparently, so we do have a couple of options in that. but it may also involve not just efficiencies, but it may involve shifting some costs or -- >> if we just do efficiency and shifting costs, will we meet that projection that you j

on that because i'm not an expert on that aspect is that i know that there's some fee-based care in vha. >> yeah. >> i do not know how they decide when it goes to fee-based care or not. >> okay. yeah. >> so -- >> okay. i'm shooting it back to you, paul. >> so when you're in the fight and you need ammo, you put your hand back, and you get ammo. you've heard from mrs. nicely, they need immediate care. >> right. >> and i think whether or not it's a contract is like d.c. talk to folks in the field. >> right. >> they want to know who can i call right now to help me. >> right. >> and i think whatever it takes to deliver at that point of impact is what we need to come up with. >> right. that's my perspective, too, i think having people who need knee or hip replacement on a list for two years, it's not a good way to run a ship. and i understand the problem with recruitment in rural america. it's in the private sector and the public sector both, so it's really important. my time has run out, long past. i will thank you all for your testimony and appreciate your perspectives. >> thank you very mu