VA Changing To Help New Types Of Veterans

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There are now more women returning from war wounded. With improvements in battlefield medicine, many of them need extensive physical therapy and mental care. Tammy Duckworth, assistant secretary at the Department of Veterans Affairs, talks about how the VA is changing to help returning veterans.

NEAL CONAN, host:

This is TALK OF THE NATION. Im Neal Conan in Washington.

For too many veterans, the VA can be a bureaucratic nightmare, a faceless government agency that can be perceived as anything but an advocate for the men and women who served in the armed forces.

Now, hundreds of thousands from Iraq and Afghanistan struggle with homelessness, joblessness, mental health and substance abuse - problems that veterans of every war suffer in greater proportion than the general population. And America's current wars have produced specific issues of their own.

Two years ago, a new administration vowed to make changes in the VA. Today, Iraq war veteran and Assistant Secretary for Public and Intergovernmental Affairs for the VA Tammy Duckworth joins us to take your calls.

Has your experience with the VA changed? How? Give us a call, 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.

Later in the program, second chances for felons and the special case of Michael Vick. Buzz Bissinger explains why he changed his mind. But first, Assistant Secretary Tammy Duckworth joins us here in Studio 3A. Nice to have you on TALK OF THE NATION. Welcome.

Ms. TAMMY DUCKWORTH (Assistant Secretary For Public And Intergovernmental Affairs, Veterans Administration): It's great to be here, Neal.

CONAN: And for those who don't know, we should explain Tammy Duckworth lost her legs when the helicopter she was flying for the Army was hit by a rocket-propelled grenade in Iraq in 2004.

So are you both an officer of and a client of the VA?

Ms. DUCKWORTH: I am both an officer of and a client of VA. And I was a client of VA before I was appointed to my current job.

CONAN: And what was your experience like?

Ms. DUCKWORTH: Well, you know, it's changed a lot. It's changed a lot from when I first went to VA in 2005. When I went to switch from the DOD to VA, while both systems, for example, had great medical records, electronic medical records, they weren't talking to each other.

And one of the things that the president charged us with doing, back in 2009, was to make that more smooth. And so those are the things that are changing.

And VA, as you were saying, had always been an adversary to veterans, and now we're becoming advocates. It's a real cultural shift.

CONAN: And it takes time to change a bureaucracy that large with policies, but the perception had been that the VA was there to find ways to deny benefits - rather than find ways to get veterans what they were entitled to.

Ms. DUCKWORTH: I think that's very accurate, but that is changing, definitely. I'm a baseball fan and so is Secretary Shinseki - although he's a Red Sox, and I'm a...

CONAN: Well, I hate to hear that.

Ms. DUCKWORTH: I know, I know, and I'm a Chicago Cub - so, you know, what can I say? But, you know, the VA's attitude is now, a tie goes to the runner. If we're going to make a mistake, it's going to be on behalf of the veterans.

And a great example is the new ruling on post-traumatic stress, so that if you are diagnosed by a VA physician as having post-traumatic stress, then you can immediately access all of your benefits, as opposed to before, where you actually had to prove that you were in country, you were at a certain place at a certain place at a certain time when something bad happened.

CONAN: And there were many cases of people who, for one reason, were found that their records were kept as clerks, so they could not have been, by definition, in combat. Yet there they were with PTSD.

Ms. DUCKWORTH: Absolutely, and women who served, all of those types of things. So when we expanded the definition of how people could access post-traumatic stress benefits, it wasn't just for Iraq and Afghanistan veterans but for veterans of all generations, especially those Vietnam vets who have been suffering for 40 years.

CONAN: Another major issue for many people is the backlog. Now, you guys get, what, something approaching a million claims a year, something like that. So you've got a lot of paper and a lot of electrons to move. But nevertheless, people complain it's five months, six months, years sometimes.

Ms. DUCKWORTH: It has been years sometime in the past. We're making that better. We're not there yet. We're working as hard as we can on the backlog. We hired something like 3,000, 4,000 more employees, working overtime, to work through the backlog.

But really, the answer isn't going to be hiring more people to push pieces of paper. You know, on the one hand we have the best electronic medical health record system in the country. On the other hand, our benefits administration is completely paperbound.

It's switching to that electronic, lifetime electronic records that will transition from DOD to VA - so that you don't have to prove to me that you were at a certain point in a certain place. I will have your records.

CONAN: And intergovernmental affairs - I assume that involves talking to the Pentagon from time to time.

Ms. DUCKWORTH: It does involve talking to the Pentagon from time to time. It also involves talking to state governments. And I came to my job at VA from having been the state director of the Department of Veterans Affairs for the State of Illinois.

So I know a lot about those benefits and programs available at the state level, the city, municipalities, counties. And so we need to reach out, and one of the other things that we're doing is reaching out to our partners across the country at all levels - not just other federal agencies, although our partnership with DOD is critically important.

CONAN: One thing, obviously, you know is that the percentage of female veterans is large and getting larger. It's - I think what, 5 percent now and is expected to increase to, well, about 10 percent as this new cadre from Afghanistan and Iraq joins - leaves the military and joins the ranks of the veterans.

And a lot of people say women are just simply, there isn't enough critical mass yet for women's affairs to be taken seriously.

Ms. DUCKWORTH: You know, Neal, it's always important to take care of every single one of our veterans, whether or not there's one or hundreds of thousands of them.

I will tell you, though, that right now, 45 percent of all women who served in Iraq and Afghanistan have come to VA for health care, and that's an astonishingly high number.

I'm one of those clients myself, and what we're doing at VA is making sure that we treat the individual human being. And that's why we put a women's health care coordinator at every single one of our medical facilities, to make sure that the women who come to our VA medical centers have someone to talk to.

CONAN: We're talking with Tammy Duckworth, an Iraq veteran herself and an assistant secretary for public and intergovernmental affairs - at the Veterans Administration since 2009.

Vets, we want to hear your calls. Has your experience changed? If so, how; 800-989-8255. Email us, talk@npr.org. And let's get Harold(ph) on the line, Harold with us from Bushnell in Illinois.

HAROLD (Caller): Yeah, turn it off, then. Yes, this is Harold Picard(ph), and thank you for taking my call. I just wanted to know why it takes two years to have a claim processed, and more than a year to even get a hearing? Are we not having enough people to process these claims, or where's the negligence at?

CONAN: And where did you serve, Harold?

HAROLD: I served in Germany.

CONAN: At what time?

HAROLD: In 1964.

CONAN: And when did you file your claim?

HAROLD: Within the last year.

CONAN: And you've not - you've obviously had very little luck, and, well, we'll get Tammy Duckworth to...

HAROLD: Well, I haven't heard anything from the officials other than, you know, they received my claim.

CONAN: OK. Assistant Secretary Duckworth?

Ms. DUCKWORTH: Sure. Well, I think Harold is speaking right, exactly to the heart of the matter of the backlog. And that is that for veterans who are from generations prior to the current one, there is a whole need to prove and explain that you were at a certain time in a certain place, and that your disability is directly connected to your service.

And I will tell you that especially with his generation of veterans, we have a real problem with records, as you mention, that were not kept properly.

HAROLD: But, but...

Ms. DUCKWORTH: Let me finish. Let me finish. And it does take a while to get through those. You should be getting a response. The hearing happens after you appeal their decision, and then you decide that you don't like the decision, and then you can appeal, and that can lead on from one to two years.

CONAN: But he's not heard a decision yet.

Ms. DUCKWORTH: So yeah, we - it can be as long as six months to a year in some cases, depending on the specific case of the veteran and what they're facing.

Some cases take less time than that. I know my case took six months; three months to get an initial evaluation, and then three months to get the decision.

But again, this is about the fact that we need to change our system. It needs to become an electronic system so that we don't have any more folks going through what Harold is going through. And that's simply unacceptable, and we're working as hard as we can to break the back of that backlog.

CONAN: Harold?

HAROLD: But you see, the thing is that I haven't even had an opportunity to get a hearing, and it's been more than six months.

CONAN: I think what she said is you don't get a hearing until you get a decision, and then if you appeal the decision, you could then...

HAROLD: But I have done that.

CONAN: You've gotten a decision, and you've appealed it?

HAROLD: Yes, ma'am.

CONAN: I see, OK. That's different.

Ms. DUCKWORTH: Right, so that's different. So he has gotten an initial decision, and he's now appealing it, and that gets into a different system. But again, he deserves to have his case heard, and we're working through that.

Harold, you are absolutely right: It is taking far too long, and we're working as hard as we can to change that. It's going to take time, and we've improved the times to respond to the backlog. And one of the things that the secretary says is, we have to break the back of this backlog.

CONAN: Harold, thanks very much for the call. We wish you the best of luck.

HAROLD: Thank you.

CONAN: Let's go next to - this is Amy(ph), and Amy's with us from Patterson in California.

AMY (Caller): Hi. I've been going to the VA for about eight years, since I got out of the Army. And for the most part, they've been very good to me. But my major gripe is for those of us who have young children, which would be the case with a lot of female vets of the younger age - in my generation.

The problem being - is that a lot of times, we'll go to a clinic appointment, and we can't bring the kids with us because they won't allow the kids above a certain floor. That happened at one hospital that I went to. And of course, they just said, well, get a babysitter.

Well, easier said than done. When you're a stay-at-home mom, you don't necessarily have a lot of support, if you will.

CONAN: Mm-hmm. And this is, I assume, a complaint you've heard before, Tammy Duckworth.

Ms. DUCKWORTH: This is absolutely a complaint that I've heard before, and it's certainly something that we are actively looking at. In fact, VA is asking all of our female veterans: What facilities do they need at their hospital, their clinic that will better serve their needs?

And in fact, one of the things that we're looking at is child care available at all facilities. We're looking at extended nights and evening hours, weekend hours to make it easier for our veterans.

And frankly, if we provide child care for our veterans, or those extended hours, for the female veterans with kids, it helps all veterans because male veterans have kids, too.

AMY: Exactly. My husband always - he can't go after work. He always has to take time off, and that would be such a help to him, too.

Ms. DUCKWORTH: That is absolutely one of the things that we are looking very closely at, and we recently have polled all of our female veterans across the country to see what they need and what we can do, to do a better job.

CONAN: Amy, can you give us a little background on where you served and what your problem is?

AMY: I was at Walter Reed in Washington, D.C. I was there on September 11th. So that was kind of a crazy time. I was in the Reserves before that. As far as what happened, I have a number of things going on. So my rating is fairly high. I'm actually considered unemployable.

But, you know, mental health, there's some physical problems. So it's just like, test after test after test. It's frustrating. Then, of course, I have to drive these long distances to, you know, get to see the specialist, which doesn't help, either, but...

CONAN: Well, we'll get to some of those issues when we come back from a short break. But Amy, we wish you the best of luck, and thanks very much.

AMY: Thank you.

Ms. DUCKWORTH: Thank you for your service, Amy.

AMY: Thank you.

CONAN: We're talking with Tammy Duckworth, assistant secretary for public and intergovernmental affairs at the Veterans Administration. We'd like to hear from you. If you're a veteran, 800-989-8255. Email us, talk@npr.org. How has your experience with the VA changed? I'm Neal Conan. Stay with us. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. Im Neal Conan in Washington.

And a brief programming note: Next Thursday, January 6th, we'll focus on the challenges of a growing world population. There will be 9 billion people on Earth by midcentury. Can we feed and house them? Can we balance human aspirations with environmental sustainability?

This is going to be a joint event with the National Geographic Society, before a live audience. If you're going to be in Washington, D.C., that day, please join us at the National Geographic's Grosvenor Auditorium. Again, the date is January 6. For information and tickets, email talk@npr.org. Please put tickets in the subject line.

Right now, we're talking about veterans. Members of today's military are coming home from Afghanistan and Iraq. Many are young, and many are women. They turn to the VA for service but for years, the VA has been seen as an archaic bureaucracy, unable to keep up with the volumes of requests it receives from vets.

Now, the VA, headed by General Eric Shinseki, aims to change all that. The assistant secretary for veterans affairs, Tammy Duckworth, is our guest this hour. She's taking your calls.

We want to hear from veterans. Has your experience with the VA changed? How - 800-989-8255 is our phone number. Email us, talk@npr.org. You can also join the conversation at our website. That's at npr.org. Click on TALK OF THE NATION.

And let's go back to the time when you were not so very recently Major Duckworth, and coming off terrible injuries, and transitioning from the active duty and the Department of Defense, to Veterans Administration.

You went through an experience there that you were describing, that just sounds terrible.

Ms. DUCKWORTH: Yeah, so what happened was, even though DOD had an electronic medical records system, I came out of Walter Reed, where I got amazing care, and then when I went to enter into the VA system - and it also has this great electronic medical record system. The two systems didn't talk to one another.

And so as far as the two systems were concerned, my records didn't exist. And so when I went to VA, I had to wait three months to see a physician, and then I had to strip down and show that I was still an amputee. And I found that an incredibly humiliating experience.

And when I got this position, when the president appointed me to VA, I knew that was one of the things I had to work on, to make sure that no veteran would ever have to go through that process.

That's why these agreements between DOD and VA that the president asked us to enter into in 2009 are so important because those records should talk to one another. Those records should be for the rest of your life. You should never have to strip down for a second set of doctors because he can't legally accept the word of the surgeon who amputated your legs.

CONAN: Tammy Duckworth, the assistant of the - the Department of Veterans Affairs, 800-989-8255. Emailtalk@npr.org. Let's go next to Aaron(ph), Aaron with us from Phoenix. Aaron, are you there?

AARON (Caller): Oh, hi, this is Aaron. I'm calling you from Phoenix. Thank you for taking my call.

CONAN: Sure.

AARON: I go to the Southern Arizona health care facility, the Tucson veterans' hospital. And I want to state that it's an incredibly efficient health-care delivery system.

Appointments are scheduled. They're timely. The patient care is efficient, and you're treated like a customer when you walk in the front doors of that hospital.

It's suddenly amazing. I love the electronic records. You sit down, put the doctor - on the annual physical and within a couple minutes, she just knows everything that's gone on with you in the last couple years. She has your blood tests, etc., etc. I just want to tell you I am so thankful for you; it's great.

Ms. DUCKWORTH: Aaron, thank you so much, and that's exactly where we need to go for every single one of our veterans. And we're working as hard as we can to get there as quickly as possible.

We have to become a 21st century organization, and we're going through that sometimes difficult, sometimes painful process right now. But we're all determined to make sure that happens.

CONAN: Aaron, do you feel like they're acting as your advocate, or sometimes does the bureaucracy...

AARON: Absolutely. Absolutely. Anything I ask for, I've gotten. Any issues I have are addressed. I think everybody in the country should get it, myself. But, I mean, unfortunately, they don't all get that.

Ms. DUCKWORTH: Thanks, Aaron...

AARON: But I had to call, and I tell more and more people I've gotten a whole number of veterans who got out during the '60s and when I was in, and wouldn't go to the VA. And now they do, and that's how it works in Tucson. I just thought I'd tell you.

My friends in Phoenix also report to me that they get very good service there.

CONAN: Aaron, thanks very much for the call.

AARON: OK, thank you.

Ms. DUCKWORTH: Thank you for your service.

CONAN: Let's go next to Linda(ph), and Linda with us from San Antonio.

LINDA (Caller): Yes, thank you. I'm 100 percent service-connected disabled Army veteran. I'm also a licensed clinical military psychologist. And I'm very embarrassed to tell you that I can't even get a job at the VA because no veterans' preferences are given.

It looks like that on the surface, but those go to low-skilled, blue-collar jobs. A human resources person told me that the VA didn't want a disabled vet psychologist; they wanted a really good psychologist.

And I cannot tell you how humiliated that made me feel. I've had multiple interviews for jobs. I'm told over the telephone in the 20-minute, no-face-to-face interview: This sounds great, we're going to check your references. And then that's the last I hear of anything. And that's happened multiple times. I think that really stinks.

Ms. DUCKWORTH: Well, let me address that because that sounds very unusual. And if you can leave your contact information, we actually have an office at VA central office, here in Washington, that addresses this very issue because one of the things the president has said, that has been an initiative of his, is the veterans' employment initiative.

LINDA: Yes, but the way they get around that is they call it a hybrid position.

Ms. DUCKWORTH: Well, let me have somebody follow up on that from our main offices in Washington.

LINDA: That's great. I'd really appreciate that.

CONAN: All right, we're going to put you on hold, Linda.

LINDA: Thank you so much.

CONAN: And thanks very much. I have to remember to hit the right button. All right, she's on hold now. So we'll get back - information so you can get back in touch with her.

In the meantime, let's get another caller in, and this is John(ph). John's with us from Des Moines.

JOHN (Caller): Yes, compliment and a complaint. And I would echo Aaron: The medical professionals at the hospital level are getting better and better and better - and such a difference from 15, 20 years ago. There's just a new generation, a new breed of VA employee, that are just super.

My complaint would be the backlog on claims in the regional offices. The administrative function definitely is antiquated, and needs to change.

I would also like for your guest to give me a definition of the Nehmer decision and how that affects veterans, their claims, and the retroactive pay on claims.

CONAN: The Nehmer decision? What's that?

JOHN: Nehmer, N-E-H-M-E-R. She knows about it.

CONAN: I'm sure she does.

Ms. DUCKWORTH: So for a lot of our veterans who filed claims - I'll give you a good example. Secretary Shinseki recently made a ruling on Agent Orange - long overdue. So veterans, for example, who filed a claim for one of the new conditions that are recognized now as a presumptive condition...

JOHN: Presumptive condition, absolutely. I understand, and I have...

CONAN: John, if you would let her speak, please.

JOHN: Yes.

Ms. DUCKWORTH: So if you filed a claim, say, 15 years ago for Parkinson's disease due to your service in Vietnam and exposure to Agent Orange, you were denied because it wasn't a presumptive condition.

Just as - Under Secretary Shinseki, he just passed, made a decision that says Parkinson's is, indeed, a presumptive condition from Agent Orange. You would actually get back pay going back to your original claim.

And so you needed to have filed that claim. The back pay will go back to whenever you inputted a claim request for that condition.

JOHN: OK. What - I had a heart attack 13 years ago. I was put on the non-service-connected disability pension. In order to be put on that pension, you have to be considered 100 percent totally disabled but not service-connected.

And now, with the presumptive claims - that I have filed one, by the way -I feel that they should subtract the pension amount, and pay me at that rating - going back 13 years. Is that a pipe dream or is that, in reality, what's going to happen with these claims?

Ms. DUCKWORTH: So you are getting right to the heart of the matter of why we have a backlog. We have to treat every claim on an individual basis. And that's why we have our appeal system and also the - our actual, own Veterans Board of Appeals, with judges who look at every single one of these.

And this is why, in the past year, we had a million new claims and a million new appeals that were asked to be looked at and...

JOHN: Right. If Agent Orange wasn't specifically mentioned in the original claim - you know, I was laying in a hospital bed at the VA hospital in Kansas City, Missouri, and a guy from the American Legion came in and had me sign a form, and they put me on the pension, OK.

But now it turns out that this ischemic heart disease, being considered a presumptive illness, that should go back to that date, in my mind. Now, am I wrong, or am I right?

Ms. DUCKWORTH: Well, that's one of those things that the appeal process is going to look at. I don't - I hesitate to say anything now because I am not an appeal specialist, and I'm certainly not a VA judge. But that is - you're getting right to the heart of where we are with each and every individual case, and that's why we have this backlog.

And, you know, we're going to deal with your case, and ischemic heart disease is one of the new conditions, along with hairy cell leukemias and Parkinson's, that the secretary...

JOHN: Right, I understand.

Ms. DUCKWORTH: ...and so we will definitely work with you. And again, my heart goes out to you, and we're going to get to you, definitely, and get you an answer.

CONAN: John?

JOHN: OK. We'll - hey, keep up the good work, and I think General Shinseki is the best thing that ever happened to the VA. And President Obama is a pro-veteran president, and General Shinseki is for the troops -and that's the way it should be.

CONAN: John, thanks very much. We appreciate the phone call.

JOHN: Bye now.

CONAN: Good luck to you.

Ms. DUCKWORTH: Thank you for serving, John.

CONAN: Let me ask you a question. We've seen suicides spike this year among veterans. Do you have any particular understanding of why? What's the VA doing to try to address the situation?

Ms. DUCKWORTH: Well, post-traumatic stress is one of the big issues that we're facing at VA, and it's certainly something I've been working on since I was a director of the State of Illinois Department of Veterans' Affairs. I don't know that we're seeing a spike - like more of suicide attempts compared to previous eras. We just have a name for it now. But frankly, veterans have been dealing with post-traumatic stress as long as we've had men and women in uniform. One of the - so we're expanding our outreach to veterans to inform them, educate them and their family members about the signs of post-traumatic stress.

With Iraq and Afghanistan veterans, there's an issue of traumatic brain injury as well, and those conditions can mask one another. So it's really important for our veterans to come to VA, get the proper diagnosis, and get the care because if you are willing to be treated for a gunshot wound, you should be willing to be treated for a wound to your brain.

CONAN: And TMI is sometimes described as the singular - or the definitive injury of the - well, there's a lot of definitive injuries, sadly - of Iraq and Afghanistan. But there are more and more men and women who survive that particular injury.

Ms. DUCKWORTH: There are more and more women - men and women who survive a traumatic brain injury, and this is - you know, I think about a high school football game. If you saw your quarterback get sacked three or four times in the course of a school year, you know those parents would make sure that quarterback was medically evaluated for concussions and any type of brain injury. Yet we didn't do that in the beginning part of this war.

We had guys and gals who were getting into multiple IED explosions, and they were not being screened. We now screen 100 percent of our veterans who come to VA, for both brain injury and post-traumatic stress, to make sure that we get that diagnosis early and that we prevent the PTS from becoming PTSD, which is the disorder.

CONAN: We also know stigma is a major problem in the active armed forces and in the separation units in which people are transferring out, in the process of moving over to the VA. Is it a problem at the VA?

Ms. DUCKWORTH: It's not a problem at VA except that, you know, as -these are military men and women. They're going to carry their opinions, and how they feel about things, with them. But we make it clear that this is a war wound. This is no different than me getting my legs blown off - you coming home with post-traumatic stress. It is something that needs to be treated. And we're finding new ways at VA to make sure that we allow our veterans and their families to access us.

We have a new hotline; it's 2-7 - 1-800-273-TALK - where veterans or their family members can call and chat with a counselor. We started one like that in Illinois first, and then we allow family members to call in. We actually have had over 400,000 calls to that hotline, and over 11,000 saves of suicides in progress. So we're very proud of the headway we're making.

CONAN: Iraq veteran Tammy Duckworth, assistant secretary for public and intergovernmental affairs at the Department of Veterans Affairs. You're listening to TALK OF THE NATION from NPR News.

And let's go next to Hugh, and Hugh's with us from Jamestown in Rhode Island.

HUGH (Caller): Hello.

CONAN: Hi, Hugh. You're on the air. Go ahead, please.

HUGH: OK, thank you. I'd like to say thank you very much for your service, Tammy. I salute you. I have six years' active duty. I went in when I was 17. I was regular Army, and I've been going to the VA ever since I've gotten out, with my disability of 40 percent. And I've got nothing good - everything good to say about the VA. And my blood work is done every six months, and they take very good care of me. And I go to the VA regional center in Rhode Island, which is in Providence. And I have a care provider that takes care of me in Newport, near the Navy base. And the only thing is, I'm waiting for an increase in benefits, and it takes five years for an appeal. And I was just wondering if you had any idea why it takes five years for an appeal, you know, to increase my benefits?

Ms. DUCKWORTH: Sure. Well, it doesn't take five years for every single appeal. It has to do with how many appeals you put in. So again, this goes back to someone who may have received a decision at three months, and then they're appealing. And over the course of their lifetime, they may appeal and ask for an increase in benefits for the course of their lifetime. And again, this goes back to, that's why we have this large backlog because we want to make sure that we listen to every single veteran and their appeal, and for them to make the case. And it can take awhile. I mean, it sounds like you've been talking with VA for a while. Keep at it, keep coming to us for care so we can take care of you. And I hope that you can get through the process and, you know, make your appeal. And I'm not sure what the appeal court schedule is like where you are, but we will listen to every single veteran.

HUGH: Well, if my doctors keep sending, you know, more records to them all the time because I'm being treated for, you know, my disabilities, and, you know, I'm trying to get - thank you.

CONAN: Hugh, thanks and good luck to you. Appreciate it.

HUGH: OK.

CONAN: And he raises a question that's come up tangentially in other calls, and that's that so many vets live so far away from the facilities they need to visit - long drives for specialists, or they might live in a rural community. Is - what's the VA trying to do to address those situations?

Ms. DUCKWORTH: We are definitely increasing outreach to our veterans. At current - presently, we have over 800 medical facilities across the country, so no veteran should be more than 75 miles or a couple of hours' drive from a VA center. They may be a long way away from a specialist, and VA certainly wants to make sure that they get the care that they need.

But we've tried some new things. We're moving into the 21st century. We're trying telemedicine. We have a lot of veterans in rural areas who have, now, telemedicine and access with home health monitors. We are certainly a fee basis so that veterans can be paid - can - we will pay the veterans' bills to a local physician, to take care of that veteran. We're trying all sorts of new ways.

And in my office, I actually - I've stood up a new office, called the Office of Tribal Government, to try to reach out to our veterans and the tribal governments for our Native American and Pacific Islander veterans. So we're - one of the big things we're doing is outreach, and making sure that we reach out and touch every single one of those 23 million-plus veterans that are out there.

CONAN: We have been overwhelmed by emails and phone calls. We apologize for not getting to everybody. We thank everybody for calling in, for emailing. Tammy Duckworth, can we invite you back at some point - we can work out another visit - because this has just been overwhelming.

Ms. DUCKWORTH: I would love to come back. This is a very important issue. And as you said, VA is where I go for my health care, so it's a personal issue as well.

CONAN: Tammy Duckworth, assistant secretary for public and intergovernmental affairs at the Department of Veterans Affairs, kind enough to join us here in Studio 3A. We hope to welcome her back soon.

When we come back, we're going to be talking with sports writer Buzz Bissinger on why he changed his mind about Michael Vick. President Obama called the owner of the Philadelphia Eagles this past week to say thank you for giving a convicted felon a second chance. Have you changed your mind? Stay with us. It's the TALK OF THE NATION from NPR News.

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