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STEVE INSKEEP, host:

The man whose job is to look after returning veterans has been thinking about the mental stress of war. Retired General Eric Shinseki knows veterans who suffered for years from post-traumatic stress disorder. He met more as head of the Department of Veterans Affairs.

General ERIC SHINSEKI (Secretary of the Department of Veterans Affairs): Ive had a veteran tell me, sitting in a PTSD session in one of our medical centers, I take a two-week vacation every year. My family thinks Im on vacation. I come here with my friends, getting treatment. This program saved my life.

INSKEEP: We spoke with Shinseki near the end of a busy week. He attended a memorial service for 13 soldiers killed at Fort Hood. The next day was Veterans Day. He spent part of that with paralyzed veterans. On Thursday, Shinseki was thinking of less visible injuries. Doctors have diagnosed 138,000 cases of post-traumatic stress disorder from the wars in Afghanistan and Iraq. A few days ago, Shinseki met service members attending college in Florida.

Gen. SHINSEKI: These are all veterans. I asked them how many of them were combat veterans, you know, hands went up. So I said, well, you know, youre all carrying baggage. And theres this pause. They looked back and forth. And I said, well you are. No one goes through the experience that you did comes out essentially untouched. Still, no comment. So I said okay, well, how many of you have a little trouble sleeping at night? How many of you have to read the same passage of assigned reading four and five times for it to begin to stick? Super vigilance, drawing the shades in a lighted room, maybe even anger management -how many of you? And hands go up, and they look at each other and they suddenly realize theyre not the only ones in it.

INSKEEP: Is there anything distinctive about this generation of veterans and their mental problems given the kinds of wars theyve sent to, the repeated deployments, the fact that its an insurgency, and so forth?

Gen. SHINSEKI: I frankly dont know. Two years ago, I used to use the term resilience, and the term is still in use today. When I use the term resilience, it was a throwback to my days as an engineering student, where you hold a ball at a certain level and you drop it and the ball bounces back up a certain - and never bounces back up to where you dropped it from. So that difference is the coefficient of resilience. Well, if you let it bounce again, each succeeding bounce is some portion of that start point. And so this also describes the multiple deployments. Quality of resilience is affected.

INSKEEP: Has this department had a version of the same problem you encountered with those veterans when you initially started talking with them about this trouble discussing the subject, trouble really getting their brains around it?

Gen. SHINSEKI: You know, speaking with nine months of experience here, but certainly, if there is a department that has an opportunity to do contrasting and comparison, its Veterans Affairs, because we have patients in relationships, doctor-patient relationships for a very long period of time. And we have a lot of data there that helps us understand these kinds of stresses, and we have an opportunity to study that.

INSKEEP: An opportunity to study it, but I guess Im wondering if you feel that youve arrived in a department that fully understands the scale of this problem, and given all the other issues that VA must deal with, even all the other kinds of injuries that VA must deal with, if this is a problem thats fully addressed and fully resourced.

Gen. SHINSEKI: I think were better at addressing and resourcing it. I dont know what fully is right now. I cant quantify the size of the challenge, which is part of the reason why we have been outreaching to establish a good partnership with the Department of Defense to find veterans wherever they live. In the future, we are working with the Department of Defense to create an automatic enrollment, if you will, creating a record in DOD and having it replicated in VA. A virtual

INSKEEP: Oh, because people were not properly enrolled to begin with, and problems get worse.

Gen. SHINSEKI: Well, they were not enrolled, in some cases. Whenever the uniform came off, they were healthy enough, they didnt feel they had any issues. And 10 years or 20 years or 30 years later, a health condition crops up and they say: I wonder if this associated with that event that occurred that many years ago. And so we think creating this electronic health record when an individual joins the military, have that record also created in VA so when the uniform comes off, we have all the evidence we need to make faster, better, smarter adjudications.

INSKEEP: I wonder if that greater efficiency will lead to another layer of challenges. Youve got something like a million veterans already from the last several years of war, hundreds of thousands of them must have registered with the VA. Many of them have not had any contact with you at all, and I suppose if more and more automatically have contact with you, youll end up, perhaps, with more claims, more demands on your resources and more requirements.

Gen. SHINSEKI: I think thats likely. But again, the reason we exist as a department is to care for veterans, and right now we are very much paperbound. We have to take all of this and convert it into an electronic means to make faster and better decisions.

INSKEEP: When we think about some of the problems that youd mentioned, it must be a multi-year project at best to get this department to the point where you feel its addressing everybody who needs to be addressed.

Gen. SHINSEKI: Im afraid it could be. I also tend to be impatient. Were going to push as hard as we can. I remind folks that are on here, the average life of a secretary of veterans affairs is three years. I better get moving.

INSKEEP: General Shinseki, thanks very much.

Gen. SHINSEKI: Youre quite welcome. Thank you very much for this opportunity to speak with all of you and the people listening to NPR.

INSKEEP: Hes Secretary of Veterans Affairs.

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