Veterans’ Challenges in the Transition to Civilian Life

Event Description

One Mind's Peter W. Chiarelli, Veterans Benefit Administration's Allison A. Hickey, and Goldman Sachs' Owen O'Driscoll West join Matthew Pottinger of Davidson Kempner Capital Management to discuss the transition of military veterans from the battlefield into civilian life. The panel addresses public and private employment opportunities for veterans, streamlining veterans' services, how the Veterans Administration is handling claims, and the challenges of educating hiring managers about the skills and leadership veterans possess.

The Renewing America series examines how policies at home directly influence the economic and military strength of the United States and its ability to act in the world.

Event Highlights

Owen West on employing veterans:

"…I'd like to see people get beyond this notion that you need a college degree for certain jobs. I mean, if you look at an NCO (non-commissioned officer), especially our senior NCOs, it makes no sense. …from a corporate perspective, I don't know why you'd require this degree when the quality of the service is so high. But you do need veterans to begin to screen that service, because otherwise…the applicants do tend to get lumped together…then there's the danger that you hand over the reins to someone who can't differentiate."

Allison Hickey on the Veterans Administration reducing the backlog of veterans' claims:

"The good news in all of it…is by the nature of our transformation over the last two years, we have taken the inventory, all claims, down…we've reduced the backlog by 60 percent. We reduced the inventory by 41 percent."

Peter Chiarelli on the need to improve diagnosis and treatment of post-traumatic stress disorder and related conditions:

"…the issue for all of us is, how do we take our ability to treat and diagnose these particular problems to a level we've taken so much of the rest of medicine? …if you feel you've got post-traumatic stress today and you go in to get help, it truly is like going back into the 1930s with a heart condition and asking for help. We just don't know enough about the biology of what occurs."

POTTINGER: Good morning, everyone. I'm Matt Pottinger. I'd like to welcome you today to the Council on Foreign Relations for this meeting. Before we get started, please take a minute just to silence your smartphones and BlackBerrys and other handheld devices, put it in airplane mode, or turn it off. When it's on, even if it's muted, it will distort the sound system.

I'm very pleased to be moderating this panel of three distinguished guests and to engage them in an on-the-record discussion and conversation about public and private efforts to improve health care, education and employment for military veterans.

There are about 2.5 million veterans who served in America's post-9/11 wars who are now transitioning back to life on the home front. I've got some questions that I'd like to ask the panel. And after we've spoken for a little bit, I'll open up the floor to CFR members to ask some questions of their own. And we'll wrap up at 9:00 a.m. sharp.

All of the panelists today have significant military experience and now serve in government like Undersecretary Hickey, or in the nonprofit and private sectors, in the case of General Chiarelli and Owen West. And, General Chiarelli, since you're joining us over the TV screen, maybe I'll start with you just by asking a question about the health of veterans today, particularly post-9/11 veterans.

And, you know, the media has really referred to traumatic brain injury as the signature wound and injury of the post-9/11 wars. You now head a nonprofit organization that is dedicated to improving the diagnosis and the treatment of brain injuries and brain disease. Maybe you could update us a little bit on the status of the health of this generation of veterans.

CHIARELLI: Well, I think it's absolutely critical that everyone understand that the large majority of veterans that served in these conflicts are just fine. There's a tendency to believe that anyone who was deployed comes back with the invisible wounds of war, specifically traumatic brain injury or post-traumatic stress.

And there's also a tendency—and I think it's affecting everything. I think it's affecting things like employment. I think (inaudible) H.R. managers look at two files that are absolutely the same between two individuals, one who's deployed in service of his country during the last thirteen years and another who has not, and all things being equal will skew toward the individual who was not deployed, fearing that that individual who served in the armed forces may have traumatic brain injury or post-traumatic stress.

I think it's a good thing that we have, in fact, got at the stigma associated and started to talk about these conditions. We never did that after our previous wars. That's a really, really good thing. But the backside of that is this tendency to believe, number one, that we have great diagnostics and we know everyone who is affected and, number two, that everyone's affected, just dependent upon the number of deployments they've gone on. And I really, really think we've got to beat down that assumption.

At the same time, I think we need to take the action that's necessary on the research side to understand the biology of these problems and get at better diagnostics and treatments.

POTTINGER: When we were speaking earlier, you were actually mentioning that issue of standardization of treatments, that you sometimes have veterans who did sustain an injury and they are treated within the Department of Defense, but then once they finish active duty and shift over to the V.A., sometimes V.A. doctors are not actually empowered to prescribe the same kinds of treatments that the DoD was able to prescribe.

CHIARELLI: I think that the whole area of treatments is a very difficult one. The two treatments for post-traumatic stress that are evidence-based are cognitive behavioral therapy and prolonged exposure and therapy. I don't think that either the V.A. or DoD have the number of people that they need that are either trained in these standards of care or are given an amount of time they need to execute the protocols to standard. And that was clear in the Institute of Medicine report that was published recently.

I think there are bureaucratic differences between the two organizations that make the handoff of veterans isn't necessarily seamless. The one that I just—am on a campaign to try to get fixed is the different drug formularies. DoD has a very expansive drug formulary, so it allows—when it treats a service member, it can put them on just about any FDA drug. The V.A. has a very narrow drug formulary, and the result is that the veteran treated by DoD gets put on a prescription of a thirty or forty year old antidepressant. It's very, very hard to get the dosage and the right drug for the individual, but he gets it, gets it right, transfer to the V.A. system, and the V.A. says, I'm sorry, we can't prescribe that drug because it's not on our drug formulary.

That's OK if you're going from Bayer aspirin to St. Joseph's aspirin, but when you're talking about these antidepressants, you would think we would rationalize the drug formularies so we have more of a seamless handoff from the DoD to the V.A.

POTTINGER: Undersecretary Hickey, is that an area that the V.A. would be able to tackle and improve?

HICKEY: So, first, I just want to thank publicly General Chiarelli. He has been for my entire time here at V.A., since June of 2011—in fact, the anniversary of D-Day, so I'm claiming the victory for us all forward—he has been, in my opinion, the strongest advocate in all of DoD for our returning veterans and for their care and their service. And I appreciate his partnership.

While I don't oversee the VHA, the health administration side, I do the benefits administration side, which is all the non-medical issues. I can tell you from just good exposure to all this information that we are working closer with DoD on the formulary issue, so I thank General Chiarelli for his advocacy there.

I can also tell you, we working in other areas, as well. We have just released a press release that described a new relationship which we have with NIH on looking at also alternative therapies that might be co-joined with some of this medical science pieces, things in the areas of mindfulness, equestrian care, yoga, meditation, those kinds of calming, sensing, bringing you back in an environment where you want to move away from the distress that you're feeling. So they're studying that, and they will be studying that.

I will also say, in support of what General Chiarelli said, we are increasing in V.A. the number of physicians who are capable of delivering on the two therapies that he described. A lot of training going on across the nation in that respect to make sure that our physicians can use both of those two well-cited therapies.

And then the last thing I will say is that V.A. has since I think about 2000—mid-2000s—has been screening 100 percent of every veteran that comes back to V.A. for their health care for TBI, PTSD, and, frankly, military sexual trauma. And more than 777,000 veterans or servicemembers, transitioning servicemembers, have now been screened for mild TBI or worse. Of those 777,000, I think current numbers are somewhere around 140,000 of those have been—have met the conditions for what we would describe as mild TBI. And then—or greater, but in most cases, mild TBI.

There are a few and a low numbers—in the 3,000-3,500 range—that are screened for very severe conditions of TBI. And those folks are engaged by our five nationally recognized polytrauma centers that are across the country, and they are there.

But of the—the ones that are screened and are screened positive for TBI, they are invited to—it is still their choice and their decision to make—invited to participate in medical care associated with that TBI to improve their conditions. About half—a little more than half of them respond to that treatment right away and, at subsequent follow-ups, are deemed clear of the conditions associated with that TBI.

There are some, though, that will remain impacted by that mild TBI, large so—to General Chiarelli's point, not everyone—certainly not everyone is coming back with TBI, nor sustained medical impacts associated with TBI. And though I would also agree with his original comment about employment, but I think we'll get there later in the conversation, I'd like to have a chance to talk about that later.

POTTINGER: Yeah, on employment.

HICKEY: Yes.

POTTINGER: Well, maybe we'll move to that. I have, you know—and, Owen, you've worked and jumped fairly seamlessly back and forth from military service into the private sector and back again. What can you tell us about the situation for unemployment right now? What we've seen the post-9/11 veterans generation has been returning from wars, that the unemployment rate has remained above the national unemployment rate. It's coming down, as is the national rate, but there's been that stubborn differential. What...

WEST: Depending on the age bracket. I think veterans are much more likely to be employed long term.

Let me just, first, say—you used the adjective "distinguished." My service was not distinguished. I think I'm here because it was pretty commonplace. I left the military and decided that, you know, I—like so many in this room and thousands of others—needed to do what I could for vets, so at the grassroots that's mentorship, joining some 501(c)(3)s, which have exploded over the last decade. It's so wonderful to see.

And then I've tried to convince my corporation to start a hiring program to get more vets. And I think we've done a good job, and we're indicative of corporate America now.

I'd like to hit General Chiarelli's first point. I think it's really important and it does go to the heart of employment. I might disagree a little bit in that, you know, when you look at the resume side by side, I think you're more likely to take a veteran, but I think the General is absolutely correct in that there's been a deteriorative effect because of the narrative that I think started well-intentioned out of the DoD and our government to make sure that we took care of the folks who needed care.

But now there's no doubt, if you look at—and I think it's begun to creep into corporate America. I've got two advertisements on my iPhone which have—you know, which, again, are very well-intentioned, one about mortgages and one about selling cars, which depict their veterans program. And in both pictures, the veteran appears forlorn and as if he might kill himself at any moment if he doesn't get the mortgage.

I'm deeply concerned about the legacy of this generation of vets, and I don't know how to strike the balance of getting those the help they need, where on the other side, you know, at the grassroots, I think the community is basically split, when you have 45 percent of us filing claims, as to how many false claims are out there and what this is doing to the entire pot. I think it's a third-rail issue that no one in the government has taken on and certainly no one in the V.A., when they face that tremendous backlog.

I'll tell you, at the grassroots, I think the dam broke some time around 2006 or '07, where I returned from my first tour, and there were very few claims by individuals from units who hadn't seen combat. And then my second tour in 2007, an email began going back and forth which split my own unit, basically saying the money's out there and you should go get the money, because you deserve it.

And I think until this problem is fixed, corporate America and the media are just reflecting what's coming out of the government and our own community, and I think it's a very thorny issue. I'm curious as to who should take this on.

POTTINGER: Well, maybe I can follow up on that with both Undersecretary Hickey and with General Chiarelli. I mean, is there a mechanism for weeding out fraudulent claims so that the vets, the substantial number of vets who really need, you know, first-rate care are getting it, and not being pushed further down in a backlog because there are sort of dishonorable attempts in some cases to take claims?

HICKEY: Let me just level-set us on what our claim is, sort of our anatomy of the claim issue real quickly, if I can. So, first of all, we are—we get basically two types of claims. We get an original client, which is the first time you've ever come to us here in V.A., to say I need to claim so many different parts of my body that were injured, ill, something, during my service.

And they all have to occur in service. They can't occur after service, unless it's the—unless the degradation occurs after the event occurred in service. So there's an evidentiary requirement for these claims that something had to occur in service and you had to tell somebody, mainly a doctor, a physician, or some—one of your buddies that this thing happened. And then there's an evidentiary diagnostic exam that has to be done to link the two up, and now you have what we call a nexus, and now you can either make a decision to grant or deny the claim.

Sixty-seven percent of the inventory—and that's not the backlog, by the way—inventory is all claims. While we even were sitting here in fifty-six regional offices across the country, they've been getting new claims in. That's in inventory. Backlog is any claim older than 125 days still in our inventory.

So while we have been sitting here, those have come in, inventory. In our inventory, 67 percent of them are not first-time-come-in-the-door claims. Those are—34 percent are first-time-come-in-the-door, we've never seen you before claims. The 60—well, I didn't do the math right. Forgive me for that. The 67 percent are claims where our system by law allows you, as that condition worsens that we've already rated you on at least once, that you can come back and ask for an increased level of disability.

And that is the nature of the way this process has been wired into law since the beginning. We don't do like Social Security, where you get zero or 100. We are at a 10 percent increment from zero to 100. So there are eleven levels of rating disability that you can get. So the system itself kind of invites a lot of those supplementary claims, because of the nature of its openness and the allowance of degrading of that disability.

The good news in all of it—I want to make sure I hit this—is by the nature of our transformation over the last two years, we have taken the inventory, all claims, down from 884,000 down to today there are about 520,000, 515,000. The backlog of claims that peaked, those ones that are older than 125 days, eighteen months ago was at 611,000 claims. Today, it's at 241,000 claims.

So we've reduced the backlog by 60 percent. We reduced the inventory by 41 percent. But the volume of claims is going up. And it's not just...

POTTINGER: What explains that?

HICKEY: ...so it's the filing rate by veterans is going up. And it's not just the filing rate of a claim. It's this issue that you have a bit described, Owen, which is it—if World War II veteran—I think I might have mentioned this earlier—might have filed 20 percent of the time with one or two medical issues inside of the claim. Today's veteran is filing—it's higher than 50 percent now. It's closer to 55 percent, 60 percent of the time. And they are filing with sixteen medical issues per claim.

That means a claim is not a claim is not a claim anymore, and the amount of work to do, the sixteen medical issues, is fundamentally different that the workload to do one or two, and the complexity of those is different.

Now, I would—I would—is there fraud in our system? Do people claim things that they are not entitled to? I would hope the fact that we grant 65 percent to 67 percent of them and deny, you know, the rest would say that the process sort of weeds some of that out. That does not mean a veteran's happy with our denials in all cases, and in many cases, they are not.

But it does say that we do apply some medical science to that decision, some exam thresholds to that decision. We have a complete process that gets into every one of the 800-plus diagnostic codes and has an understanding of what has to happen in that diagnostic code to get you in one of those eleven different categories of a disability.

So from that perspective, I would say that helps weed it out. I would say that being online now helps us identify other kinds of fraudulent actions which you would expect. You know others who have gone online have seen a growth in identity access management kinds of things, I pretend to be somebody else, I've stolen your identity, I'm pretending to be Veteran A, and we have an entire group of investigative folks just like they do...

POTTINGER: Focusing on that.

HICKEY: ... to find those, weed those out, and to protect our veterans' identity in that respect.

POTTINGER: Well, let me go back to the issue on the employment side, because you raised something, Owen, you were talking about that it really depends which demographic you're looking at, where the unemployment level remains high.

The—some of the areas where it's remained particularly stubbornly high, interestingly, one is women vets. Undersecretary Hickey, you were in the first Air Force academy class that had women in it. What explains why the rate of unemployment among female vets has been higher? And what can be done to help with that?

And also, on—in the case of—of course, we know that very young vets have had a tougher time, but they seem to land on their feet after a certain amount of time. Sometimes they take advantage of the G.I. Bill, which I'd like to talk about.

But some of the older vets who come out that are in their 30s, the real rate of unemployment is actually high.

HICKEY: It is higher there.

POTTINGER: So maybe the three of you can talk a little bit about why that is and what can be done to address those pockets of high unemployment.

HICKEY: So, first of all, for—I call them my sisters in service, because they are, but I also call my brothers in support helping us out, and I think it's going to require an all-of-that-partnership to respond to the situation.

Women veterans, let's just—let's lay it out from that perspective first. First of all, as a woman veteran and in great many conversations with women veterans, I will tell you that post their separation from service, they have a fundamentally different experience. Though we have lumped them together strategically and through strategy and how we do this into the same bucket, the tendency is a woman veteran is, when you are—when you hang up the uniform, you are disconnected with your colleagues in service. You are—you know, I mean, the lines are cut. There is no—very little connection. You have lost your network.

And also, pile on top of that, many of our women serving today in Iraq and Afghanistan are married, so there's a big relational aspect when they come back from service that they're trying to restore relationships and they're driven by that motivation.

Secondly, many of them have children. That is a new phenomenon, as well. So when they come back from service, the last thing they want to do is move away from re-establishing this connection with children they've not seen in more than a year.

And so some of that is self-selection to be able to focus back in on my family relationships, that relationship, I need to do and build, and that connection. But the other part of it is, once that happens, they're just—they seem to fall off into invisible environments. And so we have to do some things very strategically to grab them and pull them back in.

POTTINGER: General Chiarelli, you mentioned when we were talking earlier that sometimes—I mean, there's an enormous number of employers out there who are actually looking to hire vets, but sometimes the challenge is actually getting—getting them in touch with vets.

CHIARELLI: Yeah, and I know the V.A. and DoD are doing a lot more work at trying to make this system much better than it was even two years ago when I was vice chief of staff. But, you know, the explosion in 501(c)(3)s and the ability of veterans to get the support that they need, it's very, very difficult to go to any single place and understand exactly what is available.

I think cities like New York have done an absolutely fantastic job with Robin Hood, an organization that tries to provide that one-stop shopping for veterans to go to, to find out what is available for them. But other cities have not. I know Owen—I know at the higher levels, this employment issue is a concern of many, many CEOs. I just worry about that middle-level manager, that person in the center who makes a lot of the hiring decisions, I just hope that we're doing the best we can to educate them, that not all these veterans are, in fact, broken.

WEST: Yeah, I think that's the key point, that the veterans inside the corporations have to take ownership of this issue and transition. We've all been through TAP, or whatever they call it now. And it starts at the grassroots, because when you get the resume, you know, imagine you get a resume from someone who served as a machine gun section leader.

But I tell you, the quality of that service on a decentralized battlefield over multiple deployments in terms of decision-making is so much higher than my education at Harvard, where I was a rower, I had a girlfriend, you know, I was president of my frat, which meant I had—I was responsible for ordering kegs on Friday. And I mean that.

I think we've got to—you know, within the firms, also, you know, I'd like to see people get beyond this notion that you need a college degree for certain jobs. I mean, if you look at an NCO, especially our senior NCOs, it makes no sense—and I know that the G.I. Bill is so generous now that on some level you may want to take advantage of this—but from a corporate perspective, I don't know why you'd require this degree when the service—the quality of the service is so high.

But you do need veterans to begin to screen that service, because otherwise the folks, the applicants do tend to get lumped together. You know, and as General Chiarelli said, then there's the danger that you hand over the reins to someone who can't differentiate, and the one or two bad apples begins to sour your program.

POTTINGER: So Owen was—was mentioning that just for the audience, TAP, which is the Transition Assistance Program, so when someone finishes active duty, they go through a week-long course, basically, that's supposed to prepare them for going back into the civilian life. And they explain all of the veterans benefits that are available and that you administer. They help you with your resume writing and so forth.

But when I went through this four years ago, I was surprised that there was no effort to directly link these young servicemen and women with prospective employers. Why not take it that extra step and...

HICKEY: So, great point. So let me talk about what we've done in the last two years since General Chiarelli sort of set us up for that conversation. And, granted, four years ago, you didn't benefit from this, and I don't how many of the rest of you who have separated from the service that are in the room still bearing your good military haircuts—so easily recognizable, by the way—had this experience otherwise, but in the last two years, we fundamentally changed the process for transitioning our servicemen and women out of service. Now, in that respect, it's not just a week-long—you can also opt into another career track training program, as well.

Third, recently just announced by the first lady was a veteran employment center that's now been set up, is connected through ebenefits.va.gov. Please sign up, every veteran who's in the room. Please encourage every veteran to get an eBenefits account.

But on there, you can reach into the veteran employment center which has now—and it was confusing for our veterans. Heck, everybody had a website for them to go to, to learn how to translate their military skills. But I'm sorry, if your military skill was walking up and down the road between Fallujah and Baghdad as an infantry guy or gal, or sitting at the top of an MRAP vehicle manning a gun, it's hard to write a good resume in that respect, so I'm going to talk to you in about—in corporate America about what they need to do to help translate—not translate, transform those resumes, in just a minute.

But we have now set up a one-stop shop, not a "go to 15,000 different sites," where we are essentially setting up that introduction between the veteran and the employer, both ways. And we have more than 135,000 just since this past summer when this was put up, 135,000 veterans who've secured a job by that introduction, by that site, facilitated with several—2,500, 2,800 different companies who are on that site now who—it's more than just "I post my jobs." It's the—it's a bigger, deeper connection between that veteran and that employer on real-life jobs and the back-and-forth.

One of the things, though, I would like to come back to a comment made by both my two colleagues here, is this idea of the middle manager H.R. I think that we have to get—and we've tried to some extent, but maybe we need to do more work here through the society for human resource manager, SHRM, and like groups to really get involved in some training associated with H.R. managers, part of their continuing education.

But I will say this. I've been in numbers of roundtables with CEOs and H.R. managers talking about employment issues. And any point in time, any one of those discussions, someone raises the issue, moose in the middle of the room, well, what if that person with PTSD comes in and gets really rageful and picks up the computer and slams it on the floor? What do we do? And I said, what would you do normally? You know, that's unacceptable behavior. But what's the likelihood of that happening? Not likely.

You know, what's the—I've heard other circumstances. Well, what if they were a customer service rep and they slammed the phone? I guarantee you, I guarantee you in customer service organizations everywhere across this country who have no veteran relationship whatsoever, and no veteran answering the phone, that these guys and gals get stressed sometimes to the point where they slam the phone on the customer, don't they? I mean, this is normal living.

Then the other thing I would say—and I often say is—let's break past this whole point of this is a veteran and this is PTSD. No, how about the fact that across the corporations of America and the world you have people that are dealing with depression, anxiety, PTSD—by the way, PTSD is prevalent in people who have car accidents, who have other significant emotional events in their life that create traumas for them. This is not a conditionally—as a byproduct of war and all the terrible things that these people—men and women—are exposed to when they make that ultimate sacrifice.

This exists in society today. It exists in the workforce today. Have good EAP programs today in your companies. Deal with issues that they—that arise. If the only thing you ever have to worry about is if this guy or gal doesn't like sitting with his back in his cubicle to the door that slams automatically behind them, then move his cubicle. I mean, this is not really hard stuff to figure out how to do, but we've got to get to that level of discussion with our mid-level H.R. managers to really break through that kind of discussion.

And I agree with you. I think it starts at the bottom. Veterans have to come in and have that conversation. They have to be networked into companies for other veterans to pull them across, because let's get to the end point of that. Resumes don't really get you jobs in the world. Who are you—the friends you know, the networks you've made, or what brings you in and gets you a job in the world, though H.R. managers across the country wouldn't like me to say that, but that's really how it happens. So veterans pulling other veterans in, a critical part of this discussion.

But CEOs standing up and taking positions in this discussion and saying, we will hire these men and women, they have done a service, and, by the way, even small businesses across the country, you may not be able to hire that veteran full-time, but I guarantee you, while they're going to school, you can get them an internship and you can then totally transform their resume.

POTTINGER: With that, I'd like to open the floor to members and their questions. There's a couple microphones going around. If you have a question, just be sure to please state your name and affiliation. I know there are some vets out there who probably have questions. Yes, sir?

QUESTION: I'm not a vet.

POTTINGER: Hold on just one second for a mic.

QUESTION: Tom Nagorski from the Asia Society. General Chiarelli, great to see you again, even by long distance. I'm not a vet. I'm a veteran of journalism, which is how I came to know the General in another life. I'm very interested both in the conversation begun about how you convince employers that—that these returning veterans are not PTSD carriers necessarily, balancing that against the advocacy that you all are doing and so many people are doing.

But I'd mostly like to hone in on the comment Owen West made about—which I would endorse and I assume many people would—that an NCO or anybody else with that level of experience carries a whole breadth of knowledge and experience and skills that are not available to people in schools.

And I wonder, maybe General Chiarelli, since you started on a pessimistic note, do you agree with that? And how to communicate that, then, to people who are making hiring decisions, it would seem—the way Mr. West put it, it's a pretty easy sell. How best to disseminate that kind of message? Where is it happening?

CHIARELLI: Well, Tom, first of all, I didn't try to start on a pessimistic note. I tried to start on a very positive note, by saying the large majority of veterans that serve are unaffected by these invisible wounds, so to speak, or even the visible wounds.

And we really need to understand that. And I'd like to kind of build on what Secretary Hickey said, that, you know, 3.4 million Americans, according to the CDC, have head trauma every single year, 3.4 million. There have just been over 300,000 cases of traumatic brain injury that have been diagnosed since the beginning of these conflicts.

So this is a huge problem nationwide. In post-traumatic stress, we estimate anywhere between 250,000 to 500,000 may come back with post-traumatic stress, but the fact of the matter is, 8 percent of the population will go through post-traumatic stress. And I couldn't agree more with Secretary Hickey.

I really think that the leadership skills that NCO gets serving in the service in whatever branch of service they're in—and it doesn't just have to be Iraq or Afghanistan—or huge benefits to any organization. But I am concerned with an environment—and I think the press has been part of this. I don't think you've educated yourself enough about these wounds. I think when you hear somebody make a declarative statement that somebody has post-traumatic stress, you take it as the same statement as saying that somebody has a broken leg, that a medical official has looked at it and knows for certain, and I'm here to tell you that the instruments that we have to diagnose post-traumatic stress are such blunt instruments that we throw that term around many, many times when people really don't have that issue.

They've got something else. And the issue for all of us is, how do we take the—our ability to treat and diagnose these particular problems to a level we've taken so much of the rest of medicine? I mean, if you feel you've got post-traumatic stress today and you go in to get help, it truly is like going back into the 1930s with a heart condition and asking for help. We just don't know enough about the biology of what occurs.

And I'll make one final point. The thing that shocked me the most when I retired after forty years in the service was going into a Fortune 500 company, I'd been asked to come and speak at a veterans event that they were having. And this is a Fortune 500 company that had a really strong veterans program. And the leader of it came up to me prior to me going on and speaking, he said, you know, sir, one of the biggest issues we have is trying to get our veterans to self-identify as veterans and join this group.

We know we're not getting everyone, because there are those that are afraid that if they identify themselves as veterans that they may be discriminated in the workforce. I was shocked. I was absolutely shocked. So I agree with my counterparts that there's a lot of education that needs to go on out there.

HICKEY: If I might offer, we have a very practical new program that we're working both with DoD, Department of Labor, Commerce—yes, we actually do do some interagency things every now and again in D.C.—called the accelerated learning program. And I would offer this as a solution to this mid-level NCOs, and it's one of the messages I'm stumping around with, talking to industries, as well.

You know, you don't have to teach these people how to become seasoned employees and seasoned team leads and things of that nature. What you've got to teach them is the practical, tactical skills associated with doing the job in that new company, in that new organization. And you've got to give them a little knowledge about the internal culture of the organization, and that comes from being there.

But one of the things that often I hear from veterans is, I don't have four years. I've got a family. I need a job. I need to work. I don't have four years or five years to use my G.I. Bill. I need to go quickly. I need to quickly be able to jump into an employment opportunity now.

So under this new accelerated learning program, we're talking to companies and others who can help teach a skill in a really tight six-month window. I mean, this is boot camp, like you read about, which these folks are used to, by the way. They're used to long days, long hours, learn it well and learn it fast. And I can help pay for it using the G.I. Bill. It allows for certification training, non-degree programs, all the rest, so it's no money out of the organization's pocket. And we can get these people through a much faster process into a position in a company.

I just finished talking to a very, very large insurance organization who's highly interested—the entire insurance organization is highly interested in increasing their veteran employment opportunities. And one of the things I told them was, do not just bring these people in as your, you know, brand-new, start-at-the-bottom person and expect them to work up over the next ten years to where they are now and where they have been in the standard of leadership and salary and expectations.

Bring them in, in a defined program, an internship-like or an apprenticeship-like program, where you say, You are in this special program. We're going to seat you here as a basic person, learning that mission for the next four months. Then we're going to move you over here to the next level for the next four months and cycle you through almost like we do presidential management fellows in federal government to expose you to the work with a defined pattern that in that year period of time, when you get done with that program, we are putting you directly into a leadership opportunity, maybe small teams, so you get to demonstrate you—you work well in this environment, but we're putting you directly into a leadership program and having that program ready for you to receive you at the end of the day.

I think that's the answer in a large way to a lot of this mid-level experience that we have in our services where they're fighting and looking for employment opportunities.

POTTINGER: Great. Yes?

QUESTION: I run a large foundation. And I've experienced what the general said, which is daily we get a dozen letters from various small 501(c)(3)s asking for contributions to help the veterans, varying quality, quite microscopic in scope in some cases. What's the best place for private philanthropy to help in this?

POTTINGER: Owen, you want to take that one?

WEST: Oh, I think at last count, there were over 45-odd thousand VSOs. Again, I would rely on veterans to vet these organizations. Listen, there are—I'm sure you subscribe to some of the services that do the vetting and look at payout ratios, et cetera. But there are some really good things out there.

HICKEY: I would...

WEST: I mean, I'll just say, on a personal note, that, you know, my father served in Vietnam, and certainly—we were talking two years ago, and the reception that the modern-day veteran gets is so much better, obviously. I mean, we're in the midst of a nationwide movement to help the veteran. Yeah, there are dozens, if not hundreds of thousands of places to go, but it's nice to see nationwide. I would come back to the narrative issue again, but we're on another topic.

HICKEY: There has been a push—and I know that there's been some thought and leadership applied to this issue, because we're constantly asked from a V.A. perspective, what's the best place to go if we want to make a donation in a philanthropic way to this in a large way and a consolidated way? And while we certainly can't endorse one or the other, there's been some discussion about whether there ought to be, especially as we get further and further away from current Iraq and Afghanistan action.

Ought there to be some kind of an umbrella organization that is not mandatory attendance, but where they come together and they make some strategic decisions about optimizing the resources in all of these different areas.

It's tough to do, because every one of those 501(c)(3)s, or whatever they are, depend on their own funding stream to keep the viability of their organizations. But I think it would certainly help those people like you who are looking for—who's got the Good Housekeeping seal of approval. And I'm not sure that we have that yet, though there are some that I think you could do your homework easy and research easy to decide who puts the most money towards the actual health and wellness of that veteran and delivers on that promise.

You do a lot of that work, General Chiarelli. I'm sorry, I'm taking over your job. Your thoughts?

CHIARELLI: I really don't have anything to add to what both of you have added. I think that a vast majority of them are very, very fine organizations that are trying to do the best for veterans. And I think individuals just have to—like you said—do their own work and pick the one that best suits their desires to try to find a way to help.

POTTINGER: Sir?

QUESTION: Mark Jaffe, Greater New York Chamber of Commerce. Great presentation. We appreciate it. The focus here on describing the attitudes of the veterans and how well they would fit into corporate America, to jobs, translating their experience was well presented. My question is, there's a lot of small businesses and entrepreneurs. In fact, the New York state Department of Education is now focusing on redefining education, not just a Regents diploma, but going back into maybe thirteen core industries, like hospitality, more focus towards the small business.

Is there a way you can use your resources to take some of your leaders in these thirteen fields to use your interagency skills to reach out maybe to the New York state Department of Education and others with similar leanings to help your shining stars in these industries be the new magnets and attraction for the tools and skills that they're taught in the military in the service of our country?

HICKEY: So, absolutely. We work very closely with the Department of Labor and all of their one-stop groups all over the place. In fact, a lot of their employment coordinators actually sit in our regional offices. The one in New York is down in Manhattan to help work with our vocational, rehabilitation and employment counselor, who are really about employment counseling for disabled veterans.

But we also work closely with all the state directors of veterans affairs across the nation, as well, and I think that three-way partnership would be very helpful. Specifically, we look for opportunities to showcase, once they're doing something unique, and we can apply G.I. Bill benefits and vocational rehabilitation benefits that they have a certain disability or certain level of disability there, as well. All of those things—they do not have to apply to four-year brick-and-mortar schoolhouses. That G.I. Bill benefit can apply to anything.

And it's really—at the end of the day, the outcome is not, did you graduate? The outcome is, did it turn into a better employment opportunity for you? And so, happy to work with anybody you would like, and I look forward to that opportunity.

POTTINGER: Someone back there? Yes.

QUESTION: Hi, I'm Loree Sutton. I retired four years from the Army as a military psychiatrist, founding director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, and have just this last month, September, been appointed by Mayor de Blasio as his commissioner for veterans affairs here in New York City.

To the question of what should someone invest in at this point, we've gone from a period of scarcity several years ago to now, as has been mentioned, tremendous proliferation. As General Chiarelli has said, over the years, like a thousand flowers blooming, we are now in a position to move towards synchronization and sustainability. Right here in New York City, organized through Jim McDonough and Mike Haynie at Syracuse University, the Institute for Veteran and Military Families, they've just started this month a soft launch rollout of an eighteen-month pilot program which brings together a couple of dozen of the leading organizations here in New York City, across the span of services, legal, health, housing, all kinds of things, as you might imagine, and they are being supported by an incredibly robust platform designed by Unite US, again, a program here in New York City.

What's going to happen over the next eighteen months is not only can veterans and their loved ones access this network virtually, put together a profile, and then all twenty-four organizations can see the profile and can customize a strategy for that veteran. They can go into, you know, the brick-and-mortar shop and do that, but what's going to happen is that there's also a crowd-sourcing function that will not only let the service providers rate their experience in working with the veterans and their families, but will let the veterans and their families rate their experience with the services.

We're working now to add in city services. As you know, there's billions of dollars right now in services across the city that have not been synchronized into this kind of effort. But I think if you're looking for places for innovation and for leading us into this next essential phase, which is to synchronize, to do the cluster, big data analysis that will show us what's working and for whom, let's invest more, and then likewise what's not working, and with the best of intentions, thank them very much...

POTTINGER: And sharing that with other cities, I hope.

QUESTION: ... and sharing that with other cities, so that we can learn together and accelerate and catalyze this way forward.

POTTINGER: Are you coordinating with other cities?

QUESTION: We're just starting that now. I've just been on board for, you know, a few weeks now. I promised the mayor a ninety-day assessment, and we are reaching out to Boston, to San Francisco, to places around the country, and would welcome input from any other cities or any other places which are going down this road. But it is so essential, because how in the world can you determine, when there are 46,000-plus VSOs who are out there, which one perhaps could have the greatest impact for your dollar? So, look forward to working with all of you towards this end. Thank you.

POTTINGER: Thank you for that. Sir?

QUESTION: Steve Rodriguez. I work in venture capital land. Know Dan Brillman the Unite US guy, as well. I think the—I think the challenge is that you have this decentralized model of start-ups, and I guess the question I put to all of you is, is there a decentralized model that you should pursue engaged in the cities? Or is there kind of—more of a federal top-down model, in terms, you know, optimizing care?

HICKEY: So—go ahead. You want to talk to that one? OK, let me take a stab at it. One of the things that we have—so I would like to see how we can do some integrations teams development, but one of the things that we have just resolved for, for a longstanding complaint was that everybody was standing up things everywhere and our veteran was really confused on where to go.

So part of the concept behind the veteran employment center was to consolidate in one place a single one-stop shop for seeking that sort of, you know, match between me, my job interests, and actual employment opportunities that are live right now and connecting me to that employer through that process.

I never want to stifle innovation. We never do want to stifle innovation. I would like to see if we find interest in decentralized approaches to this, that we find a way of at least connecting them to a centralized environment, so the veteran's not, you know, feeling like I got to go out and Google and then go through the list of 200, you know, different possible websites that might be open to me.

So I think it's a combination of both, is what I'm saying. That sounds like a, you know, political answer, but it's not. It's a realistic answer. A veteran sort of needs to know, what door do I go in? And then, once I'm in, I'm happy to explore the world beyond.

But when we give them too many doors to go in, they get frustrated and their experience grows weary of searching for what's approved, what's not approved, how do they do, how do they not do, though I think your interesting idea on VSO comparison and letting the crowd-source reaction to that happen. I think you'll end up with a whole lot of VSOs who pile on to make comments about their own organizations, but that's OK. That's OK. I just see that live and in color all the time on our Facebook site.

So I think it's a combination of both. I think let's provide a federal level that we teach the veteran at the transition assistance program, which by the way is supposed to be mandatory now. DoD is still catching up. So maybe a few of you had gotten out in the last two years and say, not me, I didn't get to go through. And in that case, I say they're still trying to get up into the mandatory level for all the separating service members.

But I think teaching them at that point, here's what the employment center looks like, here's how you navigate it, here's how you find different attributes. You can get to state and find out what the state has to offer. You can get to commercial companies, find out what they have to offer.

I think getting through one portal like ebenefits.gov, which gets you access to your health care and gets you access to the employment center and gets you access to all your benefits is a smart move from both a DoD-V.A. perspective, because there's just so much out there.

POTTINGER: Let me ask, of—all of you identified this problem, as did you, Tom, of, you know, the mid-level manager or senior-level managers, others who just don't understand the leadership capabilities, the skills, the incredible experience that these vets have. How much of that is just a function of us having an all-volunteer force and having a relatively self-selecting population of people who go into the military? Would any of you be in favor of, you know, to use the D word, drop the D word, a draft, or some other form of national mandatory service or something approximating that, so that you have a broader cross-section of society going into the military?

What's the Obama administration's opinion on that?

HICKEY: So I'm not going to make a comment on the draft or anything else. That's a DoD perspective. That's a DoD mission. I no longer am in DoD, so I will not—you know, from a veteran perspective, I'm worried about taking care of those who have served.

I will point to, I think, it was—from General McChrystal, a recent article that he stated that now 0.47 percent of the nation's citizens have ever served in uniform. And I think that's a rather telling data point on how many of them understand what the experience is in military uniform or what the training is and what the preparation and sacrifices by all of our serving members and their families, and in particular, I think over the last decade-and-a-half and current wars, their children. I think those are significant issues.

WEST: I think—you know, I'm a numbers guy. This is just a function of numbers, the civilian-military gap, this supposed gap. We have a growing population. We allocate a certain percentage of our GDP to the military. And from there, we get a force projection. So I don't see how—and I think we do a pretty good job of the socioeconomic spectrum and the folks who join, by and large, you know, 70 percent of our high school seniors are not qualified to join the military or thereabouts. So if we want to close this gap or have more people in uniform, we've got to allocate 6 percent or 10 percent of the GDP.

I think there are plenty of vets in all walks of life, in all areas of the country, but, again, I think the onus is on us to take ownership of this issue. And I think it's not that difficult to do, because there's a groundswell behind you.

CHIARELLI: Yeah, I would argue your point is very well taken, though. I happen to believe the 0.47 is really relative here, when you're understanding some of the programs and some of the issues that we have here today.

I mean, when we fought World War II, the Army went from 300,000 to 8.5 million folks. At the height of this particular—these two conflicts, we were at 570,000, and now we're moving down to somewhere between 440,000 and 420,000. We've done it with such a significant smaller population.

I think the other thing you've just got to remember, and historical comparisons are great, but at the same time, this is the first time in the history of our country, the very first time we fought anything even close to this long with an all-volunteer force. We have not fought anything before with an all-volunteer force. Every single person that served in Iraq or Afghanistan, except for a few that were left over from Vietnam that were drafted—and I remember saying goodbye to the last one in the United States Army, was a volunteer. And that's a totally different dynamic that we have here today.

And I think it's a totally different dynamic as those who didn't volunteer look at those who did volunteer. And I think it's one of the reasons why we see such great support for returning vets. But I really do think the smaller percentage of our population that does serve today has an effect on this gap that seems to be present between those who have served and those who haven't served.

POTTINGER: We have time for one more quick question. Please have it end in a question mark. Yes?

QUESTION: My name is Brigid McDermott. This is actually a continuation on that. One of the things that Hollywood has been really successful in recently is introducing people to lifestyles or types of people that they don't actually know, right? So people give a lot of credit to gay marriage passing to "Ellen" and to "Will and Grace."

When I think about what's on TV right now, I can't think of a single veteran being represented as a popular TV character. Has anyone thought of actually enlisting Hollywood in getting to the middle managers, the H.R. managers, to get them to think about veterans as somebody who lives down the street, somebody who's, you know, Raymond or whatever?

POTTINGER: Is there anyone in the movie business here?

WEST: They've tried. I've—you know, I've written a screenplay, for what it's worth, and had something turned into a screenplay. You know, again, this goes back to the issue of narrative, in my judgment. If you look at the—there have been about ten films made about Iraq and Afghanistan, and the theme, separate from lone survivor, is really clear. It's one of victimhood, which—you know, it took fifteen or twenty years before "Platoon" debuted, I think, in 1985. Similar theme, by the way.

But from—they're basically coming-home dramas on the big screen. And, you know, we were told something like the battle for Fallujah would take another five years before Hollywood wanted to see that, because they needed to put some time between the war and the depiction of this fight.

So what you see are nostalgic films, World War II films. "Fury" just debuted. I think it was number one. I don't know how quickly—I think "Lone Survivor" was probably the first breakout, and then "American Sniper" may follow and do well.

On the small screen, though, I think it's—I don't watch a lot of small-screen TV, but "NCIS"—I met the creator of that series. He did something called "JAG" years ago and, before that, "Magnum PI." Tom Selleck played a Vietnam vet. That's the number-two or -three show—I mean, it may be a cheesy show, and those of us in the Marine infantry never looked at "NCIS" agents pleasantly when they came down to interview you, but, you know, that's number-three or -four on the...

(CROSSTALK)

POTTINGER: Are you saying you want to be played by Tom Selleck in the...

(LAUGHTER)

HICKEY: I would offer a slightly different...

(CROSSTALK)

WEST: I think society gets what it wants or what it's ready for.

HICKEY: And I would offer a slightly different view. I would like Hollywood to quit depicting every berserk, rage-filled person in a show as a direct result of a wartime veteran of some kind and nature, every homeless person as a homeless veteran. I would even—I would be satisfied if they stopped that demonstration of what a veteran is. It would just be cherries if they—and whipped cream—if they actually started depicting servicemen and women in positive lights.

POTTINGER: With that, we're known for stopping on time. So I want to take a moment just to thank the panelists today. And...

(APPLAUSE)

Thank you very much. We'll see you again.