The Changing Face of America's Veterans

Opening Remarks

MS. LEE: Hi, good morning. I'm Jennifer Lee, Director of Events at The Washington Post. Thank you all for joining us for this important program about the changing demographics of America's veterans and the challenges they face.

In a moment, we'll hear from a 26-year veteran of the United States Air Force, who is now a Senator from Arizona. Senator Martha McSally is using her experience in the military to help victims of sexual assault and harassment.

We'll also hear from Congresswoman Tulsi Gabbard, a veteran who was deployed in Iraq and Kuwait as a member of the Hawaii National Guard. She's pushing for veterans to have more convenient access to a variety of health care choices.

Experts will also discuss the growing dangers our veterans can face from toxic exposures, which can lead to a variety of serious health problems.

Before we begin, I'd like to thank our presenting sponsor, The Wounded Warrior Project, whom we will hear from later in the program, as well as the University of Virginia, our supporting sponsor.

And now, I'd like to introduce The Washington Post's Karen Tumulty and Senator Martha McSally.


Women in Combat: A Senator's Story

MS. TUMULTY: Hi, good morning. I'm Karen Tumulty. I'm a columnist here at The Washington Post. And we want to begin this program by thanking Senator McSally for being with us here this morning.

And before we start, I'd love to tell our audience that--both here and our virtual audience--that you can tweet your questions using the hashtag #PostLive, one word, and I'll try to get to some of them later on, because they send them to me through this.

You know, Senator McSally, you read your resume, and you begin to think that your first name is not Martha, it's "First. You were the first woman to fly a fighter in combat. You were the first woman to command a fighter squadron. How did this ambition take root in you?

SENATOR MCSALLY: Well, thank you for having me here today. Really grateful for the opportunity.

I did not have a probably typical path. I was actually motion sick when I was a kid. So, if anyone told me I was going to be a fighter pilot, I would have laughed at them. But my path was one where my dad was first generation to go to college, served in the Navy, you know, lived the American Dream through people believing in him and serving and using the GI Bill.

He provided opportunities for us and was very driven to make a better life for us. And I'm the youngest of five kids, and I lost my dad when I was 12, and this was a really formative and difficult thing to go through as a young person. He was 49 years old.

And for me, I was brought up in a house where I was told I could be anything I wanted to be, that there were no limits on me as a girl. And then my mom--think about it: single mom, five kids, you know, went back to school, back to work to raise--you know, raise the family.

And I knew education was the key to my future, but I didn't want to saddle my mom with debt. I was looking for opportunities to channel my feistiness. I'm a little bit of a rebellious spirit. That could have gone really either way, and I was self-aware enough to know that I wanted to do something that mattered with my life. Before my dad passed away, got to visit with him in between heart attacks, and he told me to make him proud.

And so, this propelled me on this path. But I didn't know what I was doing. You're 17 years old when you make these decisions. So, I ended up sort of stumbling in to go to the Air Force Academy, but I didn't have a clue. You know, you're a teenager--about what I was getting into. I was just looking for a way to pay back in service. I thought it would channel my energy to be a part of something greater than myself, but I thought I was going to be doctor.

And it wasn't until I got into the Air Force Academy that I found out for the first time, just because I had ovaries, I couldn't do something. It was against the law at the time for women to fly fighters, and we were going through the same training as the men. And I was like, "Are you kidding me?" And it just--just--you know, I speak like a fighter pilot--it just pissed me off. I was like--if you--people who know me know that just tell me I can't do something or tell me I can't do something because I'm a girl, it's just going to make me--you know, even if that's not what I was supposed to do, it's going to make me prove you wrong.

And so, I just had this dream in my heart that, like, I was going to prove them wrong. And I marched around like, "I'm going to be the first woman fighter pilot." I had no idea what I was talking about. I didn't know the difference between a flap and an aileron. It's not like I had any sort of aviation influence, but I just wanted to show them that girls could be fighter pilots.

And I had nothing to do with the change. I--just so grateful for the pioneers who went before me. There were so many of these women who were qualified and capable, like the women World War II pilots who really paved the way for us--the women Air Force service pilots--and others who went before me in the military.

But like many things in life, you know, timing is everything, right? So, I was in the right place at the right time when the door finally opened. The law changed and the policy changed. I had the right grit and the right qualifications. I wouldn't let the dream die, but it took, like, nearly 10 years until I actually took off in an A-10 Warthog. So, it didn't happen overnight, but I wasn't going to let it--I wasn't going to let the flame go out. and I looked for opportunities to bloom where I was planted, to not have a chip on my shoulder, to keep serving and excelling and learning. And then, when the door opened, I was ready to go.

MS. TUMULTY: So, what--over the course of that time--I mean, it's one thing to change the regulations--


MS. TUMULTY: --it's another thing to change the culture. So, what did you see? Did you see a lot of change? Did you not see the things changing that needed to?

SENATOR MCSALLY: So, I was in the ninth class at the Air Force Academy that allowed women, and we were around 10 percent women at the time. And, I mean, I had three older brothers so maybe I--you know, had to fight for my food. It gave me a little bit of feistiness to prepare for a little bit of an environment to stand up, you know, for myself and to not be intimidated.

But I'd have to--I kind of look back at it. At the time I was just trying to get through it, survive, excel, prove that we belonged, but the culture was challenging, for sure.

There--women were not accepted across the board. There were definitely dynamics of ostracization, or we would even isolate ourselves, as I look back. Like, we--you know, it was one of these dynamics--I'm sure a sociologist would better understand this as they studied it, where, like, I'm just trying to, like, be one of the guys, but that means, you know, you're not. And so, we didn’t necessarily even help each other out if--you know how that is, right? Women, we're not, like, the best to each other, especially when we're in tough environments like that.

And we're just trying to prove that we belong, prove that we could serve alongside and it didn't matter whether you were a boy or a girl, but it was not an easy transition or environment. It was taken to a whole other level when they opened up fighters to women.

I mean, you had our--at the time, the debate going on in Congress, you had our Chief of Staff for the Air Force at the time testifying before Congress, and he was asked--I'm going to paraphrase--you know, "Would you rather take a less qualified man over a more qualified woman to fly in these cockpits?" And he said yes. He said, "I know it doesn't make sense," or something like that, "but this is just the way we feel." Like, this is the leader of our Air Force, responsible to organize, train, and equip our Air Force. This is the culture that were in at the time where--and I've written about this, where the arguments over the course of our history where women have served since the Revolutionary War and never under compulsion, and in unbelievable positions, to include spies and some of them disguising themselves--and in the early days--they've always served. And there was always these arguments as to whether we should or could be in these positions, right? So, the "should" is the cultural argument; the "could" is lumping all women together and making gross generalizations about all--you know, all of our characteristics, which would just drive me crazy.

I mean, I feel like the calling in my life is to create cognitive dissonance in people so that I break their stereotypes, right? All women are not a certain way, all men are not a certain way. And I used to say, when they were arguing about whether women should be in combat, and even on the ground, wait, so that means, like, all men are qualified and no women are? So, like, Justin Bieber and Pee-Wee Herman are qualified and Serena Williams is not? Like, how do you come up with these generalizations? We're America, right? We pick the best man for a job even if she's a woman. Set the qualifications. If we want our best military, why would you exclude 50 percent of your people from competing. Why would you have an order of merit and have a woman graduating at or near the top of her class in pilot training and then go to the next person down to fill the fighter cockpit? It's not good for our readiness, it's not good for our military.

So, this was a real challenge. When they opened up--the debate to upon up fighters to women was so emotional and so based on these stereotypes and feelings and, in my view, underlying insecurities, quite frankly. And I mean, it was real--when you have the leadership talking about how you don't belong there, but then, basically, it's opened up to you. There's a picture if you ever want to look at it, where I was at a press conference with that very same Chief of Staff of the Air Force. When they opened up the positions and they flew a couple of us in, they had identified seven of us to go to fighters. And I was purposefully sitting there with my arms crossed, giving him side eyes, like, on purpose, like--like, you know, didn't--whatever. I don't want to use a swear word.

But like, you know, he was a part of the problem in setting the culture. So, it was challenging. You know, they would often say, you know, women can't be fighter pilots because they're too emotional. I've never met a more emotional group of people than those who are against women serving in the military. They were, like, these emotional arguments. I'm like, "That sounds a lot like emotion to you. I'm looking objectively at, you know, what's going on here."

So, it was a difficult journey, for sure, but I am grateful that I had the opportunity to blow the door open for others and to pave the way. I'm just the kind of person, I'm not going to sit on the sidelines. I'd rather be the one that goes through the hardship to provide more opportunities for others.

MS. TUMULTY: And you also ended up filing a lawsuit, right?


MS. TUMULTY: Because when you got to Saudi Arabia--


MS. TUMULTY: --you know, airwomen were required to cover up head to toe, and men were not.

SENATOR MCSALLY: So, this was a ridiculous situation that is a classic case of what I call "bureaucratic policy creep," which big bureaucracies can often do. And I actually started fighting this when I was first deployed to Kuwait. It didn't apply to me; I just found out about it. And I felt like I was in a position as an officer, as a leader, as a fighter pilot, that I had a voice to fight for others, the young enlisted women who were in Saudi Arabia being told, "You can't drive. You got to sit in the backseat of the car. You've got to put on basically a burqa." And it got more and more ridiculous over time.

And it just kept cutting, you know--people kept adding on to it. We were told "You have to always have a male escort." And if you were stopped by the religious police in Saudi Arabia, you were to lie and claim your fellow servicewoman as your wife to comply with Sharia law.

Like, this was--integrity first is our top core value in the Air Force and we literally had a policy on the wall saying, "Lie, and that's not your boss, that's not your commander, that's not your fellow servicewoman." It was so screwed up on so many levels.

So, I went on this eight-year journey--it's a long story, you can Google it, but I didn't intend to have this turn into such a high-profile fight, but I just thought it was wrong. And I started looking into it, identifying where it came from. Everybody thought it was above their pay grade. Nobody realized it was only a two-star general's policy. The two-star general didn't even know his policy, by the way. I mean, they rotate in and out, things get handed down to them.

But ultimately, they ordered me to Saudi about six years into this and then threatened to court martial me if I didn't put the burqa on myself. I complied with it, but then I filed--I tried one last time to change it from the inside out, and then I filed Martha McSally versus Donald Rumsfeld in court. That wasn't a very good career move, but I would do it again. I believe it was really unnecessary. And honestly, if they had just looked at the facts and changed the policy--the State Department wasn't requiring it. In fact, they were telling the women not to wear--you know, the U.S. women, when they're representing the government, not to wear the garb.

And so, I ended up, after we were going through the court process getting an act of Congress passed, as--you know, I was on a one-woman lobbying campaign, and attached some legislation to the defense bill in the Senate and a freestanding bill in the House and got it signed into law to overturn the policy once and for all. It was about an eight-year battle.

MS. TUMULTY: But through this whole thing, through your rise in the military, you're knocking over every barrier in front of you, through your rise in politics--


MS. TUMULTY: --you were carrying a personal secret that you finally decided to talk about at a Senate hearing a few months ago, and that was that you had been sexually assaulted, that you had been raped by a superior officer--


MS. TUMULTY: --and that, not only did you carry that trauma with you, but you had the second trauma of finding out the system was just completely not going to take you serious.

Well, talk about your decision--


MS. TUMULTY: --that you actually, finally had to speak about this.

SENATOR MCSALLY: Sure. Well, I wouldn't call it a secret, because, you know, people who know me and love me and people in my life knew that this is what I had been through. So, it wasn't like I was saying it for the first time, but I was saying it for the first time publicly as a Senator. And this is something that so many women and so many men go through. Let's just be frank about it.

In an audience this size, you know, one of three women, and one of four men, the CDC says in their lifetime will have been sexually assaulted.

Some people go to their graves. Other people go through a different process where they immediately, you know, report it and go through that law enforcement judicial process.

For me, I did not take that path at the time. I look back at where I was just emotionally and just where I was, without getting into the details. I was just trying to survive and thrive. And I just didn't--like many people, didn't report it. I was just trying to continue to do my job and just deal with the trauma in the ways that I best knew how to deal with it to survive it.

And when I decided in March to share publicly what I went through, I just felt like I was at a place where--again, I was not hiding it. Like, people who know me, they all know this happened to me. But I have a new, unique platform as a United States Senator, and we were about to have a hearing about the topic and we were--we had victims testifying and we are having much debate and discussion about whether the commander should stay responsible for making the decisions or not. And I felt very strongly that, having been a commander and a survivor and not taking this lightly, that commanders need to be ultimately accountable and responsible and equipped and selected based on the right criteria to address this issue and it not be stripped from them.

But I felt like my perspective was incomplete and it wasn't because I was a commander but also because I was a survivor that I just felt like I needed to complete that perspective as I stepped up to lead on this issue.

And look, I'll be frank, when I got appointed to the Senate and sat down with my team and we sort of strategically planned what are our focus areas going to be and what are we going to lead on, this wasn't a topic I had planned to lead on.

MS. TUMULTY: Is that right?

SENATOR MCSALLY: But, I mean, I've been a voice on it, for sure, but certainly not in the way that all of a sudden I was, you know, put in that place--or put myself in that place.

I just--my decision was made on a Monday night for a Wednesday hearing as I flew into D.C. and I saw what the hearings were the week and looked through what the topics were. I just felt like I just need to say this out loud to complete the perspective that I have, to make sure people understand that I have a unique perspective and to kind of step into that leadership role based on the fullness of my experiences.

And so, I made that decision and shared what I did in the hearing. And you know, it's been an extraordinary few months since then. You know, immediately, I called on the Acting Secretary of Defense, Shanahan, to--Chairman of the Joint Chiefs to create a taskforce to really take a deeper dive in 45 days. I gave them, like, a timeline, because the defense bill was being marked up--to take a fresh look at from the moment an assault is reported to when the judicial process is over.

Instead of stripping commanders from the decision, what else needs to be fixed in this process so that we have the best decision possible once it gets to the commander, and that includes the support to the victim and the timeliness and the investigators and the JAGs, the prosecutors, across the board. Like, what's still messed up with this process? And you know, we've got--I introduced legislation and--on this issue, focused, again--we've got to deal with the prevention side, that's our next step, but I just--instead of stripping commanders, what else do we need to fix, because the status quo isn't an option?

And in the markup of our defense bill in the Senate, 17 of my 18 provisions in some form were actually included in the bill. So, I'm really honored to be able to be leading on this.

MS. TUMULTY: But you look at the statistics and you look at the studies that have been done, there are more reports now of sexual assault.


MS. TUMULTY: Which is--I guess you could read is a healthy thing. People are feeling that they can step forward, but the amount of retribution that people say they still feel after they do step forward is--those statistics are pretty high, too.

SENATOR MCSALLY: Look, we have a problem in our military and we have a problem in our society. We have a problem in our universities. This is prevalent, everywhere. And we take people from society into our military. We expect more from them, right? We absolutely do. But you know, you're taking people in, you're doing the best you can to judge their character as recruiters and those who give, you know, appointments to the academies. And then, we got to inculcate them with our values, and we've got to make sure that they understand that part of what our mission and our moral responsibility is as we go put our lives on the line is that we're not committing crimes against each other, that we have good order and discipline, that we have respect that people--we're willing to put our lives on the line for our freedoms, but to have--to have you be at risk by a teammate committing a crime against you is just unacceptable, absolutely unacceptable.

So, where are we where we can--you know, again, reports are going up. That's not necessarily a bad thing because people may feel like the system is more trustworthy to treat their--treat what happened to them in a fair way, where justice has the best chance to be heard, in cases that are very difficult to prove. Just let's be honest with ourselves about that. Even if they're reported right away, they're very difficult to prove.

But when somebody does that, we still have real challenges, especially as the process lingers of individuals either--there's either, like, blatant retaliation happening which, again, that needs to be ratted out and people need to be held accountable, especially if it's a supervisor and the climate that they have. That has to be addressed and not tolerated.

The other element we have is where there is a sort of social ostracization that happens. Somebody reported, now the perpetrators may be in the same unit. People start to take sides. You're still coming to work together. There's what happens especially with this younger generation, a lot of it's happening online where the victim is now feeling isolated. And we've got to stop that from happening, too. There's a real--

MS. TUMULTY: So, how do you stop it? And have you had--what kind of conversations have you had with your Senate colleagues. I think--


MS. TUMULTY: --Senator Gillibrand is--she's one of the people who argues this has to be taken out of the chain of command--


MS. TUMULTY: --that this cannot be addressed.

SENATOR MCSALLY: So, I respect her and her passion on the issue, I just think she's wrong on it.

I mean, having served myself, having been a commander, it's like nothing else in civilian society, where we are responsible for putting people's lives on the line and telling them to take lives. We're responsible for when they eat and when they sleep and how they behave. We're responsible for literally everything. We're responsible for making sure we have good order and discipline and we have the right climate and the culture. That's what command is all about.

And so, if you want to make sure you don't have sexual harassment in your unit, commanders need to be selected, trained, educated, equipped, and held accountable to stop this problem.

The problem is not in the end when a decision comes to a commander and, with the evidence that's given them, they say go to court martial or don't go to court martial.

We've had outside groups that we've authorized in Congress who have taken a look at commanders' decisionmaking processes over the last years, and they've studied each of the cases and said--the numbers are, like, 95 percent of them, they agreed with the decision process. So, that's not what's broken.


SENATOR MCSALLY: From my perspective, what's broken post-assault is these are taking too long, for example. Where it is lingering as a cancer in the unit where there's the opportunity for a retaliation or ostracization happening while they still have to come to work and deploy every single day.

We don't have enough investigators that are highly trained to immediately address this issue. We don't have enough special victims counsels, which are unique to the military. We've given them--who is the lawyer for the victim. The prosecutor is not the lawyer for the victim; the prosecutor represents the military. But oftentimes, you want that lawyer in the room for the first interview of the victim with the investigators. But sometimes they don't have them at bases and it takes them, you know, a week or ten days to get there.

That's not acceptable. If we really are committed to addressing this issue, we've got to put resources to it. If we think it's a readiness issue, when we're turning readiness around with, you know, parts and bullets and flying hours, we put resources into it. So, a part of my bill is putting more resources into highly trained prosecutors, highly trained investigators, special victims counsels that are on the scene immediately to quickly support the victim so that that first interview has the best ability to get the forensics and the--everything that's needed in order to make that case strong.

So, that's--speed up the timeline. You can't have years going by, and thoroughness and timeliness are not mutually exclusive. As these cases linger--and while they're lingering, you have this uncertainty. And then, you have, again, what happens mostly with peers of, like, "Well, she must be a liar because he wasn't convicted."

And again, I've seen this, I've been through this. It's an extreme challenge. So, the more that we can do to very swiftly and thoroughly investigate, have the digital forensics, which is another piece of my legislation, because a lot of the information to build a case right now is in your digital life, of what the context was. 85 percent of military cases are people you know, not strangers. And that context of what's going on there, before and after, are really important. All of these pieces I think are really going to make a difference to have a stronger judicial process that people have more faith in and, therefore, more people would be willing to report.

MS. TUMULTY: So, as you were making your decision, you said it just suddenly--you realized on a plane ride that you were going to have to speak publicly about this. Over the next two days--so, how did you struggle over what you would say and what you didn't say. I mean, you didn't name the perpetrator.


MS. TUMULTY: You didn't name the people who sort of--


MS. TUMULTY: --made it harder on you.

SENATOR MCSALLY: So, my motivation, again, I decided Monday night and the hearing was Wednesday morning. And I did not--I didn't say out loud what happened to me, because I wanted to go through a process of trying to convict someone through the court of public opinion.


SENATOR MCSALLY: I actually believe in due process. There are limits when things have happened so long ago of being able to prove, or even statute of limitations related to it. That wasn't my--that wasn't my motivation.

And people can criticize me for that. Fine, go ahead. You've not walked in my shoes and, like many victims who chose not to report at the time, I was not going to--my purpose wasn't to focus on my case.

I didn't want it to be some sort of frenzy that then focused on the second phase of that, where I actually was trying to be helpful to the military based on explaining generally what I had experienced and how that was poorly handled in a very junior varsity way that very much troubled me. But I didn't want to get into naming names of when that happened and how that happened.

The point was, like, let's look through the windshield, not the rearview mirror, and just stand in the gap with credibility that I've been through this, I've seen the process. I've been a commander myself. I am a survivor myself. I understand deeply what the shortfalls are and what needs to change.

A lot has changed over the last several years. So, I didn't also want to have what I was directing to happen be based on something that I experienced even as a commander. I gave up command in 2006, but a lot has changed since then on this topic and how we've really improved the process and improved many elements of it.

And so, I just--it was more about filling in--people understanding my passion and perspective, being kind of more complete as someone who has also survived this.

I also thought it was important for people--there's so much ignorance out there about sexual assault. I mean, people are just ignorant. I mean, they're naïve. They may be well-intended, but they're just ignorant, still. There's a lot of myths out there about what it looks like or how it happens or what survivors look like.

MS. TUMULTY: Like, what are the big myths? What are the big--

SENATOR MCSALLY: Well, I've had so many people--

MS. TUMULTY: --presumptions people have?

SENATOR MCSALLY: --so many people, to include people, like, really credible, experienced people in the media and other parts of my life who have said to me since then, you know, "I don't understand how this happened to you. How did this happen to you? You know, you're a fighter pilot, you're a badass. You know, you sued the Secretary of Defense, you flew in combat. How did this happen to you?"

And my response is, like, "Oh"--again, I don't want to throw out swear words, but--

MS. TUMULTY: Oh, go ahead [unclear 00:27:01]--

SENATOR MCSALLY: --I didn’t come out of my mother's womb as a fighter pilot, first of all, right?

I mean, I grew--I found my strength and my voice and my passion in part because I survived things like this, not--I am who I am not just in spite of going through it, but in many cases because of it. It has deepen--instead of--instead of crushing me, which it had the possibility to do, and there were some days I thought it was going to, I was able, by the grace of God, to have these experiences actually propel me to strength, to action, to service, to fighting for others who don't have a voice, to fighting for women and girls.

Don't you dare hold them back. Don't you dare hold them down. Like, it has turned into a passion of service in my life that propelled me on this path.

But it's not--I didn't start here. I ended here, if that makes sense. And these types of things can happen to anyone. And so, I thought--actually, you know, I'm breaking stereotypes again, I guess. It wasn't really my intention, but to try and shake up some people's even views of how this type of thing happens.

And also, by the way, you don't have people walking around with the word "rapist" on their forehead, you know? They're hiding in plain sight, too, both the victims and the perpetrators. So, I--you know, I feel like part of--I didn't intend it at the time, but part of what has happened and part of the, I guess, the blessing of speaking publicly is also to help, you know, break up people's thinking on it, to educate people. They probably have loved ones who have been through this who have never talked to them about it.

And also, my hope was to inspire others who have been through this, whether it was yesterday or 30 years ago, that this--this doesn't have to end the hope in your life and it doesn't have to end the vibrancy of your life. And you've already had so much taken away from you. Don't let your perpetrator take any more away from you. You've got to get through this and you've got to survive it, through whatever path you take, to become whole and healed and full and empowered.

Like, I just want to, like, be that voice for them. Don't you dare let anything more be robbed of you than what's already been taken.

MS. TUMULTY: And what have you heard since then from former colleagues in the military, from other survivors of experiences like this?

SENATOR MCSALLY: We've had an amazing outpouring from so, so many people, people I know, people I will never meet, but just it's been really extraordinary.

Other survivors, as I'm even out and about in Arizona, I mean, will sometimes--a young person or sometimes an elderly person will just come up and whisper to me, like, "Thank you for being my voice. You know, I went through this, too." I mean, it's just--it's, at times, overwhelming to--you know, to realize that I can give them a little bit of hope, given the role that I'm in.

Yeah, I've had other colleagues and others reach back, like, "I had no idea this happened to you." There's a lot of people who have expressed sort of anger towards, you know, something like this happening to someone that they know. It's just--these are all natural things, but they--they can help break through what can sometimes be a challenging conversation to have.

I don't--again, we don't have to get into the details of all that, but I think it helps kind of break through some of it to take the, I don't know, the barriers down of trying to have a better understanding.

Even, you know, with commanders I met in every military base in Arizona, and making sure--having the conversation with commanders about, "What are you doing about this? What's happening in your base?" Listening to all the commanders at the squadron level and above as to what they feel is broken in the system, what needs to change.

And look, every once in a while, you have a dirtbag out there, right, whose been given the responsibility of leadership. But I will tell you, the ones that I meet every single day, when they're given that guidon to take responsibility for command, they take that so seriously. And they really want to make sure that every one of their people are protected and that nothing happens on their watch like this. Again, they may be a little ignorant and naïve about kind of how it happens, and so, we've got to make sure they're educated and equipped, and then given the resources and held accountable if they--if they fail.

But we've got amazing men and women serving in our military that are giving the opportunity to lead. And so, me, I think, just helping to break the--I think "ice" isn't the right way to say that--but just to kind of go there in a way that I uniquely can has been an amazing opportunity.

MS. TUMULTY: Well, we are out of time. And I just--but I think that the--that what you have done is so important. And yes, you're right, it is sort of a presumption of everybody, you know, if this could happen to Martha McSally. But I think that is the exact thing that makes your voice so much--that it is going to be heard in this debate, maybe in a way that so many other people's haven't. So, I think that it's such an important thing you've done here.

And I want to thank you first of all for that, but also for being here with us this morning.

And I think it is time now for me to hand it off to my colleague, Bob Costa.

And again, thank you so much, Senator.

SENATOR MCSALLY: Right, absolutely. Thanks, everybody.


Taking Care of our Warriors: The View from a Candidate

MR. COSTA: Good morning. Good morning, I'm Bob Costa, National Political Reporter, here at The Washington Post. Thanks for joining us for another Post Live conversation.

I'm pleased to be joined by Congresswoman Tulsi Gabbard of Hawaii.

REP. GABBARD: It's great to be here.

MR. COSTA: Great to be--great to have you here, a member of the Armed Service Committee--


MR. COSTA: --also the Foreign Relations--Foreign Affairs Committee inside the House of Representatives; was first elected in 2012 to the U.S. House after serving as an aide in the U.S. Senate; Also worked on the Honolulu City Council, then decided to run for Congress and won in 2012.

She's now running for the White House, a Democratic presidential candidate, seeking the nomination, with just a few other Democrats at the moment.

REP. GABBARD: Just a couple other--couple other folks.

MR. COSTA: So, let's begin with veterans' issues.


MR. COSTA: We just heard from Senator McSally, you're one of the leading female veterans in American politics, when you think about women in the military, which issue is at the top of your list of concerns?

REP. GABBARD: That's a tough--that's a tough question, because there are a number of challenges that we face. You heard Senator McSally talk a lot about sexual assault in the military. This continues to be an issue that many women in the military are dealing with and struggling with. But what a lot of folks don't often talk about is that it's an issue that a lot of men in the military are also dealing with.

We just wrapped up a marathon meeting in the Armed Services Committee last night, as you know. It started at 10:00 a.m. yesterday. We wrapped up at 7:00 a.m. this morning, but one of the issues that we dealt with was sexual assault in the military, because what we're seeing is that, even from 2016 to 2018, the numbers of sexual assault in the mil--sexual assaults in the military that have been reported have gone up 38 percent.

Now, some people are saying, "Well, hey, maybe that's a positive sign in that more and more people are actually reporting; whereas, previously, they weren't." But regardless, what it tells us is that this is something that is still too prevalent, and the current system that is in place within the military justice system is not providing that justice.


MR. COSTA: So, what's one step Congress could take on that front?

REP. GABBARD: Well, I firmly believe that there has to be a transparent, independent approach, outside of the chain of command, where a young, enlisted soldier can go to someone who she knows--he or she knows--is not going to have the bias that sometimes exists with the commander. And this is something we've heard so often from young soldiers and service members who come forward and say, you know, make the report, "I'm a victim of sexual assault." The commander, the First Sergeant says, "Well, the guy or the girl who you're saying has done this, they're my best soldier. They would never do such a thing. I don’t believe you."

MR. COSTA: So, you don't trust the chain of command to handle it.

REP. GABBARD: Well, what we have seen is that this problem has just continued to get worse. And I don't believe that we trust that a commander is going to do the right thing all the time, because we know, based on evidence and the experiences that we have had, both ourselves and with people who we know and other service members who have come forward. Unfortunately, there are those who abuse their position of power.

And on a situation such as this, look, I served as an enlisted soldier as well as a company commander. So, I personally have lived on both sides of this. The command authority is important, but commanders are not trained and equipped to be investigators of sexual assault or to prosecute it themselves.

MR. COSTA: You said you personally lived through these issues.


MR. COSTA: Did you ever personally deal with harassment or other issues inside the military?

REP. GABBARD: Yeah, I've dealt with harassment, absolutely. When I dealt with these issues, thankfully, I had a commander who I went to, told him what was going on, and he immediately took action and did something about it.

Others who I served with were not so fortunate. A friend of mine was raped just prior to our deployment and she refused to report it to the chain of command. And as much as we encouraged and urged her to do so, she did not trust that justice would be served and that, within the small community, within our unit, that there would not be some form of direct or indirect form of retaliation or exclusion. This is part of the problem.

MR. COSTA: You joined the Army National Guard in 2003. When you were enduring those kinds of experiences, or watching friends or colleagues go through that, what does that do to your spirit as a soldier?

REP. GABBARD: It's heartbreaking. It's heartbreaking, because the bond between soldiers and service members is something so special, and it's something that--and is really unbreakable and necessary for that unit cohesion where, as we're training up for deployment in the National Guard, we need to know, without a shadow of a doubt, that when we're downrange and when rounds are flying, that my battle buddy's got my back and I've got theirs.

And that's what's so problematic about this issue of sexual assault within the military, is it drives that wedge and undermines that unit cohesion.

MR. COSTA: Do you think if there was an independent body dedicated to these issues, it should be privately run or run within the military?

REP. GABBARD: I think it needs to be run within the military, because you've got people who understand the unique military culture and environment.

If you bring in somebody who comes in completely from the outside and doesn't get it, then you've got unnecessary obstacles and hurdles there.

There's an amendment that Congresswoman Jackie Speier introduced in the defense bill last night that I supported that seeks to put forward a pilot program within our academies, our military academies, where we are seeing prevalent sexual assault and harassment, yet very minimal reporting.

And the amendment says, "Hey, maybe we should look into appointing"--kind of like a special prosecutor within the military justice system, who's independent of the chain of command who can then look at prosecuting--investigating and prosecuting these crimes.

MR. COSTA: The VA is starting to move toward private health care, at least allowing access private health care for many veterans.


MR. COSTA: Do you support that decision that's starting this month?

REP. GABBARD: You know, I don't support privatizing the VA.

MR. COSTA: Well, they're privatizing access.

REP. GABBARD: In certain circumstances, it makes sense.

MR. COSTA: Rural areas, high-traffic areas?

REP. GABBARD: Absolutely. If a veteran--ultimately, this is the bottom line: If a veteran is not able to get the care that they need in a timely fashion, they need to have the option to go and get the care somewhere else.

A friend of mine in Hawaii, he was on the verge of having a heart attack. He went to the hospital that was closest to his home, went to the emergency room, was admitted, was told by the VA, "We're not going to pay for you to get the open-heart surgery that you need at that hospital, because it's a private hospital. We're going to send over an ambulance for you," and the doctor in the ER is saying, "He will not survive the trip to the VA hospital."

And so, ultimately, we were able to work through the bureaucracy to make it so he was able to get the care that he needed, but it's that kind of--those kinds of obstacles that our veterans should not be having to deal with when they're in that need of care.

MR. COSTA: One of the things you saw when you were serving in the Middle East on your tours were burn pits--


MR. COSTA: --and these are large piles of waste on or near military bases, where they're essentially put on fire--


MR. COSTA: --and the fumes are in the air.

REP. GABBARD: It's constant.

MR. COSTA: And you're calling for more regulation--


MR. COSTA: --of burn pits. So far, it looks like your legislation to highly regulate burn pits and disclose what--where they are and what's in them is part of this defense authorization bill that's expected to get a vote later this year.

Are you confident, though, that your legislation will remain part of that defense authorization?

REP. GABBARD: Congress is unpredictable, as you well know. I'm hopeful. I'm hopeful that this--

MR. COSTA: Has leadership supported you at all?

REP. GABBARD: We have the support of leadership, which has been shown both within the full Congress as well as in the Armed Services Committee as well as the Veterans' Affairs Committee.

One thing that our bill does--and it's something that I'm working with my colleague, Republican Congressman, Brian Mast, on, another fellow veteran who also was exposed to burn pits, as I and so many others were. What our provision does is it mandates the DOD to actually keep track, name by name, of service members who have been exposed to these toxic burn pits, because that's the biggest challenge that we have initially. Just in the beginning, there's so much that we need to do.

But the burn pit registry that the VA has only has, what, about 175,000 people who have registered, but the VA themselves are openly saying that there are likely over 3 million service members who've actually been exposed to toxic burn pits, and not just for a few hours, not just for a day or a week, but for those of us who were deployed for just over a year in Iraq on our first deployment, it was every single day for that entire year.

So, at a baseline, the DOD and the VA need to track name-by-name and not say, "Hey, if you were exposed then you need to come forward and you have to prove it and all this other stuff." No, that's not--that's not where the onus lies. The onus lies on the Department of Defense to make sure that they are taking care of our troops who were exposed to these toxic burn pits.

MR. COSTA: And you said you were exposed to these fumes?

REP. GABBARD: Every day. Every single day.

MR. COSTA: What effect has that had on your life?

REP. GABBARD: Look, I--thankfully, I'm of good health now, but what I've seen in people who I served with, people who were in my medical unit who I've served with is something we're seeing prevalent amongst many service members of our post-9/11 generation, where they are getting throat cancers, prostate cancers, different types of cancers that are not normal for people of that age and that level of health and fitness.

Other respiratory illness--respiratory illnesses were very prevalent amongst those of us--if you got sick, you got this thing we called "The Crud," and you were sick and you were coughing for months at a time sometimes.

So, what we're seeing, unfortunately, is that not only--not only the direct impact while were deployed but now--you know, I mean, I was deployed there in 2005, all of 2005, and a number of people who I know personally are battling cancer who were there with me at that time, and this is not an exception, unfortunately. It's becoming the rule.

MR. COSTA: You're speaking as a leader of the 9/11 generation, the post-9/11 generation--


MR. COSTA: --of people who served in those conflicts. There's also the issue of Vietnam that's come up in the 2020 presidential race.


MR. COSTA: President Trump received several deferments, including a medical deferment for bone spurs from serving in Vietnam.

Do you believe President Trump who should have served?

REP. GABBARD: Look, those who found a way to get out of serving their country is unfortunate, and I just speak from my personal experience where, no, we didn't have the draft, but being able to serve and to deploy with such amazing Americans and to be in that place like none other, serving in a combat where you experience serving people who embody what it means to put service above self, where, you know, we had people from all across the country, people of every race, religion, orientation, Democrats, Republicans, independents, such diversity, and we stood together united in our mission of service.

MR. COSTA: You did. But what about President Trump? Should he have served in Vietnam?

REP. GABBARD: You know, I personally don't think highly of--

MR. COSTA: Does that include him?

REP. GABBARD: --those who chose to dodge their service.

MR. COSTA: So, he did dodge, in your view.

REP. GABBARD: I don't know the details of--

MR. COSTA: Well, I just told you--

REP. GABBARD: Yeah, yeah.

MR. COSTA: --he got a medical deferment from bone spurs.

REP. GABBARD: Yeah, I don't know. I don't know the details of what he did--

MR. COSTA: That is the detail.

REP. GABBARD: --and exactly why, so...

MR. COSTA: Okay. What about Vice President Biden, he got many deferments from Vietnam, including a medical deferment from asthma. Should he have served?

REP. GABBARD: Again, I'm not going to--I'm not a doctor, so I'm not going to comment on that. I know there are people who I have served with who have received medical discharges because of asthma. So, I'm not going to pretend to be the judge of all of this. I can only speak from my experience and how grateful I am to have had the opportunity to serve.

MR. COSTA: So, no judgment of Vice President Biden's Vietnam experience or his medical deferment because you're saying you're not a doctor. You don't want to have any more comment on that?

REP. GABBARD: Yeah, no. I don't think it's productive in any way. I can only speak to my own experience.

MR. COSTA: When you think about foreign policy, one phrase you often use is "the cost of war."


MR. COSTA: And you've articulated a foreign policy that is in contrast to some other Democrats in terms of who you've engaged with.

When you think about terrorism in the Middle East, you fought in the Middle East and served, do you think President Assad of Syria could be an ally of the U.S. in countering terrorism in the future?

REP. GABBARD: I don't know the answer to that. Perhaps. We've got to be clear about one thing, that I think it's lost in this discussion and this conversation, which is the terrorist attack that occurred on September 11th by Al Qaeda was the beginning of a war that continues to be waged.

It was that terrorist attack, like so many Americans, that inspired me to enlist in the military, to try to do my part to serve my country, and to go after those who attacked us.

Now, we can talk about different strategy and what's going on. I think the reality is that, in Syria, since you brought up Syria, you hear from people like Brett McGurk is as long as two years ago saying Al Qaeda is stronger in Syria today than ever before. And this is one of the reasons why I'm so outspoken on our ending our regime change war policies, is because in Syria specifically there was a CIA program that was directly and indirectly helping to equip and train and provide support to different armed groups, including those who are allied with and affiliated with Al Qaeda to overthrow the Syrian Government. This has directly attributed to the growth of Al Qaeda today, where they're in control of an entire city in Syria.

MR. COSTA: Just to understand that point--


MR. COSTA: --does the CIA shoulder some blame for the rise of Al Qaeda in Syria?

REP. GABBARD: The decisions made to initiate that program that the CIA led does carry responsibility for using taxpayer dollars that ultimately helped strengthen Al Qaeda in Syria.

That's why I introduced the bill called the Stop Arming Terrorists Act. You would think you wouldn't need something like that, but taxpayer dollars should not be used to provide support, arms, or otherwise, to terrorist groups like Al Qaeda or others who are supporting them.

MR. COSTA: You use the word "perhaps" in terms of President Assad as a possible partner in countering terrorism in Al Qaeda in Syria. When you say "perhaps," how do you factor in his record on human rights, the attacks on civilians?

REP. GABBARD: Well, I think if we're going into Syria, as our troops have been deployed there, they're deployed there under the 2001 authorization to use military force that was passed by Congress after the attacks on 9/11 to go after terrorist groups like Al Qaeda and those affiliated with them. That is the reason our troops have gone and deployed there, to help and work with other local forces on the ground, like the Kurds in the north, to fight against Al Qaeda and ISIS. There are others within the region who share that objective. I think that we should be working with them.

There are also others in the region who have proven to not share that objective and have been--there's evidence time and again of Turkey, for example, allowing open passage to both Al Qaeda and ISIS in and out of Syria, restocking them, providing arms and support to them, along with countries like Saudi Arabia and others.

So, again, I think this mission of regime change wars has been so counterproductive and costly to our service members, and it's actually undermined our national security in places like Syria where, again, Al Qaeda is stronger now than any other time since 9/11, actually.

MR. COSTA: Do you accept that Assad's used chemical weapons?

REP. GABBARD: That has been reported. There is also new information coming out from the UN and their--

MR. COSTA: What's that new information?

REP. GABBARD: That their OPCW, their organization that is directly supposed to investigate the use of chemical weapons in different parts of the world, there was a report that was leaked a few weeks ago basically calling into question some of the previous reports and changing their outlook saying, "Hey, rather than, for example, missiles being dropped from a helicopter it looks like it was a staged attack and those missiles were placed there by hand."

So, anyway, it's a serious issue and I'm looking into this further. I've reached out to the OPCW to get more information. Because coming from someone who served in Iraq, a war that was based on lies and false evidence, I think it's important for all of us, those in the media, those in Congress, and Americans to ask the tough questions. Ask for the [unclear 00:18:16]--

MR. COSTA: So, you haven't made a conclusion, yet. You're still in a factfinding phase.

REP. GABBARD: There's still more information that's coming out.

MR. COSTA: What about President Putin and Russia? How do you see his role in helping--or not helping--the U.S. on terrorism issues in the Middle East?

REP. GABBARD: I think there's an opportunity to work with others who are concerned about this terrorist threat coming from groups like Al Qaeda and ISIS.

Putin has talked directly about his concern in that area that we share, given the thousands of foreign fighters who have left both Russia and other former Soviet states and gone to join the forces of Al Qaeda and ISIS in places like Syria, and like other European countries who have seen other foreign fighters go there. They are concerned about--

MR. COSTA: So, should the U.S. be working more with Putin on these issues?

REP. GABBARD: To defeat this shared threat like Al Qaeda and ISIS, I think we should be working with others, whether it's Russia or other countries who share the same concern.

MR. COSTA: But others would say--critics of Putin--that he interfered in the elections in 2016 and he wouldn't be a part--a natural partner because of that.

REP. GABBARD: Look, I think it's dangerous when we look at the state of affairs that we're in now, where there's ever-escalating tensions between the United States and nuclear-armed countries like Russia and China, because it's pushing us closer and closer to the brink of nuclear war. I mean, nuclear strategists now are saying we are closer to the likelihood of nuclear catastrophe now than we--

MR. COSTA: Between the U.S. and Russia?

REP. GABBARD: Between the U.S. and Russia, and you can also see escalating tensions between the U.S. and China. They have been studying this issue for a long time and are recognizing that, if we continue down this same path that we are on, the inevitable result will be nuclear war. And it's not a war that the United States can win. It's not a war--

MR. COSTA: But it's not a path the U.S. went on. Russia intervened in the elections [unclear 00:20:16]--

[Overlapping speakers]

REP. GABBARD: Well, I'm talking about--I'm talking about the sit--the overall situation that we are in, yes, there are issues that we have with Russia. We've got to work out those differences, but on issues like counterterrorism, there's a shared objective, and I think there's opportunity for us to be able to work with others who are serious about defeating that threat.

MR. COSTA: What did you think of the Mueller--

REP. GABBARD: Cybersecurity is another issue.

MR. COSTA: Well, on that front, on cybersecurity and Russia, the first volume of the Mueller Report is all about Russian interference. Does that--did that specific part of the Mueller Report alarm you or do you think it was overheated?

REP. GABBARD: You know what alarms me most when people talk about interference in our election is the fact that, even with all the discussion and the focus that there has been on this issue since 2016, as we sit here today, there are still many states in this country who have no paper ballot or no paper backup to their electronic voting systems. So, when we go in and cast our votes and there's some question called in about some interference or manipulation of those votes, many of these states have no paper trail to audit the votes that we cast.

This is something I've introduced legislation to address, called the Securing America's Elections Act, which very, very simply just says you either use a paper ballot--

MR. COSTA: Right.

REP. GABBARD: --or if you use an electronic system, there has to be a voter verified paper backup.

Virginia is a state, in 2017, that recognized this vulnerability in their own election, where they saw in a hacking conference there was a teenager who hacked into an election system in less than 15 minutes.

MR. COSTA: But--

REP. GABBARD: They immediately made a change in their system, had those paper ballots put in place. And they did not--that year, they had not a single complaint about the integrity of the votes being cast.

MR. COSTA: The integrity of the ballot, such an important issue--

REP. GABBARD: It's everything--

MR. COSTA: Well it's not everything--

REP. GABBARD: I don't think--

MR. COSTA: But also--

[Overlapping speakers]

REP. GABBARD: I don't think we can--

MR. COSTA: What about--what about--

REP. GABBARD: --discount this.

MR. COSTA: --the disinformation campaign in the 20--you're a presidential candidate in 2020. Our federal government has reported that disinformation is expected again in 2020. What steps should be taken and how much of a threat is it?

REP. GABBARD: You know, I have faith in the American people. If you look online every single day on Twitter, on Facebook, on social media, bloggers, different news sources, there--there are a lot of people who are putting out their own information trying to influence others. And this is coming from people here. It's coming from people in other countries. I think we've got to have faith in the American people to recognize the truth and to be able to have the intelligence to make the decision--

MR. COSTA: A lot of times they can't, though, on social media.

[Overlapping speakers]

REP. GABBARD: --who they want--

MR. COSTA: That's very difficult for some people. Deep fakes videos--

REP. GABBARD: So, this becomes a challenge, right? And this is what we're seeing in social media now, which I think is really dangerous, is you have Facebook and Google, for example, this is something that we're debating heavily--who have such great power that they are now going to be the arbiters for who they believe is telling the truth or what kind of information or what kind of opinions they want the American people to see. I think that's really dangerous.

Because again, let's have faith in the American people. Let's have faith in voters to be able to discern what their opinions are, how they feel about different issues, and what kind of leader they want for our country.

MR. COSTA: I'm not sure if you saw President Trump's interview with ABC News, yet, but he was asked this question--

REP. GABBARD: I have not.

MR. COSTA: --"Would you accept opposition research from a foreign actor or a hostile power?"

REP. GABBARD: I strongly disagree with that statement.

MR. COSTA: You would not?

REP. GABBARD: I would not, absolutely not.

MR. COSTA: And you would report it to the FBI immediately?

REP. GABBARD: Yes, without a doubt.

MR. COSTA: Do you think we're heading toward war with Iran?

REP. GABBARD: I certainly hope not. The actions of this administration, people like John Bolton, Mike Pompeo, my concern is they appear to be setting the stage for a war between the United States and Iran.

MR. COSTA: What do you mean "setting the stage"?

REP. GABBARD: They are hyping up and escalating these tensions that began with Trump withdrawing from the Iran nuclear deal, with ratcheting up sanctions, strangling the Iranian economy, even though U.S. and, you know, European and other intelligence sources said that Iran was complying with the Iran nuclear deal. These things are creating a scenario where a war against Iran is seeming more and more likely.

But I think it's important for us and for the American people to understand a war against Iran would make the war in Iraq look like a cakewalk. The cost, the human cost, on our service members is immeasurable. The human cost on not only people in Iran but people all across the region would be devastating. The refugee crisis, that would be heavily escalated in Europe. The cost, trillions of dollars that would cost us as the American people to wage such a war, and recognize that this is not a war that would be contained just in Iran. We're talking about Iran and Iraq, Israel, Syria, Lebanon, Jordan, all of these countries across the region getting sucked into this war. And it's something that I believe strongly we need to do all we can to prevent.

I was able to include legislation in the defense bill last night that said nothing in this bill can be misconstrued as an authorization to use U.S. military force against Iran, unless specifically authorized by Congress.

MR. COSTA: At the beginning of the Trump administration, one of President Trump's then-advisers, Steve Bannon, invited you to meet with President Trump, and he has praised you in the past.

Describe your relationship with Steve Bannon, if any.

REP. GABBARD: There is no--there is no relationship. I got an invitation to go and talk to President Trump specifically about my views on foreign policy, specifically about my views on ending regime change wars, coming from my own experience as a soldier, understanding not only the high human cost, but how counterproductive it is to our own national security, and that's what I did.

I wanted to take the opportunity to hopefully try to be of influence to this person who had just been elected, who would be our next Commander-in-Chief, in the hopes he would not kind of be grabbed up in the claws of the neocon war hawks, of the likes of John Bolton, which unfortunately it appears what has happened.

MR. COSTA: "Grabbed up in the claws of the neocon war hawks"?


MR. COSTA: Bannon's at the opposite side of that, in sense. He's a nationalist. Do you share any of Steven Bannon's nationalism?

REP. GABBARD: Oh, I'm not going to get--you know, I'm not going to get into what Steve Bannon believes or any of that.

I believe in serving my country. I love our country. I love our people. It's why I'm running for President, to be able to be in that position to end these wasteful regime change wars, work to end this new Cold War we're in, deescalate these tensions, prevent us from getting to this place of a nuclear war, and make sure that we're investing the trillions of dollars--

[Overlapping speakers]

MR. COSTA: Right. And beyond Steve Bannon, President Trump has used that phrase "nationalist." I just wonder, do you ever consider yourself a nationalist?

REP. GABBARD: I think we need to put the American people first. I think that a lot of these things are used to divide people when really, I'll tell you, folks who I'm meeting out in communities across the country, they're just saying, "Hey, I'm struggling just to put food on the table. I just want to make sure my kid gets a good education, that my family has clean water to drink, clean air to breath, that our farms are not going to be flooded by failing levies and failing infrastructure."

These are the things that I'm focused on and why it's so necessary to address the cost of our current foreign policy and the direction we're headed and to take those resources, those trillions of dollars, and actually invest them in serving the needs--the urgent needs of the American people.

MR. COSTA: Just in the last few minutes we have here, a little bit of a lightning round.

New York Magazine has a big story--a profile of you. It talks about your religious background. It mentions a man named Chris Butler. Are you still part of his group?

REP. GABBARD: I'm not going to comment on that article. That was a smear article that was based on a bunch of things that people who don't know anything about me said.

MR. COSTA: So, but just on the--

REP. GABBARD: If you want to ask me if I am--

MR. COSTA: --but your religious--

REP. GABBARD: --practicing Hindu, yes, I'm a practicing Hindu. I study and draw great inspiration from the Bhagavad Gita. I was raised in an interfaith home: dad, Catholic; mom, Hindu. And really, the values that I grew up with had to do with trying to dedicate my life in the loving service of God and service of others.

MR. COSTA: Understood. And I understand you don't want to comment on that article, but just for clarity purposes, that name Chris Butler, repeatedly mentioned in article--that article and a few others about you. How would you describe--

REP. GABBARD: He's one of my spiritual teachers.

MR. COSTA: One of your spirit--what does that mean?

REP. GABBARD: One who provides spiritual guidance.

MR. COSTA: Has he been a mentor politically or is it just spiritually?

REP. GABBARD: No, no, not at all.

MR. COSTA: What about--you were homeschooled. How has that informed your position on education?

REP. GABBARD: I value education greatly. Both my parents are teachers, and I feel grateful to have had the opportunity to have the education that I've had where there's a lot of flexibility. I was able to focus on different things that I was really good at, spend more time on other things that I wasn't very good at.

I think we need to dedicate far more resources to our public education system to make sure, ultimately, whatever the skills and talents that each of our kids has, that they're able to maximize those and be set up for success for our future.

MR. COSTA: You quite the Democratic National Committee in 2016 because of the way it treated Senator Sanders. Do you have confidence in Chairman Perez and the DNC this time around to provide a fair process?

REP. GABBARD: You know, I resigned as Vice Chair of the DNC so that I could endorse Senator Bernie Sanders specifically because, as a veteran, I felt a sense of responsibility to speak out on the qualities that I felt were necessary in a Commander-in-Chief.

I think that some of the rules that have been put out this go-around have provided more transparency, and I think--and I think more fairness, at least at this point as we're going through the process.

MR. COSTA: Should President Trump be impeached?

REP. GABBARD: I believe that the American people need to--

MR. COSTA: It's a relevant question.

REP. GABBARD: I believe that the American people need to be the ones to remove Donald Trump from office in 2020; that's why I'm running and plan to do so.

MR. COSTA: Last question: If you're the Democratic nominee for President, who would be on your shortlist for VP?

REP. GABBARD: I have no idea. That's not what I'm thinking about.

MR. COSTA: Congresswoman Tulsi Gabbard of Hawaii, thank you very much.

REP. GABBARD: Thank you, everybody. Good to talk to you. Aloha.


Warrior Care Networks

MR. PLENZLER: Good morning, everyone. On behalf of the Wounded Warrior Project's chair of the board of directors, Dr. Jonathan Woodson; and our CEO, Lieutenant General (retired) Mike Linnington, thanks for being here today.

My name is Joe Plenzler. I'm the director of Communications for Wounded Warrior Project, here in Washington, D.C.

Joining me on stage to my left is retired Army Lieutenant Colonel Mike Richardson, and Mike is our Vice President of Independent Services and Mental Health.

Wounded Warrior Project is our nation's largest direct‑service nonprofit focused on transforming the way America's veterans are empowered, employed, and engaged in our communities.

As a 501(c)(3) nonprofit and as today's presenting sponsor, it's important to know that we do not endorse any political party or candidate for office. Our mission is very simple. We honor and empower our nation's wounded warriors.

Since 9/11, more than 3 million American veterans have served in Iraq, Afghanistan, and other battlefields around the world, more than half with multiple deployments. Nearly 53,000 are wearing the Purple Heart medal for wounds received in combat. To visualize that, that's enough people to fill Washington's Nationals ballpark to capacity and still have 12,000 people outside waiting to get in.

And you might not be aware that the Department of Defense has recorded nearly 380,000 traumatic brain injuries since the year 2000, and according to the National Center for PTSD, nearly 500,000 servicemembers have been diagnosed with PTSD.

130,000 veterans are enrolled with Wounded Warrior Project: 76 percent of them report struggling with PTSD, 41 percent report sustaining traumatic brain injuries, and 70 percent report suffering from depression. And the Department of Veterans Affairs estimates about 20 veterans a day die by suicide.

So, clearly, we have a mental health crisis on our hands, and Mike is here to talk to you today about what Wounded Warrior Project is doing about it.


MR. PLENZLER: Mike, let's start at the 30,000‑foot level. Can you talk about why Wounded Warrior Project is in the mental health space and what we're doing?

LTC RICHARDSON: Sure. And, again, it's an honor to be here, and thanks for coming. A very important topic.

And so we heard the numbers. The need is great, and it's still growing. And Wounded Warrior Project has been immersed in the mental and brain health space for a number of years. Matter of fact, it's our largest program expenditure through our budget.

And we've built a continuum of program support‑‑we call it "mental health continuum of support"‑‑addressing those who are in psychological distress, acute psychological distress, all the way to those that are still struggling with‑‑further along in their recovery, if you will, but still struggling with mental health challenges. And we have programs for warriors and their family members throughout that continuum.

What you may not know as well is that the expertise that we have on our staff, Joe. On my team, in particular, I have a number of teammates with PhD's, master's in social work, MBAs, all geared towards ensuring that we are being as impactful with the program and the development of the programs as possible to make sure that our warriors and their families get the services and treatment they deserve.

MR. PLENZLER: So given that mental health is kind of at the center of what we do programmatically, I've heard you describe the Warrior Care Network as the centerpiece of the centerpiece. So can you unpack that a little bit and talk about what the mission is, how it's comprised, and what it does?

LTC RICHARDSON: So one of the programs within the continuum is called our Warrior Care Network, and so a number of years ago, the Wounded Warrior Project wanted to make sure that we were innovative in the space and developing innovative models of mental health treatment for our veterans. And so we created the Warrior Care Network to leverage the expertise and the commitment of four academic medical centers, world‑renowned academic medical centers across the country, to develop a two‑to‑three‑week Intensive Outpatient Program, all geared towards having‑‑providing a path of wellness for our veterans and their families.

MR. PLENZLER: Could you tell us what the four centers are?

LTC RICHARDSON: Sure. So Emory University out of Atlanta, Rush University in Chicago, UCLA Health out in L.A., and then Mass General Hospital up in Boston.

And bummer about the Bruins last night, but congratulations to the Blues.


MR. PLENZLER: Awesome. And let's talk about, like, this is not business as usual for these programs, right? I mean, could you talk about why‑‑a little bit more about the innovation aspect to the Warrior Care Network?

LTC RICHARDSON: Yeah. So all four of those academic medical centers that I mentioned were all serving veterans before, but what we know with traditional outpatient service, you get care once a week, once a month. The dropout rate before the treatment protocol is finished is between 50 and 70 percent dropout. They don't complete that with traditional outpatient.

And so we directed the academic medical centers to develop the two‑to‑three‑week Intensive Outpatient Program. That's one part.

The other part is we demanded collaboration. It wasn't going to be a primary funder in four very separate distinct clinics. No. We were developing a network that shares best practices, data shares across the board, learning from what works at each of the sites, doing research together. That's what really makes that stand apart.

MR. PLENZLER: I wonder how much arm wrestling you had to do to get them to share intellectual property.

LTC RICHARDSON: Yeah. So anybody who's worked with academic medical centers, bless their hearts, but just to get them at the table to agree to talk about it, never mind actually execute it, has been amazing. And those four centers absolutely have the same passion and mission driven towards our veterans and their families as the Wounded Warrior Project.

MR. PLENZLER: Awesome. What kind of effects is the Warrior Care Network having?

LTC RICHARDSON: Yeah. So, again, we started Warrior Care Network about‑‑launched it three and a half years ago because, again, we knew traditional therapy was not‑‑the treatment works, but not the same treatment works for everybody. So we were looking for that innovative model.

And what we've done‑‑so, to date, we've served about 1,500 in the Intensive Outpatient Program, and on average, the aggregate, our warriors are starting the Intensive Outpatient Program at the severe level in post‑traumatic stress and depression. Upon completion, two or three weeks later, minimal level, and that same holds true for depression.

What does that mean in life? Right? Well, that's functionality. Where they were isolating nightmares, et cetera, they are now engaged with their families, getting back to school, getting back to work. The clinical‑‑significant clinical outcomes are real.

MR. PLENZLER: Yep. And I had lunch with a warrior just the other day who went through late fall last year and for the first time ever took his two kids to Disneyland by himself. I mean, for where he was before that, it was a tremendous change.

How are you measuring this? This isn't just feel‑good responses that we're getting. I mean, you're putting clinical data to this as well, right?

LTC RICHARDSON: Immense clinical data. Academic medical centers‑‑as a matter of fact, one of the challenges is that they are so data driven, as is Wounded Warrior Project, to where it can almost interfere with changes.

Well, our data is so detailed to make sure that, again, we are learning from each other, and so we use clinically validated scale, such as‑‑I'll just name a couple of them off‑‑PCO‑5 [phonetic], PHQ‑9, the Conner‑Davidson for resilience; VR‑12 for psychological well‑being and the like. And so it is all absolutely data driven.

MR. PLENZLER: Awesome. And let's talk a little bit about‑‑I think a lot of people don't know that there's a private and public venture aspect to this. We're in partnership with a federal agency. Can you talk about that?

LTC RICHARDSON: Sure. Veterans Affairs, amazing organization doing great work, massive. No one can do this all by themselves, and it takes a real partnership. And so we are working hand‑in‑hand with the VA in what we're doing to the point where we have an MOA, the Wounded Warrior Project does, with the VA to where they provide a full‑time FTE, a VA employee, in each of the academic medical centers.

We originally thought they were going to‑‑because we had challenges getting medical records, and so we wanted to make sure the continuity of care from the VA into the Intensive Outpatient Programs and then when they go back to their homes in their communities‑‑we thought they were going to spoon‑feed us medical records. They've actually turned into a Swiss Army knife of resources, doing briefings, helping with benefits. Most of the warriors and veterans, before they leave the Intensive Outpatient Program, have an appointment at their local VA. They're doing referrals to and from, game changer.

MR. PLENZLER: So they're catching them on the intake, advising them of the benefits, making sure that they're enrolled, if they elect to enroll, and they're doing a handoff off the back side of the treatment.

LTC RICHARDSON: They're also integral‑‑part of the governance, another innovative aspect of the network, is that we have a real strong governance section with the network, where we have an executive steering committee, data and outcomes committee, clinical practice committee, et cetera, and the VA is actually at every one of our executive steering committee‑‑

MR. PLENZLER: Let's talk a little bit about the experiential side of it. So if I'm a veteran coming to Warrior Care Network, am I going by myself, or how is that orchestrated?

LTC RICHARDSON: Yeah. Again, one of the‑‑a lot of innovation in this. That's one of the nice things about being a nonprofit. We are that agile in working with folks, and these four academic medical centers are willing to be that agile with us as well to where the 10 or 12 warriors show up on day one of the Intensive Outpatient Program together.

Now, Emory University, they have five starting every Monday. So it's a cohort‑styled model to where they go through the two‑to‑three‑week intensive outpatient program as a cohort.

MR. PLENZLER: And then they're building a sense of tribe, right? So it's the patient experience with the therapist, the cohort itself, which is kind of culturally congruent, right? I mean, 10 to 12 is about the same size as an infantry squad in the Army and Marine Corps and the same as a boot camp squad, so it's like a pattern that's already familiar. And they're accomplishing their health care outcomes as a team, really.

LTC RICHARDSON: Sure. So the clinical side, absolutely. I talked about the clinical outcomes. The therapy is anchored and evidence-based, while it's surrounded by complementary and alternative therapies as well, Tai Chi, equine therapy, et cetera, but again anchored and evidence-based. And so that's working well.

The next piece of that working real well is the cohort‑styled model to where the warriors and the veterans and the patients, they hold each other accountable. If someone's not putting it all in, they'll be knocking on the door, "Come on, Mike. You got to do that. Do your homework," because this is all day. This is really an intensive outpatient program, and the big part of that is really the connectedness to the other warriors.

MR. PLENZLER: So the bonding aspect is critical.

Let's talk about the destigmatization part. I mean, you've talked about that quite a bit.

LTC RICHARDSON: Yeah. And so when you get warriors talking about mental health care, you're normalizing the conversation. You are destigmatizing mental health care.

One of the‑‑‑not a clinical outcome, but an outcome, as I mentioned, the dropout rate is 50 to 70 percent in traditional outpatient. In our Intensive Outpatient Program, we have over a 92 percent completion rate. Ninety‑two percent are completing the care once they start it. And over 96 percent of the warriors that go through it are very satisfied with the care, and they say, "I'm going to tell my buddy. They need this care as well." That is destigmatizing.

MR. PLENZLER: And how many veterans have gone through the intensive outpatient part of this so far?

LTC RICHARDSON: Yeah. So it took us about a year‑‑excuse me‑‑two and a half years to get to a thousand patients, because we were ramping up and developing and growing the network. To date, we have served over 1,500 through the Intensive Outpatient Program.

Now, because of our investment in the expansion of each of the sites--the Wounded Warrior Project's investment and expansion--while it took us two and a half years to get to 1,000, starting next year, we'll be treating over 1,100 every year. For the next five years, where we committed this past October, another 160 plus-million for the continuation of our Wounded Warrior Project, because of all those outcomes that I mentioned, tangible and intangible, to where we'll be serving over 16,000 warriors and family members in that five years, with almost 6,000 just in the Intensive Outpatient Program.

MR. PLENZLER: And that's on top of the 100 million that has already been‑‑

LTC RICHARDSON: Yeah. So we kind of started, as I mentioned, a pilot. We didn't quite know it was going to work. We expected it to, and so, collectively, we committed a million dollars for the first three years. And when we saw these outcomes, we were like, "There is no way we can't do this. We have to do this," and so from our board to our leadership committed another $160 million. We're already looking at what the next phase looks‑‑

MR. PLENZLER: And what's the cost to the veteran?

LTC RICHARDSON: Yeah. And so, as with all of Wounded Warrior Project's programs, warriors and their families don't pay a penny, not a penny for any of our programs. They paid their dues on the battlefield and in service to our country.

I'm talking not just the treatment, but we fly warriors and family members from all over the United States to those four academic medical centers, even other countries, Algiers and Guam. And they don't pay for their flights. They don't pay for hotel rooms. They don't pay for food, parking, or anything. That's all completely covered because that's one of the barriers to care.

Everything we do is trying to ensure our warriors and their families get the care they need, and so we break down those barriers.

MR. PLENZLER: Which is probably appropriate that we thank all of our donors all across the United States because it's because of their love and concern for these wounded, injured, and ill veterans that we're able to do these programs and services.

Let's talk about going forward. You talked a lot about where we're at right now, but what's coming down the pike? I mean, you're investing in some novel technology.

LTC RICHARDSON: Yeah. So, as I mentioned, Wounded Warrior Project has been immersed in the mental and brain health space for years and years about the treatment of today, taking care of the warriors' needs today.

A couple years ago, our leadership and our board recognized that we wanted to be part of the solution for tomorrow. So we're actually investing in the research side of this as well. Biomarker research. If we can figure out through DNA and biology what treatment works best for Joe and get him to that treatment right away, precision medicine for mental health, if you will.

We're also investing in which in research for‑‑you know, is CPT, cognitive processing therapy, better than prolonged exposure and traditional outpatient or intensive outpatient, based on the demographics of the patients themselves? So that, again, we can get to the right patient to the right care at the right time. While we will always be part of the treatment of today, we absolutely need to be part of the solution for tomorrow.

MR. PLENZLER: So that's kind of the mental health corollary to what the Department of Veterans Affairs is doing with the Million Veteran Program‑‑


MR. PLENZLER: ‑‑the genomics and the research database they're building up in Jamaica Plain.

LTC RICHARDSON: Yeah. It's pretty exciting stuff.

MR. PLENZLER: That's really cool.

So I think that's about all the time we have right now.

Ladies and gentlemen, on your way out, we're going to be handing out our resource center cards. So if you know a veteran in distress or someone who knows a veteran who needs some help, please take those cards and pass that information along.

We often said in the Marine Corps that leaders show what's important by where they put their bodies on the battlefield, and the fact that you are all here today is a testament to your fidelity to helping solve these issues.

So thank you very much. On behalf of the Wounded Warrior Project, thank you for being here, and with that, we'll turn it over to the Washington Post.



Toxic Exposure: A Looming Crisis

MR. HORTON: Good morning. I'm Alex Horton. I'm a reporter here at The Washington Post, and we're here to talk about something that is dear to me as an Iraq veteran and someone who's covered veterans, like Patricia Kime, a freelance journalist and associate editor of; Bonnie Carroll with the Tragedy Assistance Program for Survivors. It's an organization that cares for families of our nation's fallen heroes.

And we've heard a little bit about it today, the emerging issue of toxic exposure for troops overseas, and it's not just an overseas problem. It's for folks who are living on military bases and exposure to their families as well.

So we're going to get started here with you, Patricia. We've heard a lot about burn pits today, already. So give us a larger scope of the issue with burn pits and other toxic exposures that are affecting veterans.

MS. KIME: So, historically, preparing for national defense and the actual going to combat is a dirty job, and going back to World War II when we see atomic veterans, people who are exposed to radiation, going through Agent Orange at Vietnam, the post‑9/11 veterans face a number of toxic exposures, burn pits being probably the most visible.

And those, as Representative Gabbard said, were these mass pits where they would burn 24/7, and they would burn things like body parts and waste and chemicals and batteries and all sorts of things that ran 24/7 over‑‑drifting over bases. The one at Balad, Joint Base Balad, was 10 acres wide and burnt like 250 tons of trash a day.

But it's not just the burn pits that are the issue. Some veterans believe that their exposure to depleted uranium has made them ill. There's been research that the dust over in Iraq contained small particulates of heavy metals, so there's been some absorption of heavy metals into lungs. There is lead exposure.

And then at home, we have right now a developing issue with the nonstick chemicals that are in firefighting foams called perfluoroalkyl substances, or PFAS. These are not things that break down, and they are in many of the water supplies.

There's 60 bases, I believe‑‑or former bases that are areas of concern to the DoD, and then there's long‑term contamination at certain bases like Camp Lejeune, where there were solvents and military cleanup solvents dropped that leached into the water supply.

So it's a very large scope to address.

MR. HORTON: Right. So this isn't 2003. This isn't 2004. This is 2019, and if the war in Afghanistan was a person, in a few months, it can walk down to the recruiting office and enlist to fight itself. And that's how long Afghanistan has been going on.

Now we know about these things, but that wasn't true in the early days of Iraq and Afghanistan. So what kind of problems did that present when you had men and women go overseas, be exposed to this stuff, come back and just be totally aware of what was going on at the time?

MS. KIME: I mean, there have been‑‑since 2010, there is a tiny group called Burn Pits 360 that sort of started realizing that veterans were getting ill and trying to pull it all together and get a scope as to what was making them sick.

It started out really focusing on respiratory diseases because the automatic assumption is you're breathing in this stuff, and a number of vets do have a disease called constrictive bronchiolitis, which is a very rare lung disease. It's sort of scar tissue that sort of builds up. And so that was the initial sort of illness.

But now‑‑it's only now that we're starting to see‑‑and Bonnie can talk to this more. There's a lot of cancers, rare cancers in young people that are unexpected and not a whole lot of research being put into exactly what diseases are related.

MR. HORTON: Before I get to you, Bonnie, some housekeeping. If you're in the room or watching online, tweet questions to me using the #PostLive, and we'll get to them a little bit later in the program.

So, Bonnie, tell me‑‑you have a vast network of military families and surviving spouses. Tell me what they're saying about toxic exposure right now.

MS. CARROLL: Well, TAPS is a national organization for all those grieving the death of a military loved one. So we see not just those who have lost loved ones on active duty but guard and reserve whose loved ones died now not in a duty status or veterans or those who have ETSed, gotten out of the service for one reason or another.

Over the past five years, we've had a 51 percent increase in the number of surviving families coming to us stating their loved ones died of an illness. Last year, we had over 1,500 surviving military family members who shared with us that that was the cause of their loved one's death, and this year alone through May, we've seen over 700 surviving family members who are stating that's the cause.

And these are family members‑‑like one, in particular, her husband was a lieutenant colonel. He was a chaplain. He was deployed to Afghanistan. Came home with a cough that just never went away, and finally, when it was ultimately diagnosed, it was inoperable cancer, lung cancer, but a form that was determined by the medical community, by his physicians, to be environmentally caused, not genetic. And he was not a smoker, so it was a nonsmoker's variety. And he died on Christmas Eve of 2016. That's one of just hundreds, thousands of stories we have now of those loved ones who have died after they have gone forward to serve.

MR. HORTON: One of the issues we talked about earlier, if you're listening to this, you can say, "Oh, why don't they just go to the sick call? Why don't they go to the doctor and get this checked out?" But there are a lot of military cultural challenges when it comes to things like that. Can you walk us through some of those issues that kind of kick the can down the road, as it were, when it comes to treatment?

MS. CARROLL: Exactly. And that's a great question. Coleen Bowman's husband, Rob, was at the Sergeant Major Academy down at Fort Bliss, and he had served 20 years. He had been on multiple deployments. I mean, this was the soldier's soldier and never been sick a day in his life, and now all of a sudden, he's just not feeling right. And things are getting worse, but they're telling him, "Oh, you'll get over it. It's the flu," it's this, it's that, and not really addressing what was wrong until he finally went to the physicians there and said, "I'm not leaving until you tell me what's going on with me." And they did extensive testing to determine he had stage 4 inoperable cancer and just potentially weeks to live.

He told Coleen that he wanted to do everything that he could with the time that he had left to really understand what was going on and maybe to help others who would come after him. So they did a lot of testing on his case, determined it was absolutely environmental.

So he did pass after 19 months, leaving behind his wife and his four daughters, and today Coleen is a tireless advocate with us for this cause. But Rob is just one of so many who ran towards the bullets, towards the bombs, into the battle, and as we say, he also ran towards the burn pits and was housed near there.

So now it is up to us to care for he who shall have borne the battle and his widow and his orphan.

MS. KIME: Alex, you make a really interesting point. I did a story a while ago about several special operations troops who have chronic lead poisoning, and so one of the sources I spoke with, one of the military doctors said, "There's a real lack of intellectual curiosity among some military doctors." I mean, there are some fabulous military doctors. Don't get me wrong, but a lot of them is, "Oh, it's the flu."

Quite often, you get brushed off or, you know, you're not as sick as you are. There's a real effort to just put you back into the job, the battle, and you're going to be fine. And we've seen this time and time again.

There's another same issue with lung cancer stage 4, very late diagnosis, because they kept saying you've got pneumonia or you've got the flu and just not trying to figure out what really is going on.

MR. HORTON: So a lot of this sounds like déjà vu when it comes to Agent Orange, the toxic defoliant that was sprayed over Vietnam and Laos, and it took decades for veterans to be heard by VA, by Congress, by the White House on something that was going on. And it was killing veterans long after they came home.

You could say that maybe VA learned a lesson, a hard lesson on something that looks very familiar, something that appears to be linked to combat service but maybe not, maybe the science isn't there. And then the science is there, and everyone who is exposed is either sick or dead after that.

Has the VA learned its lesson? How has it done that, and how has it kind of failed to look back at history and say, "You know what? We should get this right this time"?

MS. KIME: VA early in the late 2000s commissioned a study for the Institute of Medicine to take a look at burn pits and their effects, and that report came out in 2011. They're now the National Academies of Sciences, Engineering, and Medicine, and they said that they could not draw a conclusive link between burn pits and illnesses.

VA again has commissioned the National Academies to look at the issue now. This is eight years later, but the charge there is for them, for the National Academies, to look at the relationship of burn pits and airborne hazards to lung diseases only.

And one of the issues we're seeing is the veterans have rare cancers and autoimmune disorders and illnesses that are not lung diseases, and again, some of the advocacy groups will tell you that many of the diseases they're seeing are similar to those seen in the 9/11 first responders. Many of the materials that were burned in the burn pits also were in the twin towers on 9/11, and so these veterans have breathed in chemicals that can cause diseases beyond lung cancers. So that's a very restrictive sort of charge they've given the National Academies.

VA also consistently says, "We're doing a lot of research on burn pits." They gave me a list of 30 research projects that are going on, but they're on chronic pulmonary diseases, and they're respiratory focused.

There's not a lot going on with perhaps any link between cancers like brain cancer or leukemias, lymphomas that we're seeing in hundreds of veterans.

MR. HORTON: And, Congresswoman, early on, Tulsi Gabbard, she mentioned the Burn Pit Registry that VA maintains, and she talked about it as a potential solution. If we get people on there, we get people registered, and we know who they are. We can kind of track their health and track their progress. It seems like too good of a solution for this complicated problem. So can you explain, Bonnie, the purpose of the Burn Pit Registry and what it reveals or may not reveal about what to do next?

MS. CARROLL: Well, I think she was also talking about the Burn Pits Accountability Act‑‑


MS. CARROLL: ‑‑and absolutely getting everyone who was deployed accounted for so that we know where people were, what they may have been exposed to, and we can better care for them to prevent cancers, to treat them early, to bring awareness to the medical community, and to care for their surviving families.

MR. HORTON: And we were talking earlier about the registry itself, and if you die, you don't go on that list. It's not posthumous.

MS. KIME: Right.

MR. HORTON: So what are the issues with that?

MS. KIME: Well, so the registry was set up. Congress actually ordered the VA to create the registry, and it is a long questionnaire. In fact, the one thing Representative Gabbard did not say is that she has gone online three times to try to complete the form and register, but she has either been booted off of the system or she has not been able to finish it because it's very time consuming. So there's this sort of‑‑so there's 175,000 people in this registry who have gotten through the process.

If they pass away, there is no way for their family members to get online and take them off the list. There's also no way if a veteran is incapacitated or cannot do it themselves that their loved one can get on there, or if the veteran died before the registry was created.

There is some legislation being introduced, trying to get that solved, but the issue is then you've got 175,000 people that you really don't know what their progress is because they're not really updating it. They just filled out this form, and it really does need to be probably made more effective and be used as a research tool, which it currently is not being done.

MR. HORTON: And it's a problem if you don't know what you don't know, right? Like if you don't know about the list, you don't go on it. Like I only know about the list because of the work I do, but I get plenty of mail from VA about registering for private health care under the MISSION Act. I've never gotten anything about a burn pit that alerted me to this problem in the first place.

So we have a Twitter question here. It says, "An annual chest CT scan takes less than 15 minutes. Are military members and veterans exposed to burn pits and other toxins receiving this test for early detection of cancer, and why not?" Can you speak to that?

MS. KIME: I'm not aware of that. The DoD has a pretty aggressive sort of lung cancer screening program, at least they did a few years ago. VA, I believe, is also leading the way on lung cancer screening, so that is a chest CT of some sort. Whether they're advertising it, I do not know.

MS. CARROLL: One of the challenges that we see are many of our families or their loved ones were National Guard or reserve, and so they may not have been in an AD status. They may not have that kind of advanced medical screening or opportunities, and that's another community we really need to take care of.

MR. HORTON: Yeah. And that's something we talked about too, where this is‑‑you talk about one group of active duty folks who deployed. They come back, and they've heard about this from friends and loved ones or they see it on the news, but then when it comes to the guard and reserve who are used with very high frequency in Iraq and Afghanistan, historically so, come back, and they feel culturally and socially removed from what it means to be, quote, "active duty." So how does that cause issues later down the road when they kind of conceive of themself having a health problem?

MS. CARROLL: Well, you're exactly right, and in our survivor community, we find family members who will start out by saying, "Oh. Well, my loved one had multiple deployments with the guard but then died completely unrelated of a cancer, a rare cancer several years later." And it's not until we start talking and they meet other family members and putting the pieces together that they discovered it may well have been related.

MR. HORTON: So you've spoken to the VA a lot about this. So what is their position now when it comes to the science, the evidence, the modalities of care when it comes to exposures, and what are they lacking at this point?

MS. KIME: Well, VA has set up a war‑related illness and injury study center that they are taking a look at some of these issues, but‑‑and they also see patients at these centers. They are‑‑as, again, they've hired the National Academies. They're accepting‑‑they accept claims on a case‑by‑case basis. They've had about 11,000 claims filed that have at least one burn pit‑related illness. They've approved about one in five of those. So about 20 percent are getting approved, and they just feel that they have a way for veterans to claim, to make claims, disability claims. And that's how they're going to handle it.

MR. HORTON: Bonnie, this is the last question. What are some of the things that families are saying now when it comes to living the rest of their life, either without their loved one or someone who is dealing with these health challenges? How has it affected them going forward? Their loved one came back. It's not like they died in battle; they came home in a casket. They thought they were safe, and it turns out they're not. What kind of impact is it having on‑‑

MS. CARROLL: It's absolutely devastating. Their loved one's death was no less related to their service than someone who did die in combat, and we honor the life in the service of all of our men and women, all of our surviving family members, loved ones. So to give their journey now a meaning and purpose, for them to be part of the research that's being done, to share the experiences, to help others who are coming along, to be mentors to caregivers who then become survivors, is critically important.

Awareness is critical, panels like this, and we're so grateful to the Wounded Warrior project for doing this today, for bringing TAPS into a joint effort with VBA, to further efforts. Every one of these steps is making a difference. It's giving meaning and purpose to the life and the service of our loved ones and to their death, and it's allowing survivors to have a voice.

So thank you again for this panel today.

MR. HORTON: And thanks for your expertise and your reporting on this. Thank you, Bonnie. Thank you, Patricia.

That’s it for the panel. For more events, go to, and thanks for joining us.


[End recorded session.]