U.S. Congressman Tim Walz, D-Minn., is currently serving his sixth term representing Minnesota’s First Congressional District. He is the ranking member of the Veterans’ Affairs Committee, and serves on the Agriculture Committee.

Walz was born in West Point, Nebraska, and enlisted in the Army National Guard at the age of 17. He retired 24 years later as a command sergeant major. Walz is the highest-ranking enlisted soldier ever to serve in Congress.

Veterans Affairs & Military Medicine Outlook: You served 24 years in the Army National Guard and you’re currently serving your sixth term in the House of Representatives. What motivated you to serve in the military and also to go into public service?

Rep. Tim Walz: I grew up in a very rural area. I always tell people I graduated with 24 classmates and 12 were cousins in that rural farming community.

My dad and my uncles and everyone had served. My dad was a Korean War-era veteran. He took me down, and as I recall, we drove about 40 miles, and there was a lieutenant in the National Guard who had the ability to swear us in. So, the day after my 17th birthday I joined the military. So, I think for me, from an early age, it was expected what you would do. I think my father was also the first person in his family to get a college degree, and he got it via the GI Bill. And that’s exactly what he was thinking for me. He knew he was dying of cancer at the time. So, he got us in, and I’ve said, for me, it was parents looking out for me. It was one of the best decisions that could have been made. I was maybe too young to understand the implications of it, but I’ve always said that I believe I got so much more from the military maybe than they got out of me – that sense of service, that sense of something bigger than yourself. So, [those were] kind of the drivers for us – I think like so many families, it’s tradition. It’s the chance to not only serve, but to then have the opportunity to use some of those benefits that are there as part of it.

You sponsored the Clay Hunt SAV (Suicide Prevention for American Veterans) Bill that became law in 2015. Could you explain the issues the act addresses, and what kind of progress is being made with the problem of veteran suicides?

This is … I think personal for so many of us, both military and civilian, this issue of suicide and mental health. When I first came to Congress, we were still debating whether we should bury these warriors with honor if they committed suicide. There were still those that argued that they should not have military honors, which was just a stigmatization of it. And then for me, it was very personal with Clay [Hunt]. Clay actually came [to Capitol Hill] as part of a group of Iraq and Afghanistan veterans, and they were lobbying us on veterans’ issues. Clay’s issue was an extension of the GI Bill, and making it more friendly to post-911 veterans. I got to know him during their time up here on the hill. Then I got the call from his parents that he had taken his life. Clay was a central-casting Marine. He was shot by a sniper and went back and trained for himself to go back – just the consummate professional, the consummate warrior. If someone like that was struggling to get the help they needed … you know we all knew it and it’s all kind of theoretical, but it was just so personal. So, what the act did was we kind of used Clay as an example that seemed to be … typifying what was happening in this epidemic of veteran suicides. It wasn’t just post-9/11. We know that the vast majority are Vietnam veterans.

One of the things that is so appealing to veterans going to the VA is they feel a sense of comfort there. They feel a sense of cultural competency, and people know what they’re talking about in terms of veteran experience, so making sure we were building capacity in the community to use our veterans who were there to deliver that.

So, what it tried to do was it increases [the] mental health capacity of the VA. We were grossly short there. We made some changes to make sure that if you serve as a mental health professional, we’ll pay for your education. We’ll make sure that there are programs to pay off your loans, those types of things. We also asked existing programs in the VA to tell us if they are working, did we have data that showed the efficiency, and were there new things coming out. We are seeing every day that things that used to be considered alternative therapies – yoga, long-distance biking – those types of things were working, and we put those in. And then probably the thing for us [was] we found we needed the capacity and the community to be peer to peer, making sure that we had people who had that shared experience. That’s one of the common threads that runs through. I’m sure we’ll talk a little bit about it in terms of how do you balance VA care and community care.

One of the things that is so appealing to veterans going to the VA is they feel a sense of comfort there. They feel a sense of cultural competency, and people know what they’re talking about in terms of veteran experience, so making sure we were building capacity in the community to use our veterans who were there to deliver that. And now it is with everything in the VA, continuing to try and see that they’ve implemented fully, continuing to try and follow up if it is working. I think all of us know whether the number is 22-20 or whatever, this is a zero-sum proposition. We may never get there. But our goal is to make sure that every single veteran in crisis has access to life saving care and hopefully prevent that from happening.

Could you describe H.R.4334, the Improving Oversight of Women Veterans’ Care Act of 2017, that you were cosponsoring? Could you explain the intent of that legislation?

It used to be 10 years ago you’d hear the stories of a veteran walking into a VA clinic and being asked if she was there for her husband. No, she was there because she was blown up in Iraq. That’s why she was there. We have now become a little more sensitive to that. But the problem that we have, that we were experiencing, was that we were seeing a massive increase – and it’s a good thing – [of] 2 million women veterans, adding 18,000 a year over the next 10 years. So, we’re going to add an awful lot of folks, and especially a lot of combat veterans of the current conflict. What this bill is really meant to do, like so many things we try and do, is make sure we assess the problem correctly before we try and prescribe or invest money in it. So, the bill was really focused on the fact that we just don’t have data on what they’re doing. We don’t have performance measures of how they’re doing. We’re not sure. I know anecdotally, and we’re starting to gather more data. Phoenix is a really great example. Phoenix, of course, was in the news for its wait times. But there is also a women’s clinic in Phoenix that is absolutely spectacular – same-day appointment mammograms, open from 5 a.m. to 10 p.m., open on the weekends, provides access to childcare, and has same-day results and scheduling if you need surgery or treatment for breast cancer. I mean, for a working veteran mother, it’s incredible. They were finally doing this the right way. But I don’t have data to show how many veterans have access to that type of quality, accessible ease of care. This bill was really meant to focus on: Are we getting there? Is there an equality of care? Where are the gaps, kind of a gap analysis. So, this bill isn’t prescribing them to do something at this point other than to be better at assessing where we’re going. So, I think that’s a pretty easy one. We think they should be able to do that and report to the secretary if they are getting it right or not.

You’ve cosponsored H.R.2631 – the Justice for Servicemembers Act of 2017. What shortcomings do you believe the Uniform Services Employment and Reemployment Rights Act (USERRA) of 1994 has that this bill seeks to correct?

Yeah, USERRA is a good bill, and I want to be clear: The vast majority of employers in this nation are absolutely supportive of their warriors, especially our National Guard and Reserve. Especially in smaller rural communities, they accept a real burden. When a guard unit is deployed – and some of my communities are 8[000] to 10,000 people – they’ll lose 130 members of that community. Well, that tells you that it’s going to be a big chunk of the police force. It’s going to be a big chunk of the teachers. It’s going to be a big chunk of some of the private industries that are there [in that community]. I want to be clear that we believe that the vast majority are already following USERRA, which was basically put in place to ensure that you couldn’t deny a veteran employment because you might get deployed. So I don’t want to hire you for this, or any of the issues that come with it. So, I think the vast majority are there. But there has been a phenomenon that has happened, like the forced arbitration clauses that people sign, [they] don’t give our veterans what the intention was; that you were going to be able to be adjudicated if you could make the case that you lost your job or were denied promotion because you were deployed or doing military service. And the forced arbitration clause basically undermined the ’94 law that allowed us these protections. It cut those off, and it forced them to sign things that could then say, ‘Well, I’m certain that you fired me because of this, but there is no way to prove it because of the forced arbitration clause. So, what this piece of legislation does is it just tries to go back and give service members the ability to pursue their case, to be able to go to court. I mean if anybody in the country has earned the right to due process in the legal system it’s someone who is serving their nation, especially in a time of war. So that is the argument I’m making.

What do you see as the biggest challenges the VA faces today?

Well, I think for us, we understand it’s that internal capacity. The VA, I said I’m their staunchest supporter and their harshest critic when they need it. A lot of times we’ve got shortages. We have capacity as it’s growing. I think most people that are not veterans would assume that the VA wait times and access to getting in are being caused because we’ve been at war now. I believe today [March 20] marks the 15th year in Iraq. It’s not that it’s an aging population, especially of Vietnam veterans. It’s all the people, to [be] very honest, going to the VA because the care is good. That old mantra is that ‘if you can get in the VA, you’re going to leave pretty satisfied.’ So, I think that internal investment and capacity and balancing that with the care in the community – of how do we make sure that veterans and their physicians are making choices for them, and there is an appropriate role of care in the community – I think the fear is always getting those things out of balance.

Our population in rural areas is disproportionately represented with veterans, and I think that is cultural.

It’s interesting that the public, they care deeply, and they want to do right by veterans. Those that don’t really know about veterans’ care or think that you should just give them a card, and they should go wherever they want. That’s not what veterans want. They understand the discord that will come with that, of coordinating care. They understand that the VA is the absolute epicenter of research into those traumatic injuries that are only seen in war or in major industrial accidents. So, that piece is balancing out. I know that the secretary made what something I advocated for from the first day I was here: aligning the electronic records between DOD [Department of Defense] and the VA. I am under no illusion that that is going to go smoothly. I’m under no illusion that that is not going to be a long multiyear process. But we have to stay there on top of that, because that’s more than just having a computer screen with a veteran’s name on it. That is a diagnostic tool that smooths the delivery of care. It makes care in the community easier, so we get away from the frustrations that people experience with billings and record transfer.

I think this issue of accountability and leadership … one of the things I’ve always said is to make sure we attract and retain the best employees. I’ll be very clear – you cannot fire your way to excellence in an organization. You certainly should have the capacity to be able to make sure that you have good employees there. But the problem is this focus on firing people isn’t a really great recruiting tool and not a great retention tool. Should we be getting rid of employees? Yes, there are processes in place, and leadership needs to do the things that they are supposed to do. But my concern is about accountability is the flipside. And I would argue the more important side is the accountability to recruit, retain, and make sure we have a culture of positive morale in the VA. That needs to be addressed simultaneously.

We’re trying to modernize claims’ appeals is I can’t look a veteran in the eye seven years later. I saw one last week in Minnesota at a veteran’s rally on the hill in St. Paul [Minnesota’s Capitol building]. And we were talking about RAMP, the ability to use the new claims process. And he echoed exactly what I said in the hearing. He’s been in line for five-and-a-half years. He said I’m afraid to get out of line and try this program, Tim, because I’m afraid I can’t get back in the line. No veteran should have that. We should get a fair adjudication. But they should expect to have an answer quickly and fairly. This veteran’s point when he explained his situation I’m absolutely convinced in his case when he gets to make his appeal he’s going to win. But it’s five-and-a-half years later. So, I think those are the major issues facing us, in re-establishing that culture of excellence and morale at the VA.

The VA now allows its physicians to discuss state legal medical marijuana use by their veteran patients. Along with nine of your fellow Democrats you inquired whether the VA would conduct research on medical marijuana in veterans suffering from post-traumatic stress disorder (PTSD) and chronic pain. What response have you received?

Well, the initial response was wholly unsatisfactory. And I have to be honest, totally out of character. The VA’s medical research arm is second to none in the world. I represent the Mayo Clinic [which is in his congressional district]. And those physicians and their research arm would tell you that too. One of the things we’ve seen with chronic pain, with PTSD, and to be very honest, I started working on opioid legislation in 2007 with step pain management. In 2007, we were seeing an over prescription of these pain killers that are valuable tools, but need to be used appropriately. We were looking for alternatives, and one of the alternatives that … has been in the states and has been looked at was medical cannabis. All I asked for was that the VA do what they’ve always done – conduct world-class research into the validity of using medical cannabis as a way to treat PTSD amongst our soldiers. Well, what they sent back, and I’ve spoken very openly about this, what they sent back was basically Attorney General [Jeff] Sessions’ vendetta against medical cannibals. And they sent back what has been absolutely destroyed by outside experts on why they weren’t doing it. And so, the response has not been great.

In fairness to [former] VA Secretary [David] Shulkin, he was moving the ball on this. He was being a realist that people are self-medicating. And they are afraid to tell their physician this because they were afraid of losing benefits or being put in a bad position. That’s a dangerous situation. If you have a veteran dealing with either chronic pain or mental health issues and they are hiding something from their people at the VA, you’re creating a situation that could end in tragedy. So, I said you have to take them on. And the VA secretary – again I’m not asking them to do anything on prescription on anything that is not evidenced based – but he made what I thought was a courageous call on a related topic of service dogs. We don’t have a whole lot of research on the correlation and the effect of service dogs on improvement of health amongst veterans. But he said something very insightful in a hearing. He said, “I have never seen a veteran who has a service dog whose quality of life hasn’t increased. So, I’m going to make an executive decision at the department level and just authorize service dogs.” I wasn’t asking him to authorize prescribing medical cannabis without the research. I was just asking him to authorize the research. So, we’re at a point right now where we’re still in ongoing discussions. We’ve got a lot of allies including the American Legion, millions of veterans who want us to explore is this a viable option for the pain that our veterans are going through.

You mentioned accountability and leadership previously. Is there another thing at the VA that you think would help improve veterans’ care, and if so what would that be?

Yeah, I think again the sense of maybe ending the discussion on it’s either the private sector or the public sector. I think letting veterans have a role in how we do care in the community, making sure that they see it as a unified health care system and letting them know that when it does make sense to do a blood test at a small rural hospital like in Sleepy Eye, Minnesota, we allow them to do that. But because of the use of electronic medical records and a coordinated care system, that blood test will get back to the VA hospital where maybe they will need follow up on a more substantial treatment, but we can do that there. And I think that that is the thing that would take stress off the veterans. Our population in rural areas is disproportionately represented with veterans, and I think that is cultural. I know others have said because of its economics. Either way, with about 15 percent of our population living in rural areas but upwards of 34 percent of our veterans being there, there has to be a system that is not so focused on just the bricks and mortar at the VA, which is critically important and must be there. It has to be an integrated system that lets that care be coordinated, makes sure that the VA internal capacity is there, but also makes it smooth for people to do some of those things with care in the community. It’s not a false choice of privatization versus big government care. It has always been a combination of the two. And I think figuring that piece out, having an honest discussion about funding in the regular order of things not stuck in some big bill, that is the way we could improve care.

You’ve successfully pushed for the audit of the DOD, something that has never previously occurred. Recently you introduced the Veterans Administration Legislative and Objective Review, the Valor Act, H.R.3122, which would require the VA to undergo a biannual independent audit by a nongovernmental entity. Why do you think this is needed and what is the status of the bill?

Yeah, several reasons. One is I think these audits are to reassure people’s faith in the system. Internally I think the VA’s inspector general and others do a very nice job. But I think it’s really important to give trust to the public about what is happening here, where their money is going. So, they are willing to pay. If there are things that this country is willing to pay for, it’s for defense and veterans, but they have every right to know where that money is going. I think, to be honest with you, both at the Pentagon and at the VA they are such large organizations it would give them a better idea. We’ve seen some of these independent researchers were showing upwards of nearly $100 billion wasted over at the Pentagon. That is decreasing our national security. It is decreasing our quality of life for our warriors. And it is not serving the taxpayers well. So, I’m a big fan, and I’ve spent my career here on transparency and good government things. I think this makes the agencies more effective. I think it restores faith in the system, because if you don’t do this the anecdotal Monday morning at the coffee shop thing is “well, hell they’re paying $800 for a hammer and I can’t get in the VA and yet I see these people sitting around so what are they doing?” Tell them what they’re doing. Tell them who is working there. Tell them where the money is being spent and find the places where there is waste and cut it and find the places where we’re not investing enough and beef it up. That’s what I hope that accomplishes.

With respect to Veteran’s Choice, can you describe your view of private care for veterans versus the care within the VA facilities. I know you kind of touched on this earlier.

Yeah, well first of all it’s that false choice. We’ve always done care in the community. There are those that are convinced that – and they are certainly not veterans because when you see the VFW [Veterans of Foreign Wars] or any outside groups if you ask about their satisfaction with VA care it ranks very high. As I said, again, I represent the Mayo Clinic. So, I have kind of a litmus test on what quality care looks like, and the Minneapolis VA ranks right there. With that being said, the brick-and-mortar delivery system of large 500-bed hospitals like you see that were built after World War II, that doesn’t make sense in many cases. And we have a fragmented health care delivery system in this country anyway. The way I’ve always seen it is trying to make it easier to have this model that internal capacity in the VA is funded accordingly. The folks who need to be there are there, but with an understanding that using care in the community fee-for-service makes sense. And so, it is not a capitulation and saying full privatization. That’s not what veterans want. But we’re also not saying that it makes sense to ask a World War II veteran to drive 300 miles to have a blood test in Minneapolis when they could certainly do it in their own community.

So, my take has always been to have an honest discussion, an honest funding discussion about where the two are at and making sure that veterans understand, and then educating the public on this, because again, the public has been told, well, just give these guys a card and let them go anywhere. If you ask a veteran, they’ll say no. If you ask a health care provider in these areas, they would say, well, that’s not going to work either, we don’t have the capacity to do what they’re asking to do. And what medical professionals know is that, especially with veterans, you would have fragmented care. When they go in to see a VA doctor they may just randomly say I’ve got this spot on the back of my hand and it’s not healing or whatever. So now they’ll run them through the tests on that. If we’re in the private sector, chances are they would have to come back in another appointment and go through that. So, my take has always been that this is a model of integrated care. You cannot talk about veterans’ health care in a vacuum from health care in general. Rural communities are losing their providers in the private sector also. So, we’re going to have to figure out how do we leverage our VA. I thought at times it makes sense to have a wing of the VA at the local hospital. Why build two separate buildings? Why not use it? You have a hybrid vision. You have the VA there. You’d have VA integrated care and you would have private sector care that is right on the same campus. Those are some things that I think we approach to get the right size of the VA, the right size of care in this nation. And then start to coordinate amongst themselves.

What legislative achievements with respect to veterans are you most proud of, congressman?

Certainly, I think Clay Hunt, in moving the whole cultural piece on the acceptance of mental health parity. Early on, I think advanced appropriations so that if we ever get into a government shutdown our veterans are protected from that because we budget a year in advance. I think the Forever GI Bill, and an update of a GI Bill that has been a generation in the making, that makes sense. I think those are things that improve lives. They were done with a spirit of collaboration and honest debate. And I think how those bills came into law reflected how Congress should work, and in respect to what our veterans fought for. Our veterans fought and served for the right for us to govern ourselves, to have civilian government and to have this representation. And I think the way we’ve conducted ourselves in the VA brings honor to them. I think those three pieces of legislation showed that we’re not going to allow politics to interfere with your payments. We’re going to update the GI Bill because there is a new reality of who is getting deployed, and we’re going to recognize that those invisible wounds of war are every bit as valid as the ones that we can see, the extremity injuries or whatever else it might be. And I think we’ve changed the entire debate in the country on mental health because of it. So, I think if I’m remembered for my time here of doing those things, that is something I’m grateful to have had the chance to do.

To switch gears, you’ve launched your candidacy for governor of Minnesota. What made you decide to run for the governorship?

I think more than anything Minnesota is a state that has a long reputation of governments working. I see some of the same patterns starting to develop there of the gridlock. And I was convinced that the big issues facing people are going to be able to be dealt with at the state level, at least in the immediate future. But I think more importantly of bringing a different style, one that I’ve modeled here especially dealing with veterans, that I start to kind of bridge the gap. I’m one of those rare animals – I’m a rural Democrat. I think people who have exploited this idea that we’re a country divided, that we’re all a red, blue map. We’re all urban/rural. I’ve kind of straddled both those worlds. And I think bringing that to it can maybe keep our state functioning in a way that I would say used to happen here, but not so much anymore.

Do you have any outgoing comments about veterans that you would like to share with our readers?

I think the biggest thing is those people who serve in the VA and those people who serve our veterans – as a nation this is one thing that really unites us. It is an area of commonality. I think it can help set the tone for how we repair some of the damage that’s been done to the country. And for the veterans I would say belonging to these veterans’ service organizations, I can’t stress how important their voice is up here. It’s very hard for people when they’re scattered across the country, they are working jobs, they are busy, to feel like their voice is being heard. So, I used to always wonder what my dues went to when I paid it to the Legion or whoever I was paying my dues to. Being on the other side of this now and seeing that they are able to come in there and articulate and petition their government for those things that were earned benefits or things that make this country stronger, I would encourage folks to get involved with that, to know that it makes a difference. And if you need to just complain about government remember we are government. We are the school teacher and retired sergeant major down the block or the physician from Tennessee like Dr. [Phil] Roe. We’re a hospital administrator like Secretary Shulkin. That’s how this works. And so, in the area of veterans care the public is behind us. It’s a noble thing. We’re moving things forward. It’s making government work in a way that it’s supposed to. And that all happens because of the accountability of those veteran groups that are here and the individual veterans who speak up. So, I would just encourage them to keep the faith and keep speaking out.

This interview was first published in the Veterans Affairs & Military Medicine Outlook 2018 Spring edition.