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DoD News Briefing with Adm. Mullen, Col. Sutton and Col. Horoho from the Pentagon

Presenters: Chairman, Joint Chiefs of Staff Adm. Michael Mullen, Director of the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury Col. Loree Sutton and Commander Walter Reed Health Care System Col. Patricia Horoho
May 01, 2008

                BRYAN WHITMAN (Pentagon spokesman):  Well, good morning, and thank you for joining us today.   


                As most of you may be aware, the secretary made a statement this morning from Fort Bliss about the importance of ensuring servicemembers, who experience emotional or mental health problems, to seek professional help, help that they deserve and that they need.  To that end, reducing the stigma associated with seeking such care is crucial.   


                With us today to talk about one important area, in which the department is reducing the stigma associated with making -- associated with seeking appropriate psychological treatment -- are Colonel Loree Sutton, who is the director of the Defense Center of Excellence for  Psychological Health and Traumatic Brain Injury, and Colonel Patricia Horoho, the Walter Reed Health Care System commander.   


                But before I bring the two of them to the podium, we're privileged also to have with us the chairman of the Joint Chiefs of Staff, who I know has been personally interested in this issue for some time and is able to join us here, at the top of this, to emphasize the importance that the senior leadership of this department places on this issue.  Unfortunately he has other things that he will have to depart off to.   


                But we appreciate you taking the time this morning, Admiral, to open up this discussion on this very important issue.  Thank you.   


                ADM. MULLEN:  Good morning, and thanks.   


                I just would like to open up by saying how pleased I am that we've been able to make this change, specifically to the question posed on the security questionnaire regarding mental and emotional health.   


                It's a significant change.   


                And I thank the secretary for leading the effort.  That we needed to do it at all says a lot about how seriously we are taking both the mental health issue in the military and our commitment to making sure people seek and then get the help that they need.  But it also says a lot about what we've learned about the stigma of mental health in our culture.   


                I hear everywhere I go the belief that admitting to the need for counseling and assistance or the fact of having received it only penalizes you and stifles your career.  Good people, many of whom have seen combat up close and faced its grim reality, whose courage is absolutely unquestionable and who deserve only the best physical and mental health care we can provide, are actually willing to deny themselves that care out of the fear that doing so hurts them and their families in the long run.  Nothing could be further from the truth, and it's time we got over that. 


                It's time we made everyone in uniform aware that the act of reaching out for help is, in fact, one of the most courageous acts and one of the first big steps to reclaiming your career, your life and your future.  It's time for leaders of all stripes to step forward and lead by example when it comes to mental health issues.  You can't expect a private or a specialist to be willing to seek counseling when his or her captain or colonel or general won't do it.  It's way past time, some seven years into this war, that we recognize the toll it's taking inside -- our minds -- as well as outside -- our bodies -- and to deal with that reality in a measured, mature and thoughtful manner.  


                Psychological health and fitness is no different than physical health and fitness.  Both are readiness issues; both are leadership issues.  Getting this question changed is a terrific step to achieving better readiness for the individual and for the service.  I hope it's also a great first step in changing our culture.   


                Thank you. 


                COL. SUTTON:  Good morning.  I'm Colonel Loree Sutton and this is Colonel Patty Horoho.  


                We're so delighted to be with you this morning.  Thank you for coming here to address this important issue on this most historic day. I say that because earlier this morning, the secretary of Defense, Secretary Gates, out at Fort Bliss announced this important change to question 21 in the security questionnaire.  And as you've just heard from the chairman, this is a message that is being issued, being emphasized, being delivered at all levels. 


                As the director of the Center of Excellence for Psychological Health and Traumatic Brain Injury, this issue of stigma and building resilience is central to our efforts.  We know that during this time of national challenge, it is so important that we encourage our families, our service members, our communities to step forward and to get help for whatever physical or mental wounds, illnesses or injuries that they may have.   


                We know that early intervention makes all of the difference.  We know that, as the chairman said, this is a readiness issue, it's a leadership issue, it's a fundamentally human issue.  And so we are working, with our leaders, with our families, with our service members, with our communities so that we can get the word out at all levels that seeking health is a sign of strength.   


                And so today we celebrate this historic moment.  And I look forward to your questions.  At this point I'd like to turn it over to Colonel Horoho, and we'll go from here. 


                COL. HOROHO:  Good morning.  As the commander of the Walter Reed Health Care System, I'm responsible for a large number of soldiers assigned to the hospital staff, as well as for the health of our soldier patients.  Through the PTSD and our Traumatic Brain Injury chain-teaching program and other initiatives, the Army has invested significant resources in removing any stigma associated with soldiers seeking behavioral or mental health care.   


                Leaders must ensure their soldiers understand that this campaign applies across all of the units.  All of our soldiers are encouraged to seek the health care that they may need.  Psychological health is no different from physical health care. 


                This policy change on question 21 demonstrates that we are taking action where we can to ensure our service members receive the care they need and reduce the potential stigma associated with seeking psychological health care.  Our goal is to build resilient forces and families, both physically and mentally.  Just as we encourage our service members to work out and maintain physical fitness, so too we must encourage them to go to the psychological gym to maintain their psychological health. 


                As a commander, I will ensure that all Walter Reed soldiers are aware of this policy change and allay any misperception of a negative impact on their security clearance or career for seeking psychological help.   


                Walter Reed Army Medical Center operates comprehensive inpatient and outpatient psychiatry and psychology programs, with a total staff of 218. 


                We manage the Department of Defense largest and busiest inpatient psychiatry program.  As the demand for mental health services among OIF and OEF veterans have grown, Walter Reed has begun hiring additional mental health professionals, with 56 new positions added since January of 2007.  Thirty of those are on board, 19 others have been selected, and we're actively recruiting for the remaining seven open positions.  This is an increase of 34 percent over the staff prior to January of 2007.  We have also temporarily deployed some of our mental health providers to installations experiencing increased demands for those services as units return from deployment to OIF and OEF.   


                Outpatient mental health services are a critical care and a critical part and support for our warriors in transition.  Many warriors assigned to Walter Reed's transition unit receive treatment for PTSD and behavioral health symptoms associated with traumatic brain injuries. 


                As commander of the Walter Reed Health Care System, I'm proud of the soldiers who provide all aspects of health care to all those entrusted to our care, and equally proud of those who have deployed and recognized the need for and sought out behavior health treatment as part of their healing process. 


                COL. SUTTON:  At this time, we would welcome any questions or comments. 


                Q     People will still be skeptical that this getting psychiatric treatment is not going to hurt their careers.  And Admiral Mullen said people should step forward and step up and lead by example.  Why doesn't the department have someone in a high-ranking position to use as an example?  If there's no stigma to it and we need to lead by example, where is someone who can be put up as an example to people that they can get this help and not be hurt in their promotions? 


                COL. SUTTON:  That's a great question.  As we prepare this year, working with the services, to launch what will be a national pro- resilience awareness campaign, that is exactly one of the first questions that we will be posing to the senior leaders.  I've talked with a number of them already, and we already have folks who are standing up and ready to come forward and tell their story.  


                Because you're absolutely right.  We can change the policy.  We can talk about how important it is.   


                Ultimately, troops and families, they want to see leaders walking that talk.  And so that's absolutely one of our important activities for this next year, is to bring forward leaders to talk about this, to be very open about their own personal issues that perhaps they've thought helpful and been able to receive.   


                Q     So what numbers are we talking about, and what kind of forums would they be stepping forward, speaking -- 


                COL. SUTTON:  You know, what we're working to do is, we're working to launch a national awareness campaign.  We're going to be using all modalities in terms of media -- you know, more conventional, of course, print and broadcast and radio, but also we want to use the modalities that our warriors, our troops, our families use.  So we're planning to harness the power of YouTube, MySpace, Second Life, podcasting, all manner of ways, because it's so important to get this message out.  And if you have any ideas, certainly we'd love to hear them. 


                But right now, for example, one of the things -- one of the ideas that has come forward is, you know, why don't you all put together sort of like an eHarmony website but this time linking up mentors -- families, perhaps, that may be living across the country from each other but who have similar interests, maybe similar concerns, similar backgrounds, who would like to support each other.  The same is true on the warrior front, to be able to connect folks across geographical boundaries to unite them in a common community of purpose and meaning. 


                And I think that as we go forward, we'll really be able to harness that power of story, the story of real warriors -- and that is to say, troops as well as their family members.  There are two fronts to this war.  You've got the battlefields.  You've got also the home front.  And so to have individuals, families, communities come forward to tell their stories, illustrating the real battles that they face, both on the battlefield, on the home front, coming back in the case of those who are ill and injured and wounded, the very real struggles that we are working to -- to help clear those barriers. 


                And this is one of those barriers that is so important for us to deal with, because, you know, when you think about it, stigma is really a toxic occupational work-related hazard. 


                For any other such hazard, we would take immediate action.  We would take comprehensive action.  That's what we're doing. 


                And of course it's not enough just to harness the stories and to illustrate the battles, but then we also will want to point to the real strength, the post-traumatic growth, if you will, that can come from going through extreme adversity; the power of community, of family, of the family ties at home as well as within the unit. 


                And that leads to the final component of the campaign, and that will be to identify real solutions.   


                Thank you. 


                Q     Thanks.  I just want to clarify one thing about the new regulations, and apologizing -- this is a somewhat stupid question, but I've never had to deal with this form, so I'm not sure exactly what it means.  Does this mean in practical terms that if you, as a member of the military, have had counseling for anything relating to a problem developing as result of being in a combat environment, you can answer no to question 21?   


                COL. SUTTON:  That's exactly what it means.  And even more broadly, it pertains to anything related to deployment, so not just combat, but there are a variety of deployments that our service members are involved with -- the stresses of preparing for, be engaged in, of coming back from deployment.  That's exactly what it applies to.   


                Q     Deployment in a combat zone, yes? 


                COL. SUTTON:  Deployment into combat, deployment to humanitarian missions, deployment to -- after disasters.  There are just a broad number of deployments as well 


                COL. HOROHO:  And it's even broader.  Any family issues, marital issues, as well, so that you have the whole spectrum. 


                Q     (Off mike) -- right, because the language says adjustment from service in a military combat environment.  But you're saying that would encompass also humanitarian and disaster relief missions as well? 


                COL. HOROHO:  Yes. 


                Q     Yes? 


                COL. HOROHO:  Deployment-related stressors.  Thank you. 


                Q     Just -- that actually goes to my question, which is, is this really broad enough?  I seem to recall when Secretary Gates first brought this up and he was talking about how important it was to eliminate question 21, not modify it, but eliminate it, this is a good first step, it seems, but it is taking out of the picture whole swaths of civilian DOD employees who may be affected by this, large numbers of people who are not necessarily suffering from PTSD.  I mean, as a professionals, you know that these are very complex comorbidities. You don't necessarily have psychological issues that are only combat- related, but equally treatable, not mental illnesses.  But these people are still going to be having to report the same way they always did. 


                COL. SUTTON:  Let me unpack that a little bit for you, because I think while certainly some will always ask, "Has this gone far enough" -- and that's a legitimate question.  It's one that -- I think the debate will probably continue for some time.   


                I think what's important today to celebrate is that this is such an important step along that journey.  And it applies not only to our servicemembers but it also does apply across the Department of Defense, to contractors, to civilians.   


                You know, it will take some time to change the form.  But implementation of this change starts immediately.  It starts today.   


                There's a cover letter that goes on the form.  This new wording will be used by all of our servicemembers, civilians, contractors, who are filling out their security clearance.  So it does get beyond the servicemembers to include civilians and contractors.   


                And it also -- I'm glad you raised the point in terms of comorbidities and other issues.  We know that if we were to resolve all of the issues related to post-traumatic stress today, we would still have close to half of the other psychological health issues and concerns: depression, anxiety, substance abuse.   


                So it's important for us to take a broad look at this.  And that's exactly what we're doing, so that we make sure that we can intervene early, identify folks who are most at risk, and then link them up with the resources.   


                Q     But that's not -- the stigma is still present in the security clearance issue.  I mean, that's still something that, if I had depression, I would still have to report that.  And it would still potentially affect my security clearance, just as it always has.   


                COL. SUTTON:  When it talks about adjustments related to deployment-related experiences, that would include adjustments related to trauma, to exposure and development of anxiety, depression, sleep- related problems.   


                Q     But what if I was a DOD civilian and I worked in some department that is extremely busy and for whatever reason, I was developing depression, perfectly treatable, something that was easily resolved.  But yet I was in a very sensitive position and I knew that the next time my security clearance came up, I would have to report that, if I went to a counselor for that, because I'm not deployed.  It isn't necessarily related to anything about the war, except for the fact that I work in the Pentagon, and my job touches the war.   


                COL. SUTTON:  You have raised a very good question.    


                You know, our efforts to this point have really focused on the needs of the servicemembers.  I think as this rolls out to include the civilians and contractors, we may need to look at the language to make sure that it fully applies to civilians and contractors, as well as the servicemember experience.   


                So I'm glad you raised that point.  I think it's one that we need to pay attention to.  Thank you. 


                Q     The secretary mentioned in his remarks that this is government-wide form, not a DOD form.  So would this change apply to, for example, State Department employees or employees of intelligence agencies who are deployed in that situation? 


                COL. SUTTON:  Initially, it applies to the Department of Defense. But our understanding is, is that this will then be broadened to include all of the government agencies, everyone who uses this form. So I think the point's well taken is that as we go to broader implementation, we'll need to make sure that we have the language that is appropriate for the civilians and others who are not necessarily deployed in various settings. 


                Q     But at this point, it applies only to DOD? 


                COL. SUTTON:  That is correct. 


                COL. HOROHO:  (Inaudible.) 


                COL. SUTTON:  Yes, sir? 


                Q     What does the DOD expect to result from this change in the short term?  And as an aside to that, do you still believe that a review of a person's mental health status is important when allowing him to manage classified information? 


                COL. SUTTON:  I think that in the short term, what this will do is it will remove some of the fear that has really blocked folks from getting the care that perhaps they know they need; their family, perhaps, has pointed out that they need; but they're afraid about their career.  I think that's a very near-term result of this change.   


                In terms of whether or not someone who's receiving mental health care should be evaluated as a routine part of their routine -- their security clearance evaluation, you know, I would really -- I would want to take a step back on that, because as it stands now, as a -- and I'm a psychiatrist, by the way, so, you know, as I and colleagues in the behavioral health field, whether they be social workers, nurses, psychologists or psychiatrists, we are bound to report if the person that we're working with is a danger to themselves, is a danger to someone else, has done something illegal or is suffering from an  untreated substance abuse difficulty.  And under those circumstances, you know, we make sure that we link the person to get the help that they need.   


                So I wouldn't -- I wouldn't support the need for a routine evaluation of everyone seeking help, because after all, the purpose of this question is to really determine -- you know, the purpose of the entire evaluation is to determine is there any factor or issue or health-related concern that might affect the judgment, the reliability, the stability of someone who is executing very sensitive duties. 


                And so when you think about it in those terms, there are any number of medications or other health-related issues that go far beyond mental health care that might have that effect.  So I think that's where it's important for us to ensure that we don't single out and stigmatize mental health care when really the broader issue is evaluating the reliability and the judgment of the person who's seeking the clearance. 


                On a broader level, you know, beyond the security clearance issue, I think that, you know, as our service members are preparing to go downrange, some of them for the second and third time, as they're deployed downrange, we have a number of behavioral health assets that are deployed in theater.  Leaders now are very comfortable in referring troops.  They see that when they refer early and get the help that they need, those troops come back and are able to perform very well.  


                And then, of course, that reintegration period following deployment.  That's why we've got the pre- and post-combat health assessments.  That's why three to six months following redeployment, we've got the post-deployment health reassessment, because we know that that's a time of tremendous transition and stress for families as they reintegrate with their service member.  And sometimes after the honeymooon sort of wears off, some of those issues can crop up.  And that's been a very fruitful endeavor for us to be able to identify folks during that window. 


                And of course, you know, a troop can seek health care -- whether it be mental health care, physical health care -- on any given day. They don't have to wait for the screening process to be able to seek care.  But it's our way of being able to stay connected and to identify are there any issues that are going on, anything that we can help you out with.  


                COL. HOROHO:  And I think that what the policy change does is that there was a perception out there -- not reality, but there was a perception that if they answered yes, that it would negatively impact their security clearance.  And so what this -- I think the power of it from a leadership perspective is that it removes that negative perception and it makes it -- it removes the stigma and makes it much more comfortable for service members to reach out and get that mental health support. 


                Q     How many people are actually operating with security clearances? 


                COL. SUTTON:  You know, I'll have to defer that question.  I really don't know.  I know we've got some security experts here who can help you with that. 


                Q     Because aside from that, you know, this one change, it would still -- for people who don't even get security clearances, it would still be elsewhere in their personnel files or whatever that they have gotten treatment.  And how do we convince -- this doesn't do anything for those people, but how do we convince them it's not going to hurt their career? 


                COL. HOROHO:  There is a HIPAA compliance.  So when individuals -- when service members seek mental health care from -- on an outpatient perspective or an inpatient, that is protected health information.  And so it is not information that can be shared with -- it is the individual's personal information, and it's a private protection between the physician and the patient.   


                Q     And so it's not information that would come up, for instance, when someone is reviewing a packet for promotion? 


                COL. HOROHO:  No, absolutely not. 


                COL. SUTTON:  That is correct. 


                Q     Sort of to that end, what about retroactively, people who have answered yes to this question previously?  Are those answers used in any way in the future of a troop?  Do they look at past security clearance applications in any way when they're reviewing, you know, again for --  


                COL. HOROHO:  I think part of what you've raised is the implementation plan for this process, this policy change.  And in the past, you usually do build off of your past security clearances.  But because this is now going to be a change where you don't have to answer yes if you -- care within the last seven years, then I think part of that implementation plan would be that individuals that are conducting security clearance would know that regardless of what was answered in the past, their current answer is what they would need to use. 


                Q     Do you know how that might be enforced at all?  Isn't there some judgment taken from these security agents that can see that and maybe show a little bias in some way, shape or form? 


                COL. SUTTON:  Well, let me address that.  I think it's important to look at the numbers here.  Of the several hundred thousand security clearance questionnaires that have been answered just within the last couple of years, less than .05 percent of those questionnaires have resulted in a security clearance being denied as a result of question 21.  So it's a very small -- very small -- number. 


                As we implement this policy, I think it's going to be important for us to help folks understand that the security clearance evaluation process is really designed to take a holistic view, to look at the whole person, not just one question on the questionnaire. 


                And that's why I think -- I think that's why, you know, we see so few numbers, because the security clearance questionnaire and the folks who execute that program, they do take a look at the whole person and take things into account as they're making these important judgments. 


                MR. WHITMAN:  A couple more -- (off mike). 


                Q     That actually goes directly to my question, which is that for the several hundred people who've had their clearances denied -- security clearances are now being done by contractors in many cases. These people are extremely busy.  They're very backed up.  They don't necessarily have time to go through the packages -- I know this because I work on this area.  They don't necessarily have time to study this quite as carefully as we might like it to be, and in some cases they can take a lot of prejudice out of a single question.  How are these people who are dealing with the security clearances being trained to deal with this change? 


                COL. SUTTON:  You know, I think that's something that I would defer to the security experts.  Certainly, with every policy that gets implemented, there's always a training package that goes with that. 


                But I would like to also go back to your earlier point.  You said several hundred who'd been denied.  Actually, I gave you a percentage before, less than .05 percent, and actually that's four clearances. [sic – correction to response: approximately 75 of 800,000 people investigated for clearances in 2006 were rejected on the sole issue of their mental health profile.] 


                Q     Four? 


                COL. SUTTON:  -- since 2006.  [sic – correction to response: approximately 75 of 800,000 people investigated for clearances in 2006 were rejected on the sole issue of their mental health profile.] 


                Q     Oh, okay. 


                COL. SUTTON:  And so it's a very, very small number.  So I hope that helps.   


                The other thing that I would add here is, you know, as a practicing psychiatrist for over 20 years in the Army, what I've always told folks who come in for help -- because this is always a concern that comes up very early in the treatment process -- is that, you know, yes, if you have a problem and you get help, then, with the old form, you know, in most cases you had to, you know, say yes to that, and now this new change makes that much, much less of an issue. But if you need help and you get it, chances are it's going to work,  because in the vast majority of cases, we're able to keep folks on active duty, keep them living the lives and honoring the commitments that they've made in uniform.  And that's a good thing.  If you have a problem and you don't seek help, chances are you're going to have career problems down the line because you're not getting help, and you might develop a very serious problem, whether it be depression or anxiety or some sort of really very disabling problem. 


                And so this change -- our excitement today about this change is that I think our service members, our family members, our communities can now know that the department really does take invisible wounds just as seriously as we do the physical wounds.  We're on a journey.  We've come a long way.  We've got a long way to go.  But this is a very important step along the way.   


                MR. WHITMAN:  Last one. 


                COL. SUTTON:  Yes, ma'am?   


                Q     I have one -- just a very brief follow-up on the -- and then a question.  On the national pro-resilience campaign, so that's going to start when?  And you will have senior members of each service who will tell the story of their own psychological problems?   


                COL. SUTTON:  You know, we are in the planning stages of that campaign right now, and we're planning to engage the senior leaders of the services.  So more details to follow.  Right now we're developing federal partners across the federal government, as well as reaching out to a variety of private advocacy organizations, as well as professional health organizations.  Everyone wants to be part of this effort. 


                You'll hear more about it as we get to the point of actually having a formal announcement.  I would imagine that that would be sometime probably in the June, July time frame.   


                The planning is going very well at this point, and we'll keep you posted on progress. 


                Q     Then the question was on the four clearances [sic – correction to response: Approximately 75 of 800,000 people investigated for clearances in 2006 were rejected on the sole issue of their mental health profile.]  Only four clearances have been denied since 2006 because of this question.  So in effect, this is just a perception problem that you're alleviating, because it really hasn't been an obstacle to security clearances, but what you're taking away is people's perception that it could be an obstacle.  Is that --  


                COL. SUTTON:  You know, perception can take on a reality of its own.  So it's effort that's directed to both those issues, both making sure that folks understand, if they have that perception, that really they can get help and feel confident in doing so, and that they won't have to necessarily declare that on their security clearance if that help has been for family, marital, grief issues or issues related, as we mentioned, to deployment-related stress. 


                COL. HOROHO:  And Department of Defense is a cross-section of our nation.  And there is a stigma with seeking mental help across our country. And so part of what -- the Department of Defense, I think, is sending a very powerful message with this policy change -- is that we are truly looking at every perceived barrier, whether real or not, and trying to make it as easy as possible for service members to seek help, to seek mental health care.   


                MR. WHITMAN:  Ken, we'll take you and that's it. 


                Q     Okay.  Two factual questions. 


                First of all, what was the situation with question 21 before this change?  Did you have to answer "yes" if you had sought mental health counseling for any reason in the past seven years, no exemptions? 


                COL. SUTTON:  The current -- the historic question had the exclusion for marital, family and grief issues.  What's been added is the deployment-related adjustments, whether it be related to trauma, to stress, to depression, anxiety. 


                Q     And the second factual question.  I know you said you couldn't give us an actual number as to how many DOD military people have security clearances, but can you give us at least some broad sense of at what point in a military career do you need a security clearance?  Do all members -- active-duty military members need it? Do only some at a certain rank?  What determines whether you need a security clearance? 


                COL. SUTTON:  You know, what I would do is I would defer that question to the security experts.  Certainly I can tell you from the officer standpoint, I mean, typically -- 


                COL. HOROHO:  You come in with secret security clearance, and then depending on your position -- 


                COL. SUTTON:  Right. 


                COL. HOROHO:  -- you know, then it's raised at a -- 


                Q     (Off mike.) 


                COL. SUTTON:  When I was a captain, I had to apply for secret, and as, you know, advancing in grade as well as responsibility, it goes up from there and becomes more increasingly stringent, depending upon what your duties are. 


                Q     Is it possible that an enlisted person would -- 


                COL. SUTTON:  Oh, absolutely.  Absolutely.  So this is -- 


                MR. WHITMAN :  We can get you some details on that.  (Off mike) -- some characterizations.  But it's primarily around this issue -- (off mike) -- responsibility. 


                COL. SUTTON:  But as important as the question on the security clearance is the broader issue, and that is to send out the word that this is a readiness issue, it's a leadership issue.  We in the medical community, we play a supporting role.  And we really applaud the efforts of the department at this historic time to make this announcement, and now to live it, to get the word out.  We need your help.  Because early intervention does make a difference.  And the earlier we can identify folks who may be struggling, the sooner we can intervene and prevent needless tragedy.  


                And so I would thank you for your interest in this important topic, and we'll continue to work and go down this journey together. 


                Colonel Horoho, anything -- 


                COL. HOROHO:  Thank you.  Thank you all. 


                COL. SUTTON:  Thank you very much.


















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