members of the Subcommittee on Post
Traumatic Stress Disorder of the Committee on Gulf War and Health:
Physiologic, Psychological, and Psychosocial Effects of Deployment-Related
Stress, Vietnam Veterans of America
(VVA) thanks you for the opportunity to present our views
on the current state of the clinical
diagnoses and the disability compensation claims process as accorded our
nation’s veterans suffering from PTSD.
Foremost, Vietnam Veterans of America
applauds this Committee for its obvious concern about the mental health care
of our troops and veterans that we saw evidenced at your first public
meeting. The quality of your questions and demeanor indicated the both the
sincerity and the sophistication of your concern.
No one really knows how many of our troops
in Iraq and Afghanistan have been or will be affected by their wartime
experiences. Despite the early intervention by psychological personnel, no
one really knows how serious their emotional and mental problems will
become, nor how chronic both the neuro-psychiatric wounds (particularly PTSD)
and the resulting impact that this will have on their physiological health.
However, recent reports have suggested that troops returning from service in
Afghanistan and Iraq are suffering mental health problems at a rate higher
than the levels seen in Vietnam War veterans. Other reports indicate that
the service members who served in a war zone in Iraq or elsewhere are
getting sick at a higher rate than those who were not deployed. In fact, VVA
has no reason to believe that the rate of veterans of this war having their
lives significantly disrupted at some point in their lifetime by PTSD will
be any less than those estimated for Vietnam veterans by the National
Vietnam Veterans Readjustment Study.
the NVVRS demonstrated that some 15.2 percent of all male and 8.5 percent of
all female Vietnam theater veterans were current PTSD cases (i.e., at some
time during six months prior to interview). Rates for those exposed to high
levels of war zone stress were dramatically higher (i.e., a four-fold
difference for men and seven-fold difference for women) than rates for those
with low-moderate stress exposure. Rates of lifetime prevalence of PTSD
(i.e., at any time in the past, including the previous six months) were 30.9
percent among male and 26.9 among female Vietnam theater veterans.
of current and lifetime prevalence rates indicate that 49.2 percent of male
and 31.6 percent of female theater veterans, who ever had PTSD, still had it
at the time of their interview. Thus the NVVRS was a landmark investigation
in which a national random sample of all Vietnam Theater and era veterans,
who served between August 1964 and May 1975, provided definitive information
about the prevalence and etiology of PTSD and other mental health
readjustment problems. The study over-sampled African-Americans, Latinos,
and Native Americans, as well as women, enabling conclusions to be drawn
about each subset of the veterans’ population.
enabled the American public and medical community first become aware of the
documented high rates of current and lifetime PTSD, and of the long-term
consequences of high stress war zone combat exposure. Because of its unique
scope, the NVVRS has had a large effect on VA policies, health care delivery
and service planning. In addition, because the study clearly demonstrated
high rates of PTSD and strong evidence for the persistence of this disease,
it was generally accepted that the VA would pursue a follow-up or
longitudinal study of the original participants in this seminal research
Congress, by means of Public Law 106-419, mandated the VA to contract for a
subsequent report, using the exact same participants, to assess their
psychosocial, psychiatric, physical, and general well being of these
individuals. It would enable it to become a longitudinal study of the
mortality and morbidity of the participants, and draw conclusions as to the
long-term effects of service in the military period, as well as about
service in the Vietnam combat zone in particular. The law requires that VA
use the previous report as the basis for a longitudinal study.
the VA solicited proposals for non-VA contractual assistance to conduct
a longitudinal study of the physical and mental health status of a
population of Vietnam era veterans originally assessed in the NVVRS.
apparent that a longitudinal follow-up to the NVVRS is necessary in order to
meet the requirements of the law, and to do what just makes sense in both
policy and scientific terms. However, not only has the VA failed to meet
the letter of the law, there has been no effort to build upon the resources
accumulated from this unique and comprehensive study of Vietnam veterans in
a highly cost-efficient and scientifically compelling manner. More
important, however, is that such a longitudinal study could provide clues
about which VA health care services are effective and about ways to reach
the veterans who receive inadequate services or do not seek them at all.
And this has important consequences for America’s current and future
It is now
clear that the VA is ignoring the law and the Congress, and plain refusing
to do the study. The VA now has said in Congressional testimony says, “the
Inspector General stopped the study” when in fact the IG has no line
authority at all to do any such thing. The Undersecretary and the Secretary
stopped the study.
At that same
hearing on Research & Development on June 7, 2006, the VA also said that
they could not do the study because they could only find 300 of the original
more than 2,500 persons in the statistically valid random sample chosen by
the Gallup Organization at a public cost of more than $1 million in 1984
dollars. If that were true (which strains credibility at best) then that
would mean that 85% of that valid national sample has died in the past 25
years. VVA would suggest that this would be front-page news, if true.
VA has tried to claim they would be better off using the failed “Twins”
study data base from the Centers for Disease Control and Prevention (CDC)
because they do not want a longitudinal study, nor do they want to have
validated the results of what the NVVLS may demonstrate in regard to very
high mortality and morbidity of Vietnam veterans, especially those most
exposed to combat.
As even while the military’s own
studies clearly show that one-third of the Iraq and Afghanistan troops have
sought mental health services during their first year home, the legitimacy
of veterans’ claims that they suffer from PTSD is under the gun by a small
number of media savvy skeptics, whose views are not generally shared by
mainline PTSD experts.
For example, Dr. Sally Satel,
assistant professor of psychiatry at Yale's School of Medicine (with
a concurrent appointment as a staff psychiatrist at the West Haven VAMC)
from 1985 to 1993, and now “resident
scholar” at the American Enterprise Institute, has waged a campaign to
discredit PTSD as a valid diagnosis. In public statements she portrays
veterans who suffer from PTSD as looking for easy disability payments that
provide an incentive for staying sick rather than getting well, with the
implication that sick veterans are welfare cheats. In addition to her
claims of veteran fraud, Dr. Satel has also opined that cases of delayed
onset of PTSD “are rare to non-existent” and that “PTSD is an acute, not
chronic, disease and only rarely should there be a need to give long-term
Satel's approach is to try to undercut, discredit, and diminish the Vietnam
Study by questioning
how 50% of the veterans could
be reporting symptoms when 'only 15% were assigned
to combat units'. This question
signals either appalling historical ignorance of what happened in Vietnam or
slippery distortion, or both. . In 2004
Satel said, 'What is generally put forth as an established truth--that
roughly one-third of returnees from Vietnam suffered psychological
problems--is at best highly debatable.' But,
in 2005, when the Army surgeon general reported that
30% of soldiers who returned from Iraq had developed mental health
did not attempt to argue differently.
In fact, Dr.
Satel has offered no data to support her opinions. Studies done at the
National Center for PTSD confirm the delayed onset of PTSD, as well as the
fact that mental health utilization is actually higher for veterans granted
disability claims than for those who apply and are turned down.
Furthermore, VVA doubts
that the journalistic op/ed stuff Satel
writes about PTSD could show up in
reputable scholarly journals where a decent peer review process would shred
her facile, superficial assertions. By now it should be clear that
her intended audience is politicians and
policy-makers, not academics who have standards for what constitutes
credible research and scholarship. VVA would also argue that use of
the standardized and validated PTSD diagnostic assessment tools in the “Best
Practices Manual for PTSD…” would pick up any fractious PTSD disability
claims and provide for better guidance in developing individualized
VVA notes the
absence of VA research outside of that conducted at the National Center for
PTSD on the physiological manifestations of PTSD and co-morbid
medical/health conditions such as that conducted by Dr. Joseph Boscarino
(1). For the veteran suffering from acute, long-term PTSD, can one reverse
the endocrine changes that occur? Or reverse physical changes in the
brain? Of course not… But without such research efforts, the VA will
continue to labor under the fallacy that “PTSD is all in your head…”
VVA acknowledges that the culture of
the VA mental health system itself may play a yet undefined role in this
current debate over PTSD and VA compensation. For example, the studies of
Sayer and Thuras (1), as well as Kimbrell and Freeman (2) suggest that VA
clinicians had a more negative view of the treatment engagement of veterans
who were seeking compensation and of clinical work with these patients in
comparison with those veterans not seeking compensation and those certified
as permanently disabled and thus not needing to reapply for benefits. The
longer VA clinicians had been working with veterans who had PTSD, the more
extreme were these negative perceptions.
What is clear to us is that these
clinical “researchers” are not even aware that their patients seek service
connection so that the veteran will not have to pay for medical treatment
for a condition that they believe resulted from their military service.
This, and the sense of validation are often more important to the individual
veteran that any compensation payment he or she may derive (and deserve!) as
a result of this psychiatric wound(s) that are every bit as real as a gun
shot wound, if properly diagnosed according to the VA’s own “Best Practices
There are numerous other points that
we wish to make to you before you wrap up this project, but we will close
here for now with urging that this panel strongly recommend that VA complete
the National Vietnam Veteran Longitudinal Study (NVVLS) exactly as directed
by Public Law 106-419. Because that sample is not limited to those who use
VA, the results will validate the prevalence of PTSD in the last previous
large generation of combat veterans.
Thank you for
your kind attention. I will be pleased to answer any questions you may have.
1. Boscarino, J. A. 2006.
Post-traumatic stress disorder and mortality among U.S. Army veterans 30
years after military service. Ann. Epidemiol. 16: 248-258.
2. Sayer, N. A. and Thuras, P.
2002. The influence of patients’ compensation-seeking status on the
perception of veteran’s affairs clinicians. Psychiatry. Serv. 53:
T.A. and Freeman, T. W. 2003. Clinical care of veterans seeking
Psychiatry. Serv. 54:910-911.
VIETNAM VETERANS OF AMERICA
July 6, 2006
The national organization Vietnam Veterans of America (VVA) is a non-profit
veterans membership organization registered as a 501(c)(19) with the
Internal Revenue Service. VVA is also appropriately registered with the
Secretary of the Senate and the Clerk of the House of Representatives in
compliance with the Lobbying Disclosure Act of 1995.
VVA is not currently in receipt of any federal grant or contract, other than
the routine allocation of office space and associated resources in VA
Regional Offices for outreach and direct services through its Veterans
Benefits Program (Service Representatives). This is also true of the
previous two fiscal years.
For Further Information, Contact:
Director of Government Relations
Vietnam Veterans of America.
(301) 585-4000, extension 127
Dr. Thomas J. Berger
Berger is a Life Member of Vietnam Veterans of America and currently serves
as national chair of VVA’s PTSD and Substance Abuse Committee. As such, he
is a member of the Veterans’ Healthcare Administration (VHA) Consumer
Liaison Council and the Mental Health Quality Enhancement Research
Initiative for the Committee on Care of Veterans with Serious Mental
Illness. In addition, Dr. Berger holds the distinction of being the first
representative of a national veterans’ service organization to hold
membership on the Executive Committee of the Veterans’ Administration
Substance Use Disorder Quality Enhancement Research Initiative. He is also
a member of VVA’s national Health Care, Government Affairs, Women Veterans,
and Project 112/SHAD committees. At the local level he serves as Secretary
of the Missouri Vietnam Veterans Foundation and as both Board President and
Secretary for Welcome Home, Inc., a non-profit domiciliary for veterans
suffering from PTSD and substance abuse problems.
Upon completion of his military service as a Navy corpsman with the 3rd
Marine Division in Vietnam and then subsequently after earning his doctoral
degree, he has held faculty and administrative appointments at the
University of Kansas in Lawrence, the State University System of Florida in
Tallahassee and the University of Missouri-Columbia, as well as program
administrator positions with the Illinois Easter Seal Society and United
Cerebral Palsy of Northwest Missouri. His professional publications include
books and research articles in the biological sciences, wildlife regulatory
law, adolescent risk behaviors, and post-traumatic stress disorder.
Dr. Berger now devotes his efforts full-time to veterans’ advocacy at the
local, state and national levels on behalf of Vietnam Veterans of America.
resides in Columbia, Missouri and his hobbies are cycling, music, cooking,
Richard F. “Rick” Weidman serves as Director of Government Relations on the
National Staff of Vietnam Veterans of America. As such, he is the primary
spokesperson for VVA in Washington. He served as a 1-A-O Army Medical
Corpsman during the Vietnam War, including service with Company C, 23rd Med,
AMERICAL Division, located in I Corps of Vietnam in 1969.
Mr. Weidman was part of the staff of VVA from 1979 to 1987, serving
variously as Membership Service Director, Agency Liaison, and Director of
Government Relations. He left VVA to serve in the Administration of Governor
Mario M. Cuomo as statewide director of veterans’ employment & training
(State Veterans Programs Administrator) for the New York State Department of
He has served as Consultant on Legislative Affairs to the National Coalition
for Homeless Veterans (NCHV), and served at various times on the VA
Readjustment Advisory Committee, the Secretary of Labor’s Advisory Committee
on Veterans Employment & Training, the President’s Committee on Employment
of Persons with Disabilities - Subcommittee on Disabled Veterans, Advisory
Committee on Veterans’ Entrepreneurship at the Small Business
Administration, and numerous other advocacy posts. He currently serves as
Chairman of the Task Force for Veterans’ Entrepreneurship, which has become
the principal collective voice for veteran and disabled veteran
Mr. Weidman was an instructor and administrator at Johnson State College
(Vermont) in the 1970s, where he was also active in community and veterans
affairs. He attended Colgate University (B.A., 1967), and did graduate study
at the University of Vermont.
He is married and has four children.