Mr. Chairman, Ranking Member Michaud, and distinguished
Members of this Subcommittee, Vietnam Veterans of America (VVA) thanks you
for the opportunity to present our views on the current state of the
disability compensation claims process as accorded to our nation’s veterans
suffering from mental illnesses and/or traumatic brain injuries as a result
of their military service.
Vietnam Veterans of America thanks this Committee for your concern about the
mental health care of our troops and veterans, and your leadership in
holding this hearing today. However, given the nature of the conflicts in
Iraq and Afghanistan and the fact that many service members are serving
multiple combat tours, VVA is again compelled to repeat its message that 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 much-touted
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 (e.g., PTSD and Traumatic Brain Injury or
TBI) and the resulting impact that these wounds will have on their
physiological health, risk of suicide risk, and their general psycho-social
readjustment to life away from the battle zone.
As we have
stated before in Congressional testimony, Vietnam Veterans of America has no
reason to believe that the rate of PTSD for veterans of OEF and OIF will be
any less than that found for Vietnam veterans. What is beyond argument is
that the more combat exposure a soldier sees, the greater the odds that
soldiers will suffer mental and emotional stress that can become
debilitating. And in wars without fronts, “combat support troops” are just
as likely to be affected by the same traumas as infantry personnel.
particularly important implications for our female soldiers, who now
constitute about 16 percent of our fighting force. Returning female OIF and
OEF troops face ailments and traumas of other sorts. For example, studies
conducted at the Durham, North Carolina Comprehensive Women’s Health Center
by VA researchers have demonstrated higher rates of suicidal tendencies
among women veterans suffering depression with co-morbid PTSD. And
according to a Pentagon study released in March 2006, more female soldiers
report mental health concerns than their male comrades: 24 percent compared
with 19 percent. In addition, roughly 40 percent of these women war
fighters have musculoskeletal problems that doctors say likely are linked to
lugging too-heavy and ill-fitted equipment. A considerable number - 28
percent - return with genital and urinary system infections. In addition,
there are gender-related societal issues that make transitioning tough,
psychologists who work with female veterans say.
more likely to worry about body image issues, especially if they have
visible scars, and their traditional roles as caregivers in civilian life
can set them back when they return. In other words, they are the ones who
have traditionally had the more nurturing role within our society, not the
one who need nurturing. Additionally, the VA has, after much prodding by
this subcommittee over the years, finally come to a place where there is
pretty good coverage throughout the nation of services to women to treat
PTSD and other after effects of Military Sexual Trauma (MST) at VA Medical
Centers. However, there are very few clinicians within the VA who are
prepared to treat combat situation induced PTSD as opposed to MST induced
PTSD. Additionally, there are already cases where returning women service
personnel have a combination of the two etiologies, making it extremely
difficult for the average clinician to treat, no matter how skilled in
treating either combat incurred PTSD in men, or MST induced PTSD in women.
Because of the number of women who are de facto now combat veterans because
of the nature of the conflicts in both Afghanistan and particularly Iraq, we
have entered a whole new world of need.
has proven in the last twenty-five years to be one of the most efficient as
well as effective treatment modalities. However, you cannot mix the women
with the men in these groups, as there are just some subjects that one
gender will not generally share with the other and discuss, such as problems
with intimacy or relations with one’s spouse or significant other.
experts say traumatic brain injuries (i.e., TBI) are the “signature wound”
of the Iraq war, a by-product of improved body armor that allows troops to
survive once-deadly attacks, but does not fully protect against the blast
effects of roadside explosive devices and suicide bombers. They have become
so common that special traumatic brain injury centers have been set up by
the Army and by the VA.
In addition, the Armed Forces Epidemiological Board (AFEB) sent a memorandum
(1) to the Honorable William Winkenwerder, Jr., M.D., Assistant Secretary of
Defense for Health Affairs, in August 2006, which cited not only the
evidence regarding the acute and long-term health implications of TBI, but
also contained detailed recommendations on how the Department of Defense
(DOD) should approach TBI prevention, medical management and research. VVA
is not aware whether any of the AFEB recommendations have been acted upon or
implemented by DoD.
In any case,
some physicians fear there may be thousands of active duty and discharged
troops who are suffering undiagnosed. Our anecdotal experience bears this
out, in that many active duty service troops, as well as Reservists and
members of the National Guard, are chary of reporting problems, as they
believe that doing so would effectively sabotage their military career.
Symptoms include slowed thinking, severe memory loss, and coordination and
impulse control problems.
injury is a physical loss of brain tissue that shares some symptoms with,
but is markedly different than post traumatic stress disorder (PTSD), which
is triggered by extreme anxiety, and permanently resets the brain’s
fight-or-flight mechanism. Battlefield medics and medical supervisors often
miss traumatic brain injuries, and many troops don’t know the symptoms or
won’t discuss their problems for fear of being sent home stigmatized with
mental illness. The same is true for those who return to the Continental
United States for garrison duty or who end their term of service, and exit
the military to become veterans.
symptoms, such as seizures, can be treated with medication, but the most
devastating effects of TBIs – depression, agitation and social withdrawal –
are difficult to treat with medications, especially when loss of brain
tissue occurs. In troops with documented TBIs, the loss of brain function
is often compounded by other serious injuries that affect physical motor
coordination and memory functions. These patients need a combination of
psychological, psychiatric and physical rehabilitation treatment that is
difficult to coordinate in a traditional hospital setting, even when it is
properly diagnosed at an early date.
as more and more troops return home with brain damage, their families must
contend not only with the shock of seeing the physical and psychological
destruction to their loved ones, but also with how their own lives change
dramatically. In cases of severely brain-damaged casualties, spouses,
parents and siblings may be forced to give up careers, forsake wages and
reconstruct homes to care for wounded relatives rather than consign them to
a nursing home. Families say they also struggle with military and VA
medical systems that were unprepared for these wounded. In some cases new
equipment and the specially trained staff at VA needed for the
rehabilitation of catastrophic cases has not kept pace with the advances in
battlefield medicine that kept these service members alive and brought them
home safely. In addition, there are issues about the intensity and drains
of vitally needed family support that will be hard to sustain, as well as
significant issues regarding the complexity of the medical and other
specialized needs that have to be addressed.
Finally, VVA recognizes that there is
a debate about the exact influence of combat-related trauma on suicide
risk. For those veterans who have PTSD as a result of combat trauma,
however, it appears that the highest relative suicide risk is observed in
veterans who were wounded multiple times and/or hospitalized for a wound7.
This suggests that the intensity of the combat trauma, and the number of
times it occurred, may influence suicide risk in veterans with PTSD. Other
research on veterans with combat-related PTSD suggests that the most
significant predictor of both suicide attempts and preoccupation with
suicide is combat-related guilt8.
Many veterans experience highly intrusive thoughts and extreme guilt about
acts committed during times of war. These thoughts can often overpower the
emotional coping capacities of veterans.
began in Afghanistan in October 2001, nearly 20,000 American military
personnel have been wounded in action, according to the Defense Department.
Many of these injuries have been life threatening, requiring multiple
surgeries, extensive rehabilitation and ongoing care. But the immediate
financial and logistical challenges of coping with the thousands of severely
wounded are just two of the problems military and civilian authorities (in
addition to the servicemembers themselves) face.
the Congress and the VA have directed several hundred million dollars to
restoring organizational capacity in key networks that were most lacking
because they laid off so many neuro-psychiatric clinicians in the 1990s.
Some of these funds were directed toward hiring more clinicians, and some
funds were directed toward establishing effective outreach programs to reach
as many Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF)
veterans as early as possible. There appears to be widespread assent to the
notion that the earlier that these individuals can be reached, the less
severe and the less chronic their PTSD problems will be in the future.
VA has still not moved forward and contracted to finish the National Vietnam
Veteran Longitudinal Study (NVVLS), we do not know if that is accurate or
not. VVA again urges the Committee on Veterans Affairs to strongly support
insisting that the VA follow the law, and contract to get this study
completed as soon as possible, as it will give you and all of us in the
veterans’ community some insight into the chronic PTSD and other
socio-psychological readjustment problems of combat theater veterans may be,
and when and how these problems will be likely to manifest in the current
impulse to strengthen the organizational capacity of VA in mental health
(particularly PTSD) and to do outreach programs aimed toward our newest
generation of veterans is a laudable one, VVA is not certain that we have
gotten the “bang for the buck” in expenditures of these taxpayer dollars.
VVA encourages this committee to get an accounting of all of the funds
allocated out to the Veterans integrated Service Networks (VISNs) on a
competitive grant basis to determine who received these funds, what did they
do with the funds (e.g., how many clinicians hired who did what with how
many veterans served for what period of time), and what is the overall
analysis of how effectively the VISNs used the funds for both short term (1
– 2 Years), and what appears to be the medium term or possibly permanent
effect (e.g., more than two years). Reports from some areas in the country
indicate that since virtually every VISN and every VAMC was kept running
once again by using other than operational dollars, that these funds did NOT
result in any meaningful outreach programs, and that no more clinicians were
actually hired to handle the dramatically increased number of veterans
seeking assistance and care.
road, these active-duty, reservist and Guard military personnel will need
employment, housing as well as both mental and physical health-care
assistance for years to come. Accordingly, with the conflicts in
Afghanistan and Iraq continuing with no end in sight, VVA believes that
now is the time to address these issues, rather than later.
I thank you
again for the opportunity to offer our views on these issues. Thank you for
your kind consideration.
AFEB Memo Reference
Armed Forces Epidemiological Board
Memorandum. “Traumatic Brain Injury in Military Service Members – 2006 –
02. August 11, 2006.
VIETNAM VETERANS OF AMERICA
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:
Executive Director of Policy
and Government Affairs
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.
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,