Mr. Chairman, Ranking Member Miller, Distinguished Members of this
Subcommittee, and guests, Vietnam Veterans of America (VVA) thanks
you for the opportunity to present our views on H.R. 3051, the “Heroes
at Home Act OF 2007,” that is designed to improve the diagnosis
and treatment of TBI (traumatic brain injury) for service members
and veterans, and to review and expand the tele-health and tele-mental
health programs DoD and VA. With your permission, I shall keep my
remarks brief and to the point.
First, VVA thanks you, Mr. Chairman and Mr. Miller as well as distinguished
Members of this Subcommittee for your active concern in regard to
Traumatic Brain Injury (TBI) and related mental health problems of
our troops and veterans, and for your leadership in holding this
In general, Vietnam Veterans of America supports the intent of
H.R. 3051. However, medical experts say that traumatic brain injuries
are the “signature wound” of the Iraq war in particular,
a by-product of the explosions caused by I.E.D. roadside blasts and
suicide bombers. TBIs have become so commonplace that they, in fact,
form the basis for today’s hearing.
Although TBIs may share some symptoms with post traumatic stress
disorder, it is markedly different than PTSD, which is triggered
by extreme anxiety, and permanently resets the brain’s fight-or-flight
mechanism. Battlefield medics and corpsmen can 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
U.S. for garrison duty or exit their term of military service and
Certain TBI symptoms, such as seizures, can be treated with medications,
but the most devastating effects – depression, agitation and
social withdrawal – are difficult to treat with medication,
especially when there is loss of brain tissue. In troops with documented
TBI, the loss of brain functions is often compounded by other serious
medical conditions that affect physical coordination and memory functions.
These patients need a combination of psychological and physical treatment
that is difficult to coordinate in a traditional medical setting,
even when properly diagnosed at an early date. And we must remember
that both concussive and contusive brain injuries are never just
isolated injures. Over time without proper diagnoses, care and treatment,
it can affect nearly everything about the survivor including one’s
cognitive, motor, auditory, olfactory and visual skills, perhaps
ultimately resulting in behavioral modifications, not a mental illness.
As more and more troops return home damaged from the war, their
families must contend with not only the physical desolation of their
loved ones, but come to grips with the new emotional reality of their
lives which have changed drastically and not necessarily for the
better. Take for example, a 35-year old soldier or Marine who returns
home with what is diagnosed with traumatic brain injury (TBI). His/her
impairment affects the future of the entire family. His or her spouse
and children have to deal with his/her ability to concentrate, the
mood swings, the depression, the anxiety, even the loss of employment.
As you can well imagine, the economic and emotional instability of
a family can be as terrifying and as real as focusing or simply waking
in the middle of the night and crying because of nightmares. 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 their wounded relatives, rather than to consign
them to the anonymous care of a nursing home or assisted living facility.
Families say that they also struggle with military and VA medical
systems that were unprepared for these wounded. In some cases new
equipment and specially trained staff needed for the most catastrophic
cases are not available or have 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 drain of 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 need to be addressed. Of all the
war’s medically challenging injuries, brain injuries require
the most personal involvement and cost over time.
TBI also presents a most puzzling challenge, especially in mild
to moderate cases. Symptoms can be hidden or delayed, diagnosis is
difficult, and evidence-based treatments are as of yet largely undetermined.
Very few medical facilities are capable of providing even the most
basic level of care for brain-injured patients, forcing most to seek
treatment miles from home, if they can find it at all, and we must
remember that over forty percent of our troops deployed in Iraq and
Afghanistan come from rural America.
As you are well aware, one of the recommendations of the Dole-Shalala
Commission was to “significantly strengthen support for families.” This
will not be an easy task, but VVA believes H.R. 3051 to be a key
step in achieving this recommendation and providing a mechanism for
empowering the families of brain-injured service members IF the VA
can develop effective implementation strategies for certification,
competency evaluations, and meaningful outcome measurements to carry
it out. As they say, “the devil remains in the details”.
I thank you again for the opportunity to offer VVA’s views
on this proposed legislation, and I shall be glad to answer any questions
you might have.
Thomas J. Berger, Ph.D.
Dr. Tom Berger is a Life Member of Vietnam Veterans of America (VVA)
and founding member of VVA Chapter 317 in Kansas City, Missouri.
He currently serves as National Chair of VVA’s PTSD and Substance
Abuse Committee. As such, he is a member and Chair of the Veterans’ Healthcare
Administration’s (VHA) Consumer Liaison Council for the Committee
on Care of Veterans with Serious Mental Illness (SMI Committee),
the Executive Committee of the Mental Health Quality Enhancement
Research Initiative Depression Work Group (MHQUERI), and the South
Central Mental Illness Research and Education Clinical Center (SC
In addition, Dr. Berger holds the distinction of being the first
representative of a national veterans’ service organization
to hold membership on the VHA’s Executive Committee of the
Substance Use Disorder Quality Enhancement Research Initiative (SUD
QUERI). Dr. Berger also serves as a reviewer of research proposals
for DoD’s “Congressionally Directed Medical Research
Programs”. He is a member of VVA’s national Health Care,
Government Affairs, Agent Orange and Toxic Substances and Women Veterans
committees. At the local level he serves as a Board member and Secretary
of the Missouri Vietnam Veterans Foundation and as both President
and Secretary of Welcome Home, Inc., a non-profit domiciliary for
veterans suffering from PTSD and substance abuse, located in Columbia,
Dr. Berger served as a Navy Corpsman with the 3rd Marine Corps Division
in Vietnam, 1967-68. Following his military service and upon the
subsequent completion of his postdoctoral studies, he 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. He presently resides in Columbia, Missouri and his hobbies
are cycling, music, cooking, and reading.
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