VVA Testimony VVA Testimony
VVA Testimony


Statement for the Record




Submitted By

 Thomas J. Berger, Ph.D., Chairman
VVA National PTSD & Substance Abuse Committee

Before the

Subcommittee on Health
Committee on Veterans Affairs
U. S. House of Representatives


Traumatic Brain Injuries
Post Traumatic Stress Disorder (PTSD)
Diagnosis, Treatment, & Compensation

September 28, 2006

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. 

First, 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.   

This has 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.   

Women are 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.  

Group therapy 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. 

Medical 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.   

The TBI 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. 

Certain TBI 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.

Furthermore, 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. 

Since combat 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.  

Since 2003, 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.  

Because the 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 generation.  

While the 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. 

Down the 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.

Funding Statement

          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 

Dr. Tom 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. 

He presently resides in Columbia, Missouri and his hobbies are cycling, music, cooking, and reading.                    

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