Thank you, Mr. Chairman, for convening this hearing on very important veterans’ disability assistance bills, including my proposal, H.R. 5448, the “Full Faith in Veterans Act of 2008.”  I am extremely grateful for this opportunity to testify before the Subcommittee about the need for my legislation, which I introduced in February of this year.

The enormous stress of combat has long been recognized as the source of long-term, disabling psychological and emotional illness for many soldiers, sailors, marines and airmen.  What we now know as post traumatic stress disorder, or PTSD, is not a new phenomenon.  The wars in Iraq and Afghanistan, however, have been particularly stressful, given the unpredictability of ambushes and IED attacks, not knowing who is friend or foe, and repeated tours of duty.  In addition, military and medical personnel more readily recognize the symptoms of this disorder.  So it is not surprising that so many of our brave men and women return from Iraq and Afghanistan suffering from incapacitating fears, flashbacks, nightmares and other problems associated with their experiences.  The Department of Veterans Affairs (VA) has diagnosed PTSD in about 67,000 Iraq and Afghanistan veterans.  Because many veterans do not seek care for these problems, the true number is undoubtedly much higher. 

PTSD has affected those who have served in our Armed Forces since the days it was known as “shell shock.”  Thousands of veterans from previous conflicts continue to struggle with the long-term effects of their service.  Others have had their symptoms reemerge as a result of the extensive news coverage of the events of September 11, 2001, and the ongoing wars in Iraq and Afghanistan.

The goal of the Full Faith in Veterans Act is to improve diagnosis, compensation, and treatment for veterans with PTSD.

The primary component of the legislation seeks to ensure that every veteran whose PTSD resulted from their service receives treatment and, if appropriate, disability compensation.

Veterans for Common Sense reviewed VA documents to determine the number of Iraq and Afghanistan veterans diagnosed with PTSD—about 67,000.  The organization also found the VA concluded that only about half of these veterans have a service-connected disability.  This raises the question of the status for the other 30,000 or so veterans.  Some veterans may not know they can file a claim or may still have a claim pending.  But as I have learned from veterans in my district, proving that PTSD is service-connected can be very difficult, particularly for veterans of older conflicts.  And denial of service-connection leaves these veterans without access to VA health benefits or disability compensation. 

I crafted my bill after listening to Maine veterans victimized by the current system.  In many cases, the law appears to be stacked against them.  Instead of the support and quality health care they were promised, the disabling trauma they suffered during military service has been met with skepticism and red tape.  I would like to share the story of one of my constituents that brings these shameful circumstances to life.

Terry Belanger is an Army veteran from Biddeford, Maine.  He served in Vietnam from 1969-1970.  Terry’s principal duty was to serve as a light vehicle driver; his responsibilities included delivering and distributing ammunition to troops surrounding Chu Lai Air Base.

Terry’s time in Vietnam was harrowing.  His vehicle came under enemy fire, he reports, “practically every night.”  Close friends were killed in combat; another died in a stabbing over a game of cards; he witnessed the torture of Viet Cong officers, and saw the body of the driver of the truck ahead of his fly through a canvas top after the vehicle struck a mine; he slept in the mud and saw body bags being loaded on to U.S. planes.  His captain was killed. 

On one mission, a young Vietnamese girl suddenly appeared in front of his truck and his vehicle ran over the little girl, probably killing her.  Because his convoy was under fire, he could not stop.  Terry’s nightmares about this incident were rekindled a few years ago after he nearly struck another child who darted in front of his car.

When he returned from Vietnam, Terry showed evidence of what several health care professionals have diagnosed as severe PTSD resulting from his service in Vietnam.  It took him six months to want to hold his newborn daughter, but he didn’t know why.  In 1989, Terry filed a claim with the VA for service-connected PTSD.  The claim was denied due to “lack of credible information of supporting stressors.”  Terry would spend nearly two decades fighting his own government, a government he had fought to defend.  Time and again, the VA denied service-connection due to lack of evidence that his condition was linked to his military service.  All the while, Terry and his family suffered, for his government would neither pay for his medical care for PTSD, nor provide him with disability benefits.

For 19 years, Terry tried to get the Army to search for documents that would prove that these traumatic events had occurred.  In January 1993, the National Personnel Records Center told Terry that the records he requested “would rarely show specific details about a unit’s activities and movements and that it was unable to perform the extensive research requested due to staffing and budget limitations.”  Finally, in 2005, the National Archives and Records Administration found over 4,500 pages that verified that Terry’s unit was in combat for months, just as he had claimed.  This was sufficient to establish service-connection.  But because of an enormous backlog of veterans’ claims, Terry had to wait another three years before the VA would grant his claim. 

Last month, he finally received the VA’s decision that it would grant his claim.  Terry says that it took him three days to stop being angry, and he’ll never understand why it took them so long to validate his claim. 

It took that long because the law is unfair.  The veteran, not the agency that possesses the records, has the burden of producing documents that prove the trauma occurred.  How was Terry Belanger, a disabled veteran in Biddeford, Maine, supposed to find the records that the government said it didn’t have the time or money to look for?  His doctors confirmed he had PTSD.  His nightmares and flashbacks referred to his time in Vietnam.  The Army trusted him when he served his country.  Why should we distrust him now, in his time of need? 

Indeed, what is remarkable about Terry’s case is that the records were ever uncovered.  It happened only because Terry was so persistent and would not let his family down.  He kept filing and appealing until finally, after sixteen years, someone in the National Archives found thousands of pages that they had missed before. 

Terry’s story is similar to many I have heard from veterans in Maine and, I would wager, is much like the experience veterans in each of your districts have had.  In many cases, no records are kept of traumatic experiences in a combat theatre.  As Terry had been told earlier, military records “would rarely show specific details about a unit’s activities and movements.”  In the case of Terry Belanger, the records were there amid millions of others.  Either way, bureaucratic mismanagement or red tape is no excuse to deny veterans the health care and compensation they have earned.

When no records can be found to substantiate the claim, a veteran can also submit two “buddy statements” as evidence that their claimed stressor actually occurred.  Again, the burden of proof is placed on the veteran to find fellow servicemembers who may remember and can corroborate the veteran’s story.  This is not an easy task, particularly when seeking individuals that the veteran may not have seen or spoken to for decades.  One can turn to the back of many veterans’ magazines and see ads submitted by veterans looking for others who can verify their claims, like these (all from the April 2008 issue of VFW magazine):

“173rd [Airborne] Support [Battalion], An Khe, Vietnam, 1968-69—Seeking anyone who attend [sic] [Airborne] Jungle School when one of the instructors was accidentally shot by one of the other instructors next to me; anyone there when the school and mess hall were shelled and three people were killed; cooks and supply people; Sgt. Provost and Jimmy Gibson; anyone who was there when the mess hall caught on fire and we put it out; anyone who witnessed an accidental shooting on April 9, 1968, in the bunkhouse. Need substantiation for PTSD claim.—William E. Young, Jr.”

“222nd Personnel Services [Company], Vietnam, early 1971—Seeking anyone in a convoy traveling between Vaung Tan and Long Binh and saw Huey shot down.  Need substantiation for PTSD claim.—John Westbrook”

“4th [Infantry Division Artillery] Base Camp, Pleiku, Vietnam, Sept. 1969-Nov. 1970—Seeking anyone attached to camp. Need substantiation for PTSD claim.—Roger Carroll”

Veterans should not have to take out classified ads in order to have their valid claims for PTSD approved by the VA.

Under my common sense bill, if a veteran is diagnosed by a certified medical health professional as suffering from PTSD related to the veteran’s military service, the VA must accept this finding as sufficient proof of service-connection.  As with other disability claims, the VA must resolve every reasonable doubt in favor of the veteran.  However, the VA can rebut this finding of service-connection by clear and convincing evidence to the contrary.  Thus, if contrary evidence exists, and the VA produces it, the claim will not be allowed. 

Under my bill, veterans like Terry Belanger would not have to wait two decades for the VA to find the relevant records.  The law would also help the many veterans whose traumatic experience in the service never made it into official records.  The new standards in my bill would apply to all veterans diagnosed with PTSD, not just those from the wars in Iraq and Afghanistan.  It would also acknowledge the inherent dangers of military service and be applicable to all those who served our nation in uniform, not just those who faced combat.  It also accommodates cases of PTSD related to military sexual trauma that may not have happened in a combat zone.

In addition to establishing a fair system for establishing service-connection for PTSD, the bill would also ensure that the VA does a better job at diagnosing and treating this debilitating disorder. 

The bill requires that VA employees who are responsible for rating disability compensation claims involving PTSD successfully complete a certification program that incorporates best practices issued by the VA’s National Center on PTSD.

It directs the VA to audit the examinations that VA mental health professionals conduct for veterans who submit claims for PTSD disability compensation.  This will help ensure these employees take enough time to diagnose and accurately rate the severity of the disorder. 

H.R. 5448 requires that the documents mental health professionals and raters consider when evaluating or rating PTSD must include the veteran’s records from VA Vet Centers, as well as written opinions of any medical professional providing mental health care.

The bill also directs the VA to update the schedule for rating disabilities, beginning with PTSD, traumatic brain injury, and other disabling mental health conditions.

Finally, my measure requires the VA to implement an approach for providing treatment for veterans with PTSD that combines treatment, compensation, and vocational assessment. 

This bill has received support from a broad array of veterans groups, including Swords to Plowshares, Veterans for Common Sense, the Maine Veterans Coordinating Committee and Maine’s Bureau of Veterans Services, along with the Maine departments of the American Legion, AMVETS, the Disabled American Veterans, and the Veterans of Foreign Wars.

For too long, America has neglected our responsibilities to the men and women who carry the emotional scars military service sometimes brings.  They battled for us; now we must help them battle their demons, by treating them fairly and respectfully.  Terry Belanger’s wife wrote, “This wonderful man…left part of his soul in Vietnam.”  I hope and pray that with care and support, Terry and other veterans suffering from PTSD will be restored to full and productive lives.  The Full Faith in Veterans Act can help achieve this.

Swords to Plowshares
San Francisco, CA.
March 4,2008

The Honorable Thomas H. Allen
United States House of Representatives
1127 Longworth House Office Building
Washington, DC 20515-1901

Dear Representative Allen,

I write on behalf of Swords to Plowshares to thank you for introducing the Full Faith in Veterans Act (H.R. 5448). Swords to Plowshares is a non-profit Veterans Service Organization founded by Vietnam Veterans in 1974 and dedicated to providing services and support to veterans of all eras. Our legal staff have assisted countless veterans through the complex Veterans Benefits Administration (VB A) claims process to secure compensation for Post-Traumatic Stress Disorder (PTSD) incurred during service to our country.

H.R. 5448 addresses serious flaws in the adjudication of PTSD claims. Under current law, veterans must have both a PTSD diagnosis and military documentation of the traumatic stressor which caused their PTSD, or two "buddy statements" describing the event. This process of identifying two "buddies" and eliciting their description of painful events causes undue trauma to the all veterans involved, and is triggered by a failure in military documentation for which the veteran has no control. The proposal to accept a diagnosis of PTSD by a mental healthcare professional that establishes a logical relationship between exposure to military stressors and current PTSD is a vast improvement over the current process.

We also applaud the effort to establish standards in PTSD case review through: the requirement that VBA PTSD Ratings Analysts complete a certification program incorporating best practices issued by the V A's National Center on PTSD; the requirement that V A audit their mental health examinations to ensure that sufficient time is taken to accurately diagnose and rate the severity of PTSD; and, the requirement that the Ratings Analysts consider Vet Center records and written opinions of other treating medical professionals in assessing PTSD claims.

Thank you on behalf of Swords to Plowshares for your leadership in veterans' issues and we look forward to working with you and your staff to support the Full Faith in Veterans Act.

Sincerely,

Michael Blecker
Executive Director

Veterans for Common Sense
Washington, DC.
June 10, 2008

The Honorable Thomas Allen
Member of Congress
U.S, House of Representatives
1127 Longworth House Office Building
Washington, DC 20515

Dear Representative Allen:

Veterans for Common Sense (VCS) strongly supports your new bill, "The Full Faith in Veterans Act," HR 5448. VCS asks Chairman John Hall and the House Veterans' Affairs Committee's Subcommittee on Disability Assistance and Memorial Affairs to favorably report the bill at their hearing on June 12, 2008. Our VCS goal is simple: We want VA to quickly and accurately process post traumatic stress disorder claims so our veterans are not forced to wait months or years for disability benefits. We thank you for your leadership on this important issue.

The Department of Veterans Affairs' (VA) disability claims process for Iraq and Afghanistan War veterans remains broken - as shown by the fact that VA takes, on average, more than six months to process and initial claim, and VA takes nearly four more years to process a disability claim appeal. Among the most difficult claims to process are PTSD claims. VCS supports a presumption of a PTSD stressor based on deployment to a war zone.

VCS remains alarmed that VA denies more than half of the PTSD disability benefits filed by Iraq and Afghanistan war veterans. The latest publicly available information shows that only 37,000 Iraq and Afghanistan war veterans' VA disability claims for PTSD were approved among the 75,000 veterans diagnosed at VA hospitals with PTSD. While some cases may be pending or on appeal, VA's rejection rate is suspiciously high, and the enormous disparity warrants a prompt Congressional oversight investigation above and beyond enacting HR 5448.

Your bill, HR 5448, requires VA reports on PTSD. VCS urges Congress to pass HR 1354, "The Lane Evans Veterans .Health and Benefits Improvement Act," a bill that requires VA to collect data and prepare reports about the human and financial costs of the Iraq and Afghanistan wars. VCS believes Congress should also ask VA how many non-Iraq and Afghanistan war veterans are diagnosed with PTSD by VA, and how many of those have approved PTSD claims. This information should shed more light on the issue of how VA handles PTSD healthcare and for claims for all our Nation's veterans.

Sincerely,

Paul Sullivan
Executive Director

"Vietnam Veterans Seek Proof Of Stress-Inducing Events"
The Hartford Courant
By Ann Marie Somma, Courant Staff Writer

May 25, 2008

A Vietnam veteran from South Carolina is searching for three scuba divers who helped him fish dead bodies out of Cam Rahn Bay in Vietnam in 1967.

An air rescue medic now living in Maine is desperately seeking anyone who remembers him killing 18 North Vietnamese during the Tet Offensive between January and March 1968.

A Brookfield vet is hoping to find someone else who saw the explosion of a F-100 fighter bomber aircraft at the Bien Hoa air base in Vietnam in 1966.

Every month, the Vietnam Veterans of America's magazine website is clogged with personal ads posted by vets around the country diagnosed with post-traumatic stress disorder. They may have survived harrowing experiences in Vietnam, but the U.S. Department of Veterans Affairs won't approve their claims for disability unless they can document the exact traumatic episode that triggered the disorder.

Because the service records of so many Vietnam veterans are incomplete and inaccurate, often their only hope is to find a fellow soldier who will write to the VA confirming the traumatic event, known as an in-service stressor.

The letters are known, affectionately, as buddy letters.

Robert Chechoski, a Vietnam veteran in Bridgeport who volunteers his time to help other vets file PTSD disability claims, said the need to produce buddy letters and to prove their trauma is hurtful for those who still remember their bitter homecoming.

"They hid for 30 years. They tried to put Vietnam out of their mind. A lot worked the midnight shift, because they can't deal with people, a lot drank to forget," Chechoski said. "Then something awakens in their head, they go get counseling and help and a lot get denied by the VA."

Burning Embers

The veterans seeking buddy letters served in every branch of the military. They saw soldiers die. Their lives were threatened in ambushes, rocket attacks and shelling in villages and the jungle.

But their military records typically don't include an account of the single traumatic event they witnessed. Their DD214s, the military service records issued by the Department of Defense, are incomplete and inaccurate. Some troops left Vietnam with no records at all. Those who served in top secret government missions were, in essence, never there.

Veterans advocates say the VA's arcane standard of requiring evidence of an in-service stressor has denied thousands of veterans disability pay and continues at a time when the number of Vietnam-era veterans being treated for PTSD in the VA system is increasing.

A 2007 study by Robert Rosenheck and Alan Fontana, two Yale University researchers, found that the number of those vets being treated for PTSD increased from 91,043 in 1997 to 189,309 in 2005. Some experts believe the war in Iraq is triggering Vietnam memories, causing the spike in numbers.

Before the government officially recognized PTSD in 1980, thousands of Vietnam veterans became homeless, turned to drugs and alcohol or died. The VA now considers PTSD a disability and uses a rating system, from 10 to 100 percent, to determine how the illness has affected a veteran's quality of life, relationships and ability to earn a living. Compensation ranges from a few hundred dollars to $2,500 a month.

Chechoski, who served three tours in Vietnam and was diagnosed with PTSD in 1996, offered an explanation of the delayed effects of the disorder.

"Picture a Weber grill. You set a bag of charcoal on fire, then you douse it with a 10-gallon bucket of water. You think you got that fire out, but there is one ember that is still alive and it will ignite sooner or later," Chechoski said.

Armand Flynn's ember ignited on Sept. 11, 2001, after smoldering for more than 30 years.

The Brookfield veteran dealt with Vietnam by living a simple life. He graduated from college, married and raised three children with a career administering compensation benefits for major corporations. But he drank too much. The liquor quelled his panic attacks and insomnia.

On Sept. 11, when the hijacked planes hit the World Trade Center, Flynn flashed back to Vietnam on Oct. 6, 1966.

Flynn says he was working the flight line attached to the U.S. Air Force 6234 Tactical Fighter Wing when a plane loaded with cannons and air-to-air missiles caught fire on the runway at the Bien Hoa air base.

"I saw that pilot go by me minutes earlier, then his plane blew up like an atom bomb. There was fire and noise, stuff cooking off the plane," said Flynn, 63.

After the flashback he had a breakdown, and shortly after that he sought help at the VA in West Haven. A doctor there diagnosed him with PTSD and prescribed a cocktail of pharmaceuticals to ease his depression, panic attacks and insomnia.

The explosion is recorded in the history of Flynn's Air Force unit. But VA personnel trained to search military archives can't find a record of his service in Vietnam.

Flynn says he flew from California for duty in Vietnam in August 1966 and remained there until October before moving to his permanent assignment in Korat, Thailand. The VA says his service records place him only in Thailand.

Last year, seeking a buddy letter to prove he was at the air base, Flynn placed an announcement in the Vietnam Veterans of America magazine.

Hurbert Bradshaw in California responded to Flynn's post. He says he served with Flynn in the 6234 Tactical Fighter Wing in Vietnam and wrote the VA that Flynn was in Vietnam with him.

"I met [Flynn] in Bien Hoa, that's why I wrote the letter," Bradshaw said.

The VA denied Flynn's claim, despite the letter. He is on his third appeal.

"This has been really painful. Every time I have to appeal, I have to reconstruct the stressors, all the things that I buried are coming back, the memories, the nightmares," Flynn said.

He wonders how long he can battle the government, a quest, he said, that has strained his 37-year marriage. He no longer works and relies on VA health benefits. He attends a PTSD group therapy session at the VA every Thursday.

"Is there anything else I missed, anybody I need to contact? Maybe there is a second person? I don't know what to do," Flynn said.

Fixing The Process

Veterans groups have lobbied the VA to modernize the PTSD claims process, and there are efforts in Congress to eliminate the rule that requires proof of an in-service stressor. Now, unless a veteran received a Combat Infantryman Badge or Purple Heart, their stressor must be documented.

U.S. Rep. Tom Allen, D-Maine, introduced legislation in Congress this year that would eliminate the need for veterans to prove a stressor to receive disability compensation for PTSD.

"What these guys experienced transcends military records," Allen said. "We owe it to them. We shouldn't deny them benefits and treatments on a technicality."

Under Allen's Full Faith in Veterans Act of 2008, a diagnosis of PTSD by a mental health care professional who establishes a logical relationship between exposure to military stressors and current PTSD symptoms is enough to prove that the PTSD is service connected.

At a press conference earlier this year, Allen told a group of veterans that his father was the inspiration behind the bill. His father volunteered for the Navy after Pearl Harbor, working control towers on air bases in the South Pacific. The towers were bombed nightly.

But what affected Allen's father the most were the pilots who never returned from missions.

"My father never told me a lot about what happened to him during the war, but I know that when he came back he had what today would be diagnosed as PTSD," Allen said.

Allen said the VA system needs to be overhauled to deal with the impending flood of PTSD claims from those serving in Iraq and Afghanistan. A recent study conducted by the RAND Corporation found that one in every five soldiers, or 300,000 troops of the estimated 1.7 million who have been deployed to Iraq and Afghanistan, have depression and some sign of PTSD.

"There are no front lines in Iraq, and we are going to have the lingering effects of PTSD for a long time," Allen said.

Aaron Entrekin, a Vietnam veteran from Tennessee, said he drank himself through two wives and countless jobs before seeking help at the local VA hospital. Doctors there diagnosed him with PTSD in 2001, but he hasn't found anyone to confirm his stressor.

Entrekin said he ran over a Vietnamese boy while driving a truck in a convoy heading south from Da Nang. He doesn't remember the exact year; 1970 or 1971, he guesses. But he'll never forget the boy's face.

"His dad was holding him in his arms. I see him every night in my dreams and when I close my eyes," Entrekin said. "He was trying to cry, he was bleeding out of his mouth, nose and ears."

Entrekin wanted to take the boy to the hospital.

His lieutenant ordered him to keep driving.

The U.S. Army has no record of the accident. The VA has denied his claim three times.

His announcement in the Vietnam veterans magazine in search of a buddy letter reads, "They called me Slim or Hillbilly." Entrekin hopes the nicknames will jar the memory of someone who served with him in the U.S. Army's 25th Infantry Division 18th Engineer Brigade.

"If you ain't got a Purple Heart, they don't want to help you," he said. "There are a lot of bad things that happened to people in Vietnam who didn't get a Purple Heart."