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Witness Testimony of Mr. Adrian M. Atizado, Disabled American Veterans, Assistant National Legislative Director

Mr. Chairman, Ranking Member Miller and other Members of the Subcommittee:

Thank you for inviting the Disabled American Veterans (DAV), an organization of 1.3 million service-disabled veterans devoted to rebuilding the lives of disabled veterans and their families, to testify at this important hearing to examine the Department of Veterans Affairs’ (VA) Readjustment Counseling Service provided to veterans by its “Vet Center” program. 

Mr. Chairman, we appreciate your decision to hold this hearing, since many years have passed since this Subcommittee has examined the Readjustment Counseling Service of the Veterans Health Administration (VHA).  This examination is extremely timely, given the ongoing wars in Iraq and Afghanistan.

PROGRAM HISTORY

Congress in Public Law 96-22 established the Readjustment Counseling Service in 1979.  President Jimmy Carter proposed a similar program of readjustment services for veterans in a special Presidential Message sent to Congress October 10, 1978.  That Presidential Message recognized a number of unmet health, benefits, employment, financial, and readjustment needs in the population of veterans that had served our Nation during the Vietnam Era.

It should be remembered from that time that Vietnam Era veterans, a group of over 8.7 million individuals who were called to service mostly by involuntary conscription in a very unpopular and politically charged overseas war, came home from that service with medical, personal and psychological burdens that the U.S. Government minimized and largely ignored for years.  The Veterans’ Administration, which at that time was an Independent Establishment of the federal government rather than a Cabinet Department, was managed by World War II and Korean War veterans, and its patient population consisted primarily of veterans of those same eras.  The VA then was steeped in the traditions and cultures of that generation’s experience in war and of the post-war boom years. 

For a variety of reasons, a wide gulf developed between veteran populations and seemed to become essentially a reflection of a “father-prodigal son” relationship.  As a general matter, Vietnam veterans did not seek out traditional VA health care and other benefits or services, and in particular, VA mental health services.  Additionally, World War II-veteran influenced VA facilities did not reach out to them as a new generation of combat veterans in need.  There was a sense that Vietnam veterans had “lost” the war in Vietnam, and the entire nation and the Veterans’ Administration turned its back on them, confusing the war with the warriors.  However, because of the leadership of one of those Vietnam veterans – the Honorable Max Cleland, who at that time was serving as Administrator of Veterans Affairs – the specialized and emerging readjustment services, health care and other needs of Vietnam veterans were brought to the forefront of concerns of this Committee, its counterpart in the other Body, and the Administration of President Carter. 

Max Cleland went on from his VA position to other positions of public trust, including serving as a U.S. Senator from Georgia, but we at DAV believe that former VA Administrator Cleland’s greatest personal legacy to Vietnam veterans is the establishment of the VA Readjustment Counseling Service.  Hundreds of thousands, and perhaps millions, of DAV members and other disabled veterans have regained their health because of the existence of the Vet Center program.  Today, the Readjustment Counseling Service conducts its programs through 209 facilities called “Vet Centers.”  These facilities have grown and matured over the years since first established as “storefronts” primarily in urban areas, into highly skilled, specialized psychological counseling centers that meet vital needs of multiple generations of veterans and their families. 

DEMAND FOR SERVICES

VA estimated the number of Operations Enduring and Iraqi Freedom (OEF/OIF) veterans it will see in fiscal year (FY) 2007 to be 209,308; however, as of April 2007, VA reported that 229,015 OEF/OIF veterans had actually sought VA health care since FY 2002.  Of those OEF/OIF veterans that have sought VA care, a total of 83,889 (36.6%) received an initial diagnosis of a mental health disorder such as adjustment disorder, anxiety, depression, post- traumatic stress disorder (PTSD) and the effects of substance abuse.  Some 39,243 (17.1%) unique enrolled OEF/OIF veterans have received a diagnosis of PTSD at VA medical facilities.

The most recent data available to DAV indicates the Vet Centers are providing over 1.17 million counseling visits annually to veterans.  However, we are concerned that the expanding role of Vet Centers which now includes providing military casualty assistance functions in coordinating and directly providing bereavement counseling to families of those who have been lost in the current wars; newly energized outreach activities averaging more than 13,000 outreach contacts each month to bring knowledge of VA services to the newest generation of combat veterans; and, other new responsibilities that may be assumed by Vet Center personnel, has increase this program’s workload for OEF/OIF veterans from less than 20,000 visits in fiscal year 2004, to about 242,000 visits in fiscal year 2006.

VA has intensified its outreach efforts to OEF/OIF veterans through the Vet Centers.  Those centers now make an annual average of 250,000 referrals to the VHA.  The department reports relatively high rates of health care utilization among this veteran population.  Nevertheless, with such ready access to VA health care provided without cost for two years following separation from service for problems related to combat exposure, it should be noted that roughly two-thirds of separated OEF/OIF veterans have not yet turned to VA for health care.  Furthermore, with post-deployment positive screening rates for mental health concerns around 32% - 36% and 1.5 million individuals having served in OEF/OIF, a very rough estimate is that there may be 480,000 to 540,000 OEF/OIF veterans who have mental health concerns but VA is only seeing a fraction of them.

STRAINING TO MEET THE NEEDS

In October of 2006, subsequent to the VA Secretary’s announcement of the permanent hiring of 100 OIF/OEF combat veterans to serve as peer counselors[1] at Vet Centers and the opening of 2 new Vet Centers[2] for a total of 209, the House Committee on Veterans Affairs issued a staff report on the capacity of the Vet Centers.  The report found that in the nine months from October 2005 to June 2006, the number of OEF/OIF veterans turning to Vet Centers for PTSD services had doubled.  All of the Vet Centers surveyed reported a significant increase in outreach and services to OEF/OIF veterans.  Half of the Vet Centers reported that this increase affected their ability to treat existing workloads. 

According to news reports on a subsequent internal Vet Center report, 114 of the 209 Vet Centers need at least one additional psychologist or therapist to help with the influx of new veterans.  Twenty-two Vet Centers reported that they couldn’t provide family counseling when necessary (“Staffing at Vet Centers Lagging,” USA Today, April 19, 2007).  We at DAV believe that VA staffing should be increased in existing centers to ensure all veterans—including previous generations of combat veterans—who need help at Vet Centers can gain access to these important readjustment services.

Moreover, we are concerned that highly dedicated Vet Center personnel may be nearing their maximum efficiency and ability to maintain their professional effectiveness.  We believe the Subcommittee should exercise strong oversight in this area to ensure that Vet Centers are being properly staffed for the expanding functions they are expected to perform.  We believe VA has the resources available to increase Vet Center staffing, and should do so at the earliest possible date.

            In February of 2007, the Department of Veterans Affairs Fiscal Year 2008 Budget Estimate indicates that VA plans to operate 209 Vet Centers in 2008, and that, “Vet Centers are located in the community, outside of the larger medical facilities, in easily accessible, consumer-oriented facilities highly responsive to the needs of the local veterans.  As provided at Vet Centers, VA’s readjustment counseling mission features community-based service units emphasizing post-war rehabilitation, a varied mix of social services addressing the social and economic dimensions of post-war readjustment, extensive community outreach and brokering activities, psychological counseling for traumatic military-related experiences to include PTSD, and family counseling when needed for the veteran’s readjustment. In carrying out its mission, the Vet Centers prioritize services to high-risk veterans to include high-combat exposed, physically disabled, women, ethnic minority, homeless, and rural veterans.”

As shown below, VA states that the increase in requested funding is required to provide readjustment counseling at VA’s Vet Centers to veterans who have served in the Global War on Terrorism (GWOT).  VA plans to operate 209 Vet Centers in 2008 that are essential for accessing and treating PTSD or other conditions experienced by our veterans.  VA also states that it expects an increase in PTSD as veterans return from OEF/OIF after multiple tours of duty.

Readjustment Counseling

2006

2007

2008

Obligations ($000)................................

$100,333

$110,300

$114,822

Visits (000)...........................................

1,170

1,185

1,200

Concurrent to this budget request, VA announced its intention to establish 23 additional Vet Centers distributed throughout the nation, which would bring its total capacity to 232 service delivery points.  According to VA, only three of these centers will be opened this year and the remainder are planned to be activated in 2008.  Given growing demand for Vet Center services for chronic and acute PTSD and other adjustment disorders, substance abuse, marital dissolution, and financial problems among active duty, National Guard, and Reserve forces who have been deployed in these wars, and given the availability of significant new Medical Services funding in VA health care, we question why the bulk of these Vet Center openings are being delayed.

ADAPTING TO A NEW GENERATION OF VETERANS

Mr. Chairman, in examining the needs of the newest generation of veterans disabled by war, the Independent Budget for Fiscal Year 2008recommended and urged that both VA and DoD adapt their programs to the needs being presented by new veterans, rather than require new veterans to adapt their needs to the programs traditionally offered.  DAV believes that, particularly in respect to mental health care needs, significant VA adaptation is still imperative.  As indicated earlier, the Vet Centers were established because Vietnam veterans saw little about the “old’ Veterans’ Administration of thirty-five years ago that appealed to them.  That gulf provided the impetus for the creation of the Vet Center program. 

From our contacts today with veterans of the wars in Iraq and Afghanistan, we are learning that today’s VA, including its Readjustment Counseling Service, may not generally be perceived as an organization that is tailoring its programs to meet the emerging needs of our newest generation of veterans.  Many of these veterans are asking the government to allow them a choice of private care rather than be relegated to care in the VA system.  Others wounded in these wars seem to be resisting or delaying a smooth transition to VA health care

Rather than react swiftly in authorizing dramatic shifts to private health care of uncertain quality and questions in continuity, we urge prudence on the part of the Subcommittee.  We hope VA will adjust its programs in a way that provides a more welcoming, age appropriate, culturally sensitive and responsive service to our newest generation of combat veterans, in particular the wounded, whether with “visible” or invisible injuries.  We do note that VA’s recent announcements of employing outreach specialists with direct OEF/OIF experience, designating case managers and others to assist with OEF/OIF veterans’ special needs, and other similar initiatives, are moves in the right direction.  We appreciate these initial changes.  We hope more of these kinds of initiatives can be sustained and expanded where appropriate, to make VA services more relevant, age appropriate and more effective in meeting these new veterans’ needs.  We would be pleased to follow up with you and your Committee staff to ensure you gain full understanding of our views on these matters.

CLOSING

Without question, Americans are united in their desire and obligation to care for those who have been severely wounded as a result of military service.  This obligation is a continuing cost of national defense.  Service members who have suffered catastrophic wounds with multiple amputations, traumatic brain injury, or severe burns draw great public sympathy and admiration for their sacrifices.  But a greater challenge exists for those that suffer the devastating effects of PTSD and other injuries with mental health consequences that are not so easily recognizable and can lead to serious health catastrophes, including suicide and other social pathologies, if they are not treated.

We can meet that challenge by doing everything in our power to bring these resources into place to promote early and intensive interventions, which are critical in stemming the development of chronic PTSD and other related problems, without simultaneously displacing older veterans with chronic mental illnesses under VA care.  Finally, we must also ensure that family members of veterans devastated by the consequences of PTSD, adjustment disorders, and other injuries have access to appropriate and meaningful VA services.

Mr. Chairman, thank you for considering the views of DAV on the status of the Readjustment Counseling Service of the Veterans Health Administration.  I will be pleased to address any questions from you or other Members of the Subcommittee.  This concludes my testimony.


[1]VA Press Release April 6, 2005 and confirmed during the House Committee on Veterans' Affairs, Statement of the Honorable R. James Nicholson, Secretary, U.S. Department of Veterans Affairs, Testimony Before the House Committee on Veterans' Affairs, May 9, 2007

[2] VA Press Release June 28, 2006