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Witness Testimony of Paul Sullivan, Veterans for Common Sense, Executive Director

Veterans for Common Sense (VCS) thanks Committee Chairman Filner, Ranking Member Buyer, and Members of the House Veterans’ Affairs Committee for inviting us to testify about “The True Cost of War,” and the consequences of the Iraq and Afghanistan conflicts.  We are honored to be in the company of experts, advocates, and fellow veterans to discuss this important long-term issue.

VCS begins by presenting the Committee with the most salient official government statistics about the human and social costs of the current conflicts.  Our top priority for this hearing is to inform Congress, the press, and the American public about the human cost of the Iraq and Afghanistan wars because everyone in our country is impacted by high taxes, spending, and lost opportunity costs caused by war.

As of March 2010, government statistics show 565,000 new veteran patients were treated at Department of Veterans Affairs (VA) hospitals and clinics since 2001.  As of today, based on an average of 9,000 new patients each month, VCS estimates the current count of VA patients is approximately 619,000.

The significant post-deployment statistics about our veterans must be contrasted with events during 2002, when the Administration had no casualty estimate, no plan to monitor or estimate fatal or non-fatal casualties, no plan for caring for non-fatal casualties, and no dedicated long-term funding for non-fatal casualties.  

The consequences of the war are high, especially for non-fatal casualties.  There is a general lack of awareness about the hundreds of thousands of post-deployment casualties.  And there appears to be a lack of urgency to adequately and promptly meet our veterans’ growing needs.  Therefore, VCS urges Congress to pass a new law mandating that the Administration must estimate, monitor, plan, and fund healthcare and disability benefits for our casualties before starting or entering into a war.

VCS broadly defines casualty.  This includes battlefield deaths, and caring for our grieving families.  Casualty includes our servicemembers who become wounded, injured, or ill on the battlefield as well as during training.   This includes post-war medical conditions among our veterans not immediately apparent while in the military, such as toxic exposures, traumatic brain injury, and mental health conditions.

Part One: Official Statistics

Government statistics paint a disturbing picture of enormous human suffering among our servicemembers and veterans.  VCS obtained the following facts from the Department of Defense (DoD) and VA using the Freedom of Information Act (FOIA).

According to DoD:

  • At the end of August 2010, a total of 5,670 U.S. servicemembers died in the Iraq War and Afghanistan War combat zones.
  • At the end of August 2010, a total of 91,384 U.S. servicemembers in the two war zones were wounded or were medically evacuated due to injuries or illnesses that could not be treated in the war zones.
  • The grand total of U.S. battlefield casualties is more than 97,000.

According to VA:

  • As of March 2010, VA treated and diagnosed 565,000 new, first-time Iraq War and Afghanistan War veteran patients.  Again, based on VA data trends, VCS conservatively estimates VA has treated 619,000 patients as of today.
  • VA’s count excludes veterans who sought private care, retired veterans treated by the military, and student veterans treated at campus clinics.  VA’s count also excludes treatment for wounded, injured, or ill civilian contractors.
  • As of June 2010, VA received 513,000 disability compensation and pension claims filed by our Iraq War and Afghanistan War veterans.

VCS Analysis:

  • When VA and DoD reports are viewed side-by-side, VA data reveals 100 new, first-time veteran patients for each battlefield death reported by DoD.
  • At the current rate of approximately 9,000 new veteran patients and claims entering the VA medical and benefits systems each month, VCS estimates a cumulative total of one million patients and claims by the end of 2014.

Missing Facts:

In order for VA and DoD to properly manage the human and financial cost of providing medical care for our casualties, more robust data must be collected and analyzed immediately by the Administration, Congress, academics, and advocates. 

  • VA must be able to answer simple, straightforward questions.  For example, what is the total number of unique deployed Iraq and Afghanistan war veterans who have received any VA benefit (healthcare, disability, etc.) since returning home?  In another example, is VA able to accurately and consistently provide the expenditures for all of these VA programs?  VCS remains alarmed VA is incapable and unwilling to answer these two easy questions.
  • DoD and VA must prepare an official accounting of the financial costs for medical care, disability benefits, education benefits, life insurance, home loan guaranty, and all other DoD and VA benefits for servicemembers, veterans, and families.  For the past several years, VCS has requested this information from VA using the Freedom of Information Act.  VA has not provided any cost data.  Starting in 2001, VA employees urged VA leaders to begin tracking war-related benefit use and costs, and nearly all requests were refused.
  • DoD must provide an accounting of all discharges by type and branch of service, sorted by year, to monitor trends for both deployed and non-deployed servicemembers since 1990.  Two prior hearings by this Committee documented tens of thousands of improper discharges, often for veterans at high risk of readjustment challenges due to TBI and PTSD.  As the number of less than fully honorable discharges increases, additional highly vulnerable veterans flood into society.  Many of these veterans either don’t seek VA assistance or are refused VA help, instead turning to private, state, local, or university campus programs for assistance that should have been provided by the Federal government.
  • VA should monitor negative post-deployment outcomes, such as homelessness, suicides, divorce, and crime, as well as state, local, and private expenditures on veterans.  The most important oversight remains the Administration’s inability to provide complete and accurate active duty, Reserve, National Guard, and veteran suicide data.  Every year DoD has set new, and highly disturbing, records of active duty suicides.  Most of the initial monitoring began with FOIA requests from advocacy organizations or journalists investigating patterns of disturbing developments such as suicides, homicides, unemployment, and homelessness.  VA and DoD only began limited monitoring and research after repeated advocacy organization, media, and Congressional inquiries.
  • The Department of Labor should monitor unemployment and underemployment, both for veterans and families.  Veterans often move from the military installation to their home town shortly after discharge.  Often, these cross-country moves uproot spouses from their jobs.  The use of the Post-9/11 GI Bill, legislation introduced by Senator Jim Webb of Virginia, by hundreds of thousands of Iraq and Afghanistan war veterans may be masking already alarming reports of high unemployment among returning veterans.
  • VA and DoD should monitor and report on the positive post-combat, post-deployment, and post-military outcomes of our veterans.  For example, new businesses started by veterans, higher wages earned by veterans, diplomas earned by veterans, increased homeownership among veterans, and other signs of a vibrant post-war adjustment to civilian life. 
  • VCS provides additional examples of the cost of war at the end of our statement.  The important statistics were summarized by reporters in the article, “The Numbers,” published last weekend by the Fayetteville Observer. 

Part Two: Need for Trust Fund and National Plan

VCS believes we must learn from the past so we do not repeat mistakes.  VCS endorses the Vietnam Veterans of America, when they remind us that, “Never again shall one generation of veterans abandon another.”  This is why Veterans for Common Sense fully endorses the proposal by Linda Bilmes and Joseph Stiglitz to create a Trust Fund to make sure our veterans receive the healthcare and benefits they earned. 

As a non-profit advocacy organization, VCS uses the Freedom of Information Act to obtain data from DoD and VA to monitor and publicize the needs of our veterans.  VCS was honored to provide our data to Linda Bilmes and Joseph Stiglitz for their book, The Three Trillion Dollar War: The True Cost of the Iraq Conflict (2008).  In their ground-breaking work on the subject of the cost of war, Bilmes and Stiglitz called for the creation of “A Veterans Benefit Trust Fund . . . so that veterans’ health and disability entitlements are fully funded as obligations occur.”  In their book, the experts stated:

There are always pressures to cut unfunded entitlements.  So, when new military recruits are hired, the money required to fund future health care and disability benefits should be set aside (“lockboxed”) in a new Veterans Benefit Trust Fund.  We require private employers to do this; we should require the armed forces to do it as well.  This would mean, of course, that when we go to war, we have to set aside far large amounts for future health care and disability costs, as these will inevitably rise significantly during and after any conflict (“Reform 12,” page 200).

The issue of establishing a Trust Fund is timely because we have now endured nine years of war in Afghanistan, and seven years of conflict in Iraq.  In 1995, Congress was forced to intervene and appropriate $3 billion in emergency funding for VA.  One of the main reasons cited by VA for the funding crisis was the unexpected and unanticipated flood of Iraq and Afghanistan war veterans.  Thanks to the strong pro-veteran leadership of Senator Patty Murray, the daughter of a war veteran, VA was given additional resources to meet the tidal wave of new, first-time Iraq and Afghanistan war veteran patients flooding into VA.

VCS remains a strong supporter of VA, and VA has made many improvements in personnel, budgeting, and policies in the past 20 months.  VCS wants VA to live up to the high standard set by President Abraham Lincoln: “To care for him who shall have borne the battle and for his widow and his orphan.”  VCS encourages Congress, VA, and DoD to learn lessons from past mistakes.  VCS urges Congress to mandate national monitoring and planning for the return of our servicemembers.  A national plan must also include fully funding all needed health care and benefits for our veterans.

Honoring and remembering our fallen, our wounded, our injured and ill, VCS quotes the eloquent poetry of Archibald MacLeish, a World War I veteran and former head of the Library of Congress.  During World War II, MacLeish wrote:

They say, We leave you our deaths: give them their meaning: give them an end to the war and a true peace: give them a victory that ends the war and a peace afterwards: give them their meaning.

As an organization of war veterans, Veterans for Common Sense is here today to give meaning to all of our nation’s fallen, wounded, injured, and ill who deployed to Southwest Asia since 1990: Our Nation must learn the painful lessons from prior wars and take care of our veterans who enlist in our military to protect and defend our Constitution, even when the American public does not support the war.  

Gulf War combat veterans formed VCS in 2002.  After our return from Iraq in 1991, we veterans learned President George H. W. Bush led our nation to war based on false pretenses.  There was no formal declaration of war by Congress, only an “authorization for the use of force.”  There was no threat to our Constitution or the safety of our Nation, as this first invasion of Iraq was a war of choice.

The most painful lesson for Gulf War veterans has been the continuing lack of a national plan to care for our returning veterans, starting in 1991.  The brutal irony today is the fact the Agent Orange Act of 1991 was enacted by Congress shortly after the Gulf War began, nearly 25 years after the Vietnam War began.  On October 30, 2010, VA is set to finally begin, in earnest, providing additional health care and disability benefits to seriously ill Vietnam War veterans due to exposure to Agent Orange.

We tried to learn a lesson from past government mistakes.  On March 10, 2003, as our Nation prepared to re-invade Iraq, VCS petitioned for calm and reason.  As war veterans who actually served on Iraqi battlefields during 1991, VCS wrote a detailed letter to President George W. Bush co-signed by 1,000 veterans:

Over the long term, the 1991 Gulf War has had a lasting, detrimental impact on the health of countless people in the region, and on the health of American men and women who served there. Twelve years after the conflict, over 164,000 American Gulf War veterans are now considered disabled by the U.S. Department of Veterans Affairs. That number increases daily ...  Further, we believe the risks involved in going to war, under the unclear and shifting circumstances that confront us today, are far greater than those faced in 1991. Instead of a desert war to liberate Kuwait, combat would likely involve protracted siege warfare, chaotic street-to-street fighting in Baghdad, and Iraqi civil conflict. If that occurs, we fear our own nation and Iraq would both suffer casualties not witnessed since Vietnam.

We regret to inform you that the White House never answered our letter.  President George W. Bush started his war of choice based on false pretenses.  He ignored the wise and experienced counsel of the only group of living Americans who had ever fought in Iraq.  Our veterans who raised serious, legitimate concerns about escalating the Gulf War with another invasion of Iraq were brushed aside in the rush to war.

Earlier, on October 12, 2002, our VCS Executive Director, Charles Sheehan Miles, published an editorial criticizing the Congressional Budget Office (CBO) for failing to estimate the cost of caring for war and post-war casualties.  The decorated Gulf War veteran wrote:

In a surprisingly rosy cost estimate of something which can’t be accurately estimated, the Congressional Budget Office Monday released an analysis of what Gulf War II might cost in real dollars paid by U.S. taxpayers.  Only they left out the most important part: the casualties.  The CBO estimate is naïve and unrealistic when you consider the kind of war we are preparing to enter—an open-ended war of regime-change and occupation and empire building that may involve heavy casualties in an urban setting such as Baghdad. The CBO report is illuminating and instructive for what it avoids. CBO uses the word “assume” 30 times, “uncertain” 8 times, “unknown” 4 times. Finally, twice it says there is “no basis” for an estimate on key items. In other words, it’s a wild guess: kind of like taking your broker’s advice to buy Enron or WorldCom last summer.  CBO states up front: “CBO has no basis for estimating the number of casualties from the conflict,” therefore, any discussion of casualties was simply excluded. 

At the end of the day, robust monitoring, planning, implementation, and oversight are best for our returning veterans.  VCS advocates pre- and post-deployment exams, as required by the 1997 Force Health Protection Act (PL 105-85) as well as hiring more DoD medical professionals to provide exams and treatment.  VCS believes early evaluation and treatment are best because treatments are the most effective and often the least expensive.  Recently published medical research conducted by Dr. Susan Frayne, of the VA Palo Alto Health Care System and Stanford University supports our VCS advocacy.  Dr. Frayne told Businessweek on September 24, 2010:

Looking to the future, the impetus for early intervention is evident. If we recognize the excess burden of medical illness in veterans with PTSD who have recently returned from active service and we address their health care needs today, the elderly veterans of tomorrow may enjoy better health and quality of life. 

Conclusion

Why does Veterans for Common Sense care about the U.S. casualties from the Iraq and Afghanistan wars?  Our founders are Gulf War veterans, and many Iraq War and Afghanistan War veterans are members.  When we returned home, we encountered a DoD and VA medical system unable and unwilling to listen to our concerns about toxic exposures Iraq and Kuwait in 1991.  Based on our experience, in late 2002, we saw the handwriting on the wall: misleading information to start another war of choice.  There were other disturbing signs: CBO, the White House, VA, and DoD had no post-deployment plan.  As Gulf War combat veterans and advocates, we could see that in 2002 the George W. Bush Administration was going to repeat the miscalculation the George H. W. Bush Administration made in 1990 by failing to estimate or prepare for the true long term costs of war.  This unique hearing presents us with a rare opportunity to begin a dialog and plan for our long-term casualties.

The statistics describing the damage to our Gulf War veterans are stunning in depth and scope.  As of 2009, the widely respected and credible Institute of Medicine, part of the National Academy of Science, estimated as many as 250,000 Gulf War veterans remain ill after exposures to toxins while deployed to Southwest Asia during Desert Shield, Desert Storm, and Provide Comfort between 1990 and 1991.  This research, mandated by the “Persian Gulf Veterans Act of 1998,” is confirmed by VA’s Research Advisory Committee on Gulf War Veterans’ Illness.

Here are the two messages VCS sends to Congress, VA, DoD, and fellow Americans. First, as of today, VCS estimates our nation currently has as many as 619,000 Iraq and Afghanistan war veteran patients, plus a similar number of claims.  VA can reasonably expect another half million new veteran patients from the two wars by the end of 2014, for a total of one million current war veteran patients and claims.   This estimate is supported by the fact 44 percent of current Iraq and Afghanistan war veterans were already treated at VA.  Based on 2.2 million servicemembers deployed to the two war zones, that also equals one million patients.  Second, our nation has no strategic plan to identify, monitor, treat, and compensate those veterans.

In order to resolve this current problem, Veterans for Common Sense urges Congress to demand transparency from DoD and VA.  Furthermore, VCS urges Congress to establish a Trust Fund, as proposed by Linda Bilmes and Joseph Stiglitz, so our Nation never again faces billion-dollar budget short-falls at VA and national scandals such as Walter Reed.

Again, we thank Chairman Filner and Ranking Member Buyer for your interest in this important issue.  As a Gulf War veteran, I remain impressed with your advocacy for our veterans.  We want our service to our Nation to have meaning.  However, I remain deeply disappointed how, after 20 years of warfare in Iraq and neighboring countries, our Administration can’t tell us, with accuracy, the full human and financial costs of the conflict.  Even more troubling is the lack of monitoring, planning, and funding to provide care and benefits for we who have defended our Constitution.  Please fix this now.

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News Articles Cited by VCS:

The wars in Iraq and Afghanistan have taken a toll on soldiers that isn't readily visible. In a five-part series published on September 26, 2010, in The Fayetteville Observer and on www.fayobserver.com, reporters Greg Barnes, Jennifer Calhoun and John Ramsey examine the mental health challenges facing Fort Bragg and how they will impact the military and civilian communities.

“The Numbers”—A look at some of the research into the mental health of soldiers and their families.

  1. 38 percent of Army soldiers and 31 percent of Marines report symptoms of psychological problems. The figure rises to 49 percent for members of the National Guard.  Source: Department of Defense Task Force on Mental Health, June 2007.
  2. Lengthy U.S. Army deployments increase the occurrence of depression, anxiety, sleep disorders and other mental health diagnoses for soldiers' wives left at home. Among women whose husbands were deployed during the study period, 36.6 percent had at least one mental health diagnosis. Source: Jan 2010 study by RTI International, the University of North Carolina at Chapel Hill and the Uniformed Services University of the Health Sciences.
  3. The overall rate of child abuse and neglect was more than 40 percent higher while a soldier-parent was deployed for a combat tour than when he or she was home.  Source: Study in 2007 by RTI International and the University of North Carolina at Chapel Hill's School of Public Health. The study was funded by the U.S. Army Medical Research and Materiel Command.
  4. The overall rate of child abuse and neglect was more than 40 percent higher while a soldier-parent was deployed for a combat tour than when he or she was home. Source: Study in 2009 led by Dr. Eric M. Flake of the Madigan Army Medical Center, Tacoma, Wash.
  5. Children of U.S. military troops sought outpatient mental health care 2 million times last year, double the number at the start of the Iraq war. The number of military children who were hospitalized for mental health reasons also skyrocketed, from 35,000 to 55,000 during that time. Source: 2009 analysis of internal Pentagon documents by The Associated Press.
  6. Researchers found that 37 percent of Iraq and Afghanistan war veterans who used the veterans health system for the first time between April 1, 2002, and April 1, 2008, received a mental health diagnoses. Of those, 22 percent were diagnosed with PTSD, 17 percent with depression and 7 percent with alcohol abuse. One-third of the people with mental health diagnoses had three or more problems, the study found. The study says fewer than 10 percent of the veterans diagnosed with PTSD received the appropriate level of care at VA facilities. Source: 2010 study by the San Francisco VA Medical Center and University of California-San Francisco.
  7. Stigma remains a critical barrier to accessing needed psychological care. Analysis revealed that 20 percent to 50 percent of active duty servicemembers and Reservists reported psychosocial problems, relationship problems, depression and symptoms of stress reactions, but fewer than 40 percent sought help for their problems. Source: Report of the Department of Defense Task Force on Mental Health, June 2007.
  8. "The Task Force was not able to find any evidence of a well-coordinated or well-disseminated approach to providing behavioral health care to servicemembers and their families... Another concern identified by the Task Force involves the care provided to servicemembers as they transition from the Military Health System to the VA system." Source: Report by the American Psychological Association Presidential Task Force on Military Deployment Services for Youth, Families and Service Member, 2007.

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“Veterans With PTSD Suffer More Physical Ailments Than Their Peers; Female vets with disorder plagued by more medical illnesses than male counterparts, study shows”

Published on September 24, 2010, by HealthDay News / Businessweek 

U.S. soldiers with post-traumatic stress syndrome (PTSD) returning from the wars in Iraq and Afghanistan suffer more physical ailments than those with no mental health issues, and this effect is stronger in women than men, a new study shows.

The findings suggest that veterans with PTSD need closer integration of their physical and mental health care, said Dr. Susan Frayne, of the VA Palo Alto Health Care System and Stanford University.  The study appears online in the Journal of General Internal Medicine.

The researchers analyzed data from more than 90,000 U.S. veterans who used VA services and found that women with PTSD had a median of seven physical ailments, compared with a median of 4.5 among those with no mental health issues. Lower spine disorders, headache and leg-related joint disorders were the most common physical complaints.

Among men, those with PTSD had a median of five physical ailments, compared with a median of four for those with no mental health concerns. Lower spine disorders, leg-related joint disorders, and hearing problems were the most common physical conditions.

"Health delivery systems serving our veterans with post-traumatic stress disorder should align clinical services with their medical care needs, especially for common diagnoses like painful musculoskeletal conditions," Frayne said in a journal news release. "Looking to the future, the impetus for early intervention is evident. If we recognize the excess burden of medical illness in veterans with PTSD who have recently returned from active service and we address their health care needs today, the elderly veterans of tomorrow may enjoy better health and quality of life," she concluded.