Chairman Filner, Ranking Member Buyer, and distinguished Members of this committee, on behalf of our officers, Board of Directors, and members, thank you for allowing Vietnam Veterans of America (VVA) the opportunity to present our testimony today regarding the implementation of the health effects of the Vietnam War and the efforts to discern those effects, including the National Vietnam Veterans Longitudinal Study.  

National Vietnam Veterans Longitudinal Study

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 early intervention by psychological personnel. No one really knows how serious their emotional and mental problems will become, nor how chronic the neuro-psychiatric wounds (particularly PTSD) and the resulting impact that this will have on their physiological health.  However, reports from researchers at Walter Reed have suggested that troops returning from service in Afghanistan and Iraq are suffering mental health problems at rates at least comparable to or higher than the levels seen in Vietnam War veterans, if indeed not higher rates. 

There is no reason to believe that the rate of veterans of this war having their lives significantly disrupted at some point in their lifetime by PTSD will be any less than those estimated for Vietnam veterans by the National Vietnam Veterans Readjustment Study. There is mounting peer reviewed evidence that the incidence of PTSD will be even greater than in the Vietnam generation, largely because of ever longer exposure to hostile action.

Results from the original NVVLS which was conducted more than 20 years ago demonstrated that some 15.2 percent of all male and 8.5 percent of all female Vietnam theater veterans were current PTSD cases, e.g., at some time during six months prior to interview.  Rates for those exposed to war zone stress were dramatically higher – a four-fold difference for men and seven-fold difference for women – than rates for those with low or moderate stress exposure.  Rates of lifetime prevalence of PTSD were 30.9 percent among male and 26.9 among female Vietnam theater veterans.  Comparisons of current and lifetime prevalence rates indicate that 49.2 percent of male and 31.6 percent of female theater veterans, who ever had PTSD, still had it at the time of their interview.  Thus the NVVLS was a landmark investigation in which a national random sample of all Vietnam theater and era veterans, who served between August 1964 and May 1975, provided definitive information about the prevalence and etiology of PTSD and other mental health readjustment problems. The study over-sampled African-Americans, Latinos, and Native Americans, as well as women, enabling conclusions to be drawn about each subset of the veterans’ population.

The NVVLS enabled the American public and medical community to become aware of the documented high rates of current and lifetime PTSD, and of the long-term consequences of high stress combat exposure.  Because of its scope, the NVVLS has had a singular effect on VA policies, health care delivery, and service planning.  In addition, because the study clearly demonstrated high rates of PTSD and strong evidence for the persistence of this disease, it was generally accepted that the VA would pursue a follow-up, or longitudinal, study of the original participants in this seminal research project.

Thus in 2000, Congress, by means of Public Law 106-419, mandated the VA to contract for a subsequent report, using the same participants, to assess their psychosocial, psychiatric, physical, and general well-being.  Such research would become a longitudinal study of the mortality and morbidity of the participants, and draw conclusions as to the long-term effects of service in the military as well as about service in the Vietnam combat zone in particular. The law requires that the VA use the previous report, and the same sample population, as the basis for the longitudinal study.

In early 2001, the VA solicited proposals for non-VA contractual assistance to conduct a longitudinal study of the physical and mental health status of a population of Vietnam era veterans originally assessed in the NVVLS.  It is apparent that a follow-up to the NVVLS is necessary to meet the requirements of the law, and to do what just makes sense in both policy and scientific terms.  However, not only has the VA failed to meet the letter of the law, there has been no effort to build upon the resources accumulated from this unique and comprehensive study of Vietnam veterans in a highly cost-efficient and scientifically compelling manner. 

A longitudinal study would provide clues about which VA health care services are effective and about ways to reach veterans who receive inadequate services or do not seek them at all. This has important consequences for America’s current veterans, and for future veterans not to mention the casualties returning today from the wars in Iraq and Afghanistan.

At that same hearing on Research & Development on June 7, 2006, the VA also said that it could not conduct the study because staffers could only find 300 of the original more than 2,500 persons in the statistically valid random sample chosen by the Gallup Organization at a public cost of more than $1 million in 1984 dollars. If that were true (which strains credulity at best), then that would mean that 85 percent of that valid national sample have died in the past 25 years. VVA would suggest that, if true, this should be front-page news.  The VA has claimed in the past tat they would be better off using the widely discredited and failed “Twins” study data base from the Centers for Disease Control and Prevention (CDC) that has no women at all and not nearly enough African-Americans, Hispanics, or Asian-Americans to make valid conclusions. Furthermore, the twins “sample of convenience” database is so small that it is not a statistically valid random sample for anybody. One can speculate that the VA has refused to obey the law because officials do not want a longitudinal study, or perhaps they do so because they do not want validation of the results of what the NVVLS may demonstrate in regard to high mortality and morbidity of Vietnam veterans, especially those most exposed to combat.

It is now clear that the VA has been ignoring the law and the Congress and just plain refusing to undertake the study, until recently. It also seems clear that some in the VHA hierarchy intend to continue delaying the study and/or doing everything they can to stop the study from being done correctly, despite the orders from Secretary Shinseki last September 15.  Clearly the senior officials in the Office of Research & Development (ORD) think they can act this way with impunity, and so far there has been no action or repercussions from this “slow rolling” dilatory behavior to disabuse them of their hubris.

The VA has said in past Congressional testimony that “the Inspector General stopped the study,” when in fact the Inspector General (IG) has no line authority to do any such thing. The then Undersecretary and Secretary halted the study. The only real criticism by the IG was for VHA failing to follow proper contract procedures or exercise proper oversight. The VA convinces no one that this decision is anything by the so-called permanent bureaucracy to try and minimize possible future costs to the VA by underestimating the needs of combat veterans.

It has now come to our attention that the VA, though their contract officer is apparently still demanding of the Research Triangle Institute (RTI) to know the names and social security numbers of the participants in the original study, who had been assured anonymity. Previous as well as current VHA leaders not only have tried to besmirch the reputation of this respected research institution by citing things in a report by the VA IG that the report did not contain, but now they are threatening RTI with legal and or other punitive actions, through the VA contract officer, if they don’t violate privacy rights of the participants in this study. This unconscionable effort to compromise the study population, to violate basic scientific principle of protection of human subjects, as well as an effort to again violate the privacy rights of the individuals concerned, must be stopped by Congress before the VA totally mucks things up and precludes a proper follow-up study ever being done on this population.

Secretary Shinseki ordered VHA and ORD to move forward to complete the replication of the National Vietnam Veterans Readjustment study, thereby making it a robust longitudinal mortality and morbidity study of Vietnam veterans (NVVLS), has resulted in inaction since he announced the order to proceed on September 15 of last year. There has not even been a “Sources Sought” notice put out to discover which private research institutions might be interested in this contract, much less any concrete action in the almost seven months since the announcement. We are somewhat baffled as to why this clear thwarting of a direct order of the Secretary is allowed to continue.

With your strong support, we are hopeful that the VA will finally do the right thing and finish this study and intended by the Congress, and observe scientific ethics in doing so. The results of this study are vitally important to this Committee and to all stakeholders and policy makers as plans for the future of VA services are being made now.

Agent Orange

VVA reiterates our strong support for early passage of HR 2254, the Agent Orange Equity Act. We must do whatever needs to be done, in this thirty fifth year since the end of the Vietnam war, to ensure that these veterans receive some measure of justice as soon as possible.

Vietnam Veterans of America is the only veterans service organization who is a member of the Research!America, which is the nation’s premier consortia of groups that strongly favor and advocate for increased medical research in America.. Our commitment to this effort is unflagging.

Mr. Chairman, there may well be much that is excellent and deserving of great respect in the VA Research program. However, most of it has little or nothing to do with the wounds, maladies, injuries, illnesses, and conditions that stem from military service.

VA is currently funding no research into the long term effects of Agent Orange, nor are they funding any research into the long term effects of exposure to environmental toxins in Gulf War I that may be causing Gulf War illness.

VA celebrated Research week in the latter part of April, spending a good deal of money and effort to run this self-congratulatory in regard to all the wonderful research they are doing that benefits veterans. It is, however, not much more than “spin.” VVA has inquired as to how money much all of this “hoopla” costs, including staff time, but has yet to receive an answer.

For the second year in a row VVA did not participate nor support this effort, because VA ORD leadership continues to act in an irresponsible manner toward Vietnam veterans, as well as other generations of veterans, by willfully ignoring the adverse health conditions of veterans and our families resulting from exposure to toxins during military service. Therefore our decision to not support VA’s effort was not taken lightly, but only after numerous years of `unresponsiveness on the part of the current head of ORD.

We have brought this lack of proper focus in research to the attention of the current Secretary of Veterans Affairs, as well his last four predecessors, but the pattern does not seem to fundamentally change.

The position of the VA and of the Federal government is untenable, and just not honest on the face of it. First the federal government does not fund any research into the long term adverse health effects of Agent Orange on Vietnam veterans (or our progeny), and then claims that there is no scientific proof of any adverse health effects on Vietnam veterans, nor our children and grandchildren. Clearly Dow Chemical is not going to fund this research. Any reasonable and honest person knows this. Therefore this position amounts to “willful ignorance.” We would suggest that the only unpardonable sin is willful ignorance in the face of gross injustice.

After much thought and discussion within VVA it is clear that while pressing for enactment of the pending legislation we must forge a contingency plan that will achieve the same purpose. The analogy would be that while many of us still believe that health care funding for veterans should be mandatory, we supported Advance Appropriations in the meantime.

As the Members of this Committee no doubt know, all of the National Institutes of Health (NIH) have two basic sections of their budget: one is for intramural research performed with full time scientists employed by that institute as the principal investigator; and, two, extramural research whereby they put out grants to universities and other private and public research entities. VA only has an intramural research program at present. Much of the money in this program goes to the “stars” at medical schools that are affiliated with a VA Medical Center, whether it has anything in particular to do with the wounds, maladies, injuries, illnesses, and adverse health conditions that may be attributable to military service or not.

Clearly what is needed is the creation of an office of extramural research at VA that has totally separate leadership that the current leadership of ORD. Said office should be structured in such a way that there is strong input from the veterans’ community and from the elements of the scientific community outside of government that have a good track record in regard to this kind of research that is focused on the wounds, maladies, injuries, illnesses, and adverse medical conditions that result from military service, depending on when and where one served as well as one’s job (MOS) in such service. Further, said office should be contracting for epidemiological studies of various groupings of veterans, and use that information to inform the priorities for further research to be funded.

Additionally, the need is for full disclosure of all use of any form of Agent Orange, other herbicides, or pesticides, or other toxins, wherever they were used in the world on military bases. There is absolutely no national security reason that would legitimately prevent such full disclosure. During the Vietnam war, there is reported use of herbicides in Thailand, Okinawa, the Philippines, Guam, and many other locations on the Pacific rim. There is also evidence that in addition to Eglin AFB there was extensive use of said herbicides on other military bases in CONUS during the same time period. This evidence from DOD records must be made available to VA, as well as to the public, prompting action by the Secretary to extend service connected presumption to veterans who served in those locations.

It is also clear that there is strong evidence, reinforced by the latest Institute of Medicine (IOM) report that the so-called “blue water” Navy veterans should be included in the group of those who are included in the presumptive group of those who are considered to be “in-country” Vietnam veterans for purposes of service connection, along with their brethren in the Army and Marines. The evidence from the desalinization units on board ships resulting in even higher exposure to dioxin than many on land is clear.

Mr. Chairman, again all of us at VVA thank you for this opportunity to present our testimony before you today. I will be pleased to answer any questions that you or your distinguished colleagues may have.