Post Traumatic Stress Disorder (PTSD) and Personality Disorders: Challenges for the VA
POST TRAUMATIC STRESS DISORDER AND PERSONALITY DISORDERS: CHALLENGES FOR THE U.S. DEPARTMENT OF VETERANS AFFAIRS
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED TENTH CONGRESS
JULY 25, 2007
SERIAL No. 110-37
Printed for the use of the Committee on Veterans' Affairs
U.S. GOVERNMENT PRINTING OFFICE
For sale by the Superintendent of Documents, U.S. Government Printing Office
COMMITTEE ON VETERANS' AFFAIRS
CORRINE BROWN, Florida
STEVE BUYER, Indiana, Ranking
Malcom A. Shorter, Staff Director
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records of the Committee on Veterans' Affairs are also published in electronic form. The printed hearing record remains the official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process is further refined.
C O N T E N T S
July 25, 2007
Post Traumatic Stress Disorder and Personality Disorders: Challenges for the U.S. Department of Veterans Affairs
Chairman Bob Filner
Prepared statement of Chairman Filner
Hon. Steve Buyer, Ranking Republican Member
Hon. Ciro D. Rodriguez
Hon. Phil Hare
Hon. Corrine Brown, prepared statement of
Hon. Stephanie Herseth Sandlin, prepared statement of
Hon. Cliff Stearns, prepared statement of
Hon. Ginny Brown-Waite, prepared statement of
Hon. Harry E. Mitchell, prepared statement of
U.S. Department of Veterans Affairs, Ira R. Katz, M.D., Ph.D., Deputy Chief Patient Care Services Officer for Mental Health, Veterans Health Administration
Prepared statement of Dr. Katz
U.S. Department of Defense, Department of the Army, Colonel Bruce Crow, Chief, Department of Behavioral Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, and Clinical Psychology Consultant to the Army Surgeon General
Prepared statement of Colonel Crow
Committee on Veterans’ Compensation for Posttraumatic Stress Disorder, Institute of Medicine and National Research Council, The National Academies, Dean G. Kilpatrick, Ph.D., Member, and Distinguished University Professor, Director, National Crime Victims Research and Treatment Center, Medical University of South Carolina
Prepared statement of Dr. Kilpatrick
Kors, Joshua, New York, NY, Reporter, The Nation, and Contributor, ABC News
Prepared statement of Mr. Kors
Satel, Sally, M.D., Resident Scholar, American Enterprise Institute
Prepared statement of Dr. Satel
Shea, Tracie, Ph.D., Psychologist, Post Traumatic Stress Disorder Clinic, Veterans Affairs Medical Center Providence, RI, Veterans Health Administration, U.S. Department of Veterans Affairs (on behalf of herself)
Prepared statement of Dr. Shea
Town, Jonathan, Findlay, Ohio
Prepared statement of Mr. Town
Veterans for America, Jason W. Forrester, Director of Policy
Prepared statement of Mr. Forrester
Veterans for Common Sense, Paul Sullivan, Executive Director
Prepared statement of Mr. Sullivan
SUBMISSIONS FOR THE RECORD
Miller, Hon., Jeff, a Representative in Congress from the State of Florida, statement
POST TRAUMATIC STRESS DISORDER AND PERSONALITY DISORDERS: CHALLENGES FOR THE U.S. DEPARTMENT OF VETERANS AFFAIRS
Wednesday, July 25, 2007
U. S. House of Representatives,
Committee on Veterans' Affairs,
The Committee met, pursuant to call, at 10:00 a.m., in Room 334, Cannon House Office Building, Hon. Bob Filner [Chairman of the Committee] presiding.
Present: Representatives Filner, Brown of Florida, Michaud, Herseth Sandlin, Mitchell, Hall, Hare, Berkley, Salazar, Rodriguez, Donnelly, McNerney, Walz, Buyer, Stearns, Moran, Baker, Brown of South Carolina, Brown-Waite, Turner, and Lamborn.
Also Present: Representative Kennedy.
The CHAIRMAN. This hearing of the House Committee on Veterans’ Affairs is called to order. Today, we will be focusing on the relationship between treatment for post traumatic stress disorder (PTSD) for our returning veterans from Iraq and Afghanistan and the diagnosis of personality disorder and how that affects later support for our veterans.
Once again it seems that America has to be educated by the media. Just as we found out about Walter Reed from good reporting in the Washington Post we have had incredibly persuasive documentation on this issue from members of the press, especially one of our panelist here today, Mr. Kors, working for both The Nation and ABC News. And we thank you for educating America and we will hear more from you.
What the press has learned is that thousands of cases, over 20,000 of the cases in recent years, of soldiers who were claiming PTSD or other mental issues with regard to their service and their claim for disability were in fact diagnosed with a personality disorder. Then the military says that this was a pre-existing condition, which begs the question, of why these young men and women were taken into the Armed Services to begin with and what our obligation is after that occurs, but allows discharge with a very difficult time to get later care from the U.S. Department of Veterans Affairs (VA).
If the facts that we have read in the press are true or if the statements that we read in the press are true, this is doing an incredible disservice to our young men and women who are serving this Nation. We have heard that they are not getting the full story of what the implications are for that PTSD discharge. We have representatives of servicemembers and servicemembers who have talked to the press that we will hear today that they were not given the full truth in their evaluations. They were lied to in terms of the implications of this diagnosis.
In addition, there is some indication that higher policy is leading to this or—policy made at higher levels. I have personally talked to a doctor psychiatrist who told me that his commander told him to make the diagnosis of personality disorder rather than PTSD which would lead to further cost and obligations by this Nation to our veterans.
So we have a real problem here. Not only are soldiers being denied treatment for a very real problem, but they are put in the position where it is very, very difficult to get that treatment even later on. So once the servicemember is diagnosed with personality disorder we want to know what happens at the VA and how to deal with—how the VA deals with those veterans. Is the burden on the veteran to prove that he or she doesn’t have a personality disorder? Will that diagnosis prevent the veteran from receiving healthcare once the initial period for coverage ends? What barriers does the veteran face?
So we want to look at this, at first from the soldier’s perspective and that is what our first panel is about, to let them tell the story of what happens with this diagnosis, how that affects their lives and the lives of their comrades..
So we thank you all for being here. It takes a lot of courage for you to testify and talk about your own lives. And I know that is hard. And we will hear from Mr. Kors who talked to many, many of these veterans. We will have a panel that deals with the response from the VA and, in this case, the Army Surgeon General. We want to know if this is being taken seriously; what is being done if these statements are true; what is being done to rectify it.
There is legislation that has been introduced. I believe in the Senate that makes personality disorder on the diagnosis not a valid one. That would get rid of that as a potential diagnosis in dealing with, or at least in terms of the obligations that we have for treatment, and we may have to do that on the House side also.
So we have, I think, a very important issue to look into today. We thank both the soldiers who are here, their representatives and the reporter who first brought this to America’s attention.
I would yield to the Ranking Member of this Committee, Mr. Buyer.
[The statement of Chairman Filner appears in the Appendix.]
Mr. BUYER. What was originally focused and appropriate for this review was a Subcommittee hearing on post traumatic stress disorder compensation and veterans claims at the Department of Veterans Affairs. That is how this began. We have now morphed it out of the Subcommittee to the Full Committee. And the focus is now on lanes outside the jurisdiction of this Committee. If the Chairman wanted to explore these matters, what would have been substantive and helpful to all of us is for this to have been a joint hearing with the House Armed Services Committee. While we can have witnesses before us, we can take no substantive action. There are many times when we are the receiver of individuals based on policies and actions from the U.S. Department of Defense (DoD).
So a lot of this is important, but we should be working in concert with the House Armed Services Committee. The legislation I think that the Chairman was referring to, was legislation introduced by Senator Obama, and Senator Obama’s legislation would stay the discharges for a personality disorder. I think that is a bad idea. We have individuals who are taken into the military. We do the best we can as a Nation to screen individuals. At some point through the military matriculation process, individuals begin to exhibit certain types of actions that would not be appropriate. When you put a weapon into someone’s hands and you ask them to work in concert and as a team with other individuals, it requires mental steadfastness. And it requires a lot of other institutional values and virtues in order for that team to work with great cohesion and for them to be the very best.
And we have no idea as a country when an individual is going to break down. And in fact, if there are personality disorders, we have no idea when they are going to exhibit themselves. And to disarm the military from this ability to essentially discharge this individual so there is no harm not only to the individual, but also to the team, is extremely important.
So while what perhaps well intentioned, I think Senator Obama’s legislation would be very harmful to the military and thereby the national security of the country. It is also equally important for us not to confuse PTSD and personality disorder. These are clinical diagnoses. For individuals to be discharged from the military for personality disorders, you just can’t have a company commander or a first sergeant or a master chief come forward and say, “Well, I think this person has got a personality disorder. I want to get rid of them.” I mean these are clinical judgments made by psychiatrists and doctorate level psychologists through a peer review process. And this allegation that they can just be thrown out is false.
So while much of the testimony we are going to hear today is interesting and might be helpful, much of this is outside the jurisdiction of this Committee. I also do recognize that when we take an issue to the Full Committee, generally the Veterans’ Affairs Committee seeks the counsel and input from many of the chartered veterans service organizations (VSOs), and they are absent here today. And I find that to be a curious matter.
I yield back.
The CHAIRMAN. Thank you, Mr. Buyer. I guess once again we understand only for the last four years, these issues were not taken up and not explored. This is a scandal. And I don’t care who’s jurisdiction it is, although we have tremendous jurisdiction in this. It is up to this Congress to deal with it.
Are there any other opening statements by my colleagues? Mr. Rodriguez.
Mr. RODRIGUEZ. I just would make a comment that eventually it will become our problem, because when someone is diagnosed incorrectly, eventually that individual is going to come to the VA and that diagnosis remains with that individual. So it will become our problem as dealing with veterans.
The other reality is this: I worked over eight years in the area of mental health and I understood very quickly when I was told that in order for us to provide any service to any individuals, they have to receive a specific type of diagnosis otherwise we couldn’t deal with them. And so that also drove unfortunately a lot of times what we could do or not do based on the specific diagnosis that they were given.
So I am, and it is an area that we ought to be, concerned about and I know personally this, in terms with when you are diagnosed in that area, presupposes that the individual came in with those problems prior to. And so, that is important for us to come to grips with that as quickly as possible and making sure that that is not occurring and is not happening. And if anyone is going to get diagnosed, that we do everything we can to diagnose them appropriately as much as we can. And in some cases, if that is the case then we got to go back and reassess in terms of what has been happening and what is occurring with those soldiers that are out there.
And so with that, I will stop and look forward to the testimony.
The CHAIRMAN. Thank you, Mr. Rodriguez. Mr. Hare.
Mr. HARE. Mr. Chairman, I would respectfully disagree with the Ranking Member. I think this is well within this Committee’s jurisdiction. I cannot, for the life of me, believe that we would see 22,000 plus of our best and our brightest treated like this. I think it is grossly unfair. I think it is beneath what they certainly have deserved. There is substantive action that I would suggest to my friends on the other side that we can take and that would be including perhaps sponsoring my bill H.R. 3167, the "Fair Mental Health Evaluation for Returning Veterans Act."
I would again disagree with the Ranking Member. I don’t think Senator Obama idea is a bad idea at all. I think from my perspective, when we see something wrong I don’t think we need to wait around for another Committee to tell us what is wrong. I think we need to, as a Committee, get together and to try to help our servicemen and women. So from my perspective, I think this is well within the purview of this Committee. I commend the Chair for holding this. I have said many times at this Committee, if not us, who? And if not now, when?
And I want to thank you, Mr. Chairman, for doing this and to the witnesses I look forward to hearing this. But we cannot take the treatment of people in our military like this anymore. And I am not here to worry about whether or not the Armed Services is here. I am here. We are here. And I want to hear from these witnesses. And I want to see this problem solved.
So I thank you, Mr. Chairman, for giving us the opportunity to listen today. Thank you.
The CHAIRMAN. Thank you, Mr. Hare. We will hear from the first panel. If you have a written statement, that will be made a part of the record.
Jason Forrester is a representative from Veterans for America (VFA). We thank you for what your group is doing and we thank you for being here today.
STATEMENTS OF JASON W. FORRESTER, DIRECTOR OF POLICY, VETERANS FOR AMERICA; JONATHAN TOWN, FINDLAY, OHIO (VETERAN); JOSHUA KORS, NEW YORK, NY, REPORTER, THE NATION, AND CONTRIBUTOR, ABC NEWS, AND PAUL SULLIVAN, EXECUTIVE DIRECTOR, VETERANS FOR COMMON SENSE
Mr. FORRESTER. Thank you, Mr. Chairman. Chairman Filner, Ranking Member Buyer, Members of the Committee, Veterans for American works closely with Congress, DoD, the media, active-duty troops and veterans to identify the unique challenges facing today’s military. Much of our work is investigative. Specifically, our work at Ft. Carson, Colorado, where we first met Specialist Town, and our current work at Camp Pendleton, California, has prompted considerable media attention and Congressional action and has helped identify where our country is failing our servicemembers.
Given the distressing disconnect between VA and the DoD, the greatest service that VFA can provide today is to highlight the trends we have identified and are working to correct within DoD and to offer some ideas regarding how the VA can help ensure that those who have served in Iraq and Afghanistan get the assistance they deserve.
It is important for VA to understand that the experiences of nearly one million servicemembers from Iraq and Afghanistan who are still on active duty and who will eventually enter the VA system. The DoD’s Mental Health Task Force found that 49 percent of Guard members, 38 percent of soldiers, and 31 percent of Marines are experiencing some mental health issues after serving in Iraq and or Afghanistan. DoD characterized post traumatic stress disorder as a signature wound of today’s wars. At Ft. Carson, we found soldiers who had been diagnosed with chronic PTSD who are only receiving one hour of individual therapy per month. Often, these soldiers saw a new therapist each visit.
At Ft. Carson, we worked with soldiers who were not receiving the treatment they needed even though they clearly indicated on their post-deployment health reassessment that they were having difficulty readjusting to post-deployment life.
In some cases, these soldiers had been re-deployed only to have their wounds compounded by further exposure to combat. In other cases, undiagnosed and untreated PTSD led soldiers to turn to drugs and alcohol. The civilian medical community has long recognized that substance abuse is a symptom of PTSD. Unfortunately, it is DoD policy not to treat soldiers for PTSD until their substance abuse problems are addressed. There are no DoD dual track PTSD and substance abuse programs. We have worked with several soldiers who have suffered greatly from this deficiency and in a few cases, have gotten them into VA facilities that offered dual track care.
Since PTSD is so prevalent, VA must increase the number of dual track programs that treat substance abuse and PTSD. VA can help greatly reduce anti-mental healthcare stigma by increasing its outreach to servicemembers and their families on bases and within military medical facilities. Today’s servicemembers need to know that PTSD is an injury and that they deserve every opportunity to recover. PTSD is not a sign of weakness. It is a proven medical reality of sustained exposure to combat.
Finally, another distressing trend that we identified at Ft. Carson was the prevalence of pre-existing personality disorder discharges for soldiers with clear service-connected mental health problems. The consequences of such a dismissal are severe, including denial of VA benefits due to the disorder being, “pre-existing.” At Ft. Carson we met numerous soldiers who had been diagnosed with a pre-existing personality disorder regardless of the fact that they were deemed fit when they entered the service and regardless of the fact that they have been diagnosed with PTSD post-deployment to Iraq and Afghanistan.
Pre-existing personality disorder discharges remove the government’s burden to help the servicemember deal with their service connected injuries. It is unacceptable to ask an American to sacrifice for this country and not to treat the consequences of their service.
In May of this year, as a result of our work at Ft. Carson, a congressional staff delegation returned there where they met with the soldiers and family members who we had been helping. This visit prompted a U.S. Government Accountability Office (GAO) investigation into mental health treatment in the military and it led to a bipartisan group of 31 Senators sending a letter to Secretary Gates calling for a moratorium on pre-existing personality disorder discharges. This problem provides a great opportunity for VA leadership.
While VA has no obligation to treat a veteran with a pre-existing personality disorder discharge, these men and women need help. To address this problem, VA should create a streamlined process for face to face medical evaluations for such discharges. We owe these veterans a second chance to get much needed help for their service connected injuries.
This concludes my statement. Thank you.
[The statement of Mr. Forrester appears in the Appendix.]
The CHAIRMAN. Thank you very much.
Jonathan Town is an Army veteran who was diagnosed with a personality disorder. And I understand after all the publicity about your case, the VA, or you can tell us, the VA has decided they we owe you treatment. We thank you for your courage in coming forward. Many soldiers who are in the same position as you are do not feel comfortable about testifying, and we thank you for speaking on behalf of thousands of soldiers.
Mr. TOWN. Thank you for the opportunity. Mr. Chairman, distinguished Members of the Committee, ladies and gentleman, thank you for inviting me to address the Committee to tell my story.
On January 20, 1961—
The CHAIRMAN. Mr. Town? Could you just—get the microphone right up to you and make sure it is turned on. It is hard sometimes to hear, if not.
Mr. TOWN. On January 20, 1961, a United States military veteran and Purple Heart awardee who was being sworn in as President at that time said during his inaugural speech, “Ask not what you can do for your country, ask what—ask not what your country can do for you, ask what you can do for your country.”
Since January 2000, countless citizens have answered this call to duty and served in the United States Armed Forces. Thousands, in fact, 22,500 of these servicemembers who served honorably have been discharged from the military with a Chapter 5-13, Personality Disorder Discharge. The result of which they have all been denied medical care and disability benefits by our government.
There has now arisen a debate about whether these discharges were done to save the government money or to help with the military wartime and deployment strength. Regardless of the reason, it is an outrage that these servicemembers and their families have been put through this.
Now I would like to tell you my story. I served four and a half years honorable years at Fort Knox, Kentucky, as an administrative specialist. I was then given orders to permanent change of station (PCS) to Korea. After arriving in Korea, I was told that the unit I was assigned to had just received it’s deployment orders to Iraq. In August 2004, the STEEL battalion which I was now a part of, deployed to Ramadi, Iraq. On October 19, 2004, I was running mail for our battalion and incoming rounds started exploding across the street from where my vehicle was parked. While running for shelter in my S-1 shop’s office, a 107 millimeter rocket exploded three feet above my head, leaving me unconscious on the ground with a severe concussion, shrapnel in my neck and blood pouring from my ears.
I was taken to the battalions aid station where I was treated for these various wounds. I was given quarters for the rest of the day and went back to work the next day. Two months later, I was awarded a Purple Heart for my injuries I suffered on that traumatic day in October. This is when everything started to go downhill health-wise for me. Throughout the next nine months while continuing to serve my country, I battled severe and non-stop headaches, bleeding from my ears, and insomnia.
We finally got the word that we were headed home and then I would finally be able to get some assistance for the medical issues I was going through. After a few days back in the United States, I realized a new battle was taking place. My ability to adjust to loud noises, large groups of people and forgetting what happened to my unit and myself while we were in Iraq was going to be another battle.
About 45-days after coming back stateside to Ft. Carson, Colorado, I was finally able to see a psychiatrist. The first few meetings with the doctor were good and it seemed like he actually cared about helping me get through my issues, if it were possible. Then word came down that our unit was going to be re-deployed. The next time I went to see the doctor, he informed me that he was going to push a Personality Disorder Chapter and explained why.
The doctor said, “You have the medical issues that call for a medical board, but the reason I am going to push this Chapter is because it will take care of both the needs of the Army and the needs of you. You will be able to receive all the benefits you would if you were going to go through a medical board, get out of the military, and focus on your treatment to get better. For the military, they can get a deploy-able body to fill your spot.”
I told him that this is—if this is what the thought was best for the military and my family that he could do what he needed to do. I never realized that everything that was said to me during that day was all lies. I went through the final out process to leave the military. The day I was signing out, I was told by the final out personnel that I would not receive any severance pay or benefits and I actually owed the military $3,000.
I do not know everyone in this room, but I think that if you were to work hard for a company or an agency, only to be told that you owe them money, that you owed them money when you went to leave, you would obviously be—you would obviously think something is wrong. If it weren’t for my family taking us in and supporting us both financially and emotionally and new friends helping us, I don’t know where my family and I would be right now.
The last nine months have been spent trying to get assistance both medically and financially through the Veterans Department, getting the word out to the public about what is happening to my fellow servicemen and myself, and trying to get my family and myself back on our feet.
Eight months after being denied medical benefits as a Chapter 5-13 discharge, the Veterans Administration awarded me the disability status that my Purple Heart and wounds I suffered entitled me to. I am fortunate because my story received national exposure, unfortunately there are many, many injured military personnel Purple Heart winners also who have never received their benefits that they are entitled to.
In the absence of a concerted effort by the Committee to right this horrible wrong, I am afraid that the other 22,499 veterans will not be as lucky as me.
I think the government should fix the personality disorder issue in the time it takes a servicemember to receive the start of their disability from the time they leave the Armed Forces. The Chapter 5-13 personality disorder should be completely taken out of the DoD regulation, or if the military really wants a way to get servicemembers out of the service that do not have over six months of active service or have not been deployed overseas, then it needs to be written that way in the regulations.
It is 100 percent wrong to be able to use this discharge for any servicemember that has been on active service for a substantial amount of time or who has fought in a war for their country. Some have suggested a way to reduce the amount of time a servicemember has to wait till they finally start receiving disability after leaving the Armed Forces. The servicemember starts his or her disability paperwork and process at the station where he or she is currently stationed two months prior to getting out of the service. The servicemember should not be able to final out from their branch of military until he or she is either guaranteed or denied their disability claim. By going through this route it will allow the servicemember to receive their first disability check immediately after their last paycheck from the Armed Services and they will be able to receive medical assistance as soon as they leave the service.
Such a system would also facilitate the electronic transfer of the servicemembers medical records from the service branch of the veteran—to the Veterans Administration, thus allowing the Department of Defense to better work hand in hand with the Veterans Administration to assist these soldiers in need.
In closing, I want to state that I did not have a personality disorder before I went into the Army, as they have stated in my paperwork. I did not suffer severe non-stop headaches. I did not have memory loss. I did not have endless, sleepless nights. I have post traumatic stress disorder and traumatic brain injury (TBI) now due to injuries I received in the war for which I received a Purple Heart. I shouldn’t be labeled for the rest of my life with a personality disorder and neither should my fellow soldiers who also incorrectly received this stigma. I would like to ask the Committee and panel members to thoroughly think about the ideas I have mentioned to fix some of the issues we as veterans are facing. Please help those who have helped their country and remember that every time the military discharges a servicemember out of the Armed Service the way I was discharged, not only do you destroy hope for healing, but they destroy the soldier’s families hope for healing as well.
[The statement of Mr. Town appears in the Appendix.]
The CHAIRMAN. Thank you, Mr. Town, you did not sign up to have to do this, but you are helping a lot of people and we thank you for —
Mr. TOWN. It is an honor.
The CHAIRMAN. —your courage.
Joshua Kors is a journalist. He has written on this topic extensively and has been the source of much of the facts and stories around us, both for the Nation and for ABC News. So we thank you, Mr. Kors, for what you have done and we look forward to your testimony.
Mr. KORS. Good morning. I have been reporting on the personality disorder discharge for the last ten months.
The CHAIRMAN. Please speak close to the microphone so we can hear.
Mr. KORS. I have been reporting on the personality disorder discharge for the last ten months and I am here today to talk about the 22,500 soldiers discharged in the last six years with that condition.
A personality disorder discharge is a contradiction in terms. Recruits who have a severe pre-existing condition like a personality disorder do not pass the rigorous screening process and are not accepted into the Army. The soldiers I interviewed this past year passed that first screening and were accepted into the Army. They were deemed physically and psychologically fit in a second screening as well before being deployed to Iraq and served honorably there in combat. In each case, it was only when they came back physically and psychologically wounded and sought benefits that this pre-existing personality disorder discharge was discovered.
Discharging soldiers with a personality disorder prevents them from being evaluated by a medical board and getting immediate medical care. This can be life threatening for our soldiers. A good example is Chris Mosier who served honorably in Iraq where he watched several of his friends burn to death in front of him. After that, he developed schizophrenic-like delusions. He was treated at Ft. Carson for a few days then discharged with a pre-existing personality disorder. He returned home to Des Moines, where he left a note for his family saying that Iraqis were after him, they are in Iowa, then shot himself.
Surgeon General Gale Pollock agreed to review a stack of personality disorder cases. After five months, she produced a memo saying her office had, “thoughtfully and thoroughly” reviewed the cases, including Jon Town’s, and determined all of them to be properly diagnosed. With further reporting I discovered that as part of that thoughtful and thorough five-month review, Pollock’s office did not interview anybody, not even the soldiers whose cases she was reviewing. Some of those soldiers said they called the Surgeon General’s office offering information about their ailments. Their efforts were rebuffed.
The one thing the Surgeon General’s office did do was contact a doctor at Ft. Carson where many of the personality diagnoses were made, and ask him whether his doctors got it right the first time. The doctor said yes, his staff’s original diagnoses was correct and Pollock shut down the review at that point.
The Surgeon General’s office denied that for many months, insisting that the review was conducted by a panel of health experts who were not involved in the original diagnoses. This wasn’t a case of one many reviewing his own work, they said. But eventually it did come out that the only reviewer was Colonel Steven Knorr, who as Chief of Behavioral Health at Ft. Carson, oversaw many of the personality disorder diagnoses and in his capacity as a psychiatrist was reportedly involved in creating many of them as well.
When the problems with Walter Reed became public, the Pentagon took two actions: It accepted the resignation of Surgeon General Kevin Kiley and it hired the public relations firm LMW Strategies with a $100,000 no-bid contract to put a positive spin on those events. This past week as these personality disorder discharges became public, VA Secretary Nicholson stepped down. And today, Surgeon General Pollock is not here to discuss the issue.
As a journalist it is not my role to make any recommendations, but I do want to share with you the hopes of the wounded veterans I spoke to this year, which is a hope that someone be held responsible and that officials go back through the 22,500 cases and seek out the thousands of Jon Towns who are waiting there, struggling right now without benefits or the media spotlight.
[The statement of Mr. Kors appears in the Appendix.]
The CHAIRMAN. Thank you, Mr. Kors.
And concluding this panel will be Paul Sullivan representing Veterans for Common Sense. And we thank you again for your efforts at making these kinds of situations public for the American people to understand.
Mr. SULLIVAN. Thank you, Mr. Chairman. Chairman Filner and Members of the Committee, thank you very much for inviting Veterans for Common Sense to testify about post traumatic stress disorder and about personality disorder discharges among our Iraq and Afghanistan war veterans. My oral testimony focuses on offering solutions so our veterans receive prompt medical care and prompt disability benefits for PTSD.
So far, the Department of Defense has discharged more than 22,000 veterans in the past five years with a personality disorder or PD. The current DoD system assumes soldiers are malingering. And the current VA system is designed to fight fraudulent claims. These DoD and VA barriers to prevent abuse of the system are blocking too many deserving veterans from getting the high quality medical care from VA, and the prompt disability benefit payments from VA that they need and they earned.
When the military uses PD to discharge a veteran who fought honorably, then the military is breaking it’s own rules. Chapter 5-13 states that if a veteran was in combat then the military is generally prohibited from using PD. VA’s recent review of PTSD claims found no evidence of fraud. A veteran discharged with PD is usually denied VA healthcare and benefits based on VA rules prohibiting services for a pre-existing condition.
Here are VA’s latest statistics on post traumatic stress disorder. As of March 31, VA diagnosed 52,000 Iraq and Afghanistan war veterans with PTSD. However, VA approved only 19,000 PTSD claims. This disparity should be investigated.
Veterans for Common Sense urges Congress to adopt a robust package of policies listed in our written statement so Iraq and Afghanistan veterans with PTSD receive prompt medical care and benefits. Here are our top three proposals.
First, Congress should legislate a presumption of service connection for veterans diagnosed with PTSD who deployed to a war zone after 9/11. A presumption makes it easier for our dedicated and hard working VA employees to process the veterans claims. This results in faster medical treatment and faster benefits for our veterans.
Second, the military should stop discharging Iraq and Afghanistan war veterans uses PD. The military should review all personality disorder discharges for veterans deployed since 9/11. Congress should order VA to review applications for healthcare and benefits where PD was an issue at VA.
Third, DoD and VA should establish a policy to reduce the stigma against people with mental health conditions that military studies confirm hinders many of our war veterans from seeking care. The scope of PTSD in the long term is enormous and it must be taken seriously. PTSD is real. When all of our 1.6 million servicemembers eventually return home form the wars in Iraq and Afghanistan, based on the current rate of 20 percent, then VA may face up to 320,000 total new veterans diagnosed with PTSD.
In conclusion, Mr. Chairman, if America fails now to act and overhaul the broken DoD and VA disability systems, there may be a social catastrophe among many of our returning Iraq and Afghanistan war veterans. That is why Veterans for Common Sense reluctantly filed suit against VA in Federal court this week. Time is running out. The consequences of failure among our veterans are severe, including broken families, lost jobs, stigma, drug abuse, alcoholism, crime, homelessness, and suicide. The disastrous consequences are preventable, yet our window of opportunity to prevent these problems from happening is closing.
Thank you, Mr. Chairman. I would be more than happy to answer any of your questions.
[The statement of Mr. Sullivan appears in the Appendix.]
The CHAIRMAN. Thank you all very much. You have made some very powerful statements. I am going to call on Members of our panel in the order in which they got here. The Chairman of our Health Subcommittee is Mr. Michaud and the floor is yours for five minutes.
Mr. MICHAUD. Thank you very much, Mr. Chairman. I want to thank the panel for the enlightening testimony. And I have a few questions. First of all, for Mr. Town. You had mentioned in your testimony that when you went through the final out process to leave the military, when you signed out that they said that you actually owed them money. What was the reasoning they gave why you owed them $3,000? Was it for medical bills or?
Mr. TOWN. While I was in Iraq I re-enlisted for six years and a $15,000 tax-free bonus while in Iraq. And when I came back stateside, or when I was being chaptered out, they said I had—I had served one year of that six years. So I stilled owed $12,000 roughly. And there was, I had leave that I was selling back to Defense Finance and Accounting Service, and I sold my leave back. And how it came out is, I still owed $3,000 of that $12,000. And that is how that debt was made.
Mr. MICHAUD. Okay. Thank you. For Mr. Sullivan, you had mentioned the lawsuit and being a former VA employee we have been dealing with a lot issues dealing with traumatic brain injury, and PTSD. If the lawsuit is successful and VA has to respond, the lawsuit might also say in order to respond to the huge influx of men and women from this conflict and previous conflicts, Vietnam era conflict, what are your thoughts about the VA not utilizing to the degree that they probably should be to take care of the influx as far as contracting out services, particularly in rural areas for mental health services? Would you comment on that? Do you think that that is what they should do in the short term to help with the influx is to fee for services?
Mr. SULLIVAN. Thank you for your question, Congressman. I am not an expert on rural care for veterans, but there are two pretty simple standards that VA should be held to. The first standard is when a veteran comes home from war and he needs an appointment for a mental health condition. It shouldn’t matter if he lives in Nome, Alaska, or New York City. The servicemember turn veteran should be able to see a mental healthcare provider as soon as possible so the condition doesn’t worsen.
It is better for the veteran to get treatment sooner, it is also cheaper for the taxpayer so that you don’t have more complicated problems later on. So it would be a very good idea for VA to make sure, especially for Guard and Reserve units, that they beef up their rural programs.
One note related to that. I mentioned that there are fewer claims for PTSD that are approved then there are veterans who are diagnosed. One related concern is this: National Guard and Reserve, mainly from rural areas, are about half as likely to file a claim. However, Congressman, they are about twice as likely to have their claim denied. So not only do they need access to healthcare, they also need access to a good representation to assist them with their claim.
Mr. MICHAUD. Well why is it that they are half as likely to file, because they don’t know about the services or they just afraid of the stigma that is attached to it?
Mr. SULLIVAN. I don’t know the answer to that, Congressman. However, I did raise it while I worked at VA and it was in some of the briefing materials that I provided to VA executives. However, I am not aware that they took any action. You may want to ask them if they have investigated the discrepancy and if they have any answers.
Mr. MICHAUD. Okay. Thank you. And my last question to Mr. Kors is being a journalist you definitely have the power to inform the public of what is going on. Have you ever been persuaded by one side or another to be more aggressive or less aggressive as you move forward in dealing with this issue of claims?
Mr. KORS. Sure. Well any journalist works hard to keep their neutrality, but certain issues seem logical when looking at them. For example, in Jon Town’s case, they gave him a Purple Heart for his wounds of war, but yet Surgeon General Pollock says he was not wounded in war. Contradictions like that call out the strangeness, the sense of absurdity here. And I think actually that question deserves a little more detail.
Following the review that said that Jon’s case and the stack of others was properly diagnosed, the Pentagon released a second statement that went a lot farther. A statement by Lieutenant Colonel Bob Tallman, what has become known to the reporters reporting on this issue as the Tallman memo. In the Tallman memo, they said not only did they review the stack of cases presented to them, but they went back and reviewed all the cases from the last four years at Ft. Carson where Specialist Town was based. After it was revealed that—after it was revealed that there were no interviews in this five-month thoughtful and thorough review, I later discovered that the four-year review was simply invented.
I called Lieutenant Colonel Tallman to ask him about this. How they could call this a thoughtful and thorough review when not a single soldier was interviewed. And he said to me, well he really didn’t think that they could. And he said, “Joshua, let me be clear with you. I didn’t write this memo and I have no knowledge of it’s contents.” He told me that the memo was ghost written by Surgeon General Gale Pollock’s office. Something that Pollock’s office readily admitted. And after it was revealed that the review was simply invented, the four-year review referred to here, they really said that was all the information they could provide.
Mr. MICHAUD. Thank very much. That is very enlightening. Thank you very much for all of the work that you all are doing, I really appreciate it.
The CHAIRMAN. Thank you. Mr. Moran?
Mr. MORAN. Mr. Chairman, thank you very much. I appreciate the opportunity to learn about this circumstance that our servicemen and ultimately veterans are facing.
Mr. Kors, apparently—if I understand the situation, apparently pre-existing, that word is very significant. And I guess my initial question is, are there findings with our servicemen and women, that they have a personality disorder as a result of actions or activities that occur in war that result in the designation of a personality disorder for which the there is no pre-existing—let me ask this question. I am not very clear, but I want to make sure do we have a non pre-existing condition? And in that case, is there a different result? Or is everything found in these circumstances to be pre-existing and, therefore, the consequences are bad in each and every case? What makes Mr. Town’s situation different? Are other servicemen and women found to have a personality disorder but not a pre-existing one?
Mr. KORS. Well that is exactly the point, Congressman. And that is why it is such an important VA issue. The VA is not required to treat pre-existing conditions. They are required to treat wounds of combat. And why is Town’s case unique? It is not and that is precisely the point.
I looked at cases of one soldier for example who suffered a bilateral hernia in Iraq. His condition was decided as the result of pre-existing personality disorder. Another case, for example, the soldier who damaged the lens of eyeball in Iraq. That ocular damage was seen as the result of a pre-existing personality disorder.
Mr. MORAN. Are there cases in which there is no finding of a pre-existing condition? And those soldiers are treated differently than Mr. Town?
Mr. KORS. Well in Town’s case, as in all the others, there is no previous history. And in fact, it goes further to the way that the Army looks at how one does—how do they discover that a person had a condition that was pre-existing? Standard Army policy is to interview no one. In fact, I got a call recently from a psychiatrist at a major east coast Army facility who said that he is the only person in the in his Fort Hospital who does interview families. You know, for Town’s case for example, you know, perhaps his family would of noticed if he had severe hearing loss before joining the Army.
This doctor was the one and only who did seek out families to interview to see whether it was pre-existing. He said he was ceaselessly mocked by both the Chief of Behavior Health at his Fort’s hospital, and others, as being completely out of step with the Army and VA ways.
Mr. MORAN. So the finding of the condition to be pre-existing is nearly automatic in each and every case?
Mr. KORS. It is simply asserted without proof. I think that is the best—I mean you know at that point we really have to look at why this is happening. And that was a considerable part of my ten-month investigation.
Jon Town and the others here have talked about the financial components. By preventing these wounded veterans from receiving their benefits, the military is saving $12.5 billion in disability and medical care. With that financial pressure comes political pressure. I spoke to multiple trial defense services lawyers who said the commanders at their base were pressuring doctors to falsely diagnose. What one told me he knew this was happening because the commander had come to him and confessed to doing it.
On a basic level, on simply a practical level, the hospitals there are overrun, both at the Army and the VA. And you have situations where they need to get someone out of their hair fast to free that space up for the four or five soldiers who are waiting to take it. As Frank Ochberg, the doctor who codified post traumatic stress disorder for the government said, there’s a further public relations issue that even goes deeper than simply getting soldiers out of their hair. And that is making soldiers like Jon Town invisible. If Town comes back with a Purple Heart and severe problems with memory, with sleep, with headaches, we can delete him from the cost of the war if we simply say it was a pre-existing condition unrelated to his military service.
Mr. MORAN. Mr. Town, thank you very much for your service to our country. You indicate now that the VA is providing benefits to you? Is that true?
Mr. TOWN. Yes, sir.
Mr. MORAN. But are those benefits unrelated to a personality disorder?
Mr. TOWN. Correct. They actually diagnosed me with post traumatic stress disorder. The VA has.
Mr. MORAN. And are you being treated by the VA for those for that condition?
Mr. TOWN. Yes, sir.
Mr. MORAN. And the reason that you were successful or your case is no longer considered ineligible for benefits because it was pre-existing is what? Why the change? Is there some medical —
Mr. TOWN. Well —
Mr. MORAN. —finding that allowed the VA to reach a different conclusion or —
Mr. TOWN. No.
Mr. MORAN. —they just reached a different conclusion?
Mr. TOWN. No. They just—I saw this psychiatrist for about 25 minutes when I got to the Dayton VA. And she was pretty much in tears after I had talked to her for about 25 minutes. And that was all she needed for her evaluation of what I had been going through for the last two years.
Mr. MORAN. Thank you very much, Mr. Chairman.
The CHAIRMAN. Mr. Moran, just as I understand it, personality disorder is by definition pre-existing. If the other possibility is PTSD which means we gave it to you, which means you are eligible.
Mr. SULLIVAN. That is correct.
The CHAIRMAN. And, you know, Mr. Town was called, I think from a very pretty high level of in the VA, after all the publicity came out about it. He —
Mr. MORAN. The—excuse me, Mr. Chairman. But the distinction is that the VA still has not—they will still consider Mr. Town, at least initially, of having a pre-existing personality disorder. Now they have reached the conclusion he has post traumatic stress syndrome, which then qualifies him for assistance from the VA.
Mr. KORS. Congressman? That is another key issue here. The VA flatly rejected the Army’s diagnosis. In cases where a soldier gets a tremendous amount of press, this often happens. He was decided after the Army decided he wasn’t disabled at all the VA decided he was 100 percent disabled. And top officials at the VA explained to me why this is such a severe problem for the VA. False diagnoses of personality disorder short flagged—short circuited the VA’s red flag system. That is internal VA speak for the way in which the VA keeps it’s eye out for those who are severely wounded to get them immediate medical and disability benefits.
They keep their eye out by looking at the Army’s medical board and who comes out of the medical board with a very high disability rating. Soldiers like Jon who got a pre-existing personality disorder are denied the opportunity to see a medical board, thus they don’t get a disability rating at all, thus they fly under the VA’s radar and in Jon’s case, didn’t receive a single doctor's visit for eight months.
Mr. MORAN. So, Mr. Chairman, we have one diagnoses by the military and one diagnosis by the VA resulting in a different outcome?
Mr. KORS. That is right.
Mr. MORAN. Thank you.
The CHAIRMAN. Right. But that person has to come to the VA, there has to be an aggressive effort. And in conditions which make them very vulnerable and they have to fight for that new diagnosis. So fighting the bureaucracy when you are suffering from these kinds of things is not the easiest thing to do.
Mr. KORS. In Jon’s case he submitted his paperwork five times before the VA decided to take up his case and look at his medical condition.
The CHAIRMAN. Thank you. Mr. Hare, you have the floor.
Mr. HARE. Thank you, Mr. Chairman. I have to tell you I am beyond even angry. I don’t even know what word I can use.
Let me—I want to see if I can sum up this because this is almost surreal. As I understand it, we have over 22,000 people who have who got in the military, somehow slipped under the radar screen. Now they are being diagnosed incorrectly. Mr. Town, I am amazed that not only did they, since you obviously weren’t wounded according to them, that not only they asked for $3,000 I am surprised they didn’t ask for your Purple Heart back.
I think this is amazing. And so if I get this straight then, nobody has reviewed any of these cases for any of these people at all, but they made up the fact that they did. They, someone in the military or some has said, that they interviewed these people. Nobody, not one person has been talked to about this. And their lives and their families and everybody is affected. And not one person. So I guess what I would like to understand is, and maybe somebody on the panel could help me out here, in your opinion, did this really say to treat people like Mr. Town and thousands of other people to save $12.5 billion in savings that they don’t have to pay out? And then you had to try to get this five times on your own? And what about the people that give up or they feel frustrated that some how—and now we are suing the veterans once again, have to go back and sue people because of the way they are being treated. Unbelievable.
And I want to commend you, Mr. Kors, for your reporting on this issue. I know this is just maybe an opinion I would like to get from you. Are you after doing this investigation convinced that the reason that these people that this happened to them was they were just trying to get out of saving $12.5 billion?
Mr. KORS. I think there are a multitude of reasons. And, you know, it goes from the ground level to the top level. I think where the pressure on the commanders to pressure the doctors to purposely misdiagnose comes from. That is something that, you know, perhaps we are here today to look at.
You are absolutely right that the 22,500 soldiers in the last six years, none of them had been looked at. Not the 5,600 from the Army itself, or the of the stack of cases directly presented to the Surgeon General. I think another key feature we need to look at when we are figuring out how this happened is to talk at a ground level how this goes from doctor to soldier. As Specialist Town said, he like every soldier I looked at was directly lied to by their military doctor. The doctor would say, “If you accept the personality disorder discharge you will get disability pay, you will get VA medical care, you will get to keep your signing bonus for the years that you are too wounded to serve.” Their final day as they are walking out the door, their last day in uniform, they find out none of those promises are true.
For the soldiers that further resist, those block of soldiers all told me of an arm twisting tactic that the doctors would use. They would say, “Look, you know you don’t have a personality disorder, we know you don’t have a personality disorder. But if you accept this discharge we can get you out in a few days whereas if go for medical board, it will take about six months. Your unit is redeploying to Iraq and you are wounded. Your job in Iraq is going to be to cover your friends back. Do you really want your friends to die because you fought for further benefits? Wouldn&