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Hon. Jeff Miller, Chairman, Full Committee on Veterans' Affairs

Good morning.  Thank you to our witnesses in attendance, and welcome to the Committee on Veterans’ Affairs hearing entitled, “Mental Health: Bridging the Gap Between Care and Compensation for Veterans.”   

On May 10, the United States Court of Appeals for the Ninth Circuit issued a decision that was heavily critical of the care and compensation VA provides to veterans with mental illness.  The Court cited VA’s “unchecked incompetence” and the “unnecessary grief and privation” that delays in treatment and benefits cause veterans and families.

I am not here this morning to judge the Court’s decision…I’ll leave that to others.   But the heart of the Court’s analysis of the issue is something with which all of us need to be concerned.  Namely, is VA’s system of care and benefits improving the health and wellness of veterans suffering from mental illness? 

On behalf of a grateful nation, we’ve invested heavily in this system over the last decade to improve access and make treatment options that experts say are effective more readily available.  But the question remains, are veterans--especially those returning from combat with the invisible wounds of war--on a road to recovery and able to live full, productive lives?  

Recovery, restoration, and wellness…these should be overarching objectives of all VA’s programs. Yet when I look at trends in disability ratings for veterans with mental illness I see a confusing picture.   

On one hand we have a medical system that boasts of evidence-based therapies, improved access, and high quality of care.  On the other we have data from VA indicating that veterans with mental illness only get progressively worse.   These confounding facts raise the question:  Are VA’s health and disability compensation programs oriented towards VA’s mission of recovery and wellness?

I am not the first who has noted this trend or suggested the need for closer integration of VA programs.

A 2005 report from the VA Inspector General concluded the following:  “Based on our review of PTSD claims files, we observed that the rating evaluation level typically increased over time, indicating the veteran’s PTSD condition had worsened.  Generally, once a PTSD rating was assigned, it was increased over time until the veteran was paid at the 100 percent rate.”

We have a 2007 report from the Veterans’ Disability Benefits Commission--and we’ll hear from the Chair of that Commission on our second panel--which recommended that “a new, holistic approach to PTSD should be considered.  This approach should couple PTSD treatment, compensation, and vocational assessment

Most recently, we have the Administration raising red flags. In its Fiscal Year 2010 Performance and Accountability Report VA commented on how well its Veterans’ Benefits Administration collaborates with the Veterans Health Administration when providing services to veterans with mental illness. 

The report suggested that with recovery as the essential goal to helping veterans with PTSD, that perhaps VBA and VHA were working at cross purposes.  Let me quote from that report (quote):  “With the advent of the Recovery Model as central to the treatment of mental health disorders, the current system fails to support and may even create disincentives to recovery.

Today, we will move beyond numbers that simply tell us how many veterans use the system and get at the fundamental question of whether they are on a road to leading full, productive lives. 

For veterans who don’t seek VA care, we need to know why.  We need to know if there are inherent disincentives to recovery.  We need to know if the quality of treatment provided at VA is a reason many seek care elsewhere.  We need to know what is effective and what isn’t. 

Quoting from a recent policy paper from the Wounded Warrior Project, “VA’s focus on the high percentage of veterans who have been treated begs such questions as, how effective was that treatment, and how many more need treatment but resist seeking it?” I couldn’t agree more. 

It is our duty at this Committee to ask these tough questions. The veterans for whom this system was created demand it of us. 

We are fortunate to have with us on our first panel Mr. Daniel Hanson.  Dan served in Iraq, then came home troubled in mind, trying to cope with the loss of so many of his fellow Marines.   His is a story I hope everyone listens closely to as a cautionary tale of where we may be inadvertently headed. Looking back, Dan has some interesting thoughts of what it would have taken to get him into treatment sooner.  And, just as important, he’s got something to say about how he ultimately found help outside of VA’s system.

On our second panel we have Dr. Sally Satel, resident scholar at the American Enterprise Institute.  Dr. Satel will share with us the principles surrounding what she believes would be a more effective system of care and compensation for veterans seeking mental health treatment. As I mentioned we also have the former Chairman of the Veterans’ Disability Benefits Commission with us, General Terry Scott.  We also have a VA clinician, Dr. Karen Seal, who will share with us her findings on health care utilization of Iraq and Afghanistan veterans.       

Finally, on our third panel, we will hear the administration’s views, and the views of two important veterans’ organizations, AMVETS and the Wounded Warrior Project. 

Again, I thank everyone for being here today. I now yield to the Ranking Member, Mr. Filner.