Mr. Paul Sullivan
Chairman Filner and members of the committee, thank you for inviting Veterans for Common Sense to testify about “PTSD and Personality Disorders: Challenges for the VA.” VCS is a non-profit organization based in Washington, DC focusing on issues related to national security, civil liberties, and veterans’ benefits.
My testimony focuses on offering solutions to the many unconscionable, outrageous, and intentional actions taken by the Department of Veterans Affairs and by the Administration to prevent our Iraq and Afghanistan war veterans from receiving prompt medical care and disability compensation for PTSD. My testimony is based on more than 15 years’ of experience as a veterans’ advocate and as a VA project manager.
There are two common sense standards VA should meet. First, when a war veteran needs mental healthcare, our Nation must provide it immediately from a certified mental healthcare professional so the veteran can avoid a broken family, lost job, drug abuse, alcoholism, crime, homelessness, and suicide.
Second, when a veteran needs disability compensation for a mental health condition, our Nation must provide it immediately, without endless bureaucratic hassles, so the veteran can put food on the table, pay the rent, and take care of his or her family.
When the Department of Defense discharges a service member who fought honorably in combat for a personality disorder, then the military is breaking its own rules. DoD regulations state that if a service member was in combat, then the military is generally prohibited from using a personality disorder diagnosis.
DoD’s actions have serious consequences. A veteran discharged for a personality disorder is usually denied access to VA healthcare and disability benefits based on VA regulations that prohibit providing services for a pre-existing condition.
In light of the military’s inappropriate discharges, what can Congress and VA do now to begin to resolve this fiasco? VCS will describe the scope of PTSD among Iraq and Afghanistan war veterans, and then VCS will offer solutions. More than 1.6 million of our fellow Americans have deployed to the two war zones.
As of December 2006, about 686,000 are now veterans eligible for VA healthcare and benefits. A staggering 36 percent, or 229,000 veterans, were already treated at VA medical facilities. Of those treated, more than one-third, or 84,000 veterans, were diagnosed and treated for a mental health condition, including more than 20 percent, or 45,500, for PTSD.
As of June 2007, more than 202,000 Iraq and Afghanistan war veterans have already filed disability compensation claims against VA. Of the 157,000 claims approved by VA, more than 19,000 veterans are service-connected for PTSD. The PTSD claims will continue to rise as the number of PTSD patients rise, especially when the deployed veterans exhaust their two years’ of free healthcare.
When all of our troops return home, at the current rate, VA faces nearly 600,000 potential mental health patients, including 320,000 diagnosed with PTSD. The number will grow as hundreds of thousands more of our service members deploy for a third or fourth combat tour in an escalating war that surrounds our troops with 360-degree combat 24 hours per day, where our troops switched from being the predator to being the prey. The number of claims will also continue to rise, including those for PTSD.
VCS urges Congress to adopt nine new policies so that more of our war veterans with PTSD don’t fall through the cracks – the period of time between when a service member discharges from the military and the new veteran begins receiving all of his or her healthcare and disability benefits.
Failure to reduce the stigma and delay in providing healthcare and benefits will most likely result in a social catastrophe among many of our returning Iraq and Afghanistan war veterans – including broken families, lost jobs, stigma, drug abuse, alcoholism, crime, homelessness, and suicide. Many of these consequences are preventable. Please act now and take advantage of this quickly closing window of opportunity.
Proposed Solutions to Personality Disorder and PTSD Crisis
First, VCS urges Congress to order the Department of Defense to immediately stop discharging war veterans with a personality disorder diagnosis. If the military allowed the service member to enlist, then a personality disorder diagnosis should be given only in cases of fraud after providing the service member with full due process. Congress should also order the military to conduct a review of all personality disorder discharges for veterans deployed since September 11, 2001. Congress should also order VA to review applications for healthcare and disability compensation where VA denied access based on a personality disorder.
Second, Congress should order DoD and VA to establish a policy to reduce the stigma against people with mental health conditions. Military studies confirm this stigma hinders many of our war veterans from seeking mental healthcare. America can and should welcome our veterans home with full and prompt access to mental healthcare.
Third, VCS urges Congress to demand full enforcement of Public Law 105-85, the law requiring all service members to be examined for physical and mental health conditions before and after deployment. This law implements a critical lesson learned from the Gulf War, when the military failed to examine our troops before and after deployment. The military’s negligence resulted in a lack of information about Gulf War illnesses among more than 100,000 Desert Storm veterans that still stump scientists today.
Fourth, Congress can enact legislation creating a presumption of service connection for PTSD for veterans who deployed to a war zone since September 11, 2001, who are diagnosed with PTSD. A deployment since September 11, 2001, should be considered as combat under 38 USC 1154. A presumption makes it easier for VA to adjudicate the claim, and results in faster medical treatment and faster disability compensation payments for veterans. Congress should also explore automatically approving all VA claims at a modest rate within 30 days, for a period up to one year, for deployed veterans’ claims. VCS supports this bold recommendation initially made by Harvard Professor Linda Bilmes.
Fifth, Congress should enact legislation significantly expanding VA’s highly successful Vet Centers and allowing VA readjustment counselors to provide mental health services to active duty service members, either at existing facilities or at new offices on military bases. This expanded service might first be targeted at military installations that have shortages of mental healthcare providers and bases expecting large redeployments from the war zones. This way, the supply of mental health professionals can meet expected and significant surges in demand. Congress should also consider allowing families to participate in the readjustment counseling process at Vet Centers.
Sixth, Congress should enact S 1606, which was added to the National Defense Authorization Act in the Senate. This bill directs DoD to streamline policies and reduce the number of veterans falling through the cracks. The most important part of the bill, in our view, is the provision mandating that DoD provide free medical care for veterans discharged for a medical condition at less than 30 percent. Based on the series of Government Accountability Office reports over the past ten years, this legislation should be amended to mandate that DoD provide VA immediate access to full military and medical records immediately after a veteran’s discharge so that VA can expedite medical treatment and claims processing.
Seventh, Congress should enact S 1354, which directs VA to define the war zones, collect data, and prepare cost and benefit use reports about the Iraq and Afghanistan wars. This proposal mandates “truth in government” so Congress and the public are fully and regularly informed about the human and financial costs of the two wars. This proposal will also tremendously improve VA planning and budgeting. Without consistent and timely reports for the expanding Iraq and Afghanistan war population, VA may once again fall $3 billion short and be unable to provide medical care to veterans.
Eighth, in a related matter, VCS urges Congress to enact S 849 so that VA and DoD comply with all Freedom of Information Act requests in a complete and timely manner. VA routinely delays or denies our FOIA requests about the Iraq and Afghanistan wars. VA’s stonewalling unduly hinders VCS from providing fact-based advocacy. VCS used DoD and VA documents obtained under FOIA to assist Harvard Professor Linda Bilmes with estimating the cost of the two wars for VA at between $350 billion and $700 billion over 40 years. VCS also obtained obscure DoD reports confirming the two wars caused more than 65,000 casualties, defined as a person who is dead, wounded, injured, or ill (DoD and the press routinely mislead the public by providing the incomplete count of 25,000 casualties). VCS also publicized the fact that VA statistics reveal that National Guard and Reserve are half as likely to file VA disability claims than Active Duty. However, the National Guard and Reserve are twice as likely to have their claim denied.
Ninth, Congress and VA should consider a package of PTSD-related reforms:
- VA should set clear timeliness standards to screen and provide care for PTSD.
- VA should outsource current demand for PTSD treatment to the private sector, so veterans receive timely care, until such time as VA can hire permanent staff.
- VA must accept a PTSD diagnosis from private professional psychiatrists. If VA disputes the non-government diagnosis, then VA should approve the PTSD claim until the claim decision is final so that the veteran receives prompt medical care.
- VA must update the outdated and incomplete PTSD rating schedule to take into consideration quality of life issues raised recently by the Institute of Medicine. The rating schedule should be veteran-friendly and be based upon the latest medical and scientific findings.
- VA must require all claims adjudicators to receive prompt and intensive training on PTSD claims. This high-priority item should be accomplished quickly because of the escalating claims backlog and the reasonable expectation of hundreds of thousands of more PTSD claims.
- VA must be held accountable when VA makes mistakes. When a veteran wins a case based on appeal or remand, then VA should be required to pay back interest and penalties. Without accountability, VA will continue to inappropriately delay and deny veterans PTSD claims.
Background Describing VA’s Crisis
Sadly, Mr. Chairman, the current VA political leadership failed our veterans as the VA claims backlog grew 50 percent in the past three years. In a bitter irony, VA handed out $3.8 million in cash bonuses to top VA political leaders while the overall situation deteriorated at VA. More veterans are waiting much longer to receive disability compensation payments. In response to the outcry over the bonuses, VA said it wanted to retain top executives who could earn more outside government. In our view, bonuses are for exemplary performance only. Public service is an honor, not an ATM machine.
Due to the current poor political leadership, VA’s doctors and claims staff are unable to provide either immediate treatment or prompt payments because of inappropriate interference by VA political appointees. In effect, VA’s political appointees locked VA’s doors and blocked access to healthcare and disability benefits. If not for the intervention of Congress in May to appropriate $1.8 billion in emergency funds to hire more doctors and claims adjudicators, VA’s crisis would continue worsening.
In early 2005, while working at VA, I briefed political appointees and executives at VA headquarters about the sharply escalating mental health and PTSD disability claims among Iraq and Afghanistan war veterans. I personally advised several VA executives, including Ruth Whichard, Mike McLendon, Jack McCoy, Ronald Aument, Lois Mittelstaedt, and several others, that the claims situation was worsening as the two wars deteriorated and the number of eligible veterans continued growing. I advised them, in writing, that more claims processors be hired to meet the steeply rising demand, especially the even faster rise in mental health and PTSD claims. I provided several e-mails documenting these briefings to your staff in March 2007.
After my briefings, top VA political appointees shamefully broke faith with our veterans. Instead of hiring more physicians and claims processors to meet the growing demand, top VA political appointees fought against our war veterans and locked the doors.
At one briefing in 2005, a political appointee since fired for his role in the lap top theft scandal, Mike McLendon, revealed that the Bush Administration was fighting against our war veterans. At one meeting, McLendon said there were too many PTSD claims, the veterans were filing them too soon after returning home, our veterans were too young to be filing claims, and it costs VA too much money to assist them. McLendon went further with a factually incorrect and highly offensive statement that if our returning Iraq and Afghanistan war veterans simply “believed in god and country, then they would not come home with PTSD.” I immediately advised my supervisor about this incident, and I also advised your staff about it in early 2006.
After my several briefings to political appointees in 2005 warning them of the current problem, VA launched a systematic effort to block, hinder, restrict, and otherwise prevent our newest generation of combat veterans from receiving the mental healthcare they need and that they earned. In effect, VA locked the doors to cover their refusal to prepare for the surge in returning Iraq and Afghanistan war veterans with PTSD.
VA’s Four Anti-PTSD Policies Adopted in 2005
- VA ordered a re-evaluation of 72,000 previously approved PTSD claims rated at 100 percent. If implemented, VA’s policy would have further increased the 600,000 claim backlog by shifting VA claims adjudicators away from working on new claims to work on already approved claims. Luckily, Congress intervened and stopped VA from implementing this outrageous policy. In the one thousand PTSD claims VA reviewed, VA found zero cases of fraud.
- VA instituted a “second signature” requirement for approving new claims for PTSD at 100 percent. This VA policy would have also increased the backlog by requiring additional work for each claim by a second VA employee. Luckily, veterans groups raised the alarm and VA suspended this policy. Congress should legislate a termination of this policy.
- VA contracted with the Institute of Medicine for the stated purpose of validating the diagnosis of PTSD. VA’s hidden purpose was to narrow the definition of PTSD so that fewer veterans would qualify for VA healthcare or VA disability benefits, thus blocking future claims and saving VA money. Luckily for our veterans, IOM validated the serious nature of PTSD.
- VA again contracted with IOM for the stated purpose of validating PTSD disability payment amounts. VA’s hidden purpose was to reduce the amount of money paid to veterans suffering from PTSD, thus saving VA money. Fortunately for veterans, IOM responded with a report saying VA should consider quality of life issues when determining a veteran’s level of disability.
When viewed together, these four anti-PTSD policies sent a signal to veterans, veterans’ groups, and Congress that VA would fight against PTSD claims filed by Iraq and Afghanistan war veterans. We will never know how many veterans stopped fighting VA and then needlessly suffered from broken families, lost jobs, alcoholism, drug abuse, crime, suicide, and homelessness.
Under the guise of saving taxpayer money, VA’s 23-page claim form and Byzantine claims process serve to inappropriately reduce the number of eligible and entitled veterans receiving assistance for mental healthcare and disability benefits, especially for PTSD.
As a result of these and other anti-veteran policies recently adopted by VA, VCS was given no other choice than to file suit against VA in Federal Court this week. VCS hopes to bring attention to the plight of our returning war veterans with mental health conditions, especially those misdiagnosed with personality disorder and thus denied VA healthcare and disability benefits.
America must not repeat the social catastrophe after the Vietnam War and Gulf War, where veterans faced enormous road blocks when seeking healthcare and disability benefits. Veterans are citizens, too, deserving of full civil rights, equal access, and due process when dealing with our government when we return home from war.
Allow me to close with this very sharp warning that the U.S. 9th Circuit Court of Appeals issued last week in its ruling against VA for resisting payments to Vietnam War veterans suffering from chronic lymphocytic leukemia due to Agent Orange poisoning.
"What is difficult for us to comprehend is why the Department of Veterans Affairs … continues to resist the payment of desperately needed benefits to Vietnam War veterans who fought for their country and suffered grievous injury as a result of our government's own conduct….
“These young Americans who risked their lives in their country's service and are even today suffering greatly as a result are deserving of better treatment from the Department of Veterans Affairs than they are currently receiving….
“We would hope, that this litigation will now end, that our government will now respect the legal obligations it undertook in the consent decree 16 years ago, that obstructionist bureaucratic opposition will now cease, and that our veterans will finally receive the benefits to which they are morally and legally entitled."
[Attachments to Mr. Sullivan's testimony are being retained in the Committee files and include the following:]
- VA Benefits Activity, Veterans Deployed to the Global War on Terror, Prepared by VBA Office of Performance Analysis & Integrity, June 25, 2007;
- VA Facility Specific OIF/OEF Veterans Coded with Potential PTSD Through 2nd Qt FY 2007;
- Analysis of VA Health Care Utilization Among US Southwest Asian War Veterans, Operation Iraqi Freedom, Operation Enduring Freedom, VHA Office of Public Health and Environmental Hazards, April 2007;
- Study by Linda Bilmes, John F. Kennedy School of Government, Harvard University, entitled "Soldiers Returning from Iraq and Afghanistan: The Long-term costs of Providing Veterans Medical Care and Disability Benefits," January 2007http://www.mofo.com/docs/pdf/PTSD070723.pdf; and
- Complaint filed against VA written by Gordon Erspamer, Esq., of Morrison & Foerster: http://www.mofo.com/docs/pdf/PTSD070723.pdf