[House Hearing, 110 Congress]
[From the U.S. Government Publishing Office]
INVISIBLE CASUALTIES: THE INCIDENCE AND TREATMENT OF MENTAL HEALTH
PROBLEMS BY THE U.S. MILITARY
=======================================================================
HEARING
before the
COMMITTEE ON OVERSIGHT
AND GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED TENTH CONGRESS
FIRST SESSION
__________
MAY 24, 2007
__________
Serial No. 110-111
__________
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COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM
HENRY A. WAXMAN, California, Chairman
TOM LANTOS, California TOM DAVIS, Virginia
EDOLPHUS TOWNS, New York DAN BURTON, Indiana
PAUL E. KANJORSKI, Pennsylvania CHRISTOPHER SHAYS, Connecticut
CAROLYN B. MALONEY, New York JOHN M. McHUGH, New York
ELIJAH E. CUMMINGS, Maryland JOHN L. MICA, Florida
DENNIS J. KUCINICH, Ohio MARK E. SOUDER, Indiana
DANNY K. DAVIS, Illinois TODD RUSSELL PLATTS, Pennsylvania
JOHN F. TIERNEY, Massachusetts CHRIS CANNON, Utah
WM. LACY CLAY, Missouri JOHN J. DUNCAN, Jr., Tennessee
DIANE E. WATSON, California MICHAEL R. TURNER, Ohio
STEPHEN F. LYNCH, Massachusetts DARRELL E. ISSA, California
BRIAN HIGGINS, New York KENNY MARCHANT, Texas
JOHN A. YARMUTH, Kentucky LYNN A. WESTMORELAND, Georgia
BRUCE L. BRALEY, Iowa PATRICK T. McHENRY, North Carolina
ELEANOR HOLMES NORTON, District of VIRGINIA FOXX, North Carolina
Columbia BRIAN P. BILBRAY, California
BETTY McCOLLUM, Minnesota BILL SALI, Idaho
JIM COOPER, Tennessee JIM JORDAN, Ohio
CHRIS VAN HOLLEN, Maryland
PAUL W. HODES, New Hampshire
CHRISTOPHER S. MURPHY, Connecticut
JOHN P. SARBANES, Maryland
PETER WELCH, Vermont
Phil Schiliro, Chief of Staff
Phil Barnett, Staff Director
Earley Green, Chief Clerk
David Marin, Minority Staff Director
C O N T E N T S
----------
Page
Hearing held on May 24, 2007..................................... 1
Statement of:
Kilpatrick, Dr. Michael E., Department of Defense, Deputy
Director, Deployment Health Support, accompanied by Dr.
Jack Smith, Acting Deputy Assistant Secretary of Defense
for Clinical and Program Policy; Dr. Antonette Zeiss,
Department of Veterans Affairs, Deputy Chief Consultant,
Office of Mental Health Services, accompanied by Dr. Al
Bates, Chief Officer, Office of Readjustment Counseling;
Dr. Thomas Insel, Director, National Institute of Mental
Health; Major General Gale Pollock, Army Surgeon General;
and Dr. John Fairbank, Duke University, member, Institute
of Medicine Committee on Veterans' Compensation for Post-
Traumatic Stress Disorder.................................. 60
Fairbank, John........................................... 102
Insel, Thomas............................................ 91
Kilpatrick, Michael E.................................... 60
Pollock, Major General Gale.............................. 100
Zeiss, Antonette......................................... 80
Smith, Army Specialist Thomas; Army Specialist Michael
Bloodworth; Richard and Carol Coons, parents of Army Master
Sergeant James Coons; and Tammie LeCompte, wife of Army
Specialist Ryan LeCompte................................... 16
Bloodworth, Michael...................................... 17
Coons, Richard and Carol................................. 18
LeCompte, Tammie......................................... 33
Smith, Thomas............................................ 16
Letters, statements, etc., submitted for the record by:
Coons, Richard and Carol, parents of Army Master Sergeant
James Coons, prepared statement of......................... 22
Fairbank, Dr. John, Duke University, member, Institute of
Medicine Committee on Veterans' Compensation for Post-
Traumatic Stress Disorder, prepared statement of........... 105
Insel, Dr. Thomas, Director, National Institute of Mental
Health, prepared statement of.............................. 92
Kilpatrick, Dr. Michael E., Department of Defense, Deputy
Director, Deployment Health Support, prepared statement of. 63
LeCompte, Tammie, wife of Army Specialist Ryan LeCompte,
prepared statement of...................................... 36
Waxman, Chairman Henry A., a Representative in Congress from
the State of California:
Followup questions and responses......................... 118
Prepared statement of.................................... 4
Zeiss, Dr. Antonette, Department of Veterans Affairs, Deputy
Chief Consultant, Office of Mental Health Services,
prepared statement of...................................... 82
INVISIBLE CASUALTIES: THE INCIDENCE AND TREATMENT OF MENTAL HEALTH
PROBLEMS BY THE U.S. MILITARY
----------
THURSDAY, MAY 24, 2007
House of Representatives,
Committee on Oversight and Government Reform,
Washington, DC.
The committee met, pursuant to notice, at 10:15 a.m. in
room 2154, Rayburn House Office Building, Hon. Henry A. Waxman
(chairman of the committee) presiding.
Present: Representatives Waxman, Maloney, Cummings,
Kucinich, Davis of Illinois, Tierney, Clay, Watson, Yarmuth,
Braley, McCollum, Hodes, Murphy, Sarbanes, Welch, Davis of
Virginia, Platts, Issa, Sali, and Jordan.
Also present: Representative McCaul.
Staff present: Phil Schiliro, chief of staff; Phil Barnett,
staff director and chief counsel; Karen Lightfoot,
communications director and senior policy advisor; Sarah
Despres, senior health counsel; Brian Cohen, senior
investigator and policy advisor; David Leviss, senior
investigative counsel; Susanne Sachsman, counsel; Molly
Gulland, assistant communications director; Earley Green, chief
clerk; Teresa Coufal, deputy clerk; Matt Siegler, special
assistant; Caren Auchman, press assistant; Zhongrui ``JR''
Deng, chief information officer; Leneal Scott, information
systems manager; David Marin, minority staff director; Larry
Halloran, minority deputy staff director; Jennifer Safavian,
minority chief counsel for oversight and investigations; Keith
Ausbrook, minority general counsel; Ellen Brown, minority
legislative director and senior policy counsel; Charles
Phillips, minority counsel; Grace Washbourne and Susie Schulte,
minority senior professional staff members; John Cuaderes,
minority senior investigator and policy advisor; Patrick Lyden,
minority parliamentarian and member services coordinator; Brian
McNicoll, minority communications director; Benjamin Chance,
minority clerk; and Ali Ahmad, staff assistant and online
communications coordinator.
Chairman Waxman. The committee will please come to order.
Today Congress is scheduled to go home for the annual
Memorial Day recess. This is a time for special reflection on
the sacrifices made by generations of American soldiers and for
giving special thanks to our brave troops fighting in Iraq and
Afghanistan.
Today's hearing is about this new generation of heroes and
the invisible injuries that will afflict many of these brave
men and women. We are going to examine startling new figures
about the number of troops that are suffering from post-
traumatic stress disorder and other mental illnesses, and we
will focus on whether the Defense Department and the Veterans
Administration are meeting the need of providing basic levels
of care.
This committee has a longstanding interest in the welfare
of our troops. Long before the American public knew about the
problems at Walter Reed, our Ranking Member Tom Davis was
asking questions, writing letters, and holding hearings about
problems that the Guard and Reserve troops encountered
obtaining health care and military benefits.
John Tierney, the chairman of our National Security
Subcommittee, held the first hearing at Walter Reed, and he
continues to take the lead as our committee examines problems
with the military's health care system.
The most recent statistics on the number of soldiers
suffering from mental illnesses caused by the war are
staggering. Dr. Zeiss, the VA's top psychologist, will testify
today about 100,000 soldiers that have already sought mental
health care, while Dr. Insel, the Director of the National
Institute of Mental Health, predicts that many more will return
from Iraq and Afghanistan with post-traumatic stress disorder.
Recent figures from the Defense Department indicate that up
to 40 percent of soldiers will report psychological concerns.
With almost 1 million soldiers and Marines having served in
Iraq or Afghanistan during the course of this war, hundreds of
thousands of troops will need screening or treatment for
combat-related mental illnesses such as clinical depression,
anxiety disorder, and post-traumatic stress disorder [PTSD].
Yesterday I received a memorandum from the Los Angeles
County Department of Mental Health about the impact of combat-
related mental health problems in my District and the
surrounding area. According to the Mental Health Department,
some Los Angeles area veterans' service providers are reporting
PTSD incidence rates for returning veterans that are as high as
80 percent. The Department has also described case studies of
area veterans who returned from Iraq with mental health
problems. One involved a 24 year old veteran who served two
tours of duty in Iraq but came home with PTSD and saw his life
enter a downward spiral of substance abuse, homelessness, and
crime. I would like to make this memo part of the hearing
record.
As these accounts demonstrate, we are facing a public
health problem of enormous magnitude. While often invisible,
these mental health injuries are real, and, if left untreated,
they can devastate soldiers and their families.
We will hear today from witnesses who experience combat-
related mental illnesses, themselves, or through a family
member. Their stories are heartbreaking, and they remind us
that behind each statistic lies a soldier and a family
struggling to cope.
I want to particularly thank the soldiers and their
families for being here today. I know that the stories you have
to tell us are not easy. This will be difficult to relive. But
they will help us to understand the magnitude of the problem
and, I think, make a true difference.
In our second panel we will hear from the Defense
Department and the Veterans Administration about their
readiness for the tremendous challenges that these mental
illnesses will pose to the system. I know these agencies are
working hard to address these problems, but I remain concerned
they are not ready for the impending crisis. Indeed, the
Defense Department's Mental Health Task Force has flatly
stated, ``The military system does not have enough resources or
fully trained people to fulfill its broad mission of supporting
psychological health in peacetime, and fulfill the greater
requirements during times of conflict.''
One of my greatest concerns is that the problem is getting
worse, not better. Mental health professionals have identified
three important factors that put our troops at risk of
returning with mental problems: longer deployment times,
shorter rest periods at home, and multiple deployments. And
they say that all three are now happening at once, creating a
growing epidemic of mental health injuries.
Just last month, Secretary Gates announced he was extending
tours of Army soldiers deployed in Iraq to an unprecedented 15
months. Some units have found that their time at home has been
cut to as few as 9 months. Many of our troops are now on their
second or even third deployment. There are even disturbing
accounts of soldiers being ordered back to Iraq despite severe
mental and/or physical injuries. These are dangerous practices
that imperil the health of our troops.
We have sent hundreds of thousands of troops to Iraq and
Afghanistan and we can never thank them enough for their
service. As we approach Memorial Day, we need to recognize that
it is a moral imperative that we do everything possible to
prevent and treat their injuries, whether physical or mental,
and give these soldiers and their families the support and care
they need when they return home.
I hope this oversight hearing will help make this happen.
[The prepared statement of Chairman Henry A. Waxman and
referenced information follow:]
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Chairman Waxman. I now want to call on the ranking member
of the committee, Mr. Davis.
Mr. Davis of Virginia. Thank you, Mr. Chairman, and thank
you for holding this hearing. Let me also thank the soldiers
and their families for sharing their stories with us today. It
is going to be very, very helpful to this committee.
We also welcome some of our students from Thomas Jefferson
High School for Science and Technology in Fairfax, as well, for
being with us.
We convene to discuss the inevitable, in many ways normal,
human response to that inhuman of all activities, war.
Psychological damage suffered by some warriors has been noted
throughout the violent history of our species. Civil war
doctors named it soldier's heart. Since then it has been called
shell shock, battle fatigue, combat stress, and post-traumatic
stress disorder.
So the questions we confront today are both timely and
timeless as we ask how our Nation prevents, detects, and treats
the invisible but no less real wounds of modern warfare.
Thanks to medical advances and proactive military health
programs, we have a greater ability to screen for risk factors,
both before and after deployment, and provide diagnosis and
treatment options for that subset of service members who suffer
neurological damage or symptoms of mental trauma. The former
may emerge as the signature casualty of this era, as superior
leadership, training, and equipment produce unparalleled combat
survival rates, while the survivors come home suffering
traumatic brain injuries in unprecedented numbers.
Recent studies conclude up to 19 percent of returning
combat veterans suffer some type of neurological damage or
mental illness. Not surprisingly, similar studies find longer
deployments and multiple tours correlate to much higher
incidences of brain injury, post-traumatic stress disorder, and
other mental health problems.
National Guard members may also be uniquely vulnerable to
combat trauma effects. That means thousands of Americans
returning from Afghanistan, Iraq, and elsewhere need care for
symptoms and syndromes that can be treated, but if left
undiagnosed could produce permanent health impairments.
So today we ask: are returning warriors screened and
informed of the warning signs of mental injuries? How many seek
the care they need? Are relevant, research-based treatments
available to them? How do we sustain the mental resilience of a
force engaged in the global struggle against terrorism?
Ironically, one of the steepest barriers to diagnosis and
treatment of combat trauma injuries appears to be
psychological. The stigma of being labeled a head case in the
military culture prevents many from seeking help. It allows
unenlightened officers to ignore the problem, threaten exposure
as a malingerer, or counsel the sick to simply gut it out and
drive on like good soldiers.
Less than half of those identifying a mental disorder on
recent post-deployment surveys sought related treatment. Many
cited stigmatization among the reasons they would not seek
care. And those who do seek help often face institutional and
bureaucratic hurdles in a system much more in tune to treating
injuries of the body than the mind.
As we say in our investigation into problems at Walter
Reed, the military health care system is overburdened and often
lacks adequate resources to provide quality care. Both the
Department of Defense and Veterans Affairs Departments are
struggling to shift fundamental health care paradigms and the
treatment of middle-aged and elderly adults to meet the needs
of 18 to 30 year olds as the number of Iraq and Afghanistan
veterans grows.
The success of those ongoing health reform efforts at DOD
and VA will enhance our ability to assess and meet the mental
health needs of active and Reserve members at home and abroad.
That capacity is critical to assure the continued readiness of
U.S. forces to meet global security demands.
Mr. Chairman, this is an important set of issues, and we
thank you for convening this hearing. Every American we send
into combat brings something of that experience back. We owe
every one of them our respect and our gratitude and a
compassionate embrace for any who come home bruised or broken
in body or soul. If the war in Iraq ended tomorrow, our
obligation to understand the mental battles of current and
future warriors would not. Mindful of that enduring debt, I
hope the testimony of our witnesses today will shed needed
light on the mental stresses encountered by today's warriors
and how we can better heal the inner wounds of modern warfare.
Thank you.
Chairman Waxman. Thank you very much, Mr. Davis.
Before we call on our witnesses and introduce them, I want
to ask unanimous consent that Representative McCaul be
permitted in this hearing. Without objection, we are pleased to
have you with us.
A couple of our witnesses are Mr. McCaul's constituents,
and we would like to call on you to introduce them, if you
would, and then we will proceed.
Mr. McCaul. Thank you, Mr. Chairman, and good morning to
you and Ranking Member Davis. I want to thank you for holding
this hearing on this very important issue of mental health and
our soldiers returning home.
It is an honor for me to introduce to you Richard and Carol
Coons, constituents of my District from Katy, TX.
Today, among other things, you will hear the story of their
heroic son, Master Sergeant James Coons, who served our Nation
for more than 15 years. Despite his unconditional service, the
United States, in my judgment, has yet to show the memory of
Master Sergeant Coons or his family its appreciation or respect
for that service.
As their Representative in Congress, I and my staff have
spent the past 2\1/2\ years working on behalf of the Coons
family to find answers to their questions about their son's
death, many of which the Army, the Department of Defense, and
the administration have yet to answer. Through my office, the
Coons have repeatedly asked for a complete set of their son's
medical records. The family has yet to receive them.
We have repeatedly asked that the Army provide Richard and
Carol with all of their son's personal effects, and
specifically Master Sergeant Coons' notebooks. The family has
yet to receive them. We have asked that the Department of Army
change the date of Master Sergeant Coons' death, which is
listed as July 4, 2003, to the more accurate date of either
July 1st or 2nd, as indicated by the Washington, DC, medical
examiner's report. The Department of Defense has yet to do so.
Most of all, this Nation has failed the Coons by not
watching over their son the way he watched over all of us and
our families for 16 years as a soldier in the Army.
Some time between July 1st and July 3, 2003, Master
Sergeant Coons took his own life, a victim of post-traumatic
stress disorder, on the grounds of Walter Reed Army Medical
Center. Despite repeated pleas to several different people at
Walter Reed, no one went to check on Master Sergeant Coons
until his death on July 4, 2003.
Mr. Chairman, my office has sent dozens of letters,
followed up with hundreds of phone calls and e-mails, and to
this very day the Department of the Army, Department of
Defense, and the administration has yet to correct any of their
mistakes or even apologize, despite overwhelming evidence of
their failure.
Chairman Waxman. Mr. McCaul, what you are telling us is
really very disturbing and I want to hear from them and the
other witnesses, as well.
We want to welcome you to our panel today. I thank you very
much for the introduction.
Mr. McCaul. Well, I would like to close, Mr. Chairman, by
saying that I hope we can turn this tragic experience that my
constituents have gone through and experienced into a positive
one in working together in a bipartisan fashion to address this
very important issue, and I want to thank you for holding this
hearing.
Chairman Waxman. Thank you. We fully agree with you.
We hadn't suggested opening statements because we wanted to
go right to the witnesses, but if any Member wishes to take a
2-minute opening, we will be glad to recognize the Members.
Ms. Watson.
Ms. Watson. Thank you so much for this hearing. I will take
1 minute to introduce a young man, Todd Bowers, who is sitting
in the second row to my left. He is the Director of Government
Affairs. He met with the Domestic Policy Subcommittee this
morning to talk about these issues that we are covering in this
hearing. I do hope that he will then submit a statement
according to your remarks that you made, Mr. Bowers, to our
committee.
I just also want to add, Mr. Chairman, that I am carrying a
piece of legislation, H.R. 1853, the Hosea Medina Veterans
Affairs Police Training Act, and it is a bill that would force
the Department of Veterans Affairs to better prepare its police
force to interact with patients and visitors at the VA medical
facility who suffer from mental illness. He went through a very
traumatic affair when he was found on the floor in the VA
hospital. More on that at another time, but I would hope that
all Members would support the Hose Medina bill. It gets to the
issue that we will cover today.
Thank you so much for the time.
Chairman Waxman. Thank you, Ms. Watson. We will hold the
record open to receive a statement so that we can have that as
part of our record.
I would like to now call on Ms. McCollum.
Ms. McCollum. Thank you, Mr. Chair. And I want to thank the
families for being here today.
I requested the Chair, because many of us have been working
on case work in which we have had a very similar response from
the armed services when trying to get answers for our soldiers'
families. Maybe the Chair and the ranking member would
entertain a way to survey our congressional offices, keeping
confidentiality always foremost in our minds, to find out just
how pervasive this is, because it is quite evident we cannot
ask the Department of Defense to turn over this information. I
think the Chair and the ranking member are going to find out
that these families are representing just a drop in the well of
how many of our service men and women have been treated.
Thank you, Mr. Chair.
Chairman Waxman. Thank you, Ms. McCollum.
Mr. Braley, did you wish to be recognized?
Mr. Braley. Yes. Thank you, Mr. Chairman and Ranking Member
Davis, for holding this important hearing.
This issue is very personal to me. My father enlisted in
the Marine Corps when he was 17, served on Iwo Jima, came home
and raised a family. When I was in high school he suffered two
severe bouts of depression that nobody in our family could
understand. This weekend I will be making my 26th annual trip
to his grave in a tiny cemetery located in the country near
York, IA.
Eleven years after he died, my brother, who works at the VA
hospital in Knoxville, IA, was approached by a patient who
recognized his name tag and told him about an incident that
happened in 1946 right after my father returned from the war,
totally unsolicited, where my father was working on a threshing
crew and became overcome by the heat, was taken to the shade,
and proceed to relate a flashback experience when one of his
best, best friends was vaporized by a shall burst on Iwo Jima.
That is why I am so proud that this hearing is being held
today, and I want to make a commitment to the witnesses who
have taken time to appear before us that this body will do
something to help get answers to the troubling questions that
you have posed for us.
Thank you, Mr. Chairman.
Chairman Waxman. Thank you, Mr. Braley.
Any other Members wish to be recognized for a 2-minute
opening? Mr. Issa.
Mr. Issa. Thank you, Mr. Chairman.
Certainly the Wounded Warriors Assistance Act that passed
yesterday is incredibly important to what we are looking to do
for, in fact, the men and women who put their life on the line.
I believe, though, that we have to do one other thing in this
committee, and that is that we have to seek very hard to be
able to put the war in Iraq separate from, in fact, what we are
doing here today.
I am looking forward to this hearing and the work we do as
a committee to recognize that the best work we do is the work
we do separate from the other committees and what often goes on
on the floor. I look forward to testimony here today, and I
look forward to working with the chairman to try to get beyond
the things we disagree on and take an issue we agree on like
dealing favorably with those who have not made a political
statement but, in fact, made a patriotic statement on behalf of
our country, and work together to find good solutions for them.
I yield back.
Chairman Waxman. Thank you very much, Mr. Issa.
Other Members? Mr. Cummings.
Mr. Cummings. Mr. Chairman, I wasn't going to say anything,
but after I heard Mr. Issa I must say this. I sit on the Armed
Services Committee and I also sit on the Readiness
Subcommittee. I cannot separate what I heard about the Coons
family and what I heard about Pat Tillman and so many others.
We have to have in this country trust, and that trust is
earned. I think that when things like, on the one hand, I sit
on Armed Services where we are trying to make sure that our
soldiers are given every single thing they need, rested,
trained, equipped, but then on the other hand we come to this
committee and we are trying to figure out why they don't get
what they need if they are injured, and something very
fundamental that has nothing to do necessarily with military or
committees, it is truth.
When the Coons family--and I am so interested to hear their
testimony--cannot get the truth, there is a breach of trust.
And when there is a breach of trust, that is a major problem.
That is why I recommend the book The Speed of Trust, because it
talks about how when we stop trusting, either with regard to
integrity, or we stop trusting with regard to competence, then
everything slows down and our country slows down.
So we cannot just separate. Mr. Issa is correct, we must
find solutions, but first we have to figure out why we are not
getting answers to questions with regard to wonderful Americans
who stand up for their country, who shed their blood, their
sweat, and their tears to be a part of making this country the
very best it can be.
So I yield back and thank you, Mr. Chairman.
Chairman Waxman. Thank you very much, Mr. Cummings.
Mr. Welch, did you wish to be recognized?
Mr. Welch. Just two points. I thank the chairman and the
ranking member.
Point one, thank you in advance for coming in and sharing
your story. It is hard to do, and Members of Congress
appreciate it, the people of America appreciate it, and your
loved ones appreciate it. We thank you very much.
Second, the cost of the war has to include the cost of
caring for the warrior, and we know that. That is why we
resisted exceeding the recommended cuts in the VA budget and we
are proposing to put the money we need into Defense health care
and the VA health care. Your coming in and testifying is
helping us do the right thing. It is helping the American
people understand what is really going on. So thank you very
much.
Chairman Waxman. Thank you, Mr. Welch.
Does any other Member seek recognition? Mr. Kucinich.
Mr. Kucinich. Mr. Chairman, thank you for holding this
important hearing.
As is becoming more and more obvious, the effects of war
are permanent. It is beyond tragic that the soldiers lucky
enough to survive the war run the risk of health problems that
range from inconvenient to completely disabling or even fatal.
Many of these problems are difficult to diagnose because they
do not fit neatly into our clean medical categorizations. When
they are hard to diagnose, disability benefits are hard to get.
The awarding of benefits is delayed as the scientific
literature catches up over many years to the reality of the
pain experienced by the veterans on this daily basis.
I would ask the Chair to include my entire statement in the
record.
I would just like to conclude by saying that the crushing
burden of these health problems being born by our veterans is
tragic enough, especially when you consider they were sent to
war under false pretenses. But to abandon them after they have
served their duty is inexcusable.
I know that our Members look forward to hearing what we can
do to better serve our veterans at this hearing, and I thank
the Chair very much.
Chairman Waxman. Thank you very much.
Are we ready to proceed to the witnesses?
I want to introduce three other witnesses in addition to
Mr. and Mrs. Coons, who have been introduced to us already.
Mrs. Tammie LeCompte is the wife of Army Specialist Ryan
LeCompte, who has completed two tours of duty in Iraq and is
now stationed at Fort Collins, CO. The LeComptes are members of
the Lower Brule Sioux Tribe of South Dakota.
Army Specialist Thomas Smith is a native of Lexington, NC.
He joined the National Guard in 1999 and went on active duty in
2003. He was deployed to Iraq in late 2005 and served in the
Ramadi area. He is currently stated at Fort Benning, GA.
Specialist Michael Bloodworth is a Kentucky National
Guardsman. Before being deployed to Iraq in March 2006,
Specialist Bloodworth studied science at Murray State
University. He is currently being treated at a traumatic brain
injury clinic at Walter Reed Army Medical Center.
We are pleased to have all of you with us. Thank you so
much for being here.
It is the practice of this committee that all witnesses
that appear before us take an oath, and so I would like to ask
each of you to stand and please raise your right hands.
[Witnesses sworn.]
Chairman Waxman. The record will show that each of the
witnesses answered in the affirmative.
We have the written statements that have been prepared for
the record, and we will have that in the record in its
entirety, but we would like--we won't be strict on this, but we
are going to run a clock that will indicate when 5 minutes are
up, and if you could possibly do it that would be a good signal
to try to summarize the rest of the testimony.
Specialist Smith, why don't we start with you if that is
OK.
STATEMENTS OF ARMY SPECIALIST THOMAS SMITH; ARMY SPECIALIST
MICHAEL BLOODWORTH; RICHARD AND CAROL COONS, PARENTS OF ARMY
MASTER SERGEANT JAMES COONS; AND TAMMIE LECOMPTE, WIFE OF ARMY
SPECIALIST RYAN LECOMPTE
STATEMENT OF THOMAS SMITH
Mr. Smith. Chairman Waxman, Congressman Davis, and
distinguished members of the committee, thank you for inviting
me to testify here today.
I, Specialist Thomas Smith, entered active duty in October
2003, and in the beginning of 2004 I was sent to 3rd Brigade
Combat Team. My MOS is 88 Mike. That is a transportation
specialist.
In August 2004 I was injured during a training. I hurt my
back. I continued to seek help for this injury for the next 2
years. I was told that I would receive a P-3 profile in late
2006. I did not actually receive this profile until my Medical
Board proceedings for my psychiatric problems were initiated.
On May 22, 2007 I went to check on the status of my medical
proceedings and the case worker told me that she had found my
P-3 profile for my back then.
The date on this profile was November 27, 2006. Even with
this non-deployable profile, I deployed to the National
Training Center and was almost deployed to Iraq. I had already
endured this injury during the first deployment. I deployed to
Iraq in January 2005. Once in Kuwait I was switched from HHC-
130 Infantry to Bravo Company 130 Infantry. While in Bravo
Company 130 Infantry my duties were, as an 11-Bravo, to drive
Bradley fighting vehicles, foot patrols, and guard duty. During
this time, I served in Bacoo, Iraq, and also in Ramadia, Iraq.
After redeployment to the States I went through a brief
mental health evaluation. It was explained that I might soon be
experiencing some adverse reactions to the war such as
nightmares, flashbacks, etc., but that they should go away and
that was perfectly natural.
In September 2006, I was still experiencing symptoms, to
include nightmares, flashbacks, excessive anger, irritability,
and anxiety problems. These problems were and still continue to
affect my daily life.
In September 2006, I called the Army One Source Hotline to
get help. A representative set me up with an appointment with a
psychologist in the community. This psychologist diagnosed me
with PTSD, an anxiety disorder, and also depression. I
continued to see a psychologist over the next few months. I
reported to my immediate chain of command that I was seeking
help from a psychologist.
In January 2007 I was deployed to the National Training
Center, where I received no treatment for the month I was
there. During my time there, I was not directly involved in the
training, and yet still had adverse reactions to the sound of
explosions in the distance.
After redeployment to Fort Benning after the National
Training Center, I made an appointment to see my psychologist
immediately. During our session she expressed her concern and
referred me to Martin Army Hospital to seek more help. I then
gave copies of the letters of concern from my psychologist to
my chain of command.
During my first visit with the psychologist at Fort Benning
at Martin Army Hospital, the psychologist also expressed his
concern for my mental health. The psychologist also diagnosed
me with PTSD. After several visits with him he wrote a letter
of recommendation to my chain of command. The letter of
recommendation said that I should not be allowed to have a
weapon and be left behind for a few months for further
treatment before redeploying me to Iraq.
My company commander was contacted and he also visited my
psychologist. My psychologist gave him a copy of this letter
and expressed his concern for my mental health. My company
commander said that he would take the issue to the colonel. I
was not told of the colonel's decision until the day before
deployment. Just hours away from the manifest, on March 9,
2007, I received a phone call from a sergeant in my platoon
stating that the colonel said that I was deploying and I had to
have my bags in at midnight that same night.
At this time I was already on my way to the hospital to
have a talk with my psychologist. When I got there, and after
speaking with him, the decision was made to put me in inpatient
care. I was immediately sent to Anchor Hospital in Atlanta, due
to the fact that there was no room for me at Martin Army.
The psychologist at Anchor Hospital also diagnosed me with
PTSD and depression and an anxiety disorder. I was put on
medication at Anchor Hospital upon getting there. I spent
almost a week there until room was made for me at Martin Army
Hospital. I was then shipped into the mental health floor at
Martin Army hospital, where I was also diagnosed with PTSD and
depression. I spent almost another week there and was released
to outpatient care.
I am still continuing my care and medication, and, although
it is a daily struggle, I am currently receiving excellent
care.
That concludes my statement. I am looking forward to your
questions.
Chairman Waxman. Thank you very much, Mr. Smith.
Mr. Bloodworth.
STATEMENT OF MICHAEL BLOODWORTH
Mr. Bloodworth. Thank you, Mr. Chairman, Representative
Davis, and distinguished guests of the committee. I would like
to extend my gratitude for being able to come here and share my
experiences.
I am Specialist Michael Philip Bloodworth, and I was
deployed to Iraq with the Kentucky Army National Guard, Charlie
Company 2nd, 123rd Armor. I have been mobilized since November
2005, when I was trained for 6 months in Camp Shelby, and in
March 2006 my squadron reached its area of operations in Iraq,
where our mission was to provide convoy security.
During the course of the 11\1/2\ months that I was in
country, I logged thousands of miles running convoys in places
such as Tikrit and Baghdad. I was also a victim of five
separate IED exposures and multiple small arms ambushes during
the course of that time span.
On January 16, 2007 I was injured as a result of an IED
blast where I lost consciousness, and have since then suffered
other symptoms of TBI, post-concussive syndrome, and PTSD.
These injuries led to my medevac to Germany, where my further
care continued here at Walter Reed Army Medical Center.
I arrived at Walter Reed Army Medical Center President's
Day weekend, which is the same timeframe that the Washington
Post made its story about Walter Reed Army Medical Center.
Within the first few days I was in-processed into the system
and was beginning to receive some care for my traumatic brain
injury and PTSD, along with the physical problems with my left
knee that I have been having.
I have been in the best of hands since my arrival here.
Even though care has been slow, the people have been
consistently trying to stay with me and make sure that every
day, even though it is a struggle, I am on two feet and making
it to my appointments and making a recovery. Even through the
changing of hands through commander at the Walter Reed Army
Medical Center with the Warrior Transition Brigade, everything
has continued on track. The new leadership has definitely taken
charge and well adapted to the needs of the soldiers and tried
to better the system.
My treatment at Walter Reed Army Medical Center has been
focused, first and foremost, on my traumatic brain injury, and
second my symptoms of PTSD, such as night terrors, flashbacks,
and inability to sleep unless on medication.
I have been involved with occupational therapies, a
treatment for my TBI, and the current treatment for my PTSD has
been seeing a psychiatrist at least twice a month and a steady
regime of sedatives or narcotics to make me sleep at night.
I have been taking my treatment 1 day at a time. I try to
remain on track through this difficult time. Through the aid of
everyone at the traumatic brain injury clinic and the aid of my
psychologist and the support of my platoon sergeants and squad
leaders I am making progress. Progress is slow, but it is
better than anything.
I have definitely needed help along the way, but it is
getting better.
This concludes my opening remarks. Thank you, Mr. Chairman.
Chairman Waxman. Thank you very much, Mr. Bloodworth.
Mr. and Mrs. Coons.
STATEMENT OF RICHARD AND CAROL COONS
Mr. Coons. Good morning, Chairman Waxman, Ranking Member
Davis, and members of the committee. Carol and I would like to
thank you for giving us the opportunity to provide you
information on the treatment of our son, Master Sergeant James
C. Coons.
There is nothing that can be done to help Jimmy now;
however, with our information and that of the others present
here today, change can and must be made in hopes of providing
the proper care for our returning heroes so they may enjoy a
healthy and productive life.
Our story: Thursday, February 13, 2003: ``Don't sweat the
small stuff. This is my life. I am a soldier. With that comes
an inherent amount of responsibility and self-sacrifice. All of
my adult life has been spent as a soldier. I knew many years
ago what I was getting myself into. I would not change
anything. Yep, I'm dog tired and my body hurts, but there is
not another place on the face of the planet earth that I want
to be right now. What I do now is not for me; it is about the
American flag. Some folks don't have a clue. They curse it.
They spit at it. They burn it. Well, one day I will be buried
with and under it. This is my generation's war, and if you are
a soldier then it is your profession, the profession of arms.
Now rest easy and tell everyone not to worry. I will find my
way home again one day.''
These words were from my son, a U.S. soldier, a proud
soldier who loved his country, his God, and then his family.
Master Sergeant James Curtis Coons was a true soldier through
and through all of his life. At a very early age he was
fascinated with anything military. Pass a truck hauling a tank
or any military equipment and he would get excited. Drive by
the Port of Beaumont, and you would have to stop so he could
watch the gear being loaded for overseas shipments. Pass an
Army surplus store, well, we had to stop. Who would think a 5-
year-old kid would eat C-rations? He had to have a parachute
hung above his bed. He took the harness off of it and tried to
jump out of a small tree. Well, he did, and we had to cut him
out of it.
My son, James, was born on April 3, 1968, in a small town
in Texas. He died in July 2003, under the care of Walter Reed
Army Medical Center in Washington, DC. Thirty-five years old, a
military man happily married to a wonderful wife who had two
beautiful daughters. Sixteen years of military service on a
fast-track promotion and slated to attend sergeant major's
academy at Fort Bliss in El Paso, TX, in August 2003.
What happened to my son? Does anyone really know? We began
to wonder, and I wonder why, if they know, won't they tell us.
What we did know is this: Jimmy was doing his tour of duty in
Iraq. He was always rock steady. He was strong willed and a
good spirit all of his life, but in April and May 2003 his e-
mails and phone calls from Iraq took on a completely different
tone, a tone that alarmed us.
On June 12, 2003, in an e-mail to his mother he said,
``This place has really put a beating on me. I found myself
struggling to understand and deal with my own personal demons.
I don't know what started this downward fall I am in. I am just
ready to come home. I love you. Jimmy.''
This was the time he started complaining about not sleeping
and seeing images of a dead soldier he had seen in the morgue.
For some unknown reason, that image remained burned in his
mind, an image he saw over and over again in his sleep and
would wake him.
He sought help for the fatigue and anxiety he was
experiencing and was only given medication. No one counseled
him. No one sought to find out the underlying reason. Just take
these sleeping pills. No followup, no more concern, just
another soldier with a sleep disorder. No one cared enough to
find out why.
The medicine did not help. On June 17, 2003, James called
his OIC and asked for help. Captain Singleton and another
soldier raced to his quarters, where they had to break in to
find him lying semi-conscious. He was then rushed to a medical
facility at Camp DOHA for evaluation and treatment. He was
diagnosed with PTSD, post-traumatic stress disorder.
During his 3-day stay at the medical facility he was
unwilling to discuss his situation with medical staff. On June
21, 2003, he arrived in Landstuhl as an outpatient. He left on
a medevac flight on June 29, 2003, arriving at Walter Reed Army
Medical Center some time around June 30, 2003. He was evaluated
upon his arrival, and the evaluation did not find that he was a
threat to himself or others. He had a scheduled appointment the
next day and was released to his own custody with instruction
to followup at the outpatient clinic. He was sent to his room
alone, had appointments set up. He never made one of those
appointments. No one ever made an attempt, even after our
calls, to check on him.
Records indicate that James checked into his room at the
Malogne House. He never left his room again.
The next 4 to 5 days were a total nightmare. Carol and my
daughter-in-law began calling Walter Reed the next day trying
to find Jimmy. We have documentation of repeated calls to
various departments trying to verify that Master Sergeant Coons
had arrived at Walter Reed. No one had any information. They
did have a room registered to a Master Sergeant James Coons,
but no one could tell us if he was actually on the property.
During this time we were told that this was a holiday
weekend and it would be difficult to get someone to check his
room. Policy will not let us go into the room until 3 days if
there is a do not disturb sign on the door.
I have since found in part of the investigation papers a
letter from Base Commander Kiley saying that rooms would be
entered daily to check on the well-being of guests. It is not
dated, so I don't know if this was prior to James or
afterwards.
We were passed around and around. A call to the hospital's
clergy, a captain told us, ``He's a senior noncommissioned
officer. I cannot get into his business.'' Calls to the
military police, and no one responded to us.
Finally, on July 4th someone took our calls seriously and
went to check his room. We were still calling and now were
really getting the run-around. They know something, they say,
but they can't tell us until the Army officially notifies his
wife. Well, thank God a worker at the Malogne House finally had
enough compassion to tell my wife on the night of July 4th that
James had passed away. The next day my daughter-in-law was
notified of Jimmy's death at approximately 0630, and we were
notified around 9 a.m.
Now the story gets interesting. Our casualty officer was
not informed of the cause of death, and we were not being told
a cause of death, either. We would not learn of it until after
Jimmy had been buried. That is not quite true. We learned about
it the day before we buried Jimmy.
No matter what we did, we were met by a stone wall. One
bureaucrat or officer after another would say that they did not
know, or would pass us to someone else who, in turn, would pass
us on to another person. No one, it seemed, knew or were
willing to tell us the actual cause of our son's death. We are,
to this day, still unsure of his actual date of death.
James' body was returned to us on July 13, 2003, and was
buried on July 15, 2003. During the visitation on Monday, July
14th, the funeral home received a call from a retired colonel
in the area saying that he had knowledge of how my son had died
and he was on his way to the funeral home to inform the family.
Our casualty officer, who still had not seen a death
certificate, got a copy of the death certificate faxed to him,
and he had the unfortunate task of taking me outside, telling
me how my son died. I then had to gather my family into a room
and tell them how James died.
We, Carol and I, are here today to relate our experience to
you in hopes that some other soldier who is having problems
won't be ignored, that he or she will be given the best care
and treatment available.
This is a great country. Its greatest asset is our men and
women in uniform. They deserve and we expect that they would
receive the absolute best medical care this country can provide
to its service people to whom those parents have entrusted
their children and to whom this country turns to for protecting
us and our country's values in times of need.
Don't sweep these people under the rug. Out of sight, out
of mind. Not my problem. That is just not acceptable. They
deserve so very much more. We, the parents who entrust our
children to you, deserve more.
Thank you.
[The prepared statement of Mr. and Mrs. Coons follows:]
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Chairman Waxman. Thank you very much, Mr. Coons.
Mrs. Coons, did you want to add anything, or was your
husband speaking for both of you?
Mrs. Coons. No, sir.
Chairman Waxman. OK. Thank you.
Mrs. LeCompte.
STATEMENT OF TAMMIE LECOMPTE
Mrs. LeCompte. Thank you, Mr. Chairman and Members here
today.
My name is Tammie LeCompte, the proud wife of Soldier
Member Specialist Ryan LeCompte from the Lower Brule Sioux
Tribe out of South Dakota.
Ryan has been in the Army for 7 years and has served two
full tours in Iraq. He had plans for a full military career and
wanted to serve 20 years. Even though that seems impossible
now, Ryan has many proud memories while serving this Nation.
But today he only feels shame and embarrassment, mostly because
Ryan's leaders did not understand his war injuries, and that is
part of what has led to my being here today.
Ryan willingly put his life on the line for all of us, and
the only thing we ask in return is understanding of his war-
related conditions--no harassment from leaders who don't
understand PTSD; proper and tailored mental health care; proper
tracking, screening, and diagnosis of traumatic brain injury;
and, finally, an appropriate discharge from the military if his
condition does not improve.
In 2004, after Ryan returned home from his first tour from
Iraq, he filled out his post-deployment health assessment form
and indicated that he was having difficulties readjusting. He
did not receive a referral to mental health. Then again in 2005
he filled out a pre-deployment health assessment form and asked
for a referral to mental health. He did not receive this
referral and was, instead, redeployed to Iraq in June 2005.
These unfortunate circumstances have impacted my family
tremendously. When Ryan returned from his second tour in Iraq,
he was a changed man. He again filled out his post-deployment
health assessment form and again indicated that he was having
difficulty readjusting. After Ryan's mandatory 90-day followup,
he received an emergency referral to mental health; however,
nobody followed up with him. Ryan needed help and could not get
it.
This period of time was very difficult for me and my
family. The changes in Ryan were apparent, and I wanted to do
everything I could do get him the help that he needed.
In August 2006 Ryan unfortunately received a DUI and was
referred to the Army's substance abuse program. During this
period, Ryan was never diagnosed with PTSD, regardless of his
repeated requests for help.
Finally, on March 22, 2007, Ryan was diagnosed with chronic
post-traumatic stress disorder. Ryan's command claims that they
were not notified of this diagnosis until May 18, 2007.
In April 2007, the abuse that Ryan received from his
command worsened his condition to the point that his civilian
mental health care provider referred him to Cedar Springs for a
72 hour acute care facility. At this point I was completely
discouraged.
I am not a PTSD expert, but let me tell you how PTSD and
the lack of care impacted my family.
As a wife, it was hard to make sense of these changes with
Ryan. I didn't understand the anger and the sudden outbursts. I
didn't understand the lack of support from his chain of
command. And I couldn't explain to my children why Daddy was
the way he was--detached, distant, and someone that I didn't
know at all.
My children were afraid. They were constantly asking why
Ryan was acting the way he was, why he was yelling at me, or
why was he always going away. It has even gotten to the point
where my 4 year old daughter, Savannah, has made up songs about
her Daddy being gone. She doesn't understand. I don't
understand. And Ryan's leaders don't understand.
I was desperate and I was exhausted. These two binders on
the desk represent the effort that I have made on behalf of my
husband.
Finally, when I contacted Veterans for America, they were
able to reach out to Congress, the mental health care providers
at Evans Army Community Hospital, and the civilian clinicians
at Cedar Springs, who indicated that Ryan needed to be in more
comprehensive, individually tailored inpatient facility.
Because of the VFA's pressure, the waiting time to get Ryan
into an appropriate dual-track PTSD/substance abuse program
with the VA went from 4 weeks to 3 days. Finally, Ryan is in an
intensive program; however, he is living with patients
primarily from the Vietnam War Area. DOD must create similar
programs for the soldiers from our newest wars.
I am encouraged to hear from Veterans for America that
Major General Hammond has recognized that mistakes have been
made at Fort Carson and that major changes within the Army as a
whole are required.
I also commend Brigadier General Tucker, who has been
tasked by the Army to be the bureaucracy buster, that he has
made a commitment to make the four following changes: That the
Army records TBI and TBI-like events in the soldier's medical
record immediately after the event, and that we screen for
these events in the post-deployment health assessment and
reassessment; that the Army institutes a leader teach program
designed to teach Army leaders at all levels about TBI and PTSD
so that they know how to identify symptoms in their soldiers,
refer them to the appropriate care, and know how to lead and
take care of these soldiers; that the Army develops a method
that improves the commander's awareness of the soldiers in his
or her unit with TBI and PTSD so that he can ensure the
soldiers diagnosed with these conditions are appropriately
taken care of; and institute a requirement that the medical
facility review the physical exams of all soldiers undergoing
administrative separation proceedings to ensure that no medical
condition requiring a Medical Evaluation Board is overlooked.
I am encouraged when I hear leaders in the Army make these
statements, because it means that another family won't have to
suffer the way our family has suffered in understanding these
illnesses.
Thank you.
[The prepared statement of Mrs. LeCompte follows:]
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Chairman Waxman. Thank you very much, Mrs. LeCompte.
Before we start asking questions, I think the students were
going to leave, and so I thought I would just give them the
signal. This is a good time.
Mr. Davis of Virginia. Thank you, Mr. Chairman.
Thank you for that good testimony.
Chairman Waxman. Well, I thank you, each and every one of
you, for a very important and powerful testimony that you have
given us from your own experiences, from your family's
experiences, what these illnesses have meant.
Oftentimes, post-traumatic stress disorder and other mental
problems are completely invisible. People may not even realize
what is happening to them. The system that is supposed to take
care of them may not realize what is going on, or they may not
be equipped to deal with it.
Mr. and Mrs. Coons, your son was certainly a remarkable
man. He would have been doing today what you are doing. While
he stood up and fought for his men, you're doing the same
thing, because it is not just your son, it is a lot of other
people's sons, husbands, fathers that experience what is going
on. I know he would be very pleased and proud of the fact that
you are carrying that message to us today, so thank you so much
for being here.
Specialist Bloodworth, it sounds like you are getting the
care you need. Do you feel that you are being responded to and
getting help that you need?
Mr. Bloodworth. Yes, I do, Mr. Chairman. At first, no. At
first, I really felt the system was kind of lax, but once they
determined what the problem was they have been doing a good
job. It was getting to the point and getting to the
determination of what the issue was, Mr. Chairman.
Chairman Waxman. Yes. Specialist Smith, your experience has
been very different. You were not diagnosed, or when you were
diagnosed they still wanted to send you back to--was it Iraq or
Afghanistan?
Mr. Smith. It was back to Iraq, Mr. Chairman.
Chairman Waxman. Back to Iraq. And you tried to tell the
military that you weren't ready to go back. Could you tell us
more about that, what happened with you there?
Mr. Smith. Yes, Mr. Chairman.
I made several attempts, taken letters of concern from my
psychologist to my chain of command, even as far as my
psychologist contacting my company commander personally saying
this guy is not ready. He typed up a memorandum stating that I
should not be allowed to be around weapons and that he just
needed more time to work with me, and he believed that I would
be ready to go again. And, according to what I was told, they
were not willing to give me that time to get better. So
following his recommendations and what we thought was best for
me, I went into inpatient care so that I could start receiving
medications and getting the proper treatment.
Chairman Waxman. So the medical system was helping you, but
then the rest of the military system didn't seem to care what
the medical system was doing? They wanted to send you back to
Iraq, even though you weren't ready to go back?
Mr. Smith. Yes, Mr. Chairman.
Chairman Waxman. Yes. Let me ask both specialists, a lot of
men don't know what is happening to them. They know they are
not sleeping well. They are experiencing all the symptoms you
have described. And they may not understand what is happening.
But is there a stigma that some of the men feel about even
going and asking for help? Is this one of the problems we are
seeing?
Mr. Smith. Yes, Mr. Chairman. Even when I began seeking
treatment, I kept it separate from the military. I went through
Army One Source and started seeing a psychologist off post
because I didn't really want anybody at work to know what was
going on with me.
Chairman Waxman. Mr. Bloodworth.
Mr. Bloodworth. Yes, Mr. Chairman, actually, when I was in
country we had a group there, the Combat Stress Team, at Camp
Anaconda, and they had initially done a briefing with every
company and squadron that was coming in and said, We are here
for you. If you have any issues, come talk to us. Immediately
after those doctors and specialists had left, you got the
feeling that people were snickering, like people don't need to
go see them. It is definitely a stigma, and especially in
country because it deters from the mission and it deters from
your mission.
Chairman Waxman. As I understand it, the way the Army finds
out is putting out a questionnaire. Can you tell us, anybody on
the panel, about those questionnaires and about whether that
really gets to the issue?
Mr. Bloodworth. Mr. Chairman, I filled out one of those
surveys during mid-deployment because the Combat Stress Team
decided it was necessary to do that on our post. Very few
questions. I think it was at least 10 questions. Do you feel
like you are a threat to yourself and others? Do you feel like
you want to hurt anyone? Questions like that. And you filled it
out with your squad, and then your squad leader would read it,
and then he would send it to the platoon sergeant, and so it is
back to that stigma again.
Chairman Waxman. Yes.
Mr. Bloodworth. You don't want to let anybody know there is
a problem.
Chairman Waxman. Well, I can see that stigma and the
reluctance, but then the question is what does the Army do once
you tell them you are having these problems. The Defense
Department convened a Mental Health Task Force to study the way
the armed forces are dealing with this PTSD and other mental
health matters, and that task force put out a draft of its
findings, and it concluded, ``The current efforts fall
significantly short in treating mental health problems, and the
military system does not have enough resources or fully trained
people to fulfill its broad mission of supporting psychological
health.'' So, in effect, they concluded our system is in crisis
and that soldiers who are suffering from PTSD and other mental
health problems are not getting the care they need.
Mr. and Mrs. Coons or Ms. LeCompte, you certainly didn't
find the system receptive and able to deal with the problems
your son was having.
Mr. Coons. No, sir, Mr. Chairman, they didn't. We do have
some documents that James did complete prior to being air-
evaced out and asking him these type questions: what would you
say your health is? Do you have any medical or dental problems?
Are you currently profiled for light duty? Have you sought or
intend to seek counseling for care of your mental health?
I mean, he answered these and it was submitted. He said he
had food poisoning, which is, I think, part of our issue is
when this originally happened with James this stigma with him
being a soldier, being a career soldier, he felt like he let
people down. He felt like his career was going to be in
jeopardy now with sergeant major academy coming up, and some of
his peers said, well, we can log this as food poisoning and/or
heat stress. So when he's filling out his forms, I mean, that
is what he's putting down on them.
Chairman Waxman. And the system just failed him completely?
Mr. Coons. Well, this was back in 2003, also, Mr. Chairman.
Chairman Waxman. Maybe we know more. Maybe the system knows
more to respond. I hope.
Mr. Coons. I hope so.
Chairman Waxman. I hope so.
Ms. LeCompte, tell us what your thoughts are about how this
system has been working for you and your family?
Mrs. LeCompte. Well, in that situation on, like, the
questionnaires that they were discussing, my husband's
situation, he filled out his and he was flagged not to go over
or back, and receive immediate help, and it was ignored. If it
says refer to mental health and they don't have the staff or
whatever it might be to help these soldiers, I mean, it really
doesn't do any good to fill out these questionnaires.
Chairman Waxman. Thank you.
My time is up and I want to recognize Mr. Davis.
Mr. Davis of Virginia. Thank you, Mr. Chairman.
Specialist Bloodworth, let me ask you how would you rate
the quality of care you have been receiving at Walter Reed?
Have they made progress now on your treatments?
Mr. Bloodworth. They are making progress, sir. Actually, I
am slotted to go on the community health care organization back
in my home State within the next month, which means that they
don't feel that I will at any point need to be an inpatient and
I can receive my care at home through civilians or the VA.
Mr. Davis of Virginia. I don't know. I have a rough idea on
statistics, but could you guess a percentage that just don't
come forward because of the stigma approached to this? Is there
talk in the barracks or guys saying something's wrong but I'm
just afraid to step forward? Either one of you have any feel
for that?
Mr. Bloodworth. Yes, sir. Overseas you see it because
people see combat or people just being separated from home and
you see everybody becoming depressed and everybody coping with
it, but the ones who are having a hard time coping with it, you
can see that they want help, and you have that stigma. I
wouldn't know a percentage, but I would say it affects many
people in the unit.
Mr. Davis of Virginia. Is there informal talk about it but
people just don't want to come forward?
Mr. Bloodworth. Yes. I mean, there are people who have been
saying I wish I had somebody to talk to somebody who wasn't my
squad leader, somebody who wasn't in the platoon, somebody that
didn't see you every day.
Mr. Davis of Virginia. Seen as a sign of weakness, isn't
it, if you are in the military to kind of come forth?
Mr. Bloodworth. Exactly.
Mr. Davis of Virginia. Specialist Smith?
Mr. Smith. I would definitely say so. You can tell the
people that are having the problems, because ones that have
come forward, people will gather around them and talk to them
more about it. But I definitely believe there are a lot of
people that are scared to come forward. I couldn't say a
percentage, either, but I believe there are a lot of people
that are afraid it is going to hurt their career to step
forward.
Mr. Davis of Virginia. Military is a macho culture. I mean,
that is just part of it. I went through my active duty and OCS
and everything else, and I understand it. It is seen as a sign
of weakness, isn't it?
Mr. Smith. Yes, sir.
Mr. Davis of Virginia. How is the care you are receiving
now?
Mr. Smith. The care I am receiving now is excellent, sir.
They are really taking care of me, making sure that I get
everything that I need.
Mr. Davis of Virginia. Mrs. LeCompte, what support networks
are available now through the military or the VA to families
and children of soldiers who are suffering from mental illness?
Have you seen any?
Mrs. LeCompte. What was that first part again?
Mr. Davis of Virginia. What support networks are available
through the military or the VA? Have you found any that are
available for situations like yours?
Mrs. LeCompte. Well, my husband is in Sheridan, WY, right
now at a VA facility. As far as the treatment there, I mean, it
really doesn't----
Mr. Davis of Virginia. I'm talking about support groups for
you.
Mrs. LeCompte. Well, there is a support group through Evans
Army Hospital; however, there are only certain timeframes to
attend.
Mr. Davis of Virginia. So it is there, but it is really not
adequate?
Mrs. LeCompte. It is not beneficial. Correct.
Mr. Davis of Virginia. Have they given you any type of
education on your husband's illness? Have they sat down and
talked about what is involved and what you can expect and what
the prognosis is?
Mrs. LeCompte. No, sir.
Mr. Davis of Virginia. How about resources available to
your children to better understand their father's illness? The
same thing?
Mrs. LeCompte. No, sir.
Mr. Davis of Virginia. We all hear from witnesses, and we
are going to hear this on our second panel, untreated emotional
trauma arising from combat situations leads to a host of other
problems, including depression, suicidal thoughts, substance
abuse. When was your husband officially diagnosed with post-
traumatic stress disorder?
Mrs. LeCompte. As far as Evans, in March 2007 was when they
finally put it on paper. They would call it everything else but
what it is.
Mr. Davis of Virginia. And during the time that he was
deployed, nothing?
Mrs. LeCompte. Nothing.
Mr. Davis of Virginia. No diagnosis or anything else? Was
he afraid to come forward, do you think, and admit that he was
having some issues?
Mrs. LeCompte. I knew that, in a way, yes, I would say he
was afraid to come forward, but he would still try to seek
help, to get some help for this. But when he comes forward, a
lot of the members of the chain of command, they ridicule these
soldiers and just not do what they should to make sure these
soldiers are taken care of.
Mr. Davis of Virginia. Thank you.
Mr. and Mrs. Coons, I just want to thank you for sharing
your son's story with us. You don't know how many times this is
repeated across when people are afraid to come forward
sometimes and talk about it in a public setting. I know it is
not easy to do. I hope that we can honor your son's life by
acting on this, understanding it better, and trying to ensure
that it doesn't happen again and take steps. I just want to
thank you. I think the story speaks for itself. We just
appreciate you coming forward.
Thank you, Mr. Waxman.
Chairman Waxman. Thank you very much, Mr. Davis.
Mr. Cummings.
Mr. Cummings. Thank you very much, Mr. Chairman.
To all our witnesses, I thank you all for being here.
To Mr. and Mrs. Coons, Mr. Coons, you said that your son
and others in matters of this nature should not be swept under
the rug. I promise you that we will do everything in our power
to make sure that does not happen. We thank you for being here.
We also thank Specialist Smith and Specialist Bloodworth
and Mrs. LeCompte for your testimony.
To Specialists Smith and Bloodworth, as I was listening to
the questions about stigma, I said to myself this must not be
the easiest thing to do. It will probably be on national
television with this testimony. That says a lot for you.
Back to Mr. and Mrs. Coons, and to all of you, I believe
that one of the reasons why Specialist Smith and Specialist
Bloodworth are getting the kind of treatment that they are now
getting is because of people like you who stood up and said
that there were problems earlier, and now we are seeing better
treatment.
Specialist Smith, we have been told that soldiers with
injuries, both mental and physical, are being sent back to
fight in Iraq against their doctor's orders, and you testified
to that. Just to followup on the chairman's questions, in fact,
back in March you had recently returned from traveling with
your unit to the National Training Center in Fort Irwin, CA, to
participate in a pre-deployment training exercise. During that
time you were at the training center, I am told that you
experienced a disturbing incident during which you attacked a
fellow soldier; is that correct?
Mr. Smith. Yes, sir. I had been having really bad
nightmares and stuff, reactions to the mortars that they were
setting off in the distance, and it just so happened about 2
a.m. one night a fellow soldier came walking in the tent, and
my bunk was right next to the tent, and it was right around the
same time that was happening, and I jumped up and grabbed him
and slammed him up next to the tent. It was a pretty scary
incident because if I had had a weapon or something, who is to
say that I would not have actually hurt this guy.
Mr. Cummings. So this was just in March?
Mr. Smith. In January, sir.
Mr. Cummings. OK. Was that part of the reason that you and
your doctors did not think that you should return to Iraq?
Mr. Smith. Yes, sir. Upon returning from that, I
immediately saw my on-post psychologist and that is when she
said that I needed to seek more help and get medications, and
that is when she referred me to on post, and that is when the
psychologist on post had made the recommendation that I not be
deployed and not have weapons.
Mr. Cummings. And did you share your doctor's letters with
your unit commanders?
Mr. Smith. Yes, sir, I did. My unit commander was even
contacted by the psychologist and he had actually sat down and
talked to my unit commander and gave him a copy personally.
Mr. Cummings. Now, do you have any idea why your commander
would have wanted to deploy you, even though your doctors felt
that you were not fit for deployment? Go ahead.
Mr. Smith. My company commander actually went to the
colonel. I don't know which colonel. I don't know if it was the
squadron colonel or if it was the brigade colonel, but he told
me that he went to the colonel with the letters. He was
actually fighting for me not to go.
Mr. Cummings. Yes. And can you tell us, based on your
doctor's instructions, what did you do to avoid being deployed
to Iraq for a third time under the conditions that you just
described?
Mr. Smith. Whenever I went and sat down with my doctor, we
discussed some things, and I told him that I would rather kill
myself than to see and experience the things that I had been
through when I was over there last time. I was not mentally
healed and not prepared to go through this kind of thing again.
Mr. Cummings. And you knew that?
Mr. Smith. Yes, sir.
Mr. Cummings. Do you still feel that way?
Mr. Smith. No, sir. The treatment that I am getting now and
with the medications and everything, it is really helping. I
mean, I am a lot better now.
Mr. Cummings. Well, we are glad that you are better.
Do you think other soldiers go through the same extreme
measures, or did any of them just return and fight injured? I
mean, do you know of situations?
Mr. Smith. Yes, sir. I know of several other people that
were also going through the same procedures as me, and I also
know several others that were actually deployed. There is
actually some that have been sent back. They were deployed over
there and then sent back because of this investigation.
Mr. Cummings. These soldiers, do you think they are able to
perform their duties, I mean, based on what you know? I know
you are not a doctor. Do they put themselves and other soldiers
at risk, do you think?
Mr. Smith. In my opinion, yes, sir. Nobody wants anybody
with a mental condition or a physical condition trying to fight
on the front lines with them.
Mr. Cummings. Did you want to say something, Specialist
Bloodworth?
Mr. Bloodworth. No, sir.
Mr. Cummings. Again, I want to thank you all for your
testimony. Hopefully we will be able to use this testimony to
help others. I thank you all so much.
You are right, Mr. Coons, this is a great country, and we
are going to do our best to make it an even better country.
Thank you.
Chairman Waxman. Thank you, Mr. Cummings.
Mr. Issa, would you want to yield some time?
Mr. Issa. Sure. I yield 1 minute to the gentleman.
Mr. McCaul. Thank you. I just want to thank my
constituents, the Coons, for coming forward with your story. It
takes enormous bravery and courage to do what you have done. It
is unconscionable to me how someone who is on suicide watch can
be put in an outpatient facility at Walter Reed.
I am glad that, because of what happened, that the Army has
changed that policy, and because you have come forward you have
changed some of the policies of the Army on this issue.
Unfortunately, the Army has not apologized to you for your
tragic experience, and I would like to, on behalf of the U.S.
Government, make that apology to you and say that we are sorry
and yield back.
Mr. Issa. I thank the gentleman.
I think I would like to pick up exactly where the gentleman
left off and say we make mistakes. We have made mistakes in
every war. When we make mistakes, people die, and so you have
my heartfelt apology for the mistakes that clearly were made in
your son's case.
You didn't say what the death certificate said for your
son. I would hope that it said service-connected death; that,
in fact, just like the men and women who were added to the wall
of the Vietnam Memorial because they died of injuries received
in Vietnam, your son clearly is a fatality of his service. You
have our deepest sympathy. All we can say is we will strive not
to make this mistake again.
I am not going to tell you that we are not going to make
mistakes and that young men and women are not going to die
again or that bureaucracy isn't going to make a mistake.
Our next panel is going to, in fact, represent health care
professionals who we are going to count on to be part of that
change. We are going to ask them if they have the resources
they need; if, in fact, the attitude necessary to ensure that
every man and woman gets the care they need and gets it in an
expeditious fashion exists both in the medical professionals
and in the chain of command.
We are going to ask if the organization needs to be
changed, because that is what this committee does, it oversees
the bureaucracy and the structure of Government.
Last, but not least, we are going to question the
leadership at all levels, not just at Walter Reed but
throughout the military structure, to find out whether or not
leadership has, in fact, gotten the message that not all
injuries can be seen from the outside.
It is very hard to ask questions in this kind of an
environment, because each of you represents somebody who has
fallen through the cracks of our system. Finding the right
changes can be difficult.
Specialist Smith, I do have a couple of questions for you.
If I understand correctly, your back injury occurred early on,
before your first deployment?
Mr. Smith. Yes, sir.
Mr. Issa. And that still bothers you today?
Mr. Smith. Yes, sir.
Mr. Issa. And are you receiving physical therapy and other
treatment to help with that?
Mr. Smith. I did physical therapy for approximately 6
months, and they told me that I had reached the extent of my
physical therapy.
Mr. Issa. And have they diagnosed what the permanent
portion of the disability is?
Mr. Smith. Yes. I have a diffuse bulged disk between my L-
4/L-5 vertebrae.
Mr. Issa. And surgery won't do any more for it?
Mr. Smith. No, sir. They said surgery could possibly make
it worse.
Mr. Issa. OK. You said you have a P-3, so you have a
limited ability to perform your duties; is that right?
Mr. Smith. Yes, sir.
Mr. Issa. What are those limitations?
Mr. Smith. I have it right here, sir. According to this
profile, I cannot carry or fire an individual weapon, I am not
able to move fighting gear at least 2 miles, I am not able to
construct an individual fighting position, I am not able to do
3 to 5 second rushes under direct or indirect fire.
Mr. Issa. Specialist, I think I have it. You are not fit
for combat?
Mr. Smith. Yes, sir.
Mr. Issa. And yet you were deployed. Now I guess I will ask
the tough question. Have you ever been offered a discharge
under medical conditions as a result of that injury?
Mr. Smith. No, sir. The only medical board that I am
getting is for my psychiatric care.
Mr. Issa. Do you think that you should have been offered or
should the military have evaluated, if you couldn't do the
job--I will tell you the honest to goodness truth. I enlisted
in the Army in 1970 to be a truck driver, so I ended up in bomb
disposal because I wasn't good enough to be a truck driver, I
suspect. But I, in fact, understand what it is like bouncing
around in a military vehicle. Do you think that, in fact, that
should have been the first sign that, in fact, you were going
to have difficulty performing in your multiple tours to Iraq?
Mr. Smith. Yes, sir.
Mr. Issa. OK. If there is a second round I would love to
pick up on this. I thank the chairman and yield.
Chairman Waxman. Thank you very much, Mr. Issa.
Ms. Watson.
Ms. Watson. Thank you so much, Mr. Chairman. I want to say
to all of our witnesses that we appreciate your valor, your
courage, and your bravery for coming here in front of this
committee. It takes a lot of courage to tell the truth, and it
is time now that we have people like yourselves come and tell
the truth.
In the middle of this war that we are fighting, the
casualties are a manifestation of the cracks in our system, and
your coming and your articulating for us what the cracks in our
system are, we are going to protect our homeland, we have to
know where to fix these cracks along the way so that we can,
indeed, protect the land that we love, we are committed to. I
just want to thank you for being here.
One of the purposes of the hearing is to help people
understand the conditions like post-traumatic stress disorder
and traumatic brain injury. These are very serious injuries,
even though they are invisible. They are injuries caused by
real, real traumatic battlefield experiences.
Now, a number of studies have shown that the more time
soldiers spend in combat, the more likely they are to develop
PTSD when they come home. The soldiers most likely to develop
these conditions are the soldiers who spend most time outside
the wire, where they are exposed to sniper and mortar fire and
IEDs.
I would like to direct this to Specialists Smith and
Bloodworth. You both have had combat experience. I would like
to ask each one of you to describe what soldiers experience
when they are in Iraq. So Specialists Smith and Bloodworth, can
you give us some description of your experiences for our
committee? Let's start with Specialist Smith, please.
Mr. Smith. Yes, ma'am. Whenever we were in Ramadi we were
under constant fire. Every day we left the wire, every day we
were mortared. We have seen RPGs, sniper fire on a constant
basis. I was hit with six IEDs, or the vehicle that I was in
was hit with at least six IEDs. Sniper fire, like I said, on a
regular basis. It is really stressful. We have seen people
blown apart. We have seen our own soldiers catch fire and burn
right in front of us. These are all things that pretty much
everybody in my whole company experienced.
Ms. Watson. Specialist Bloodworth.
Mr. Bloodworth. Ma'am, you pretty much hit the nail on the
head. I was running convoys, five on, one off. That was our
routine. With that, I have seen friends and fellow soldiers
injured, killed. Your friends will go out on a mission and then
somebody doesn't come back. I was hit with five IEDs and so
many small arms ambushes that I can't even count in 11\1/2\
months that I was there. It is a very nerve-wracking
experience, even on your off time. On the day that you are
supposed to be able to rest, you can't get the other 5 days
that you just spent out on the road out of your head.
Ms. Watson. I am looking at you in uniform and I know that
your training, at least traditionally, has been to fight in a
conventional way, correct?
Mr. Smith. Yes, ma'am.
Mr. Bloodworth. Yes, ma'am.
Ms. Watson. What you are finding in Iraq is a non-
conventional kind of experience; is that correct?
Mr. Bloodworth. Yes, ma'am.
Mr. Smith. Yes, ma'am.
Ms. Watson. Do your enemies wear uniforms similar to what
you have on?
Mr. Bloodworth. They had better not.
Ms. Watson. Similar, I should say.
Mr. Bloodworth. It would make the job easier.
Ms. Watson. They don't have patches indicating what
countries they are from?
Mr. Smith. No, ma'am. Most of the time they are dressed as
civilians, and they will even just pop out of a crowd of people
and just fire at you.
Ms. Watson. So you never know who the enemy is?
Mr. Smith. Yes, ma'am.
Ms. Watson. Right. And were you trained to deal with IEDs?
Mr. Smith. We had some brief training before we left. They
went through some obstacle courses and they told us what we can
expect, but the IEDs are constantly changing. Just in the time
we were over there, they went through, like, two different
kinds that they were using. They started out with pressure
plates, and they were using them where they were putting them
up on the telephone poles, so it is constantly changing, so it
is hard to keep up with the training.
Ms. Watson. When the other panel comes up, I want to know
how we are training and preparing our troops to fight in an
unconventional manner, and I think if we can get to that point
maybe we can start addressing the results of the experiences
that you have experienced.
I want to say to the Coons----
Chairman Waxman. Ms. Watson, your time is up. Would you
conclude your sentence?
Ms. Watson. OK, and they can respond maybe at another time,
but I just want to say that until we can get to the point that
we will understand what we are up against, we are going to see
more cases like you are describing.
Thank you so much, Mr. Chairman. I appreciate it.
Chairman Waxman. Thank you, Ms. Watson.
Mr. Yarmuth.
Mr. Yarmuth. Thank you, Mr. Chairman.
I would also like to thank the panel for your testimony and
for your sacrifices. Particular welcome to Specialist
Bloodworth, a fellow Kentuckian. Welcome. It is nice to see
you.
I think it is safe to say, and I think I can speak for
everyone on this panel and probably everyone in Congress, that
one of the toughest things we deal with is trying to suppress
our own emotions when we hear stories like yours. It is a
combination of anger and sympathy--sympathy for the quest that
you have experienced, but anger that the system is not handling
your needs as well as at it could.
I would like to kind of proceed on somewhat of a corollary
from what Congresswoman Watson was asking. Did any of you know
what PTSD was before you got in the service?
Mr. Bloodworth. Sir, they had given us some briefings about
depression and anxiety, and they gave it a face and called it
PTSD, but didn't really explain what it was.
Mr. Yarmuth. Is there any way that you can prepare
psychologically for what you experienced and what you saw?
Mr. Bloodworth. Take it 1 day at a time is the best thing
to do.
Mr. Yarmuth. Specialist Smith.
Mr. Smith. I always say that you can prepare for it but you
can never be ready for it.
Mr. Yarmuth. Do you think that the preparation that you
received as to the possible psychological impact of what you
were going to experience could have been better, or do you
think there is any way to make it better?
Mr. Smith. I don't think there is any way to really make it
better, because you don't know what you are going to see. All
you can do is maybe watch videos and have it explained to you,
what you might be experiencing, but I don't think there is any
way to really prepare for it.
Mr. Yarmuth. Addressing the question of the stigma that has
been talked about by several of the Members and you have
addressed, do you think that it would be beneficial if everyone
who came out of a combat zone, as you did, were forced to do
more than answer a questionnaire so that there would be no
question of you wimping out in seeking treatment?
Mr. Smith. Yes, sir. I think it would be very beneficial
for anywhere from 3 to 6 months for them to be forced to sit
down and talk to somebody and talk about their experiences.
That way they can be evaluated one-on-one. Nobody has to know
who said what.
Mr. Yarmuth. Specialist Bloodworth, would you agree with
that?
Mr. Bloodworth. I agree, that would definitely work for the
active Army, but for the National Guard I don't see how. I
mean, it is a good idea, but maybe a possibly longer
demobilization time and retraining soldiers to live daily life
and doing more than just a 10-question questionnaire.
Mr. Yarmuth. Mr. Coons, you were shaking your head. Did
that indicate that you had a different response?
Mr. Coons. Well, through our Congressman's office we have
been trying to get some questions answered, and just yesterday
we were given a letter from the acting Secretary of the Army,
and they bring up that subject that, in addition to post-
deployment, health reassessment is given 3 to 6 months
following a soldier's return from deployment.
I, as a citizen who has lost a son, find that deplorable.
Some of these young people are going over there for their
second and third tours. Why do we have to wait 3 to 6 months?
That is normally too late. It should be one of the first things
these people go through when they return.
I am no doctor, but, I mean, I just can't understand that.
Mr. Yarmuth. Mrs. LeCompte, do you have a comment on this
issue as to whether mandatory screening following returning
would have been helpful in your case?
Mrs. LeCompte. Yes, I do. I feel that it should have been
done right away.
Mr. Yarmuth. One further question on Specialist Smith. You
talked about the fact that when you were redeployed that you
were possibly a threat to others and that is certainly a
problem. Could you explain maybe what other ways your
performance as a soldier changed, if it did, between
deployments?
Mr. Smith. Yes, sir. I lost a lot of initiative. I really
didn't care to advance in the military any more, especially, I
mean, I felt like I was getting looked down upon. I just
started showing up to work late, where I was always one of the
first ones there, and I just really didn't care to train any
more. I was kind of out of it most of the time when I was
there.
Mr. Yarmuth. Finally, I guess a quick question for both you
specialists. Do you feel that you had to put any pressure on
the system to get the attention that you needed?
Mr. Smith. Yes, sir. Actually, whenever I was put into
inpatient care, my mother had contacted a news reporter, and
that is when all my care and all this got started for me.
Chairman Waxman. Thank you, Mr. Yarmuth.
Mr. Yarmuth. Thank you.
Chairman Waxman. Mr. Murphy.
Mr. Murphy. Thank you, Mr. Chairman. I just have a few
questions.
I would like to ask a few questions related to the stress
that multiple deployments and increased duration of deployments
may be having on our armed forces. We already know through
studies that the rate of PTSD amongst soldiers returning from a
second deployment is about 40 percent higher than it is for
those returning from their first deployment. I had the chance
to visit our soldiers in Iraq and Afghanistan in April, and I
just happened to be there on the day that the Department of
Defense announced that they would be extending the tours of
duty from 12 months to 15 months for those soldiers. This is
the first time in our military history when we have had a
policy whereby soldiers are asked to serve on the front lines,
as Specialist Smith has testified to, 5 days, 6 days, 7 days
without time off. That goes beyond 6 or 7 months. Now we are
having 12-month deployments extended to 15-month deployments.
I direct the question to Specialist Bloodworth first,
because I believe that the unit that you served with in Iraq,
the 34th Infantry Division, was extended, I think, recently by
125 days. Is that correct?
Mr. Bloodworth. Yes, sir. We received our extension orders
on January 1, 2007.
Mr. Murphy. Can you just talk for a moment how soldiers in
the unit reacted to the extension and to what extent that
affects the morale of the unit?
Mr. Bloodworth. Metaphorically you could have heard
everybody's heart's breaking when the first sergeant handed us
out our orders. That was the time when people really started to
lose their cool, really started to lose their military bearing,
and became complacent even on missions, because who cares, we
are here for another 125 days. We were actually in the process
of packing our conexes and sending bags home and they just
dropped the bomb on us.
Mr. Murphy. And I would imagine, Specialist, that for those
troops who have had mental illness or PTSD that has gone
undiagnosed, that moment can be especially backbreaking?
Mr. Bloodworth. It worsened for a lot of people, and I was
working with the Combat Stress Team. I was going and seeing
them offline without my unit even knowing. Only one person in
my unit knew, and they actually found out we were getting
extended, and I had an e-mail to come see them immediately to
talk about the issues, because my therapist there thought there
would be an issue.
Mr. Murphy. Specialist Smith, if I might ask that question
to you, as well, your thoughts on how these announcements
related to tour extensions have had an effect on both troop
morale and on troops who may have undiagnosed or untreated PTSD
and mental health issues.
Mr. Smith. I agree with the specialist here. I mean, it is
really heartbreaking to tell somebody that you are not going to
see your family for another 3 months, especially when, like,
the R&R leave, I have buddies that, we just deployed in March,
they're already coming home on R&R, and they got another 12
months they have to spend in country before they can see their
family again. I believe that plays a big role on it.
Mr. Murphy. And I will actually turn that question over
also to Mrs. LeCompte, because this is an issue that relates
not only to the soldiers that may have their conditions
exacerbated by an extension on their tour, but it also affects
their support network, those expecting them to come home after
12 months. Realizing that is extended might just give you the
opportunity to talk about how that affects families that you
may know or be in contact with.
Mrs. LeCompte. It would definitely cause more stress to the
family. I mean, of course, every day just sitting and waiting
just to hear a phone call just to make sure they are OK, and
for them to extend it even more, and still yet don't have a
clue on how to fix what is happening to these soldiers is very
detrimental. It is like an epidemic.
Mr. Murphy. Thank you very much. I know there are those on
this panel who might want to separate the issue of the policies
directed toward the wars we are fighting now with the question
of how we treat and how we prevent these illnesses from
becoming exacerbated. I think this is an example in which the
two cannot be separated, Mr. Chairman. I yield back the balance
of my time.
Chairman Waxman. Thank you, Mr. Murphy.
Mr. Welch.
Mr. Welch. Thank you. Taking up from where my colleague,
Mr. Murphy, spoke, I was with him on the trip to Iraq and
Afghanistan. It was the first time in my life where I spent 5
days with the soldiers in their world. I came away with
enormous respect, and a lot of the respect was that what is
being asked of you is really quite unbelievable. You are in
danger constantly. And we have heard the testimony about the
stress you have been under, the change in your son and the tone
of the letters that came back. I don't know what you think of
this, but as I listened to this, there are issues about the
Army and our services being responsive, and you are helping us
focus on paying whatever attention we can so it is better, but
there is also a situation there where you guys are just in
incredible danger all the time. I mean, what you describe, how
many IED events that you were involved with, sniper fire
constantly, I mean, that takes its toll. And then having news
that when you thought your deployment was going to end it is
going to be extended. All the while there is significant
questions about whether what you are doing over there is a
civil war and you are caught in the middle of it. It is so
incredibly stressful.
I just want to convey to you my appreciation for what you
are doing, but I don't know anybody who could manage to serve a
tour without a significant toll.
I would just like to maybe ask you, Specialist Bloodworth,
to describe some of the additional day to day events that you
experienced during your service.
Mr. Bloodworth. Day to day experience, I was a driver for
the longest time, so my truck commander felt that it was
necessary for me to sleep all the time unless we were on the
road, so mission days it was, wake up, eat, get the truck
ready, go on mission, try not to die, come back, go to sleep.
On off days I usually just tried to hang out with some of my
friends within our platoon and take off the uniform, put on
some PTs, and try to forget the fact that you are in Iraq.
Maybe barbecue. Maybe grill. Just talk. Go see a movie or
something to try to escape that. That was day to day living off
mission, because I think we both described what on-mission was
like.
Mr. Welch. Specialist Smith.
Mr. Smith. My day to day living wasn't quite as comforting
as his. We didn't have movie theaters or anything like that. We
actually lived in a house that was taken over in Ramadi. We had
people that lived around us, so we were constantly having to be
on watch.
We had a big gas station across the street from us where
there was people constantly in and out, so day to day living
was really stressful even there. We were in close quarters. We
had eight men in just a regular-sized bedroom. So it was really
stressful and it was really hard to deal with people on a day
to day basis living like that.
Mr. Welch. I can imagine. And, Mr. and Mrs. Coons, you
described the change in the tone of your letters. Your son
sounded like a wonderful young boy, young man, and military
person. And then you noticed a real stark change in the tone of
the letters. I would be interested in I know you have given it
a lot of thought, but do you have any thoughts that you can
share with us about what accounted for his change in tone?
Mr. Coons. With James being a career soldier, I mean, and
really I said in the beginning that even as a youth he always
had the Army first and he was over getting prepared for the
initial invasion and everything, and I guess if people can go
back to 2003 it seems like we geared up and were getting ready
to go, then we came back down. This happened two or three
times. We would talk about that in e-mails, and he said it is
frustrating people. We're ready to go, let's go. Let's go.
Let's get it over with.
I would say in April or May he has never said anything
negative about his military career. For some reason, in April
or May he became disillusioned. He said all I care about now is
my 20 years and I'm getting out, where all we had heard in the
past is I will probably be here 25 or 30 years. I want to be
sergeant major of whatever division. That was his goal. And his
whole attitude started changing about that timeframe.
I can't put my finger on it. I mean, comments we'd see. It
is a numbers game. We're not respecting our deceased soldiers.
I mean, just things like that from him on a constant basis.
Chairman Waxman. Thank you, Mr. Welch.
Mr. Welch. I yield my time.
Chairman Waxman. Mr. Hodes.
Mr. Hodes. Thank you, Mr. Chairman.
I also want to thank all the witnesses for being here
today. This is very important testimony. If we are going to
make the right kinds of changes to make sure the things that
happened to your husband, your son, and you, the soldiers, are
fixed, we really need to hear from you, so I appreciate your
being here today.
One of the things that I would like to talk about is what
the Army calls dwell time. It is the amount of time soldiers
spend at home between deployments. Now, the Army policy has
been that the ratio between dwell time and deployment time
should be two-to-one. For example, for every year you spend
deployed in Iraq, you should spend 2 years at your home bases,
and during those 2 years soldiers have time to train, to
recuperate, to spend time with their families that were
interrupted by deployment.
The Army has recently had to change that policy for Iraq
and Afghanistan. According to one recent study, there are
currently fourteen brigade units in Iraq that are deployed with
less than 2 years at home, and four brigades that have deployed
with less than 1 year of dwell time.
Now, we have also heard a report that the Army is even
considering paying bonuses to soldiers who agree to spend less
time at home between deployments. I want to explore a little
bit the importance of dwell time and why the 2-year policy is
an important policy for soldiers and their families.
Let me ask first, Specialist Smith, how much dwell time did
your brigade unit, the Third Brigade, Third Infantry Division,
have between its Iraq deployments?
Mr. Smith. Well, Third Brigade, they deployed in 2003,
again in 2005, and now again in 2007.
Mr. Hodes. Were there times when it was less than 2 years
at home?
Mr. Smith. Every time, sir.
Mr. Hodes. And did you have discussions with your fellow
soldiers about the dwell time issue and what it meant for you?
Mr. Smith. Yes, sir. The time just passes so fast when you
are back here in the States. Eight months goes by and you feel
like you just got home, and then you are gearing up to go
again. It is kind of depressing.
Mr. Hodes. So it adds to the stress of the redeployment to
have not enough dwell time at home?
Mr. Smith. Yes, sir.
Mr. Hodes. And if you had more dwell time, what do you
think the effect would be on the mental health of the soldiers
who are returning for redeployment?
Mr. Smith. I believe it would allow more time to get
evaluated, to get the things out of your mind, to be with the
ones that you love. That is a big issue. By the time you get
resituated with your family, you are gearing up to leave again,
so you can never really fully adjust back to life, being with
your family.
Mr. Hodes. Mrs. LeCompte, from your standpoint as a family
member, can you talk to us a little bit about what the dwell
time means to you and having enough time to be with your
husband in between deployments, and what impact, if any, having
shrinking dwell time means for you and the family?
Mrs. LeCompte. My husband was only home approximately about
8 months before he went back out again. I mean, it is
definitely hard to adjust, because it takes them so long to
adjust, just coming from a hostile environment back to a home
environment as it is. I just think that the shorter it gets the
harder it would be on families, because, I mean, it just takes
them so long, as we hear today, things are just now coming out
about the PTSD issues already. You have a lot of problems home
already, just from them coming home.
Mr. Hodes. Mr. and Mrs. Coons, do you have anything to add
to the question of the dwell time?
Mr. Coons. No, sir. Unfortunately, we didn't have that
experience.
Mr. Hodes. Thank you very much.
Mr. Chairman, before I yield back, I just want to say I
think it is not right to treat our troops this way. We know our
soldiers need more time at home to recuperate, preserve their
health, get ready for redeployment, and deal with what they
have been through, but in my judgment we went into this war
without the proper preparations, we have shortchanged our
troops, we are denying them the rest they need to do their jobs
and keep themselves safe, and it is multiplying the issues that
we are now facing with mental health problems, PTSD, that we
are seeing. It is an issue that we are going to have to
address.
Thank you, Mr. Chairman. I yield back.
Mr. Issa. Would the gentleman yield?
Mr. Hodes. Certainly.
Mr. Issa. I would like to join the gentleman in recognizing
that the dwell time is not enough, and that with approximately
1 million soldiers, sailors, and Marines, it is the inequity
that many, many units have never been in theater in Afghanistan
or Iraq while others are on their third deployment. I hope that
this committee will join the chairman in trying to get to the
bottom of why that inequity continues to exist.
I yield back.
Chairman Waxman. Thank you, Mr. Hodes.
I want to recognize Mr. Tierney, who is the subcommittee
chairman who has worked so diligently on the issue of Walter
Reed and has been very involved in all of the questions on what
we are doing for our returning military.
Mr. Tierney. Thank you very much, Mr. Chairman. Thank you
for having this hearing.
Thank all the witnesses for coming forward and helping us
out with this matter. I think it is going to make a significant
difference.
I think, to a certain extent, Mr. and Mrs. Coons, in an
unfortunate way you have already made a difference, and so has
your son.
I was curious. As you were testifying I was looking through
some of the records that we had produced as a result of some of
the earlier hearings on that. How long had your son actually
been separated from his family and in theater before his death?
Mrs. Coons. Around a year.
Mr. Tierney. About a year?
Mrs. Coons. Yes.
Mr. Tierney. And how long had he been home before he was
sent in for that year?
Mrs. Coons. I'm sorry?
Mr. Tierney. Had he been in before and come home and was
going in again, or was it his first deployment?
Mrs. Coons. This was his first deployment.
Mr. Tierney. I note in the reports the issues that are
here, the change of attitude that you may have experienced
seemed to follow his exposure to a number of killings in
action. It was followed by nightmares and things of that
nature. And then the acute stress disorder was compounded by
the lengthy separation from his family. I think these are all
issues that we are going to have to examine as we do more
research into the matter on that.
There is nothing in the reports, however, about your
constant contacts with the hospital once your son got home or
whatever, and I think we are going to explore that as we go on
in the hearings as to why there isn't a recording on that, why
there wasn't enough attention paid to your efforts to get in
touch with him. But there was an indication in the records that
there was apparent confusion that existed when your son was
sent home through the medical system, through the medical
channels as an ambulatory patient as opposed to an inpatient.
That is an indication that there was a policy clarification
they note here, but that people ought to have an attendant with
them, a supervisor with them when they come home, in that
sense. And there is expensive paperwork here about reiterating
that clarification and making sure that happens. So in that
sense at least I want you to know that there has been a change
made in that, and I think it is going to make a significant
difference in the lives of other people.
I won't belabor this panel, Mr. Chairman. I think that the
questioning has been pretty extensive and the answers have been
very helpful.
I just want to again thank all of you for your service to
country and give our serious condolences for your loss to the
Coons.
Thank you, Mr. Chairman.
Chairman Waxman. Thank you, Mr. Tierney.
Mr. Sarbanes.
Mr. Sarbanes. Thank you, Mr. Chairman.
Thank all of your for your testimony. It demonstrates a lot
of courage to be here.
I am struck by a couple of things at the outset. One is,
looking at you and listening to you, I know that there are
thousands of families and individuals and soldiers who are in a
similar position, and that is what makes your testimony so
powerful here today.
I am also very aware of the sheltered existence, the
protected existence that I have, not having been in the
situation you have been in, and aware that it is sheltered and
protected by you, by what you are doing, so I thank you for
that.
Mrs. LeCompte, I wanted to ask you a few questions based on
your testimony about the impact that your husband's condition
had on the family, but, in particular, the impact that the
failure to get the help in a timely way that you were seeking
had on your family. In other words, I can imagine that if there
were regular appointments that had been established right from
the beginning of his return, that would have helped you get
from one day to the next, because you knew that relief, that
help was coming, and the fact that it didn't come or you
expected it to be there and then it wasn't there only added to
the stress and the tension inside the home, so if you could
speak to that.
Mrs. LeCompte. Definitely. I mean, these guys go over to
protect the United States and they expect to be protected when
they come home. I mean, the overall effect when you think that
there is help and there is not, I mean, it is very detrimental
to the whole family, the children. I mean, it has its ripple
effects.
When these guys go in and ask for help or they are going
through the SRPs or whatever, they expect the help, and when it
is neglected they only deteriorate more.
Mr. Sarbanes. Did you find yourself having to step in to a
kind of support role that you felt should have been provided by
other resources? And what was the effect of that?
Mrs. LeCompte. I mean, I feel that my husband was ignored
and ridiculed, and so on, and so finally I had to become his
voice and kind of step in. Even myself, as the military calls
it being a civilian, it was even hard to get people to listen
to me for that help, for plea, and it shouldn't have gotten
this far.
Mr. Sarbanes. Well, I salute you for not giving up and
pushing on the system and beginning to get the results that you
deserved right from the outset.
I would like to ask you, Specialist Smith and Specialist
Bloodworth, this single question. This is a followup to the
questioning about the extension of tours. Describe, if you can,
how much a soldier invests psychologically in the end date of
their tour. In other words, right from the beginning. Again, I
don't know it from personal experience, but I have to believe
that part of what allows you to steel yourself for what you are
experiencing right from the first day is having that date when
you know you are going to come home.
The contribution to technical support division that comes
from the experiences you are having on the ground is one thing,
but is it compounded? I mean, does it actually have an effect
on your mental state when suddenly--and I think you said,
Specialist Bloodworth, that you were packing at one point when
you got word of an extension, which represents sort of
psychologically just pulling the rug.
Talk about from the beginning of a tour how important and
how invested you get in, if it is the case, in that end date
and what the effect of it is when it gets pulled away from you.
Mr. Smith. Sir, I would say that mentally you have a whole
lot invested in that. You are looking forward to it. Even when
I was there, I was told I was leaving on a certain date and it
was 2 weeks later. For that 2 weeks, I was just, like he said,
I was complacent. I got, like, all right, whatever, I am just
here. You invest a whole lot into that time they say this is
when you are going home.
Mr. Bloodworth. And, just to finish up before time runs
out, it is pretty much like seeing the light at the end of the
tunnel and it turns out to be a freight train and you don't
know what to do, because that time seems to grow indefinitely,
and every day gets longer, so it is difficult, sir.
Mr. Sarbanes. Thank you for your testimony.
Mr. Chairman, it just strikes me that the policy, itself,
is contributing to the mental state, the negative mental state,
that we are talking about here today.
Thank you.
Chairman Waxman. Thank you, Mr. Sarbanes.
Mr. Issa.
Mr. Issa. I will be brief, but I think it is very
important, since we have you here, to followup on that line of
questioning. It is not related to the topic, but it is related
to your service. Were you aware when you were in Iraq that,
while you were serving, depending upon what time you were
there, but let's just call it a 1-year tour, that other units
such as Navy, not the Corpsmen, but other than Navy Corpsmen,
were serving 4 months or less, that the Air Force routinely
serves 120 days? You are shaking your head yes, Specialist? You
were aware of that?
Mr. Bloodworth. Yes, sir. The camp I was at was actually an
Air Force base, so we saw a changing of hands constantly. Very
jealous.
Mr. Issa. So they basically came in, got their combat time,
their tax-free pay, and they were gone pretty quick, never
having gone outside the wire?
Mr. Bloodworth. The only people from the Air Force that I
was aware of that were going outside the wire was their EOD
elements, but as for everyone else, that is pretty much it,
sir.
Mr. Issa. Well, as an EOD guy I appreciate that.
Last, but not least, it has been announced that for Army
and Marine units already at 12 months, they are going to 15
months. What do you think that is going to do to the types of
tours that you have already endured?
Mr. Smith. I think it is going to make it much harder.
Three months doesn't sound like much, but when you are over
there it seems like a lifetime that you are away from your
family and that is 3 months longer you have to deal with the
same person day in and day out. You wake up, you look at them,
and it makes it a lot harder.
Mr. Bloodworth. When they say extended and you have 3
months, to me that is almost 60 more missions. That is almost
60 more days that I am going to be out there strung out,
stressed out. It is hard to look at things like that and still
keep a cool head.
Mr. Issa. Well, thank you for your service. Thank you for
your testimony.
I yield back and thank the chairman.
Chairman Waxman. Thank you very much, Mr. Issa.
Let me again thank all of you for your presentation and
your forthrightness in responding to questions and helping us
understand what has happened in your cases and realizing your
situations are magnified many times over by others who are
experiencing the very same or very nearly the same kinds of
situations. We are going to have to learn, as a country, to
deal with all of this a lot better than we have.
Thank you so much.
We are going to take a 5-minute recess before we call the
second panel.
We stand in recess.
[Recess.]
Chairman Waxman. The committee will come back to order.
For our second panel I want to welcome Dr. Michael
Kilpatrick, the Deputy Director for Force Health Protection and
Readiness Programs at the Department of Defense. Dr. Kilpatrick
is accompanied by Dr. Jack Smith, the Acting Deputy Assistant
Secretary of Defense for Clinical and Program Policy.
Dr. Antoinette Zeiss is Deputy Chief Consultant in the
Office of Mental Health Services at the Department of Veterans
Affairs. Dr. Zeiss is accompanied by Dr. Al Batres, the VA's
Chief Officer at the Office of Readjustment Counseling.
Dr. Thomas Insel is the Director of the National Institute
of Mental Health at the National Institutes of Health.
Major General Gale S. Pollock is the Commander of the U.S.
Army Medical Command and is the Army's Acting Surgeon General.
Dr. John Fairbank is an associate professor of medical
psychology at the Duke University Medical Center, and a member
of the Institute of Medicine's Committee on Veterans
Compensation for Post-Traumatic Stress Disorder.
I want to thank all of you for being here today.
As I mentioned earlier if you were here for the first
panel, it is the practice of our committee to ask all witnesses
to take an oath, and those, as well, who are accompanying those
who are making the oral presentations, if you would also rise
we would appreciate it.
[Witnesses sworn.]
Chairman Waxman. The record will indicate that each of the
witnesses answered in the affirmative.
I want to start with Dr. Kilpatrick, if he would be our
first witness. We have your prepared statements, and we will
put those in the record in full, but we would like to ask each
of you, if you would, to limit the oral presentation to 5
minutes. We have a clock. It will turn yellow when you have 1
minute left and then red when 5 minutes is up.
Dr. Kilpatrick.
STATEMENTS OF DR. MICHAEL E. KILPATRICK, DEPARTMENT OF DEFENSE,
DEPUTY DIRECTOR, DEPLOYMENT HEALTH SUPPORT, ACCOMPANIED BY DR.
JACK SMITH, ACTING DEPUTY ASSISTANT SECRETARY OF DEFENSE FOR
CLINICAL AND PROGRAM POLICY; DR. ANTONETTE ZEISS, DEPARTMENT OF
VETERANS AFFAIRS, DEPUTY CHIEF CONSULTANT, OFFICE OF MENTAL
HEALTH SERVICES, ACCOMPANIED BY DR. AL BATES, CHIEF OFFICER,
OFFICE OF READJUSTMENT COUNSELING; DR. THOMAS INSEL, DIRECTOR,
NATIONAL INSTITUTE OF MENTAL HEALTH; MAJOR GENERAL GALE
POLLOCK, ARMY SURGEON GENERAL; AND DR. JOHN FAIRBANK, DUKE
UNIVERSITY, MEMBER, INSTITUTE OF MEDICINE COMMITTEE ON
VETERANS' COMPENSATION FOR POST-TRAUMATIC STRESS DISORDER
STATEMENT OF MICHAEL E. KILPATRICK
Dr. Kilpatrick. I would like to start by expressing my
appreciation for the opportunity to hear the testimony of the
first panel. Very compelling. Very courageous people. I thank
them also.
Mr. Chairman and distinguished members of the committee,
thank you for the opportunity to discuss the Department's Force
Health Protection and Readiness Program and programs in the
military health system with the focus on the mental health
aspects of those programs.
Two primary objectives of the military health system are to
ensure a medically ready force and to provide world class care
for those who become ill or injured. The Department of Defense
is well aware of the stress that combat deployments place on
our service members and their families. We have a multitude of
proactive programs in place and underway to educate, screen,
diagnose, and treat our service members and their families. We
also have robust surveillance programs in place to monitor the
health of our force before, during, and after deployments.
In theater, we have the smaller medical footprint that is
agile, mobile, and responsive to the needs of the mission. This
includes medical support for mental health in theater. Each
branch of service has specific combat stress and deployment
mental health support programs available before, during, and
after the deployment cycle. These provide support tailored to
the service's mission and risk factors that personnel might
face.
Multi-faith chaplains deploy with units to maintain a
ministry of presence. They offer confidential counseling and
are safe havens for those who need someone to talk with during
troubling times. They often facilitate access to other avenues
of care.
Since March 19, 2003, there have been nearly 27,000 air
medical transports out of Operation Iraqi Freedom theater, 20
percent of which are for combat injuries, 20 percent have been
due to non-combat injuries, and the remaining 60 percent are
due to medical conditions that need evaluation or treatment not
available in theater. Mental health conditions have accounted
for 7 percent of those transports.
We have over 1 million post-deployment health assessments
done as people come out of theater from worldwide deployments.
The active duty, 22 percent indicate medical concerns, 5
percent mental health concerns, and 18 percent are referred for
further evaluation after discussing their issues and concerns
with a provider. All referrals are fairly equally divided
between medical only, mental health only, and medical and
mental health.
The Reserves, 41 percent have medical concerns, 6 percent
have mental health concerns, and 24 percent are referred.
We have over 200,000 post-deployment health assessments
done 3 to 6 months after people get home from these worldwide
deployments. That started in June 2005. Of active duty, 33
percent have medical concerns on those assessments, 27 percent
have mental health concerns, and 16 percent are referred for
further medical evaluation.
The Reserve component, 56 percent have medical concerns, 42
percent have mental health concerns, and 51 percent are
referred.
An important element of the post-deployment health
assessments is education of the service members about medical
conditions, both physical and mental, and the signs and
symptoms that indicate the need for further evaluation.
To better understand the mental health needs of the
deployed force, the Army sent its first mental health advisory
team to theater in 2003. This was the first time that such an
assessment was done during a war-time deployment to evaluate
the adequacy of mental health support in theater and
preparation of medical and support staff for mental health
care.
Deployment-related mental health research projects are
being conducted across DOD, VA, HHS, and other Federal and
academic institutions. Of the 67 current projects, 32 are
focused on PTSD.
In 2004, a Hogue study showed a direct relationship between
the level of combat exposure and meeting screening criteria for
major depression, generalized anxiety, or PTSD. The proportion
of people who met the screening criteria for each mental health
disorder was higher after OIF Iraq, than after OEF Afghanistan,
and was higher in the post-deployment groups than in the pre-
deployment group.
A review of post-deployment health assessment mental health
data showed a positive mental health screening in 19 percent of
people returning from OIF compared to 11 percent coming back
from Afghanistan and 8 percent returning from other locations
in the world.
Mental health concerns were significantly related to combat
experiences. Among some 69,000 veterans of Iraq who accessed
mental health in the year after coming home, only 35 percent
actually received a mental health diagnosis. The military
health system is second to none in its ability to deliver
timely, quality mental health and behavioral care. This
includes behavioral health and primary care, mental health
specialty care, clinical practice guidelines, and ready access
to high-quality, occupationally relevant primary care, along
with different modeling and demonstration projects that are
designed to help us continue to learn and improve the system of
care delivery. In addition, walk-in appointments are available
in virtually all military mental health clinics around the
world.
The 2003 Millennium Cohort Study evaluates the long-term
health effects of military service, specifically deployments.
Almost 140,000 individuals have enrolled in this DOD/VA ground-
breaking, 22-year study. As force health protection continues
to be a priority for the future of military medicine, the
Millennium Cohort Study will provide crucial steps in
understanding the long-term health effects.
The Department of Defense is very concerned about the short
and long-term health care. We look for ways to better serve our
service members, and we look forward to outside expert advise.
The Mental Health Task Force, as you have discussed, is making
recommendations, and we are looking forward and committed to
diligently working to incorporate their recommendations.
I thank you for your time.
[The prepared statement of Dr. Kilpatrick follows:]
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Chairman Waxman. Thank you very much, Dr. Kilpatrick.
Dr. Zeiss.
STATEMENT OF ANTONETTE ZEISS
Dr. Zeiss. Thank you, Mr. Chairman and members of the
committee. I am pleased to be here today and to discuss the
steps the Department of Veterans Affairs is taking to meet the
mental health care needs of our Nation's veterans.
As you mentioned, I am accompanied by Dr. Alfonso Batres,
Director of Veterans Readjustment Counseling.
I also was here for the entire first panel and agree with
the power and importance of that information.
Rehabilitation for war-related PTSD and other military-
related readjustment problems along with the treatment of the
physical wounds of war, it is central to VA's continuum of
health care programs.
Mental health services are provided in all VA medical
facilities, including inpatient, outpatient, and substance
abuse care. VA also provides services for homeless veterans,
including transitional housing, paired with services to address
the social, vocational, and mental health problems associated
with homelessness.
VA's vet centers provide counseling and readjustment
services to returning war veterans. The vet center's service
mission goes beyond medical care in providing a holistic mix of
services designed to treat each veteran as a whole person in
the community setting. Vet centers provide an alternative to
traditional access for some veterans who may be reluctant to
come to our medical centers and clinics.
Care for Operation Enduring Freedom and Operation Iraqi
Freedom veterans is among the high priorities in VA's mental
health care system. Since the start of OEF/OIF through the end
of the first quarter of fiscal year 2007, over 680,000 service
members have been discharged and become eligible for VA care.
Of those, over 229,000 have sought VA care. Of those who have
sought care with VA, mental health problems are the second most
commonly reported health concerns, with almost 37 percent
reporting concerns suggesting a possible mental health
diagnosis. Of those, PTSD was most frequently implicated, but
non-dependent abusive drugs and depressive orders are the next
most commonly indicated and are also frequent.
VA's data show that the proportion of new veterans seeking
VA care who are identified as possibly having a mental health
problem has climbed somewhat over the years. For example, the
proportion with possible mental health problems at the end of
fiscal year 2005 was 31 percent, compared to 37 percent in the
most recent report. For possible PTSD, the proportions of those
time points were 13 percent and 17 percent.
There are many possible explanations of this increase. We
have discussed extended deployments, possibly more difficult
combat circumstances. But we believe also that effective
screening and outreach efforts help identify more with possible
mental health problems, and VA has also taken and continues to
make efforts to de-stigmatize seeking mental health services.
So, regardless of the causes, there is an increase, and VA
is prepared to devote increasing resources to serving these
growing mental health needs.
The mental health initiative provides funding for
implementation of VA's comprehensive mental health strategic
plan. The plan recognizes, as part of its broad vision for
enhancement of mental health care, that ongoing war efforts
necessitate special attention to the needs of OEF/OIF veterans.
We have improved capacity and access, supporting hiring so far
of over 1,000 new mental health professionals, with more in the
pipeline. We have expanded mental health services in community-
based outpatient clinics, with onsite staffing, or by tele-
mental health. We have enhanced PTSD, homelessness, and
substance abuse specialty care services and programs that
recognize the common co-occurrence of these problems.
We are fostering integration of mental health and primary
care in medical facility clinics as well as the CBOCs, and in
the care of homebound veterans served by VA's home-based
primary care program.
We have mental health staff well integrated in the
polytrauma care sites, and we are expanding the number of vet
centers over the next 2 years.
VA promotes early recognition of mental health problems
with the goal of making evidence-based treatments available
early to prevent chronicity and lasting impairment. Veterans
are screened for PTSD on a routine basis through contact in
primary care clinics. When there is a positive screen, patients
are further evaluated and, when indicated, referred to a mental
health provider for followup. Veterans also are routinely
screened in primary care for depression, substance abuse,
traumatic brain injury, and military sexual trauma. Screening
for this array of mental health problems helps support
effective identification of veterans needing mental health
services.
I want to thank you again, Mr. Chairman, for having me here
today. I will be happy to answer any questions when we come to
time for that.
[The prepared statement of Dr. Zeiss follows:]
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Chairman Waxman. Thank you very much, Dr. Zeiss.
Dr. Insel.
STATEMENT OF THOMAS INSEL
Dr. Insel. Thank you, Mr. Chairman. I am honored to be here
and glad you thought to include someone from the NIH in this
hearing.
You have my written testimony. I think, given the time and
the number of witnesses here, I am going to just very quickly
summarize what I think is most important for us to think about.
As you listened, and as I did, to the first panel, I think
it is important to recognize there are kind of two classes of
issues that we are hearing about. One class of issues has to do
with what many of the people on the committee called the
problems of stigma, the problems of the cracks in the system,
the ripple effect of mental illness on family members and on
others. Those are not unique to this war. They are not unique
to this situation. They are really problems that we have for a
range of mental illnesses throughout this society.
As we think about what the fix is here and how we address
them, actually we may be able to learn some things from what
DOD and the VA are doing which may, in fact, be ahead of the
curve.
There are other issues, of course, that are going to be
unique that have to do with the policies that came up in some
of your questions, and there will be, I am sure, an opportunity
to talk more about those. But I want to go back to this issue
about whether this may be an example that we can learn from.
Your first comments this morning, Mr. Chairman, involved a
memo that you received from the L.A. County Department of
Mental Health, and I think that is an important signal to us
that this is not simply a problem for the VA or for DOD. This
is a problem for mental health care throughout the country.
Much of what we call the burden of illness, the public health
challenge here, will spill over to the public sector to mental
health care in the civilian sector.
One of the questions I hope we will have a chance to think
about is: are we prepared for that? What will that burden look
like? How many people are we talking about, and what are the
resources to address that?
I look forward to the questions and hopefully a chance to
discuss those issues further.
[The prepared statement of Dr. Insel follows:]
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Chairman Waxman. Thank you very much, Dr. Insel.
Major General Gale Pollock.
STATEMENT OF MAJOR GENERAL GALE POLLOCK
General Pollock. Chairman Waxman and distinguished members
of the committee, thank you for providing me the opportunity to
address you on this very important subject.
I am Gale Pollock, acting Surgeon General of the Army and
commander of the U.S. Army Medical Command. I am here today to
discuss the array of behavioral health services designed to
support our warriors and their families.
The U.S. Army Medical Command is an imperfect organization.
The 34 military treatment facilities over which I exercise
command authority are all imperfect organizations. They make
mistakes. Despite cutting-edge technology, health care still
remains as much art as science. Sometimes, despite our best
efforts and the best care, our patients still have tragic
outcomes.
Whenever we have less than optimal outcomes, it affects
every one of us. To the soldiers and their family members on
the first panel, I paused after the panel to extend my
condolences for the pain and suffering that they have gone
through and I thanked them for their courage to testify today,
and I thank you, because, although the U.S. Army Medical
Department is an imperfect organization, we are, more
importantly, a striving organization, because we strive to be
perfect. We strive to improve every day and with every patient
encounter. These tragic stories give us the opportunity to
examine our systems and processes and do everything possible to
ensure that, whenever possible, these mistakes are not
repeated.
After every sub-optimal outcome, our team can evaluate
their performance, assess our processes, and determine if we
can improve any aspect of the care we provide.
On the battlefield, we know that the majority of our
casualties die from loss of blood. Our clinicians and
researchers focus their considerable intellect and effort on
this reality and developed equipment, techniques, and
procedures to save lives. The result is that 91 percent of
warriors injured on the battlefield survive their wounds, and
this rate of survival is unprecedented in the history of
warfare. Yet, it is still not perfect, and our researchers and
experts continue to strive to find better ways to provide
higher quality battlefield care, to develop better products to
stop bleeding, and to conduct better training to save more
lives.
We are equally committed to saving lives and improving
lives where the injuries are not visible. Although an array of
behavioral health services were available to our beneficiaries
before the global war on terror began, we have steadily
improved over the past 5 years as the identified needs of our
populations have changed.
Since the attacks on 9/11, the post-deployment health
assessment was revised and updated, and in the fall of 2003 we
launched the first mental health advisory team into theater.
Never before had the mental health of combatants been studied
in a systematic manner during conflict. Three subsequent mental
health advisory teams in 2004, 2005, and 2006 continued to
buildupon the success of the original and further influence our
policies and procedures, not only in theater but before and
after deployment, as well.
Based on those recommendations, we have increased the
distribution of behavioral health providers and expertise
throughout the combat theater, and access to care and quality
of care have improved as a result.
In 2004, researchers at the Walter Reed Army Institute of
Research published initial results of a ground-breaking land
combat study which provided insights related to the care and
treatment of soldiers upon return from combat experiences, and
led to the development of the post-deployment health
reassessment.
In 2005, the Army rolled out the post-deployment health
reassessment to provide soldiers with the opportunity to
identify any new physical or behavioral health concern that
they were experiencing that was not present immediately after
their redeployment. This assessment includes an interview with
a health care provider and has been very effective for
identifying more of the soldiers, but, unfortunately, not all,
who are experiencing some of the symptoms of stress-related
disorders, and getting them the care they need before their
symptoms manifest into more serious problems.
We continue to review the effectiveness of this process and
will add or edit questions as needed.
In 2006, we piloted a program at Fort Bragg, NC, intended
to reduce the stigma, of which many of us are very aware. The
RESPECT.MIL pilot program integrated behavioral health into the
primary care setting, providing education, screening tools, and
treatment guidelines to the primary care providers. It has been
so successful at Fort Bragg that we are currently rolling that
program out to 15 other sites across the Army.
Also in 2006 the Army incorporated the deployment cycle
support program with a new training program called battle mind.
Prior to this war, there had been no empirically validated
studies to mitigate combat-related mental health problems, so
we have been evaluating the post-deployment assessments and
training now using scientifically rigorous methods with good
initial results. It is a strength-based approach that
highlights the skills that help soldiers survive in combat,
instead of focusing on the negative effects of combat.
Our striving has continued in 2007, because we have
expended battle mind training with modules for pre-deployment
training and for spouses. Our behavioral health Web site went
live in March, and I stood up a behavioral health proponency
office specifically to deal with these issues. A new PTSD
training course starts in June, and, as you noted, the
preliminary recommendations of the Mental Health Task Force
were released in May, with a final report expected this summer.
Traumatic brain injury is emerging as a common blast-
related injury. An overwhelming majority of these patients have
mild and moderate concussive syndromes with symptoms not
different from those experienced by athletes with a history of
concussion, but many of these symptoms are similar to post-
traumatic stress symptoms, especially those of difficulty
concentrating and irritability. However, we must not confuse
TBI with PTSD. TBI is the result of physical damage to the
brain, and, as such, requires different screening, diagnosis,
and treatment approaches. It is important that all providers
are able to recognize these similarities and consider the
effect of blast in their diagnosis.
The Congress has provided incredible financial support to
allow us to better understand and treat both PTSD and TBI. Let
me thank you for that and assure you that we will invest the
money in a focused manner that allows us to make a difference
in the lives of soldiers, sailors, marines, and airmen
immediately.
The Army and the Army Medical Department are committed to
provide a level of care, physical, emotional, and spiritual,
that is equal to the quality of service provided by these great
warriors. We recognize our imperfections and are striving daily
to improve.
I look forward to your questions.
Chairman Waxman. Thank you very much.
Dr. Fairbank, before I call on you, you might have heard
the bells. That indicates that a vote is on the House floor. We
are going to have to respond to those votes. There are four
votes. I think we had better anticipate reconvening at maybe
1:45. That will give you a chance to get something to eat, and
then we will meet back in this room at 1:45. We will hear from
you and then we will have questions for all of you.
Thank you. We stand in recess.
[Recess.]
Chairman Waxman. The committee will come back to order.
Dr. Fairbank, we would like to hear from you.
STATEMENT OF JOHN A. FAIRBANK
Dr. Fairbank. Thank you. Good afternoon, Mr. Chairman and
members of the committee. Thank you for the opportunity to
testify on behalf of the members of the National Academy of
Science's Committee on Veterans Compensation for Post-Traumatic
Stress Disorder.
Our committee recently completed a report entitled PTSD
Compensation and Military Service that addresses topics under
consideration in this hearing. I am here today to present a few
of the conclusions of that report and to share my experience as
a former VA psychologist and as a researcher on PTSD and
veterans' health. These remarks are a summary of my written
testimony.
I was asked to address whether there has been adequate
preparation for the men and women returning home from Operation
Iraqi Freedom and Operation Enduring Freedom. Our committee's
report made several recommendations relevant to this question.
Specifically, our review of the scientific literature and VA's
current compensation and pension practices identifies areas
where changes might result in more consistent and accurate
ratings for disability associated with PTSD.
There are two primary steps in the disability compensation
process for veterans. The first of these is a compensation and
pension [C&P], examination. Testimony presented to my committee
indicated that clinicians often feel pressured to severely
constrain the time that they devote to conducting a PTSD
examination. The committee believes that the key to proper
administration of VA's PTSD compensation program is a thorough
C&P clinical examination conducted by an experienced mental
health professional.
Many of the problems and issues with the current process
can be addressed by consistently allocating and applying the
time and resources needed for a thorough examination. The
committee recommended that a system-wide training program be
implemented for the clinicians to conduct these exams in order
to promote uniform and consistent evaluations.
The second primary step in the compensation process is a
rating of the level of disability associated with a veteran's
service connected disorders. The committee's review of VA's
ratings practices found that the criteria used to evaluate the
level of disability resulting from service-connected PTSD were,
at best, crude and overly general. It recommended that new
criteria be developed and applied.
As part of this effort, the committee suggested that VA
take a broader and more comprehensive view of what constitutes
PTSD disability. The committee believes that the current
criteria unduly penalize veterans who may be capable of working
but who are significantly symptomatic or impaired in other
dimensions and may thus serve as a disincentive to both work
and recovery.
In order to promote more accurate, consistent, and uniform
PTSD disability ratings, the committee also recommended that VA
establish a certification program for raters who deal with PTSD
claims. Rater certification should foster greater confidence in
ratings decisions and in the decisionmaking process.
Early in my career I was a co-principal investigator for
the National Vietnam Veterans Readjustment Study [NVVRS], and
served as a VA staff psychologist working primarily with
Vietnam War combat veterans. I was asked to comment on what the
lessons of Vietnam tell us about today.
First, I would like to make clear that our committee's
report did not address this topic and that these are my own
observations.
The intent of the NVVRS was to provide an empirical basis
for the formulation of policy related to Vietnam veteran
psycho-social health, especially PTSD. In a paper, my
colleagues and I reported that families of veterans with PTSD
were more likely to suffer domestic violence than the families
of veterans without PTSD. In addition, we found that children
of the veterans with PTSD manifested significantly higher
levels of behavioral and emotional problems than children of
veterans without PTSD, and that more than one-third of veterans
with PTSD had a child with behavioral or emotional problems.
In my opinion, this finding of multiple severe problems in
the families of veterans with PTSD made 15 years after the end
of the Vietnam War has important implications for today's
service men and women returning from OIF/OEF. Specifically, our
Vietnam era findings suggest that a significant number of
current members of our armed forces will need access to
effective treatments for war-related PTSD and its co-morbid
conditions, and, similarly, their spouses and children will
need access to trauma informs, treatments, and services.
A hard lesson learned from our Nation's response to Vietnam
veterans is that we do not want to delay doing our best to
prevent war-related PTSD from wreaking havoc on the futures of
our OIF/OEF veterans and their families.
An enduring and distressing memory of my work as a VA
psychologist was trying to help veterans and their spouses
process and recover from the shock, disappointment, anger, and
sense of betrayal that so often accompanied denial of benefits
or compensation for the psychological and emotional toll that
war zone stress had taken on their lives in the form of PTSD.
More often than not, a profound sense of unfairness lay at the
heart of their reactions.
The PTSD C&P evaluation disability ratings process has
improved considerably since the late 1980's, but, as our
committee's report suggests, much more may be done to enhance
confidence in PTSD compensation ratings decisions and
ultimately to improve this process for veterans returning from
combat and for their families.
Thank you for your attention. I am happy to respond to your
questions.
[The prepared statement of Dr. Fairbank follows:]
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Chairman Waxman. Thank you very much, Dr. Fairbank.
I am going to start off the questions. I want to see if I
can understand the scope of this problem and, of course,
whether DOD and Veterans Administration are prepared for it.
The results of surveys done by the Army and the Department
of Defense are alarming. A comprehensive analysis conducted in
2003 estimated 13 percent of soldiers returning from war in
Iraq and Afghanistan had PTSD. Doctor Insel referred domain to
this estimate in his testimony. We know that there are about
1.5 million troops that have been deployed to Iraq and
Afghanistan. Just doing the simple math, this suggests that
approximately 160,000 troops will return home needing treatment
for PTSD.
Dr. Insel, does that figure sound right to you?
Dr. Insel. As far as we know, I think that is right, but I
want to point out that we are at the early stages. What we
learned in Vietnam is this takes a sometimes unpredictable
longitudinal course, and that there are people who developed
the disorder sometimes months, sometimes years after they
returned from service. So one needs to be a little cautious
with any of the percentages that we are working with at this
point.
Chairman Waxman. Yes.
Dr. Kilpatrick and General Pollock, is this consistent with
the DOD and the Army, what you are seeing?
Dr. Kilpatrick. Again, I think it is very important to
understand what the statistics that are being quoted. As we are
taking a look at our screening processes, both the research
studies done in theater and the studies on the post-deployment
health assessment, we are looking at people answering questions
in a positive way that would indicate that they need further
evaluation to make a diagnosis of PTSD.
The screening questions that are being asked are not
diagnostic questions, and so I think that percentage needs to
then say the next step, what do we know as far as the number of
those people who are actually diagnosed with PTSD. I think, as
you just heard from Dr. Fairbank, that diagnosis is not one
that can be done quickly. It may take an hour. It may take
several days. I think, as Dr. Insel has just said, the symptoms
today going through that diagnostic workup may not be diagnosed
as PTSD, end up several years later perhaps being diagnosed as
PTSD.
So I think that this is a very hard area to try to identify
quickly. We have no----
Chairman Waxman. Identify it quickly or quantify the number
that----
Dr. Kilpatrick. I think to try to quantify it is very
difficult because it is going to be an evolving process. I
think people screening positive we have to understand is
different than people being diagnosed, and then people being
diagnosed, we have to really understand the extent of their
illness, how severe it is and whether it is in the chronic
phase, or hopefully with our processes for identifying it early
and being able to----
Chairman Waxman. What we heard from the first panel is that
a lot of them feel it is a stigma to come forward and to
indicate that they might be suffering from mental illness.
General Pollock, did you want to jump in on that?
General Pollock. Yes, sir. It is because of the stigma that
I would be unwilling to even estimate what numbers are, because
until we are able to eliminate the stigma, people who are
suffering won't come forward, whether it is for fear of letting
their buddies down, fear of being seen as weak, fear of what
will happen to my career. If something happens to my career,
how will I take care of my family? Well, I can just tough
through this. I am Army strong.
There are so many factors right now that are affecting
that, and, until we are able to reduce that stigma, those
numbers are going to be, I am afraid, just guesses.
Chairman Waxman. Well, the stigma is a problem, but it
seems to me the Army and the Veterans Administration need to
figure out how to ask questions that go to the symptoms so that
they are not stigmatizing by saying do you have post-traumatic
syndrome of one sort of another.
General Pollock. I agree, sir. One of the things that we
are doing now--and this is a new piece. I mentioned before we
are always trying to add something new to make it better. We
are working on a leader training program, a leader being
because at any point in time a soldier can be placed into a
leadership position, so it is not for senior leaders, it is for
every soldier, to say these are the symptoms, these are some of
the ways that another soldier, one of your buddies can manifest
that they may be suffering from PTSD. This is how you can
recognize it. This is what you can do to help them.
Just like you would watch their back if you were out on a
battlefield, you continue to watch their back and help each
other.
We are doing more work with the spouses now and encouraging
the spouses to come in when we do the 3 to 6 month reassessment
to say have you noticed anything different. Is it harder for
you to get along? Is there more stress in the family? So we can
really bring people in so they get permission to talk about it.
We are trying to move forward, but I submit the stigma
piece will continue to be a challenge. And then, as we erase
that, it will look like our numbers are much larger, because
then people are willing to admit, yes, I think I would like
some help.
But the point that Dr. Insel made early this morning with
the fact that we have inadequate behavioral health
professionals across our Nation, we can break down the stigma,
but if we don't have people who can step up and assist, have we
really done anything? I really think that we need as a Nation,
not just as a military, to look at how can we get more people
into behavioral health so that we can serve the needs of the
men and women of America, not just the men and women in the
military.
Chairman Waxman. Thank you very much.
Mr. Issa.
Mr. Issa. Thank you, Mr. Chairman.
I am going to start with Dr. Kilpatrick. You had a lot of
superlatives in your presentation, and I was a little surprised
that there were quite as many of them as there were, terms like
robust and touting surveillance programs, pre-deployment health
assessments since 1998, mental health care in theater, the use
of multi-faith chaplains, etc., is in your testimony.
How do you explain the first panel? General Pollock I think
did a very good job of saying, look, we make mistakes, things
fall through the cracks. You didn't do that in your testimony.
I was a little surprised that, in light of what we are looking
at here and some potentials for falling through the cracks,
that it was sort of, gee, this thing says nothing is broken.
Dr. Kilpatrick. Again, let me kind of start with saying
that the programs we have in place are programs that the DOD
has never had before. In the Gulf war we had nothing
electronic, and today we do. I think that is a major step
forward. The fact that we are able to track and say where
people are, what are their medical problems, I think is a major
advance.
Mr. Issa. I think it is important and it is major, but I
did a little back on the envelope, and you have 400
psychiatrists and psychologists on staff at DOD?
Dr. Kilpatrick. If we look throughout DOD, you can see that
number, but I think that----
Mr. Issa. That would be approximately what it would take if
you took a couple of hours for pre-deployment evaluation or
base-level evaluation and then a followup post, without in
theater and without any other psychiatric work, just short of
doing 250 people a day or 250 days in the year, roughly four
people a day.
I am going through the math and saying I bet you don't have
400 psychiatrists and psychologists that are doing it just for
those before they deploy and after they get back, so what do
you need and why is it you are not here saying that inherently
the resources necessary to provide the kind of pre-evaluation
where we wouldn't be deploying people who are at high risk and
the kind of evaluation coming back so they wouldn't have
tragedies like we saw in the first panel? Why is it you are not
asking for those kind of resources?
Dr. Kilpatrick. Again, I think as we take a look at what
are the resource requirements we are really looking at the
Mental Health Task Force. We believe that they have spent a
year and a half or over a year looking at this with all the
data that we could make available to them. Their early report,
as you have seen, says that there are inadequate resources--
mainly people is what they are talking about--to be able to do
this.
The question is, where do we have----
Mr. Issa. Right, and I am thrilled that they have done this
kind of work and I am thrilled that the Veterans
Administration, which, as I understand, is the best health care
delivery system in America, public or private, sought to make
it better.
Again I am going to go on to General Pollock, but I would
really hope that when you testify before Congress you come with
the problems, not just the superlatives.
Dr. Pollock, or General Pollock--both titles are good, and
you certainly earned the stars--in the first panel, which you
were here for, what we saw were things that I remember from my
days as an enlisted man and as a young officer. We saw people
who had, in the case of Specialist Smith, he had a profile that
kept him from performing his mission, then he was deployed,
came back with symptoms, mental health problems that may or may
not have been IED related, and today he is still an active duty
specialist and still in a sense in denial that he can't do the
job.
The likelihood is that, as long as he can't carry a weapon
and needs medication, he is not going to be able to do it. How
are we getting people out of what I call the penalty box or the
suspension box, the idea that you are on a profile, your
promotions are going to be reduced, your ability to do the
things it takes for a career aren't going to be there, and yet
he has quite a few years in limbo, to use an old Catholic term.
General Pollock. I think we are making progress on that,
and we started at Walter Reed. One of the things that we were
very concerned about was the lack of continuity of care when
they were outpatients. How were we really being accountable for
them? That was also evidenced by the tragedy that the parents
talked about.
So now we have put together a triad, so we have a nurse
case manager to make sure that all the pieces and the
appointments and the coordination that needs to be done for
that soldier in their care is occurring.
We have either a sergeant or a company commander, so we
will have a platoon sergeant and a squad sergeant so that we
don't have more than 12 of the soldiers, warriors in
transition. So whether they were battle injuries or other
illnesses or a training injury, if they are going to require a
profile and can't be immediately sent back to duty, they will
be assigned to a warrior transition unit.
Mr. Issa. Are these like the wounded warrior facilities at
Camp Pendelton and Quantico?
General Pollock. Yes. And by doing that, their purpose
then, the focus of their day will be to get well and to
participate in the care that they need, and with the other
staff there to help them get through the process and to
understand why they are waiting 2 weeks between a behavioral
health appointment. Is it that people aren't available? No. It
is because you have homework that you have to do. There are
pieces that you have to pay attention to.
So I think that we are going to fix that. And then the
stress that Specialist Smith was under inside his unit--you
need to go again, tough it up, let's go again--we are going to
be allowing the commanders of those units to say this person is
not deployable, they have a profile. We'd like to transition
them to the warrior transition unit so that I can have the fill
of my unit of the health, ready-to-go folks so that we can just
train to go back and do what we need to do.
That is going to correct quite a bit of this problem.
Chairman Waxman. Thank you very much, General Pollock.
Mr. Yarmuth.
Mr. Yarmuth. Thank you, Mr. Chairman.
We have heard a lot today about the deployments, length of
deployments and the redeployments and the shortened dwell time
and, in the case of the specialist we had here, as short as 8
months between deployments, and the impact that has on
families, but also on mental health.
I would like to address Dr. Fairbank. I know it is not your
job to tell the military how to fight wars, but, from a
clinical perspective, could you tell us what the impact of all
of these lengthened deployments, shortened dwell times, and the
multiple deployments will have on the soldiers' mental health,
whether or not they end up as clinically PTSD or in some other
way affected mentally?
Dr. Fairbank. I can address it from two perspectives. What
we know from the National Vietnam Veterans Readjustment Study,
where we looked at the number of months that a service member
served in the Vietnam theater of operations, when you start at
the 12-month mark and go on out, there is basically a dose
response relationship between time in theater and prevalence of
TPSD.
So, for example, I believe the prevalence rate is about
13.5 percent for men and women who served--well, men
primarily--who served 12 months. Thirteen months to 23 months,
it is about 18.5 percent. Those who served 2 years or more, it
starts to get up to 19, 20 percent PTSD prevalence.
So we even know from the Vietnam era that there is a strong
relationship between time in theater and very likely the level
of exposure to the types of traumatic events that are related
to development of PTSD.
The second observation I would have is that, when I was
working at the Jackson VA Medical Center from 1979 to 1987,
basically every day working with Vietnam veterans and other era
veterans with PTSD, the most complex and refractory cases that
I saw were veterans with three or more tours. They were, by
far, the most memorable cases of individuals that I worked
with.
Mr. Yarmuth. Clarify something for me. When we are talking
about PTSD, I am sure there is a wide range of the
manifestation of PTSD in terms of how disabling it can be----
Dr. Fairbank. Right.
Mr. Yarmuth [continuing]. And the severity of symptoms, and
so forth. I mean, not having served in combat, I would assume
that anyone who has been in a combat situation, has seen what
specialists Smith and Bloodworth described to us this morning,
would be in some way affected adversely mentally, and I can't
imagine the opposite.
So when we are talking about this, does prolonged
experience increase the severity of it and the disabling
aspects of it? For instance, when Specialist Smith was sent
back and clearly was having a problem before his second
deployment, how much does that exacerbate the situation?
Dr. Fairbank. Well, I think it was Mr. Smith who very
vividly described what it was like being on patrol every day,
the threat that he was facing each day, the sniper fire, the
IEDs. That would clearly qualify as high level of exposure to
war zone stress, traumatic stress.
So both of the service members who testified presented
pretty clear evidence that, while they were there, they were
under high levels of traumatic stress exposure.
What we do know from the research is that there is a dose
response relationship that the higher the level of exposure to
trauma, the greater the risk for developing not only PTSD but a
wide range of other often co-morbid conditions like substance
use, dependence, abuse, major depression, other types of
anxiety disorders.
So there is a relationship between the level of exposure.
So to the extent that these multiple tours and extended tours
increase one's level of exposure to the types of things that
they describe, the probability of developing these adverse
psychological reactions increases.
Mr. Yarmuth. I have a quick question I want to get in for
General Pollock. I appreciate your assessment of the
imperfection of the system, and so forth. When we are talking
about these deployments and the shortened dwell times, we all
know, by reading news accounts and so forth, that our armed
forces are strained. Because we don't have enough people to
send to the theater, we are sending people in ways that we
don't ordinarily do. Are we treating PTSD patients and affected
soldiers and others differently than we would because of the
fact that we are strained, we are stressed so much for our
personnel in the service? Are we doing things that we
ordinarily wouldn't do?
General Pollock. The way that we are treating the patients
really depends on how they present. Again, I have great
concerns that it is related to the stigma, because they are not
often willing to tell us what is really going on for them. They
are bonding with their soldier colleagues. If I go tell too
many people about this, they will put me on a profile and I am
going to have abandoned my buddies. I would rather stay with my
buddies.
So they don't always tell us. That is why the different
types of training that we are trying to get out now and the
different venues to get through so that they are all supporting
one another better I think will be helpful. But it is just
going to be very, very difficult, but we are going to keep
after it.
Mr. Yarmuth. Thank you.
Chairman Waxman. Thank you very much, Mr. Yarmuth.
We have votes on the House floor, and I gather this vote is
a very close one. I was willing to miss it. But I don't want to
ask the panel to stay here and wait for us to come back. I
thank you for being here and giving us your testimony. We would
like to send you additional questions in writing and have you
respond in writing for the record.
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Chairman Waxman. We need to, of course, deal with this
problem. It is an enormous public health threat. Our brave men
and women are putting their lives on the line, need us to be
there for them. I know you are all trying to do the best you
can. We are here to work with you to be sure we do the job.
Working with you may be to give you a push, but also to give
you the resources and ability to follow through.
Thank you very much for being here. That concludes our
hearing and we stand adjourned.
[Whereupon, at 2:15 p.m., the committee was adjourned.]
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