[Congressional Record Volume 151, Number 100 (Thursday, July 21, 2005)]
[Senate]
[Pages S8678-S8680]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN (for himself and Mrs. Boxer):
  S. 1448. A bill to improve the treatment provided to veterans 
suffering from post-traumatic stress disorder; to the Committee on 
Veterans' Affairs.
  Mr. DURBIN. Mr. President, seventy-five years ago today, President 
Herbert Hoover created the Veterans Administration by signing Executive 
Order 5398 for the ``Consolidation and Coordination of Governmental 
Activities Affecting Veterans.''
  Of course, the commitment of America to the care and welfare of the 
Nation's veterans goes back to the earliest days of our Republic. In 
1789 George Washington said, ``The willingness with which our young 
people are likely to serve in any war, no matter how justified, shall 
be directly proportional as to how they perceive the Veterans of 
earlier wars were treated and appreciated by their country.''
  The care of veterans was a central theme in Abraham Lincoln's second 
inaugural address. He said, ``With malice toward none; with charity for 
all; with firmness in the right, as God gives us to see the right, let 
us strive on to finish the work we are in; to bind up the nation's 
wounds; to care for him who shall have borne the battle, and for his 
widow, and his orphan--to do all which may achieve and cherish a just, 
and a lasting peace, among ourselves, and with all nations.''
  Today, this important work of caring for our veterans is carried on 
by the Department of Veterans Affairs at a time when American troops 
are engaged in combat under very trying circumstances overseas.
  In order to address the clearly emerging needs of the newest 
veterans, I am today introducing the ``Post-Traumatic Stress Disorder 
Treatment Improvement Act.''
  This bill requires the Department of Veterans Affairs to hire the 
number of mental health professionals which the Department's own 
internal panel of experts has for years recommended as that required to 
provide an appropriate

[[Page S8679]]

level of treatment for veterans suffering from post-traumatic stress 
disorder or PTSD.
  PTSD is a fairly new term but it is by no means a new problem. People 
exposed to extremely traumatic stressful events can suffer lasting and 
long-term mental health problems as a result. Soldiers who have endured 
the horrors--of the battlefield--who've experienced and had to 
participate in deeply troubling events--have long been susceptible to 
this problem. Among Civil War veterans it was called ``the soldier's 
heart.'' Among World War I veterans it was called ``shell shock.'' In 
World War II it was called ``battle fatigue.'' Many people will 
remember the incident during World War II in which General George 
Patton slapped a soldier hospitalized with battle fatigue. The American 
public reacted angrily to Patton's action because they understood that 
Patton was wrong; needing medical treatment to help recover from the 
psychological trauma of war was not any sign of weakness or cowardice 
but rather simply one of the understandable hazards of the very violent 
modern battlefield. In the aftermath of Vietnam, our understanding of 
what is today known as post-traumatic stress disorder or PTSD has grown 
tremendously and so has our ability to treat it. Today, as a result of 
its work with Vietnam Veterans, the Department of Veterans Affairs is 
the world leader in diagnosing and treating PTSD.
  While the quality of the expertise in the VA is high, we need to 
improve the quantity. The Department of Veterans Affairs needs more 
mental health professionals to meet the needs of the coming influx of 
new veterans from Iraq and Afghanistan.
  Two articles in the July 2004 issue of the New England Journal of 
Medicine indicate that the nature of the war in Iraq is producing a new 
generation of American veterans who will require treatment for PTSD. 
The data gathered from recently returned troops suggests that about 1 
in 6 of our Iraq veterans will develop this serious problem. One of the 
articles cautions that the actual numbers will probably be even higher 
because the data of the reported study was collected from soldiers and 
marines who served in the theater before the Iraqi insurgency rose to 
its current level of intensity. The conditions are now made even more 
stressful by the hidden enemy, frequently concealed among civilians and 
attacking suddenly with roadside explosions and suicide bombers. The 
uncertainly, the shock, the blood and destruction of this type of 
warfare understandably takes a toll on the feelings of even the 
toughest of our warriors. We know from experience that roughly 30 
percent of Vietnam veterans suffered from PTSD sometime in their 
lifetime.
  Senators don't have to read the New England Journal of Medicine to 
know that our returning veterans will need a little help to overcome 
some terrible memories and troubling mental images. We can hear it from 
the veterans in our own States.
  Several weeks ago I traveled across my State of Illinois to five 
different locations for roundtable discussions about this subject. I 
invited veterans as well as medical counselors from the Veterans' 
Administration to tell me about former service members who were trying 
to come to grips with this torment in their minds over what they had 
been through and what they had seen. I was nothing short of amazed at 
what happened. At every single stop, these men and women came forward 
and sat at tables before groups in their communities, before the media, 
and told their stories of being trained to serve this country, being 
proud to serve, and going into battle situations which caused an impact 
on their mind they never could have imagined. They talked about coming 
home with their minds in this turmoil over the things they had done and 
seen. Many of them told of having to wait months and, in one case, a 
year before they could see a doctor at a VA hospital.
  I heard from veterans from Iraq, Vietnam, Korea and World War II. One 
veteran in southern Illinois who was in the Philippines couldn't come 
to my meeting because ``I just can't face talking about it.'' This was 
60 years after his experience. Veterans of Vietnam, coming home, facing 
animosity from others, then being unable to address their emotional and 
psychological anguish and difficulty because they were afraid to even 
acknowledge they were veterans. They were left tormented by this for 
decades.
  The ones that gripped my heart the most were the Iraqi veterans. I 
will never forget these men and women. The one I sat next to at 
Collinsville, a bright, handsome, young Marine, talked about going into 
Fallujah with his unit and how his point man was riddled with bullets, 
and he had to carry the parts of his body out of that street into some 
side corner where the remains could be evacuated. Then he took over his 
friend's job as point man and went forward. A rocket-propelled grenade 
was shot at him, and it bounced off his helmet. One of the insurgents 
came up and shot him twice in the chest. This happened just this past 
November.
  When he came home, he said he couldn't understand who he was because 
of what he had seen and been involved in. He had problems with his 
wife--difficult, violent problems, and he turned to the VA for help.
  I said to this young Marine: I am almost afraid to ask you this, but 
how old are you? He said, ``I am 19.''
  Think of what he has been through. Thank goodness he is in the hands 
of counselors. Thank goodness he is getting some help and moving in the 
right direction.
  But in another meeting in southern Illinois, another soldier said, in 
front of the group, ``As part of this battle, I killed children, women. 
I killed old people. I am trying to come to grips with this in my mind 
as I try to come back into civilian life.''
  A young woman, a member of the Illinois National Guard, said when she 
returned to the United States, still in distress over what she had seen 
and done, she was released from active duty through Fort McCoy in 
Wisconsin where the Army sat her down and asked, ``Any problems?'' Of 
course, that should have been the time for her to come forward and say: 
I have serious problems. She didn't. She'd heard that if you said you 
had a problem, you had to stay at Fort McCoy for several more months. 
She was so desperate to get home she said, ``No problems.''
  She came home and finally realized that was not true. She had serious 
psychological problems over what she had been through. When she turned 
to the VA and asked for help, they said: You can come in and see a 
counselor at the VA in a year.
  What happens to these veterans, victims of post-traumatic stress 
disorder, without counseling at an early stage? Sadly, many of them see 
their marriages destroyed. One I met was on his fourth marriage. Many 
of them self-medicate with alcohol, sometimes with drugs, desperate to 
find some relief from the nightmares they face every night. These are 
the real stories of real people, our sons and daughters, our brothers 
and sisters, our husbands and wives who go to battle to defend this 
country and come home with the promise that we will stand behind them.
  So, in addition to the Vietnam, Gulf War and other veterans already 
being treated, it is clear that we will soon see large numbers of Iraq 
veterans coming to the VA for help with PTSD. What is our capacity to 
help them? Unfortunately, it does not look good.
  Disturbingly, the Department of Veterans Affairs may lack the 
capacity to treat those with PTSD. The Government Accountability Office 
recently concluded, and the Department of Veterans Affairs concurred, 
that the Department has not kept adequate accounting of the numbers of 
patients it currently treats for PTSD. Without any reliable numbers of 
patients currently receiving treatment, the VA cannot deliver to us any 
assurance about having the facilities or staff needed to treat the 
coming influx of new veterans.
  The VA has demonstrated an inability to forecast the number of 
patients it must be ready to treat. In three of the past four years, 
the Department of Veterans Affairs has submitted budget requests that 
included patient estimates which turned out to be too low in four 
different areas. In three of the past four years, the VA has 
underestimated its number of acute hospital care patients, the number 
of medical visits, the dependents and survivors' hospital census, and 
the numbers of dependent and survivor outpatients that it would see.

[[Page S8680]]

  Now, just a couple of weeks ago, the VA had to acknowledge that its 
budget for the current fiscal year was going to be $1 billion short 
because they got their estimate of Iraq veteran patients wrong. The VA 
had forecasted a 2.3 percent growth in healthcare demand this year but 
the actual increase turned out to be 5.2 percent--more than twice the 
VA estimate. The VA budget assumed that 23,553 VA patients would be 
veterans of the Global War on Terrorism. The number of these patients 
in 2005 is now estimated to be 103,000--more than four times what VA 
had estimated.
  In the absence of reliable patient information and patient estimates 
from the Department of Veterans Affairs, how can we know that the VA 
healthcare system lacks the capability to treat the incoming number of 
veterans needing PTSD treatment? That's easy--we can simply listen to 
the VA medical professionals who provide the treatment.
  In the course of conducting its investigation, the Government 
Accountability Office asked officials at VA facilities if they would be 
able to meet this coming demand. The answer they received was very 
disturbing. Fully six out of these seven VA healthcare officials stated 
that their facilities may be unable to handle the influx of new 
veterans needing PTSD treatment. Six out of seven!
  In addition, another set of internal VA mental health professionals 
has repeatedly recommended that VA expand its capability to treat PTSD. 
The Department's own Special Committee on Post-Traumatic Stress 
Disorder has issued a long list of recommended improvements. When the 
Government Accountability Office studied the progress on implementing 
these expert recommendations, it found that the Department of Veterans 
Affairs hadn't fully implemented any of them.
  Enough is enough!
  When the VA fails to count its current PTSD patients; when the VA 
consistently underestimates its number of future patients; when the VA 
ignores the improvement recommendations of its own internal mental 
health professionals it is time for Congress to step in, demonstrate 
the leadership that is required, and take action to provide the 
treatment capability that our veterans deserve.
  The bill I am introducing today accomplishes this by requiring the 
Department of Veterans Affairs to implement three of the key treatment 
improvement recommendations made by the Department's own Special 
Committee on Post-Traumatic Stress Disorder.
  The bill requires the Secretary of Veterans Affairs to do three 
things. First, it requires the Secretary to establish a Post-Traumatic 
Stress Disorder Clinical Team at every Medical Center within the 
Department of Veterans Affairs. Second, it requires the Secretary to 
provide a certified family therapist within each Vet Center. Finally, 
the bill requires the appointment of a regional PTSD Coordinator within 
each Veteran Integrated Service Network (VISN) and Readjustment 
Counseling Service region to evaluate programs, promote best practices 
and make resource recommendations.
  Let me explain the importance of these three provisions.
  The majority of the major VA hospitals already have a clinical team 
of mental health experts focused on providing treatment for post-
traumatic stress disorder. These teams include psychiatrists, 
psychologists, and psychotherapists who bring their varied skills 
together. However, approximately 60 of our VA hospitals currently do 
not have a PTSD clinical team. This bill requires that these teams be 
established.
  Nationwide, the Department of Veterans Affairs operates 207 ``Vet 
Centers.'' The community-based, informal atmosphere of these centers 
has proven to be a highly effective way to provide counseling and other 
services to veterans who might not want or be able to go to a formal VA 
hospital for help. The Special Committee has recognized the importance 
of family relationships in helping veterans deal with their PTSD and 
has recommended that there be a certified marriage and family therapist 
at each Vet Center.
  Currently only 17 centers have these specialists on staff. This bill 
helps keep families strong for our veterans by adding 190 family 
therapists to Vet Centers nationwide.
  Finally, the bill ensures that PTSD treatment capability gets the 
attention and management needed to keep it strong by requiring the 
appointment of PTSD coordinators at the regional level.
  Altogether, this bill will add about 400 mental health professionals 
to the Department of Veterans Affairs' capability to treat those of our 
veterans whose wounds are not visible, whose thoughts are continually 
troubled by the horrors of war, who need just a little help to get past 
the nightmares and get their life back on track.
  Even the toughest of warriors can have troubled feelings following 
the stress of combat. It is no sign of weakness--it is no sign of 
failure to ask for a little help in getting past some of those 
feelings. That message must be clearly conveyed to all of our veterans.
  By acting now, we can ensure that this help is available to our 
veterans when they return. This is crucial because the effects of post-
traumatic stress disorder are sometimes left undiagnosed and untreated 
for years. If we delay, we virtually guarantee a future shortage of 
treatment capability and, in so doing, we lay the groundwork for the 
plague of drug abuse, domestic violence, homelessness, unemployment and 
even suicide that so often is the result of post-traumatic stress 
disorder which is left untreated.
  America's newest generation of young veterans certainly deserve 
better than that!
  We in the Congress can step up and require that the Department of 
Veterans Affairs hire a full staff of mental health professionals that 
can help our veterans to move past the psychological trauma of war and 
to lead healthy, happy and productive lives.
  I encourage my colleagues to join me in supporting our returning 
veterans by supporting the Post-Traumatic Stress Disorder Treatment 
Improvement Act.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1448

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Post-Traumatic Stress 
     Disorder Treatment Improvement Act''.

     SEC. 2. IMPROVED TREATMENT OF POST-TRAUMATIC STRESS DISORDER.

       (a) In General.--Not later than 120 days after the date of 
     the enactment of this Act, the Secretary of Veterans Affairs 
     shall--
       (1) establish a post-traumatic stress disorder clinical 
     team at every Medical Center of the Department of Veterans 
     Affairs;
       (2) provide a certified family therapist for each Vet 
     Center of the Department of Veterans Affairs; and
       (3) appoint a post-traumatic stress disorder coordinator 
     within each Veteran Integrated Service Network and within 
     each Readjustment Counseling Service Region.
       (b) Duties of PTSD Coordinator.--Each coordinator appointed 
     for a network or region under subsection (a)(3) shall--
       (1) evaluate post-traumatic stress disorder and family 
     therapy treatment programs within the network or region;
       (2) identify and disseminate best practices on evaluation 
     and treatment of post-traumatic stress disorder, and on 
     family therapy treatment, within the network or region and to 
     other networks and regions; and
       (3) recommend the resource allocation necessary to meet 
     post-traumatic stress disorder and family therapy treatment 
     needs within the network or region.
       (c) Waiver.--Beginning on the date that is 5 years after 
     the date of the enactment of this Act, the Secretary of 
     Veterans Affairs may waive any requirement of this Act for 
     the fiscal year beginning after that date if the Secretary, 
     not later than 90 days before the beginning of such fiscal 
     year, submits to Congress a report--
       (1) notifying Congress of the proposed waiver;
       (2) explaining why the requirement is not necessary; and
       (3) describing how post-traumatic stress disorder services 
     and family therapy services will be provided to all veterans 
     who may need such services.
                                 ______