found that the Vet Centers have been one of the excellent tools for
outreach and an important arm of our efforts, and the Vet Center
is the only VA facility operating within the community without
many bureaucratic trappings. It is for many veterans the first con-
tact they will have with the VA.
Counseling outreach service.** provided by these centers are in-
valuable, but limited. There are World War II and Korean War vet-
erans who suffer from post-traumatic stress disorder who could
benefit from the counseling services that are offered by the Vet
Centers. These veterans are currently ineligible to receive these
I support pending legislation and regulations which would in-
clude these veterans for service provision.
I also support the concept of allowing the Vet Centers to provide
certain basic medical services, such as cardio-vascular screenings
and other basic health exams. Vietnam veterans are beginning to
be an aged population, and we need to take that into consideration.
Moving along just quickly, we need to look at also the World War
II and Korean War vets that are coming in and will also be aging.
The other thing that I would request is that there be a dissemi-
nation of information on Desert Storm illness. When I go out and
talk about these kinds of conditions there are many physicians in
the Commonwealth of Pensnylvania who require this information.
We created the same or similar situation with Desert Storm as
we have done with Agent Orange, and we need to clarify that by
providing information and assisting those physicians in the commu-
nity to provide assistance to those veterans who are suffering.
Many of those veterans do not use the VA services, again, because
of a resistance, because of their treatment.
So if we can provide information to the physicians, provide infor-
mation to the veterans allowing them to know what is going on
daily or weekly or with some type of public information program,
it would be most acceptable.
[The prepared statement of Mr. Edwards appears on p. 55.]
Mr. Evans. Thank you, Mr. Edwards. We do have your entire
statement, and it will be part of the record.
You have obviously made an important impact in terms of help-
ing Vietnam veterans with your commission in the State of
Pennsyvlania. Will the commission undertake a similar program
for Desert Storm veterans? And what are non-VA physicians in
Pennsylvania reporting about the health care concerns of Desert
Mr. Edwards. We are not mandated legislatively to do the same
for Desert Storm veterans as of yet. That may change as veterans
become more vocal with regard to their conditions.
The physicians report that there are veterans coming into the of-
fice that served in Desert Storm with many sjrmptoms, and they
lack the information to provide adequate treatment. They also re-
port that these veterans have a resistance to utilizing the VA be-
cause they feel as though the VA and the government are in collu-
sion to hide information from them.
So these veterans are going to physicians. The physicians have
limited information, and they are asking for all that they can get.
Every program that I have been to that we hav'e put on in Penn-
sylvania, the physicians have asked: what about Desert Storm?
What is the available information? We have got patients that are
Pennsylvania had a large number of Reservists that served.
Those Reservists are now back in their community, and they are
asking questions, and they are not asking questions of the VA.
They are asking questions of those private physicians.
Mr. Evans. You will be pleased to know that some provisions
contained in H.R. 3313, which has passed the House, will allow VA
to provide health care services in Vet Centers and expand eUgi-
bihty to all combat veterans of all other wars. I think those are im-
portant steps forward.
Ms. Ross, your comments provide a good summary of the testi-
mony received by the subcommittee time and time again when it
has examined VA women veterans' health care and the health care
concerns of women veterans.
President Clinton has directed the VA and other federal agencies
to develop customer service standards. If not today, some time in
the near future for the record, would you give the subcommittee
your recommendations for VA customer service standards?
Dr. Ross. I think those standards have to involve some monitor-
ing of interactions that occur between patients and physicians, for
I think there should be customer feedback set up at each VA
health care facility so that we talk to our veterans after they have
received care and see what they feel about the customer service.
Mr. Evans. Mr. Ensign, you have called for a review of the ac-
tivities of Science Applications International (SAIC). What informa-
tion can you provide this subcommittee that its work is faulty at
Mr. Ensign. It is inductive, Mr. Chairman. First, let me note
that there's one slight error on my written statement that I apolo-
gize for. That is that the $1.5 billion figure represents government
expenditures for all dose reconstruction. The scientific consulting
by SAIC that you refer to is a large part of that contract, but it's
not all of it. So their role is slightly exaggerated.
I reason inductively that if there are only 1,409 claims granted
out of 15,000 that are submitted, and if one of the key issues in
considering a claim is what dose was the veteran exposed to, then
I think it is reasonable to explain the very high rate of rejected
claims by referring to dose reconstruction estimates that are much
I am not charging that this consultant firm is somehow corrupt
or is scientifically inept. Instead, I am saying that it chronically
provides dose estimates that are too low given that many vet claim-
ants suffer from radiation-induced cancers.
You probably read the New York Times story on April 22 about
the Green Run releases at Hanford, WA. The release of radiation
during the "Green Run test" is something that was brought out by
Senator John Glenn back in November, 1993. It involved deliberate
releases of radioactive iodine into the environment around Hanford,
WA, back in 1949, and this was never known until Senator Glenn
asked the GAO to prepare a report.
The latest article reports that after a $26 million health study
reviewed the releases they found that radiation exposures had been
over a much larger area than they had thought in earlier studies,
including the GAO report.
What I am tr5ang to stress here is the numbers for exposure are
still very much in dispute. We really do not know what doses peo-
ple received. The committee needs to look at this radiation expo-
sure issue and how it affects atomic veterans. What was their
That is what I am trying to bring out of that, and I think as I
look into it further, I will, of course, share with your subcommittee
what we can develop. The National Association of Atomic Veterans
has been very interested in working on this question also. We will
share any new information with your subcommittee.
Mr. Evans. We would appreciate that.
I want to just say two things. First, a number of us have written
to the President to encourage inclusion of atomic veterans in the
consideration of the Secretary's deliberations, and we need to mon-
itor that process. I am a little concerned at this point that they are
not going to be included, as if veterans were somehow less worthy
or perhaps voluntarily there after being ordered there, not being on
the same status as maybe other innocent victims.
We certainly want to help those other innocent victims, but we
do not want to leave the atomic veterans behind.
As far as Vietnam veterans suffering from Agent Orange, I think
they ought to come to this committee. While I understand the con-
cerns you raise about the inadequacies of funding through the
Agent Orange settlement, it was not the chemical companies that
sent these people to Vietnam, and this committee and this govern-
ment has a primary responsibility. We have not lived up to it, in
my opinion, but we need those people to come forward.
This will be a tough experience for many of them to do so, to
demonstrate the need that they have and the lack of adequate help
that they have received from the Veterans Administration.
Mr. Ensign. I have just one thing on that. The veterans and
their lawyers in the original class action, of course, would have
been more than happy to include the federal government as a
party. It should have been included, but because of the Feres Doc-
trine, as you are well aware, it was not. So it was not the choice
of veterans not to name the government as a party to this action.
Mr. Evans. I appreciate that.
Does the gentleman from Washington have any questions?
I would like to recognize the gentleman from Illinois not only for
questions, but ask for an opening statement at this time.
OPENING STATEMENT OF HON. LUIS V. GUTIERREZ
Mr. Gutierrez. Mr. Chairman, I do have an opening statement.
I would like to submit it in its entirety for the record if there is
Mr. Evans. Without objection, so ordered.
Mr. Gutierrez. And I would like to thank you. Congressman
Evans, for bringing this hearing together and for all of the people
who have come to Washington.
I had a wonderful evening last night talking to people over din-
ner with a number of veterans, some Latino veterans from Massa-
chusetts and New Jersey and California. I will forget some state
and so I v/ill get in trouble with somebody later on today, but it
was really a good meeting, and we look forward to working with
you, Mr. Chairman, when the Hispanic Congressional Caucus has
its week. They are all excited about getting together and having in
Washington, DC, different Latino veteran organizations from
across the country to come and express their concerns, and so they
look forward to working with you, as I do, when the Hispanic Con-
gressional Caucus has that week in September.
And with all of the members of this committee, I would like to
thank you for holding this hearing. I am not going to ask any ques-
tions. I am just going to say that I think the work that we need
to do is important in terms of including women's issues. I continue
to insist that women are going to continue to be making the health
care decisions in famihes, and if the VA is going to compete, we
had better have a role for the children and the women who make
a lot of decisions about health care in those family households.
At least I know that is the way it works in my household. As I
said to someone, if my daughter was sick and in an emergency
room, you would want my wife there if you want a medical history
of that little girl, not that I am a bad father. It is just that she hap-
pens to have taken her to the hospital and to the doctor a whole
lot more times than I have and knows. She has chosen the pediatri-
cian and the doctors. I kind of follow her, and I think that is true
So we had better start including women in the health care, and
so I would just like to say that as part of the opening statement.
I do not have any questions, and I would like to thank the three
panelists for being here this morning and apologize for my tardi-
Thank you, Mr. Chairman.
Mr. Evans. We know everybody is busy today, and we appreciate
We want to thank this panel. I do not think we have any other
questions. Thank you very much for your valuable input today.
The members of Panel II are invited to come forward now. They
are Dr. John Liebert, John Woods, and Dr. Jonathan Shay.
Dr. Liebert is a psychiatrist in private practice in Seattle, WA.
John is a service-connected disabled veteran who works with incar-
cerated veterans in the Dallas, TX, area. Among his other activi-
ties, Dr. Shay has been a psychiatrist for the Boston VA outpatient
clinic program for Vietnam combat veterans with severe chronic
PTSD and provided staff training at the New England Shelter for
Homeless Veterans. He has also recently authored Achilles in Viet-
nam, Traumatic Stress and the Undoing of Character, which will
soon be released. We welcome him again before the committee. We
ask everyone to limit their remarks to five minutes.
At this time we will start with Dr. Liebert if you are ready.
STATEMENTS OF JOHN ARTHUR LIEBERT, M.D., SEATTLE, WA;
JOHN WOODS, DALLAS, TX; AND JONATHAN SHAY, M.D.,
Ph.D., CAMBRIDGE, MA
STATEMENT OF JOHN ARTHUR LIEBERT, M.D.
Dr. Liebert. My name is Dr. John A. Liebert. I am from Seattle,
WA, and I would like to thank you for inviting me to share my
findings and conclusions from studying and treating eight veterans
of special operations whose service in Vietnam has been officially
My purpose is to make you aware of a group of veterans number-
ing in perhaps the low thousands who need the specialized services
of the Veterans Administration. They represent all services and
likely all wars and are both enlisted men and officers, as well as
perhaps civilians or law enforcement agents.
They have special needs because they were highly selected for
special operations. Therefore, they are highly skilled. They are very
independent because they operated alone or in small groups, some-
Their official discharge papers are altered, and they either dis-
avow combat or even overseas duty completely. This disavowal, in
my opinion, causes second injury which, heaped upon the combat
trauma, seriously jeopardizes their loyalties to the United States.
My hope here is that a means can be found to allow these veter-
ans with special operations backgrounds access to Veterans Admin-
I would like to present the case of Matt. He was arrested in 1973
for armed robbery. In the get-away car was found a cache of mili-
tary weapons. When the police asked him whether he would have
used them, he said, "Heavens, no. I saw too much killing in Cam-
bodia. I need a psychiatrist."
I saw him some weeks later, and he in a very monotone, flat
voice presented a series of rather hair-raising operations. He was
also fluent in Maoist and Marxist rhetoric, and he was also on pro-
bation from the federal court for manufacturing LSD.
His official Army records at the time of trial showed that he was
a Special Forces lieutenant, graduating in the 94th percentile of his
graduating class in Fort Bragg. He completed briefing for Vietnam.
He was a mortar unit leader who spent his entire career, 1966
through 1970, in the Military District of Washington, DC. He was
not assigned overseas allegedly due to a record of conscientious ob-
jector status, and a psychiatrist report from Walter Reed General
Hospital, dated 1970, made a diagnosis of Inadequate Personality
Disorder — or Casper milktoast. This diagnosis is no longer used by
the American Psychiatric Association.
In the biggest presentence investigation in Washington State his-
tory, lasting 500 hours, it was established unequivocally that Matt
served in Vietnam. Matt was a captain. He was in combat, and his
extended absences were confirmed both by his pay records, which
showed large gaps wherein he was never paid, and by his es-
tranged wife stating that he was never home.
We found post-traumatic stress disorder and no evidence whatso-
ever of Inadequate Personality Disorder, because the Casper
milktoast type of personality would not have a black belt in karate,
and his hobby was ocean kayaking up the coast of Alaska. He was
always prepared for grizzly bear attacks.
The psychiatrist with whom I communicated, whose name was
on the Walter Reed General Hospital report diagnosing him as In-
adequate Personality, denied having seen him. There was no record
that he was at Walter Reed Hospital, and the psychiatrist, after I
read him his report, his own report, said, "It sounds to me like an
amateur job," and it was an amateur job.
The results of this investigation were that Matt was placed on
probation and received psychiatric treatment — which he gets until
this day — instead of a disastrous ten years of required imprison-
ment. He was, however, sent to federal prison for parole violation.
but the federal psychiatrist at Springfield Medical Facility fortu-
nately agreed with our diagnosis of post-traumatic stress disorder
and said also that he did not have an Inadequate Personality Dis-
He was, therefore, released early, after a couple of months, to my
supervision without parole. He resumed psychiatric treatment with
me and is in treatment to this day.
He has a new family, with two children. He has a second wife
and is still on his second marriage. He has completed an MBA pro-
gram at a major university in the United States. Now, he is a CPA
working for a major accounting firm in the Pacific Northwest.
In conclusion, hopefully Matt's case will open access for VA serv-
ices to thousands of special operations personnel from all wars
whose service to this country has been disavowed officially. These
veterans with extra effort and the absence of preconception and na-
ivety can be differentiated from phonies, of which I have seen
three. Special operations personnel were specially selected, and
therefore, they need special treatment.
[The prepared statement of Dr. Liebert appears on p. 81.]
Mr. Evans. Thank you, doctor.
STATEMENT OF JOHN WOODS
Mr. Woods. Yes, sir. Thank you, Mr. Chairman and distin-
guished members of this subcommittee.
I stand before you as an ex-felon service-connected Vietnam era
veteran myself. I rise in support of distinction to that group of vet-
erans across our countr/s veteran population which are incarcer-
ated at this time or will be incarcerated in the future.
My statement goes in very deep detail regarding multiple issues
of the veteran incarcerated program.
Post-traumatic stress disorder has been found by the Research
Triangle Institute and by many other clinical and American Psy-
chiatric Association findings as a significant part of drug and alco-
hol addiction and abuse. Drug and alcohol addiction has been found
as a form of self-medication for the symptomology of post-traumatic
This is not limited to the Vietnam combat veteran or veterans as
an overall whole, but also to victims of sexual, physical and/or emo-
tional abuse as children, victims of incest, victims of rapes. It ex-
pands throughout our society to all of those individuals who have
been a victim of some sort of severe abusive situation.
The post-traumatic stress disorder has been found by the Re-
search Triangle Institute to have been a problem for as many as
in excess of 800,000 veterans since their return from combat or bat-
tlefield. This represents from mild to moderate, to significant, and
several symptomology of post-traumatic stress disorder.
Also represented are approximately one in four individuals who
served in the theater of Vietnam. Quite interesting, as my state-
ment reflects, not one one-on-one interview was conducted in either
a state mental health facility or a state or federal prison facility
regarding the veteran population there, which were also combat
I guess that at least to the capacity of one in four, those incarcer-
ated across this great country not only of the Vietnam combat era,
but also of other eras, as I have found in my travels as national
liaison to incarcerated veterans for Vietnam Veterans of America,
have to be understood to have some form of major symptomology
of post-traumatic stress disorder.
Also, consistently it has been found in multiple state reviews and
studies that the incidence of drug and alcohol abuse is far greater
than the nonveteran population. Generally speaking, in 14 states
which have a preliminary study at this point, it is found that be-
tween 68 and 72, or approximately almost three out of every four,
veterans that are incarcerated today has a major problem with
drug and alcohol abuse which led to their conviction or at least
their criminal behavior, which therefore led to arrest and convic-
tion and confinement.
Also, it was found by the State of New York, which I do embel-
lish upon in my written statement, Mr. Cuomo, the Governor of
New York, and the Temporary Veterans Commission found that
Vietnam veterans, primarily through the years of 1972 to 1986,
were sentenced to much longer, harsher prison terms than non-
veterans for the same crime. It is believed, as the commission
found and suggested, that this is the result of bias by not only the
courts, but the American society and general public overall.
What we also found in the State of New York and just recently
this fall was a report by the Department of Corrections to Mr.
Cuomo, which found that the program inside the prison system,
which is at absolutely no cost whatsoever, in the last four-year pe-
riod of review, they found that recidivism, which is generally ap-
proximately 49 percent or 49 of each 100 to get out of prison return
within a one to four-year period. Of the Vietnam veterans particu-
larly, the recidivism rate has been reduced to eight to nine percent.
A^ the national liaison and the director of a national program for
WA, we have gotten out in excess of 2,078 individual combat con-
firmed veterans with drug and alcohol abuse problems recorded
prior to their criminal conduct, of which 107 have returned, 96 of
which for drug and alcohol abusive behavior upon their release to
This represents a five percent recidivism rate. All of these stud-
ies and all of these programs with which we have been very deeply
involved, I have personally been involved as somewhat of a role
model, if you will, in developing for veterans incarcerated, not only
have proven to be cost-effective, but have also proven now, after
approximately six years, to be the most effective rehabilitation tool
this country's system has ever seen.
Even the Department of Justice, although they do fluctuate be-
tween the statistics of veterans incarcerated from year to year,
pretty much I find with a change of administration, find that a sig-
nificant portion of the veteran population are, in fact, veterans and
do, in fact, suffer a higher degree of post-traumatic stress disorder
and/or drug and alcohol abuse patterns leading to their arrests and
As my time is running short, I would like to suggest on page
seven of my statement I did indicate a proposal for the States of
Michigan, New York, Florida, California, Illinois, Washington
State, Ohio, Pennsylvania, and Texas as a potential pilot program
nationwide to expand on those programs that currently exist, with
and without the help of the Department of Veterans Affairs, to uti-
lize these successful programs in other states across this country.
It reduces crime. It makes for a safer society, and it provides
those benefits to which veterans deserve by their honorable service
to our country.
Today we find Saudi or Desert Storm veterans coming into our
prison systems, to include female veterans, for charges of drug and
alcohol abuse. We need to address these problems.
This ends my statement, Mr. Chairman.
[The prepared statement of Mr. Woods appears on p. 98.]
Mr. Evans. Thank you, Mr. Woods.
STATEMENT OF JONATHAN SHAY, M.D., Ph.D.
Dr. Shay. It is a profound honor to be invited back for a second
year. I shall not repeat my testimony of last year regarding veter-
ans with so-called bad paper discharges. My concern is with combat
veterans in the three categories that are represented here today:
forgotten warriors, men who have served their country in actual
These men are either de facto or de jure not receiving mental
health, physical health, or pension benefits from the Department of
Veterans Affairs, and this is a subject of great personal shame to
me as an American citizen.
The three groups, all of whom have faced the enemy for their
country, have an absolute moral claim on the rest of us. This claim
does not depend, in my view, on any other thing, whether they are
physically located in a prison, whether they are in a homeless shel-
ter. Their claim is absolute. They have been injured in the service
of their country. It goes right back to the War of Independence that
we have recognized that people with injuries have this claim.
Now, I also want to give thought to how imprudent it is for us
not to provide services to these men. These are men who have ac-
quired the skills of combat, which are skills that are very dan-