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Viewpoints on Veterans Affairs and related issues : hearing before the Subcommittee on Oversight and Investigations of the Committee on Veterans' Affairs, House of Representatives, One Hundred Third Congress, second session, May 4, 1994 online

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Veterans Affairs Committee May 4, 1994. Jonathan Shay, M D , Ph D PAGE 1

Cambridge, Massachusetts

Not all the POWs are in Vietnam
Copyright (c) 1993 W.T. Edmonds Jr. All Rights Reserved. 1

We have 'em in the streets

in our cities and our towns.

They're livin' our past,
and it's getting 'em down.

We have 'em in our bars

and they end up in our ditches.
So we put 'em in our jails,

cause they're mean sons o'bitches.

We have 'em in our hospitals

and we're teaching 'em the walk.
It's the Thorazine shuffle,

and they don't ever squawk.

We have 'em doin' robbery

and we have 'em doin' dope.

We have 'em doin' suicide
when they run outta hope.

This poem by a Vietnam combat veteran is a fitting epigraph for the testimony that the
three of us, John Woods, Dr. John Liebert, and I are about to give, through the great courtesy of
the Committee.

I want to offer some introduction and explanation of this group of testimony on the
common theme of "Post-traumatic Stress Disorder (PTSD) and the Forgotten Warriors."

John Woods of the Vietnam Veterans of America, who has for years traveled the nation
visiting incarcerated veterans in prison and tirelessly advocating on their behalf at all levels of
govenmient and corrections officialdom, needs little introduction to this Committee. Its
Chairman, Congressman Evans, and another member. Congressman Edwards, along with
Congressmen Bonior and Brown, recently signaled their leadership in correcting injustice and
increasing practical wisdom in public policy by offering an amendment to HR 4092 "to ensure
that incarcerated veterans receive the veterans benefits to which they are entitled." This will
mean that the combat PTSD that may have been factors leading up to the crimes that they
committed will be treated ~ usually for the first time. Mr. Woods will testify regarding
incarcerated veterans.

' Used by permission "Not A]l the POWs Are In Vietnam" TM Poem Copyright (c) 1993 W T Edmonds Jr All
nghts reserved No part of this poem may be used or reproduced in any manner whatsoever without written
permission, e.xcept in the case of bnef quotations embodied in cntical articles or reviews For information,
address Tom Edmonds, 3 14 Grove Avenue, Falls Church, Virgmia.


Veterans Affairs Committee May 4. 1994. Jonathan Shay. M D . Ph D PAGE 2

John Liebert, M.D. is a forensic psychiatrist practicing in Bellvue, Washington. Over a
period of years he has worked with a number of Vietnam combat veterans, the reality of whose
combat service had been denied by the govenmient because their activities were secret at the
time of the War. In a number of these cases Dr. Liebert has obtained substantial evidence, and
eventually government confirmation, that these men's claims of participation in secret combat
operations were valid. All of these men suffered from devastating psychological injuries and all
of them had been denied VA services and benefits related to combat PTSD. Dr. Liebert will
testify regarding disavowed combat veterans. Below I shall quote (with his permission) excerpts
from correspondence on this matter from Brigadier General Donald M. Schmuck, USMC
(Retired) confirming that it is indeed possible for a member of the Armed Forces to serve in
highly dangerous secret combat operations that leave no trace in the standard paperwork
available to the personnel of the Department of Veterans Affairs, who determine eligibility for
health and pension benefits.

I am the psychiatrist for a small specialized program in the Boston DVA Outpatient
Clinic for Vietnam combat veterans with severe, chronic PTSD and personality changes due to
prolonged combat. For a number of years 1 have also done staff training at the New England
Shelter for Homeless Veterans as a volunteer. It was through this work that I became aware of
the plight of combat veterans carrying severe psychological injuries who have "bad paper"
discharges [Bad Conduct, Undesirable, Dishonorable] and who are thus ineligible for VA mental
health or other benefits. The deep sense of personal shame that I felt, knowing that there are
combat-injured veterans who are denied care, compelled me last year to petition the Congress to
redress this unjust and unsound policy. This Committee graciously permitted me to testify on
this matter last year. I did not then and do not now represent the VA in this, only myself. I am
here at my own expense, not the govenmient's, and on my own time. Below, 1 shall briefly
restate the information and conclusions I offered last year and provide an update of
developments since that time.


What is combat PTSD? Here is a brief summary of the key symptoms of PTSD and of tKe
personality changes that mark its severe forms taken from the Introduction to my book AchiUss
in Vietnam: Combat Trauma and the Undoing of Character, published by Atheneum, 1994:

All [these symptoms and personality changes ]may be imderstood as the
persistence of past traumatic experience in the present physiology, psychology,
and social relatedness of the survivor. The symptoms can range in severity from
mild to devastating, and not everyone will have all of the symptoms at the same


Veterans Affairs Coraimttee May 4, 1994, Jonathan Shay. M D , Ph D PAGE 3

Loss of authority over mental function — particularly memory and

trustworthy perception

Persistent mobilization of the body and the mind for lethal danger

with the potential for explosive violence

Persistence and activation of combat survival skills in civilian life

Chronic health problems stemming from chronic mobilization of the

body for danger

Persistent expectation of betrayal and exploitation; destruction of the

capacity for social trust

Persistent preoccupation with both the enemy and the veteran's own

military/governmental authorities

Alcohol and drug abuse

Suicidality, despair, isolation, and meaninglessness

Such unhealed PTSD can devastate life and incapacitate its victims from
participation in the domestic, economic, and political life of the nation. The
painful paradox is that fighting for one's coimtry can render one unfit to be its
This is a gruesome, but truthful portrait of severe war wounds in the mind, incurred in actual

battle for our coimtry. The men who incurred these wounds have an absolute moral claim on the

rest of us to provide treatment for these wounds. This is not a partisan issue. Neither Democrat

nor Republican can claim ownership. This is not a reflection of anyone's judgment of whether

the Vietnam War was a noble cause or a horrible mistake ~ the men who fought it and were

injured in it have the same moral claim regardless oi the Jus ad bellum, the justice of the war,

over which they had no control. One's position in favor or opposed to the American military

actions in Vietnam can neither increase nor reduce the claim that war wounded have on the rest

of us. This is not a Liberal versus Conservative issue. There are those who openly or silently

deny that it is our duty to provide treatment to these men or do not feel this duty weigh on them

very heavily. They should consider this: to provide these mental health and other benefits to

psychologically injured veterans is the smart thing to do in their own self-interest.

Today's testimony concerns three groups of war injured whose moral claim has been

rebuffed. The usual perception is that two of these groups have only themselves to blame — it is

their misconduct or criminal behavior that has deprived them of their benefits - the veterans

with "bad paper" discharges and the incarcerated veterans. For both these groups, I shall argue

that combat PTSD contributed significantly to their unmilitary or criminal conduct — and will

continue to do so if it is not successfully treated.

Incarcerated Combat Veterans:

I speak entirely for myself in this, and no endorsement of my views by John Woods, the
Vietnam Veterans of America, or the Department of Vveterans Affairs is claimed or implied.

Prolonged combat can produce not only psychiatric symptoms, it can damage good
character. Very ancient teachings, going back to Plato tell us that once good character is formed
by good upbringing m childhood, no bad events can damage a good person or his character.
Plato's ancient contemporaries, the Athenian tragic poets Sophocles and Euripides said with one
voice - Wrong! When bereavement, betrayal of what's right, and horror have been sufficiently


Veterans .Affairs Cortinultee May 4. 1994, Jonathan Shay, M D . Ph D PAGE 4

severe, even the noblest character may crack. However, Plato's view has permeated our culture
and common sense. American psychiatry has been notably reluctant to acknowledge that severe
trauma can change the personality, despite the compelling evidence to this effect produced by
the DSM-IV Field Trials. By contrast, the World Health Organization's 1992 diagnostic manual
ICD - 10, acknowledges the entity called "Enduring Personality Change after Catastrophic
Experience," which the American Psychiatric Association's diagnostic system refuses to admit.
Official American psychiatry institutionalizes Plato's dubious proposition: if bad experience
leads someone who was good to do terrible things, it must be because he was secretly flawed
from the begirming. He deserves no respect for any previously honorable conduct — all
possibility of respect or consideration has been obliterated by his criminal act.

You may wonder if I am attempting to exculpate criminals who also happen to be combat
veterans of their crimes. 1 have never testified as an expert witness on behalf of a defendant in a
criminal trial, nor at a clemency or parole hearing, and probably never will. I am not trying to
get anyone off nor get anyone's sentence shortened. However, I want to see these men receive
effective treatment for their psychological injuries, first, because the overwhelming majority will
be released 6-om prison within the next five years and are likely to commit further violence if
untreated, and second, because these men suffer continual pain. 1 work with such men. I know
this to be the truth. They suffer pain from their war wounds as surely as a veteran with a piece
of shrapnel buried in his spine might be tormented by constant pain. Are we really willing to
say that we wash our hands of responsibility for wounds a soldier received in his coimtry's
battles — physical or mental — when he goes to prison? That's what we now do.

Disavowed Veterans

Whenever I have mentioned the plight of men who have served in harrowing combat, but
who have been unable to get VA mental health or pension benefits, the listener's response has
almost always been to tell me his favorite "The Biggest Liar 1 Ever Met" story, or "Doc, you
been had by a scammer." Let me say at the outset that I am well aware that there are many
scammers and watmabes out there. Neither they nor their motivation interests me. It is
shameful and dangerous \ha.t men who were carefiilly selected and highly trained, then injured in
secret combat operations, and now, largely because of their injuries are on the fringes of our
society, unable to get mental health treatment or disability pensions, because their combat
service is not reflected in their paperwork.

Before I go any fiirther, I want to establish a prima facia case that such people exist. I
carmot do this from my own personal knowledge, but respectfiilly submit, with his permission,
excerpts from letters to me from Brigadier General Donald M. Schmuck, USMC, (Retired).

Germane to my comments are, of course, the patterns of my own life. For
the record, 1 am a umversity graduate with advanced degrees and a retired general
officer of Marines. Although in more recent wars I was a senior officer, in both
WW II and Korea 1 served in heavy combat at a level where 1 was one of the


Veterans Affairs Comminee May 4, 1994. Jonathan Shay, M D , Ph D PAGE 5

grunts when it came to hardship and incoming enemy fire, to include hand to hand
struggles with knives and grenades m mud and blood - in short, I have "seen the
elephant"! Furthermore, I was not always a senior officer-I was once a private
and even a corporal in charge of a nfle squad. I was a lieutenant m command of a
rifle platoon in 1942 when we went mto the Soudi Pacific m WW II. I made
captain and rifle company command on Guadalcanal, and led my outfit (which I
had trained and taken overseas) through the swamps and jungles of the Japanese
occupied Solomons to Bougainville under conditions worse than any combat
theater I have since observed - to include Korea, Vietnam, and the Gulf War. I was
in the assault on Pelehu where we suffered more battle casualties m a week than
similar forces in Vietaam received in years. On Okinawa, the last battle of that
war I was still in there wading the rice paddies and fighting for the ndges with my
troops and still a grunt leader. Then, of course there was Korea, where for 18
months I was an infantry commander-to include the Chosm Reservoir at 26
below-'and I never noticed my foxhole was any less frozen or my C-rattons any
better than those of my warriors. [24 January, 1994]

With regard to your third group-veterans who can not establish a claim to
ser/ice in certain types of military operations - we have therein some very difficult
problems I am aware of this situation, and I can state that it is not hmited to SE.
Asia, but most assuredly extends over the years to certain activities m World War
n and Korea - and in Vietiiam and Laos prior to our official participation m that
war with American combat elements. ^ ■ c ■ i

Rather of more profit would be research into the records of the Special
Forces at Ft Bragg - of the Marine Corps Force Recon through the great research
center at Quantico-of the combat reports of Ranger LRRP umts-and most
important, the reports and classified records of MACVSOG if available. The latter
organization, the most secretive of all combat units, had their missions assigned
not by the high command in Vietiiam but by a top level "inner sanctiim" m
Washington - and the reports of their activities as well as the identity of
participating personnel bypassed MACV and were submitted only to the same
White House level committee which originated the mission. Some of these
activities, along with certain "contingency war plans" which were formulated
during the early S.E. Asia period, in which I personally participated, might stiU be
considered so deUcate as to unpinge on national security, and therefore would be
buried deep in the limited access faults of the N.S.A. or C.I.A.-if they sumved at

all after 1975. . .

My final observation is that all the military organizations mentioned above
have very active civilian associations with personal records as to [the] who and
where of their combat operations. I suggest they could well be an untapped source
of information smce they are aware of the paucity of available records covermg
classified combat duties m several wars. [19 November, 1993, emphasis added]
How many veterans fit this description? The number is probably not large, but how can
we be content that there is even a single combat-uijured veteran who is demed health and
pension benefits because he has been unable to estabhsh his bona fides? I do not clami to know
how to remedy to this sitiiation. It is not difficult to say what such a remedy should accomplish:
It should pennit any veteran whose standard paperwork, such as the DD-214, did not refiect the
usual indicia of combat service, i.e. assigmnent to the warzone m a combat MOS, to obtain
confirmation that he had seized m combat operations, and which would be deemed to grant the
presumption of ti^th to the veteran's story for medical and pension purposes. Such confirmation
could contain a disclaimer that it neither confinned nor demed ^727 specifics of the veteran's
story, if any residual national secunty womes were to present an obstacle. Eliminating a


Veterans Affairs Comminee May 4. 1994, Jonathan Shay. M.D . Ph D PAGE 6

declassification dimension to the process would reduce the expense of implementing any such a
mechanism. General Schmuck's suggestion that the unit associations could be of use should
also surely be explored, such as by granting these associations a defined Service Organization
status that permitted them to certify, again for medical and pension purposes, that a given
veteran had in fact served in combat operations, whatever his DD-214 may say or not say.

Without being unduly melodramatic, I simply want to remind everyone how imprudent it
is to drive to the Singes of society these veterans with the kinds of lethal skills that they have
acquired through specialized training and combat experience.

Combat Veterans with '^ad Paper^ Discharges

What I said before this Committee a year ago still holds: It is shameflil that there are
battle-injured veterans who are not eligible for VA services and benefits. Most of these veterans
with less than Honorable discharges committed offenses afier combat that caused them to be
discharged fi'om military service with what veterans call "bad paper." Most Vietnam combat
veterans with "bad paper" committed infi-actions a5 a ^52//^ of psychological injuries incurred in
their war service. Typical offenses stemming directly fi-om combat PTSD were:

• AWOL or desertion after return to U.S.

• Use of illicit drugs to self-medicate symptoms of PTSD

• Impulsive assaults during explosive rages on officers or NCOs after return to the

These veterans had no treatment then, and have no treatment now for their Post-traumatic
Stress Disorder or for its complications of substance abuse, depression, and violence. They have
been profoimdly disadvantaged in finding work and comprise a disproportionate fi-action of
homeless veterans, who make up one-third of all homeless men. [National Coalition for the
Homeless, "Heroes Today, Homeless Tomorrow?: Homelessness among Veterans in the United
States." 1621 Connecticut Ave., NW, Washington DC 20009, November, 1991. Pp. 6ff.]
According to the Director for Shelter Operations of the New England Shelter for Homeless
Veterans, a 225-bed shelter in downtown Boston, 25% of the men who have come through the
door are combat veterans with bad paper. 3% of Vietnam-era vets have bad paper, and
separately, 9% of Vietnam-era service men served in significant combat. The percentage who
were both has not been published, to my knowledge. Last year, and in the intevening time, the
Committee indicated an interest in how many such veterans there are.

Since last year, I have had the good fortune to come in contact with Theodore Hull of the
National Archives, who has discovered the relevant data sources that will allow a good estimate
of the number of combat veterans who received "bad paper" discharges, at least for the Army
during a range of years when the war was at its height. 1 know Mr. Hull through the Internet - a
discussion list for Vietnam veterans and people interested in the Vietnam War for scholarly and


Veterans Affairs Committee May 4. 1994. Jonathan Shay. M D , Ph D PAGE 7

professional reasons ~ an excellent example of how the National Information Infrastructure can
help bring citizens and their government together in constructive ways. Prior to this contact with
Mr. Hull, I had been told repeatedly that the information that I and the Committee wanted
existed only in paper or microfilm files of millions of individual military discharge papers.

As a VA physician, I have never treated a veteran with a Bad Conduct, Undesirable or
Dishonorable discharge, because they caimot get through the front door ~ they are ineligible for
any VA services. Virtually everything I know of this problem comes from accounts of the staff
at the New England Shelter for Homeless Veterans where I do staff training as a volunteer.

I was aware, however, that the rod of military justice did not faU with equal weight on
every soldier. According to the well-known study by Baskir and Strauss, "A 1972 Defense
Department Task Force on Military Justice reported that blacks of comparable education and
aptitude who committed offenses of comparable seriousness were receiving much harsher
punishments than whites. . . .The NAACP study found that 45% of all less-than-Honorable
discharges went to blacks. An Urban League study showed that blacks in the Air Force received
Dishonorable Discharges at more than three and one- half times the rate of aU airmen." The
same lopsided statistics also apply to Hispanic veterans. It has been my honor and privilege to
co-author an Op-Ed piece with Congresswoman Waters of this Committee on this subject, that I
understand will be published shortly in the New York Times. The disproportionate
concentration of psychologically injured combat veterans who are ineligible for VA benefits in
Congressional districts with large African-American and Hispanic populations has made this a
matter of long-term concern to their Representatives in the House. I am proud to be able to add
my small efforts to correcting this long-standing problem.

This problem does not call for a study or for an expansion of the existing case-by-case
discharge upgrade program. Today I ask Congress for a blanket upgrade of all veterans
discharged imder less than honorable conditions who have any combat decoration: such as
Combat Infantryman Badge, Combat Action Ribbon, etc., or obviously any award for heroism,
such as the Bronze Star. I have spoken to many Vietnam combat veterans with Honorable
Discharges about this, and not one has felt that this would diminish them in any way. Their
reactions have all been either "It's about [expletive deleted] time" or "There, but for the grace of
God, go I."

An alternative remedy, one which is not as satisfactory in bringing these men home, but a
massive improvement over the present situation is this: to revise the Department of Veterans
Affairs eligibility criteria to make any veteran who has served in combat unconditionally eligible
for health and other benefits

What I propose applies only to combat veterans, who constitute but a fraction of the
566,000 Vietnam-Era veterans with General, Undesirable, Bad Conduct, or Dishonorable
discharges. [Lawrence M. Baskir, William A. Strauss. Chance and Circumstance: The Draft, the


Veterans .AiTairs Committee May 4, 1994, Jonathan Shay, M D . Ph D PAGE 8

Warand the Vietnam Generation. New York, Vintage Books, 1978. Pp, 218f.] Using the
definition as "High Combat Stressor Exposure" from the Congressionally mandated National
Vietnam Veterans Readjustment Study {NWRS) as the criterion, there are 766,000 Vietnam
combat veterans or about 24% of all Vietnam-era veterans. If the same proportion of Vietaam-
Era veterans with General, Undesirable, Bad Conduct, or Dishonorable discharges were combat
veterans, we are talking about roughly 135,000 veterans, some of whom have already had
discharge upgrades and many of whom are dead by suicide, drug-related and violence related
causes. A'W7?5' collected self-report data on type of discharge and combat exposure, but cross-
tabulation of these data has not been published. Combat veterans with bad paper are
characteristically even more mistrustful and more hostile to the government than other Vietnam
combat vets (who as a group are quite mistrustful of the government), so we should assume that
they are systematically under-represented in the A^WK^ sample, first because of difficulties in
simply finding them and second in terms of gaining their cooperation in the study. It should not
be surprising, therefore, that the percentage of veterans with less than General Discharges
measured by the NWRSviZiS considerably lower than the percentage derived from the Armed
Forces' own reports of such discharges.

I treat veterans with psychological injuries from their war service, and find the situation
of veterans with "bad paper" to be as unjust and irrational as if they had been drummed out for
failure to stand at attention after their feet had been blown off. Most of these men committed
offenses because of ihsu combat PTSD.

Pure self-interest should lead us to take this step, even if a sense of justice does not.
Between a tenth and a quarter of all incarcerated males are veterans.^ It costs an average of
$25,000 a year for each of these, and this does not include the monetary costs to society of the
criminal acts themselves.' Unhealed combat PTSD predisposes to criminal justice
involvement;'' and treatment costs but a fraction of the costs to wait for crime to happen and then

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Online LibraryUnited States. Congress. House. Committee on VeterViewpoints on Veterans Affairs and related issues : hearing before the Subcommittee on Oversight and Investigations of the Committee on Veterans' Affairs, House of Representatives, One Hundred Third Congress, second session, May 4, 1994 → online text (page 14 of 23)