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89–378 2015

SERVICE SHOULD NOT LEAD TO SUICIDE: 

ACCESS TO VA’S MENTAL HEALTH CARE 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

THURSDAY, JULY 10, 2014 

Serial No. 113–79 

Printed for the use of the Committee on Veterans’ Affairs 

( 

Available via the World Wide Web: http://www.fdsys.gov 


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COMMITTEE ON VETERANS’ AFFAIRS 

JEFF MILLER, Florida, Chairman 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida, Vice-Chairman 

DAVID P. ROE, Tennessee 

BILL FLORES, Texas 

JEFF DENHAM, California 

JON RUNYAN, New Jersey 

DAN BENISHEK, Michigan 

TIM HUELSKAMP, Kansas 

MIKE COFFMAN, Colorado 

BRAD R. WENSTRUP, Ohio 

PAUL COOK, California 

JACKIE WALORSKI, Indiana 

DAVID JOLLY, Florida 

MICHAEL H. MICHAUD, Maine, Ranking 

Minority Member 

CORRINE BROWN, Florida 

MARK TAKANO, California 

JULIA BROWNLEY, California 

DINA TITUS, Nevada 

ANN KIRKPATRICK, Arizona 

RAUL RUIZ, California 

GLORIA NEGRETE MCLEOD, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

TIMOTHY J. WALZ, Minnesota 

JON TOWERS, Staff Director 

NANCY DOLAN, Democratic Staff Director 

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records 

of the Committee on Veterans’ Affairs are also published in electronic form. The printed 

hearing record remains the official version. Because electronic submissions are used to 

prepare both printed and electronic versions of the hearing record, the process of converting 

between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process 

is further refined. 


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C O N T E N T S 

Page 

Thursday, July 10, 2014 

Service Should Not Lead To Suicide: Access to VA’s Mental Health Care ......... 1 

OPENING STATEMENTS 

Hon. Jeff Miller, Chairman ..................................................................................... 1 

Prepared Statement ......................................................................................... 77 

Hon. Michael Michaud, Ranking Minority Member ............................................. 2 

Prepared Statement ......................................................................................... 77 

Hon. Corrine Brown 

Prepared Statement ......................................................................................... 78 

Hon. Scott Peters 

Prepared Statement ......................................................................................... 79 

WITNESSES 

Howard and Jean Somers, Parents of Daniel Somers, Deceased ........................ 4 

Prepared Statement ......................................................................................... 81 

Susan and Richard Selke, Parents of Clay Hunt, Deceased ................................ 6 

Prepared Statement ......................................................................................... 83 

Peggy Portwine, Mother of Brian Portwine, Deceased ......................................... 8 

Prepared Statement ......................................................................................... 85 

Josh Renschler, Sergeant, U.S. Army (Ret.) .......................................................... 9 

Prepared Statement ......................................................................................... 86 

Maureen McCarthy M.D., Deputy Chief Patient Care Services Officer, Veterans Health Administration U.S. Department of Veterans Affairs ............... 48 

Prepared Statement ......................................................................................... 93 

Accompanied by: 

Harold Kudler M.D., Acting Chief Consultant for Mental Health 

Services, Veterans Health Administration U.S. Department of 

Veterans Affairs 

David Carroll Ph.D., Acting Chief Consultant for Specialty Mental 

Health, Veterans Health Administration, U.S. Department of 

Veterans Affairs 

Michael Fisher, Program Analyst, Readjustment Counseling Service, 

U.S. Department of Veterans Affairs 

Alex Nicholson, Legislative Director, Iraq and Afghanistan Veterans of America .......................................................................................................................... 50 

Prepared Statement ......................................................................................... 100 

Lt. General Martin R. Steele (USMC, Ret.), Associate Vice President for 

Veterans Research, Executive Director of Military Partnerships, Co-Chair 

of the Veterans Reintegration Steering Committee University of South Florida .......................................................................................................................... 52 

Prepared Statement ......................................................................................... 105 

Warren Goldstein, Assistant Director for TBI and PTSD Program, National 

Veterans Affairs and Rehabilitation Commission, The American Legion ....... 54 


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IV 

Warren Goldstein, Assistant Director for TBI and PTSD Program, National 

Veterans Affairs and Rehabilitation Commission, The American Legion— 

Continued 

Prepared Statement ......................................................................................... 114 

Jonathan Sherin M.D., Ph.D., Chief Executive Officer, Executive Vice President for Military Communities, Volunteers of America .................................... 56 

Prepared Statement ......................................................................................... 120 

STATEMENT FOR THE RECORD 

General Steele, Neurocognitive Perspectives on PTSD, mTBI and Suicide 

in the Military ...................................................................................................... 124 

American Foundation for Suicide Prevention ....................................................... 130 

CNS Response .......................................................................................................... 135 

Swords to Plowshares .............................................................................................. 145 

Vietnam Veterans of America ................................................................................. 158 

Report by Citizens Commission on Human Rights International ....................... 168 

QUESTIONS FOR THE RECORD 

Letter and Questions From: Ranking Member Michael Michaud, To: VA ......... 198 

Questions From: Ranking Member Michael Michaud and Responses From: 

VA .......................................................................................................................... 200 


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SERVICE SHOULD NOT LEAD TO SUICIDE: 

ACCESS TO VA’S MENTAL HEALTH CARE 

Thursday, July 10, 2014 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON VETERANS’ AFFAIRS, 

Washington, D.C. 

The committee met, pursuant to notice, at 9:15 a.m., in Room 

334, Cannon House Office Building, Hon. Jeff Miller [chairman of 

the committee] presiding. 

Present: Representatives Miller, Lamborn, Bilirakis, Roe, Runyan, Benishek, Huelskamp, Coffman, Wenstrup, Cook, Walorski, 

Jolly, Michaud, Brown, Takano, Brownley, Titus, Kirkpatrick, Ruiz, 

Negrete McLeod, Kuster, O’Rourke, and Walz. 

Also Present: Representatives Peters, and Sinema. 

OPENING STATEMENT OF JEFF MILLER, CHAIRMAN 

The CHAIRMAN. This hearing will come to order. Before we begin 

I would like to ask unanimous consent for our colleagues, Representative Scott Peters from California and Representative 

Kyrsten Sinema from Arizona to sit at the dais with us and participate in the proceedings today. Without objection, so ordered. 

I would like to welcome everybody to today’s full committee oversight hearing entitled, ‘‘Service Should Not Lead to Suicide: Access 

to VA’s Mental Health Care.’’ 

Following a committee investigation which uncovered widespread 

data manipulation and accompanying patient harm at Department 

of Veterans Affairs medical facilities all across this nation, this 

committee has held a series of full committee oversight hearings 

over the last several weeks to evaluate the systemic access and integrity failures that have consumed the VA health care system. 

Perhaps none of these hearings have presented the all too human 

face of VA’s failures so much as today’s hearing will. A hearing 

that I believe will show the horrible human costs of VA’s dysfunction and I daresay corruption. 

At its heart access to care is not about numbers, it is about people. Recently the committee heard from a veteran who had attempted to receive mental health care at a VA community based 

outpatient clinic in Pennsylvania. This veteran was told repeatedly 

by the VA employee he spoke with that he would be unable to get 

an appointment for six months. However, when that employee left 

another VA employee leaned in to tell this veteran that if he just 

told her that he was thinking of killing himself she would be able 

to get him an appointment much sooner, in just three months instead of six. Fortunately that veteran was not considering suicide. 

But what about those veterans who are? How many of the tens of 


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thousands of veterans that VA has now admitted have been left on 

waiting lists for weeks, months, and even years for care were seeking mental health care appointments? How many are suicidal, or 

edging towards suicide as a result of the inability to get the care 

that they have earned? 

Despite significant increases in VA’s mental health and suicide 

prevention budget, programs, and staff in recent years, the suicide 

rate among veteran patients has remained more or less stable since 

1999 with approximately 22 veterans committing suicide every single day. However, the most recent VA data has shown that over the 

last three years rates of suicide have increased by nearly 40 percent among male veterans under 30 who use VA health care services, and by more than 70 percent among male veterans between 

the ages of 18 and 24 who use VA health care services. 

This morning we are going to hear testimony from three families: 

the Somers, the Selkes, and the Portwines, who will tell us about 

their sons Daniel, Clay, and Brian. Three Operation Enduring 

Freedom and Operation Iraqi Freedom veterans who sought VA 

mental health care following combat. Each of these young men 

faced barrier after barrier in their struggle to get help. Each of 

these young men eventually succumbed to suicide. In the note he 

left behind Daniel Somers wrote that he felt his government had 

abandoned him and referenced coming home to face a system of dehumanization, neglect, and indifference. VA owed Daniel, and Clay, 

and Brian so much more than that. 

With that, I yield to our Ranking Member Mr. Michaud for his 

opening statement. 

[THE PREPARED STATEMENT OF JEFF MILLER APPEARS IN THE APPENDIX] 

OPENING STATEMENT OF MICHAEL MICHAUD, RANKING 

MINORITY MEMBER 

Mr. MICHAUD. Thank you very much, Mr. Chairman, for holding 

this very important hearing. We have had many discussions and 

debates about how to deliver the best health care services to our 

nation’s veterans and how to ensure accountability within the leadership ranks of the Department of Veterans Affairs. Over the 

course of these recent hearings and discussions we have touched on 

a number of important issues. But one that we have not zeroes in 

on too much yet has been access to mental health care and suicide 

prevention services for our veterans. That is why this hearing 

today is so important. And I would like to thank all of the panelists 

for joining us today. But particularly I want to thank the family 

members joining us who have lost a loved one. 

I know that speaking about a loss of a loved one, particularly a 

child, can be an incredibly difficult and exhausting experience. But 

in this case I think we have to listen to your stories, identify what 

went wrong, and we can take action to ensure that those failures 

are not repeated again. So I want to thank you very, very much 

for joining us today to share your stories. 

Eighteen to 22 veterans commit suicide each day. In my opinion 

that is 18 to 22 brave men and women each day who our system 

has let down in some capacity. It is totally unacceptable. When a 


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veteran has experienced depression or other early warning signs 

that may indicate mental health issues or even suicide, that must 

be treated like an immediate medical crisis. Because that is exactly 

what it is. Veterans in that position should never be forced to wait 

months on end for a medical consult. Because quite frankly that is 

time that they may not have. 

We have taken steps to help put in place programs and initiatives aimed at early detection and we have significantly increased 

our funding. The Department of Veterans Affairs funding on mental health has doubled since 2007 but it is not working as well as 

we had hoped. And we have to figure out why, and how we can correct these problems. 

Our veterans are the ones paying the price for this dysfunction. 

A 2012 IG report found that VHA data on whether it was providing 

timely access to mental health services is totally unreliable. And a 

GAO report from that year not only confirmed that disturbing finding, but also said that inconsistent implementation of VHA scheduling policy made it difficult, if not impossible, to get patients the 

help that they need when they need it. That is why we have to look 

at this situation. That is a problem that we have seen repeatedly 

as we dig into the VA’s dysfunctions, and enough is enough. 

Our veterans and their families deserve a VA that delivers timely mental health services that cover a spectrum of needs, from 

PTSD, to counseling for family members, to veterans, to urgent 

round the clock response to a veteran in need. A recent VA OIG 

report found that in one facility patients waited up to 432 days, 

well over a year, for care. 

For once again, we are finding that our veterans deserve much 

better than the care that they are receiving in all of the areas that 

we must address. We have to look at it comprehensively. And I 

would argue that fixing mental health services is among the most 

important area. And I look forward to a productive discussion that 

will begin today as we look forward to trying to solve some of the 

problems with a dysfunctional department that we have seen over 

the last several months. 

And once again, Mr. Chairman, I want to thank you very much 

for having this very important hearing and for the panelists for 

coming today to tell your stories. With that, I yield back the balance of my time. 

[THE PREPARED STATEMENT OF MICHAEL MICHAUD APPEARS IN

THE APPENDIX] 

The CHAIRMAN. Thank you very much to the ranking member. 

We are humbled and honored to be joined by our first panel of witnesses this morning. Family members of the three veterans who 

sadly and tragically lost their lives to suicide, and I am sure that 

I speak for each of my colleagues when I say that each of you have 

our deepest sympathies for your loss. I am both grateful and at the 

same time angry that you have to be here to share your stories of 

your sons with each of us. So if you could approach the witness 

table, please? 

Joining us is Dr. Howard and Jean Somers, the parents of Daniel 

Somers; Susan and Richard Selke., the parents of Clay Hunt; and 

Peggy Portwine, the mother of Brian Portwine. We are also joined 


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on our first panel by Josh Renschler, a veteran of the United States 

Army who will share his very personal story of attempting to seek 

mental health care through the Department of Veterans Affairs. 

Thank you, sir, for your service, and for being here today. Dr. and 

Mrs. Somers, please proceed with your testimony. 

STATEMENT OF HOWARD AND JEAN SOMERS 

Mrs. SOMERS. Chairman Miller, Ranking Member Michaud, and 

committee members, we are grateful for this opportunity to testify 

today. We are especially pleased to see Arizona Representative Ann 

Kirkpatrick; and Daniel’s Representative Kyrsten Sinema; and our 

own California Representative Scott Peters; who have been great 

allies to us in our efforts to advance reforms of the VA based on 

the experiences of our son. 

Dr. SOMERS. As many of you know our journey started on June 

10, 2013 when Daniel took his own life following his return from 

a second deployment in Iraq. At that time he suffered from Post 

Traumatic Stress Disorder, Traumatic Brain Injury, and Gulf War 

Syndrome. Daniel spent nearly six futile and tragic years trying to 

access the VA health and benefits systems before finally collapsing 

under the weight of his own despair. We have attached the story 

of Daniel Somers to our testimony, which provides the details of his 

efforts and we hope you will read it if you have not already done 

so. 

Today it is our objective to begin the process which will ultimately provide hope and care to the 22 veterans today who are 

presently ending their lives. 

Mrs. SOMERS. Just over a year ago and four days after Daniel’s 

death, feeling fortunate that we at least had a letter from him, 

Howard and I, Howard is a urologist and I spent 30 years in the 

business of health care, sat down with Daniel’s wife, who has a 

Bachelor of Science in nursing, and his mother-in-law who is a psychiatrist. Together we felt uniquely qualified to prepare a 19-page 

report that we titled Systemic Issues at the VA. We have shared 

that document with several of you over the last year and it is also 

attached to our testimony. 

The purpose of the report remains the same as when we wrote 

it, to improve access to first rate health care at the VA; to make 

the VA accountable to veterans it was created to serve; and to 

make every VA employee an advocate for each veteran. 

Dr. SOMERS. At the start Daniel was turned away from the VA 

due to his National Guard Inactive Ready Reserve status. Upon 

initially accessing the VA system he was essentially denied therapy. He had innumerable problems with VA staff being uncaring, 

insensitive, and adversarial. Literally no one at the facility advocated for him. Administrators frequently cited HIPAA as the reason for not involving family members and for not being able to use 

modern technology. 

Mrs. SOMERS. The VA’s appointment system, know as VISTA, is 

at best inadequate. It impedes access and lacks basic documentation. The VA information technology infrastructure is antiquated 

and prevents related agencies from sharing critical information. 

There is a desperate need for compatibility between computer sysVerDate Aug 31 2005 14:28 Mar 25, 2015 Jkt 000000 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 Y:\89378.XXX PAT

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tems within the VHA, the VBA, and the DoD. Continuity of care 

was not a priority. There was not succession planning. 

Dr. SOMERS. No procedures in place for warm hand offs, no contracts in place for locum tenens, and a fierce refusal to outsource 

anyone or anything. 

At the time Daniel was at the Phoenix VA, there was no pain 

management clinic to help him with his chronic and acute 

fibromyalgia pain. There were few coordinated interagency goals, 

policies, and procedures. The fact that the formularies of the DoD 

and VA are separate and different makes no sense since many DoD 

patients who are stabilized on a particular medication regimen 

must rejustify their needs when they transfer to the VA. There 

were inadequate facilities and an inefficient charting process. 

Mrs. SOMERS. There was no way for Daniel to ascertain the status of his benefits claim. There was no VHA/VBA appointments 

system interfacing, nor prioritized proactive procedures. There was 

no communication between disability determination and vocational 

rehabilitation. This report is offered in the spirit of a call to action 

and reflects the experiences of Daniel with VA program services beginning in the Fall of 2007 until his death last June through our 

eyes. 

Dr. SOMERS. As seen through our eyes. Our concern then was 

that the impediments and deficiencies which Daniel encountered 

were symptomatic of deeper and broader issues in the VA, potentially affecting the experiences of a much broader population of 

servicemembers and veterans. Unfortunately this has been proven 

true as dramatically evidenced by recent revelations. 

Many of the reforms outlined in our report will require additional 

funding for the VA. But with that new funding should come greater 

scrutiny and a demand for better measurable results. 

Mrs. SOMERS. There is, however, an alternative to attempting to 

repair the existing, broken system. We believe Congress should seriously consider fundamentally revamping the mission of the VA 

health system. In the new model we envision the VA would transition into a center of excellence, specifically for war related injuries, 

while the more routine care provided by the rest of the VA health 

care system would be open to private sector service providers, 

much like Tricare. That approach would compel the current model 

to self-improve and compete for veterans’ business. This would ultimately allow all veterans to seek the best care available while allowing the VA to focus its resources and expertise on the treatment 

of complex injuries suffered in modern warfare. Dr. Somers. We 

thank you for your time and would be happy to further discuss our 

recommendations and suggestions. We sincerely hope that the systemic issues raised here will provide a platform to bring the new 

VA administration together with lawmakers, VSOs, veterans, and 

private medical professionals and administrators for a comprehensive review and reform of the entire VA process. And if the VA 

Committee or Congress as a whole make the decision to involve 

other stakeholders in a more formal reform process, we would be 

honored to be among those chosen to represent the views of affected families. Thank you. 

Mrs. SOMERS. Thank you. 


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[THE PREPARED STATEMENT OF HOWARD AND JEAN SOMERS AP- PEARS IN THE APPENDIX] 

The CHAIRMAN. Thank you both for your testimony. Mr. and Mrs. 

Selke, you are recognized for five minutes. 

STATEMENT OF SUSAN AND RICHARD SELKE 

Mrs. SELKE. Thank you. Chairman Miller, Ranking Member 

Michaud, and distinguished members of the committee, thank you 

for the opportunity to speak with you today about this critically important topic of mental health care access at the VA, suicide among 

veterans, and especially about the story and experience of our son, 

Clay. My name is Susan Selke, and I am accompanied here by my 

husband Richard. I am here today as the mother of Clay Hunt, a 

Marine Corps combat veteran who died by suicide in March, 2011 

at the age of 28. 

Clay enlisted in the Marine Corps in May, 2005 and served in 

the infantry. In January of 2007 Clay deployed to Iraq’s Anbar 

Province, close to Fallujah. Shortly after arriving in Iraq Clay was 

shot through the wrist by a sniper’s bullet that barely missed his 

head. After he returned to Twenty nine Palms in California to recuperate, Clay began experiencing symptoms of Post Traumatic 

Stress, including panic attacks, and was diagnosed with PTS later 

that year. 

Following the recuperation from his gunshot wound, Clay attended and graduated from the Marine Corps Scout Sniper School 

in March of 2008. A few weeks after graduation Clay deployed 

again, this time to Southern Afghanistan. 

Much like his experience during his deployment to Iraq, Clay 

witnessed and experienced the loss of several fellow Marines during his second deployment. 

Clay received a 30 percent disability rating from the VA for his 

PTS. After discovering that his condition prevented him from maintaining a steady job, Clay appealed the 30 percent rating only to 

be met with significant bureaucratic barriers, including the VA losing his files. Eighteen months later, and five weeks after his death, 

Clay’s appeal finally went through and the VA rated Clay’s PTS 

100 percent. 

Clay exclusively used the VA for his medical care after separating from the Marine Corps. Immediately after his separation, 

Clay lived in the Los Angeles area and received care at the VA 

Medical Center there in L.A. Clay constantly voiced concerns about 

the care he was receiving, both in terms of the challenges he faced 

with scheduling appointments as well as the treatment he received 

for PTS which consisted primarily of medication. He received counseling only as far as a brief discussion regarding whether the medication he was prescribed was working or not. If not, he would be 

given a new medication. Clay used to say, ‘‘I am a guinea pig for 

drugs. They will put me on one thing, I will have side effects, and 

they put me on something else.’’ 

In late 2010 Clay moved briefly to Grand Junction, Colorado 

where he also used the VA there, and then finally home to Houston 

to be closer to family. The Houston VA would not refill the prescriptions that Clay had received from the Grand Junction VA beVerDate Aug 31 2005 14:28 Mar 25, 2015 Jkt 000000 PO 00000 Frm 00010 Fmt 6633 Sfmt 6633 Y:\89378.XXX PAT

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cause they said that prescriptions were not transferrable and a 

new assessment would have to be done before this medications 

could be represcribed. Clay had only two appointments in January 

and February of 2011 and neither was with a psychiatrist. It was 

not until March 15th that Clay was able to see a psychiatrist at 

the Houston VA Medical Center. But after that appointment, Clay 

called me on his way home and said, ‘‘Mom, I cannot go back there. 

The VA is way too stressful and not a place I can go. I will have 

to find a Vet Center or something.’’ 

Just two weeks after his appointment with the psychiatrist at 

the Houston VA medical center, Clay took his life. After Clay’s 

death I personally went to the Houston VA Medical Center to retrieve his medical records and I encountered an environment that 

was highly stressful. There were large crowds. No one was at the 

information desk. And I had to flag down a nurse to ask directions 

to the medical records area. I cannot imagine how anyone dealing 

with mental health injuries like PTS could successfully access care 

in such a stressful setting without exacerbating their symptoms. 

Clay was consistently open about having PTS and survivor’s guilt 

and he tried to help others coping with similar issues. He worked 

hard to move forward and found healing by helping people, including participating in humanitarian work in Haiti and Chile after the 

devastating earthquakes. He also starred in a public service advertising campaign aimed at easing the transition for his fellow veterans and he helped wounded warriors in long distance road biking 

events. Clay fought for veterans in the halls of Congress and participated in Iraq and Afghanistan Veterans of America’s Annual 

Storm the Hill in 2010 to advocate for legislation to improve the 

lives of veterans and their families. 

Clay’s story details the urgency needed in addressing this issue. 

Despite his proactive and open approach to seeking care to address 

his injuries, the VA system did not adequately address his needs. 

Even today we continue to hear about both individual and systemic 

failures by the VA to provide adequate care and address the needs 

of veterans. Not one more veteran should have to go through what 

Clay went through with the VA after returning home from War. 

Not one more parent should have to testify before a congressional 

committee to compel the VA to fulfill its responsibilities to those 

who have served and sacrificed. 

Mr. Chairman, I understand that today you are presented the 

Suicide Prevention for American Veterans Act. The reforms, evaluations, and programs directed by this legislation will be critical to 

helping the VA better serve and treat veterans suffering from mental injuries from War. Had the VA been doing these thing all along, 

it very well may have saved Clay’s life. 

Mr. Chairman, Richard and I again appreciate the opportunity to 

share Clay’s story and our recommendations about how we can 

help ensure the VA will uphold its responsibility to properly care 

for America’s veterans. Thank you. 

[THE PREPARED STATEMENT OF SUSAN AND RICHARD SELKE APPEARS IN THE APPENDIX] 

The CHAIRMAN. Thank you both for your testimony this morning. 

Ms. Portwine, you are recognized for five minutes. 


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STATEMENT OF PEGGY PORTWINE 

Ms. PORTWINE. Thank you, Mr. Chairman, Mr. Michaud, distinguished committee members. My son Brian Portwine gave 100 percent to every task he performed and his military service was no exception. By the time he was 19 years old Brian was awarded the 

Purple Heart and the Army Commendation Medal. I am before you 

today to share Brian’s story. 

At 17 Brian enlisted in the Army. After his training in infantry, 

he was deployed to Baghdad where he patrolled in Sadr City on the 

Haifa Streets. It was an extremely daunting serviced. This occurred 

before the surge of troops. During this tour, Brian lost 11 brothers. 

While serving in Iraq in 2006, Brian’s Bradley tank was struck 

by an RPG. The flames swiftly engulfed the tank. The driver was 

knocked unconscious and the men fought for their lives as the driver was unable to hydraulically lower the ramp. The five soldiers 

scrambled through the flames, manually lowered the ramp, and 

exited, all with injuries. Brian suffered a blast concussion along 

with lacerations to his face and legs due to shrapnel and bone fragments. This was his first experience with traumatic brain injury. 

On yet another mission Brian and his First Sergeant were patrolling in Humvee when his Sergeant signaled for Brian to switch 

seats with him. They switched seats so Brian was now in the passenger seat. Twenty minutes later an IED hit the Humvee on the 

driver’s side, killing his First Sergeant, and throwing Brian from 

the vehicle. 

Besides these two incidents he experienced six other IED explosions during his 15-month deployment. I would like to pause here 

and ask is this not enough to warrant a thorough evaluation and 

further testing? The powers that be apparently thought of sending 

Brian to Walter Reed Hospital, but did not. Are these experiences 

with the physical and mental injuries not enough to possibly exempt him for another deployment? Apparently the VA felt his care 

was iffy enough to stamp a no go on his clearance form but then 

it was crossed out and written go. How and why this decision was 

made is beyond me 

After his first deployment Brian was ecstatic to be home again. 

He enrolled in Daytona State College. He worked in the admissions 

counseling office. He created videos to share resources with students, hosted events, and linked students with part-time employment around their school schedules. But Brian suffered with short 

term memory loss. He would have to write everything on his computer, his iPhone, or his calendar. Many times his friends told me 

when he was out with them he would say, ‘‘Where are we going 

again? You know I have got scrambled brains from Iraq.’’ To help 

cope he posted all his events on his computer, his calendar, and his 

phone. 

In 2010 the military recalled Brian one month before the college 

year ended. Brian immediately dropped his classes that he excelled 

in. When I asked him why he said, ‘‘Mom, there is no point. You 

have to get your mind in a completely different place. You have no 

idea what is coming.’’ 

During the second deployment Brian did not email or call home 

to any family or friends. Little did we know how he was struggling 


VACREP180 with DISTILLER
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with anxiety attacks, panic attacks, traveling the same roads as 

the first tour. He knew the stigma of admitting PTSD, as all soldiers do. So they just man up and move on. 

Upon returning from the second deployment Brian was evaluated. He was diagnosed with PTSD, TBI, depression, and anxiety. 

At this time I would like you to refer to the documents that you 

received, Brian’s medical documents. It is documented that Brian 

could not remember that questions asked from the therapist during 

the interview. He had extensive back pain. He could not sleep. He 

felt profound guilt. He suffered from low self-esteem and as a result he was a risk for suicide. Nonetheless he was just immediately 

discharged and told to follow up. How in the world you can ask 

someone who cannot remember the questions asked to follow up 

with the VA is beyond me. 

Brian deteriorated quickly from December, 2010 to May 27, 2011 

when he took his life. He could not stand how he would be angry, 

depressed, anxious. But he did not know how to cope. It took a to1l 

on his relationships. If the DoD and VA assessed Brian for suicide 

risk, it was their duty to treat him but he received nothing. He applied for disability but was unable to wait. 

Brian’s unit has lost three others besides himself to suicide since 

the 2006 to 2008 tour. As you know, suicides surpassed combat fatalities for the first time in history. It is a very slippery slope from 

PTSD and TBI to death, something our VA should realize. 

Our soldiers never hesitated in their mission to protect, serve, 

and sacrifice for our country. Now it is time for the VA to prove 

their commitment to our soldiers. I never knew of Brian’s PTS, 

TBI, or suicide risk. I think he felt, ‘‘If I can survive two tours of 

Iraq, I can survive anything.’’ I think it is a life threatening situation like this and it should be shared with the family so we are 

able to help. The VA needs to work with the service organizations, 

including the families in the plan for care. 

I am requesting, I am begging this committee to pass Act 2182, 

the Suicide Prevention for Americans Act. This has been a most 

devastating war in history in terms of suicide. Our whole nation 

continues to suffer and everyday we continue to lose 22 Brians a 

day. 

I promised my son at his funeral that I would stop this injustice. 

These are quality young men who potentially had so much to offer 

society. Please pass this Act 2182 and support any legislation that 

gives our soldiers and timely and loving care that they deserve. 

Thank you. 

[THE PREPARED STATEMENT OF PEGGY PORTWINE APPEARS IN THE

APPENDIX] 

The Chairman Thank you, Ms. Portwine. Sergeant Renschler, 

you are recognized for your statement. 

STATEMENT OF SERGEANT JOSH RENSCHLER 

Sergeant RENSCHLER. Chairman Miller, Ranking Member 

Michaud, members of the committee, I appreciate the opportunity 

to discuss VA mental health care. And I certainly want to acknowledge the loss and the courage of these family members ensuring 

that they were not in vain. And I struggle with the similarities of 


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the stories. As an infantryman who lost so many in the Iraq War 

in injures, and struggled with thoughts of suicide from overwhelming chronic pain and other injuries, I just thank you all for 

being here. 

My experience with the VA health care system began in 2008. 

Sorry. 

The CHAIRMAN. That is okay. You have got plenty of time. 

Sergeant RENSCHLER. After I was medically retired from the 

Army due to severe injuries from a mortar blast in Iraq. Excuse 

me. I have been a patient but I am also an advocate for other warriors who are struggling with deployment related traumas. For a 

period of about 12 months I did receive excellent mental health 

care at a VA facility. It provided easy, one-stop access through a 

deployment health model staffed by medical, mental health, pharmacy, and social work providers. Unfortunately, though, hospital 

administrators decided that this well-staffed interdisciplinary care 

was too costly. Now veterans at the facility go through an impersonal intake assessment process and then have to find their way 

around a sprawling facility to access the care that they need. For 

many warriors just navigating around the facility is anxiety provoking in itself, and for others it is so frustrating that they just 

drop out of care altogether. 

There is lessons to be learned here. First, veterans with mental 

health issues will seldom open up and discuss painful, private 

issues with a clinician that they have never met. They are more 

likely to discuss surface level issues, like difficulty sleeping. It 

takes time to build the trust to talk about the deeper issues. And 

not every clinician is skilled at winning the trust, or insightful 

enough to sense when there is deeper problems. Working with a 

team increases the likelihood of someone to see something that others may have missed. 

This has implications for suicide prevention as well. Veterans 

will rarely volunteer to clinicians that they are contemplating suicide and there are not necessary obvious signs that a veteran is a 

suicide risk. One thing is for sure, we will not prevent suicides by 

doctors mechanically going down a mandatory list asking questions 

like have you contemplated suicidal thoughts lately, or harming 

others. Sometimes there is red flags that an astute clinician can 

spot, like the break up of a relationship or other major life events 

that could lead a person to take a desperate act. But in a treatment 

system where I get sent to Building 3 for a neurologist for chronic 

back pain, Building 61 to see a psychiatrist for sleep problems, and 

Building 81 to see a social worker for relationship issues, no one 

is getting the full picture. So it is likely that no one is going to see 

if my life is spinning recklessly out of control. 

As an integrated health care system the VA can provide the kind 

of care that I want to receive from an interdisciplinary health 

team. There the team members shared observations and could see 

potential problems before they became explosive. So I think that 

the most important step that the VA can take to prevent suicide 

is to dramatically improve its mental health care delivery. 

Access is certainly an issue but we have to ask ourselves, access 

to what? Access to mental health care is not enough unless that 

care is effective. For example, providers who work with combat vetVerDate Aug 31 2005 14:28 Mar 25, 2015 Jkt 000000 PO 00000 Frm 00014 Fmt 6633 Sfmt 6633 Y:\89378.XXX PAT

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erans need to understand the warrior mentality and they may have 

to work hard to earn that veteran’s trust. If a clinician lacks that 

cultural awareness, or has too many patients to give each enough 

time, veterans will get frustrated and drop out of treatment. 

Also, veterans who are not ready for intense exposure based therapy will drop out of these multi-week treatment programs even 

though they are hailed as evidence-based therapy. The bottom line 

is that the VA care must be veteran centered. That has to mean 

recognizing each veteran’s unique situation and individual treatment preferences and building a flexible system to meet the veteran’s needs and preferences, not the other way around. 

The warriors that I am describing do not come into treatment for 

PTSD or anxiety when the textbooks say that they should. Most do 

not come in to treatment until they have reached a crisis point in 

their lives. Certainly a veteran in distress who finally asks for help 

for a combat incurred mental health condition needs to get into 

treatment immediately. But we will not solve that problem by establishing an arbitrary requirement like a 14-day rule. It does not 

help a warrior who is at the end of his rope to get assessed within 

14 days but not actually begin treatment within three months. This 

is the way that the VA has currently implemented such policies. 

They have added additional steps to get into treatment so that you 

can see someone within 14 days. They have added a second intake 

process so now you intake-to-intake to finally get the treatment 

that you need. 

I know that some believe that the way to solve the veteran problem is to expand veteran access to non-VA care. I really personally 

doubt that that is any kind of silver bullet solution. The two big 

concerns with that is first detailed in my full statement. Many reports and studies point to a national shortage of mental health providers within the community. Secondly there is real quality of care 

issues here. VA could certainly benefit from a greater use of purchased care where and when it is available, and when it can be effective. But it would not help veterans just to be seen by providers 

who are not equipped to provide effective care, whether because of 

lack of training in treating combat related PTSD, or cultural competence, or any other reason. Again, it is not just a matter of access, but access to what? It has to be effective treatment. I do believe that there are VA facilities that are providing veterans with 

timely access to effective patient centered care but it is not systemwide. 

From my perspective the starting point for VA leadership at all 

levels is to adopt the principle that providing timely, mental health 

care for those with service incurred mental health conditions must 

be a top priority. The VA achieved that with its efforts to combat 

veteran homelessness recently. That tells me the VA can have a 

real impact when the direction and priorities are clear. When artificial performance requirements do not create distortions, and when 

clinicians have latitude to provide good care. 

Improving mental health care definitely requires a comprehensive approach. One part of that approach in my view should be to 

institute the kind of interdisciplinary team based model I described 

earlier. But the core of any approach has to center on the veteran 

and that patient’s needs and preferences. We need a system that 


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serves the veteran, not one that requires the veteran to accommodate the system. 

I hope that this hearing brings us a step closer to that kind of 

VA care system. And I thank you for the time, and I would be 

happy to answer any further questions that you may have. 

[THE PREPARED STATEMENT OF JOSH RENSCHLER APPEARS IN THE

APPENDIX] 

The CHAIRMAN. Thank you very much, Sergeant. Thank you, 

again, to all of the witnesses. Sergeant, if I could go back to you 

since you were the most recent person to testify. You talked about 

the interdisciplinary care team that you had for 12 months. And 

then after that you alluded to the fact that the hospital director or 

somebody said that it cost too much to do it that way. I think we 

would all benefit from you elaborating a little bit about how that 

occurred and what did you transfer to? What type of a care? 

Sergeant RENSCHLER. Yes, sir. In 2008 to 2009 the VA rolled out 

I believe four different deployment health care models nationwide. 

The deployment health care model that I speak of was one that 

was rolled out in Washington State for the American Lake VA 

Medical Center and it was put together by Dr. Steve Hunt with the 

VA. And this model provided one wing of a hospital floor in which 

an interdisciplinary care team for deployment health, Post 9/11 veterans exclusively, that had a pharmacist, social workers, psychiatrists, psychologists, and primary care on one team and weekly 

they would meet to discuss the caseload of that team. And the wait 

times were short for care, the quality of care was up, the management of our medications were the best that we had seen within the 

VA. 

However, after 12 months the team began to dissipate. And what 

I was told and have been told since by Dr. Steve Hunt and others 

within the VA is that this was a temporarily funded program and 

it was too costly to provide this level of care to exclusively Post 9/ 

11 veterans within the VA Center when a facility director has to 

provide care for all veterans, to set aside the amount of funding 

that it required to provide this level of care for only one portion of 

that population was not practical. 

The CHAIRMAN. Mr. and Mrs. Somers, I would like for you to 

elaborate if you would just a little bit on the fact that you talked 

about Daniel having innumerable problems with VA staff being 

uncaring, insensitive, and adversarial. Saying literally no one at 

the facility advocated for him. Could you give us any specific examples, or generic examples? 

Mrs. SOMERS. Absolutely. Probably the most—if I do not make it 

through this Howard will finish—probably the most egregious 

event was when Daniel presented to their ER—— 

Dr. SOMERS. It took Daniel a lot to go to the VA facility and some 

of the things that have been mentioned here were part and parcel 

of the fact. I mean, even along the highway in Phoenix there were 

speed traps on the highway. And when the lights flashed, that 

would give him flashbacks. Even if he was not the speeding, if he 

was going by on the highway at the time. So it was very difficult 

for him to drive down to the VA. It is busy. But he presented there 

in crisis. He presented to one of the departments, to the Mental 


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Health Department. He said he needed to be admitted to the hospital. Now this is something that we have been told by his wife, 

who as Jean mentioned has a B.S.N. in Nursing, and his motherin-law who is a psychiatrist. And he told them this on multiple occasions. So he was told that the Mental Health Department, they 

had no beds. And he was told by the same department that there 

were no beds in the Emergency Department. 

So this brings up another few issues. But the fact is that he went 

into the corner, he was, he laid down on the floor, he was crying. 

There was no effort made to see if he could be admitted to another 

facility. There are two major medical centers within a mile and a 

half of the Phoenix VA. The VISN issue is another issue that we 

need to discuss at some point. But he was told that you can stay 

here, and when you feel better you can drive yourself home. That 

is just an example of the lack of advocacy, the lack of compassion 

that we know that not only Daniel has encountered through the VA 

system. We have met other veterans, specifically in Oklahoma City, 

who had very, very similar circumstances at different VAs. 

The CHAIRMAN. Do you know if he ever spoke to any VA official 

about how he was treated? 

Dr. SOMERS. We do not. The other problem, of course, is that 

these visits are never, the appointment system is so antiquated 

that things are not even documented. There is no way to go back 

into the system and to document a contact in the system. So no, 

as far as we are aware, Daniel did not speak to anybody at the VA 

about this. It is just something he would not do. He just would not 

do. It was a feeling of I tried, and this is just another example of 

what the pressures that are brought to bear. We brought not only 

the VHA but the VBA issues into account. And these are just 

things that altogether just became overwhelming. 

Mrs. SOMERS. My believe is that he still had that military mentality. You know, this is what somebody in authority told you. I 

have to accept it. I cannot go above and beyond. I just need to accept what they are telling me. 

The CHAIRMAN. Thank you. Mr. Michaud. 

Mr. MICHAUD. Thank you very much, Mr. Chairman. Once again, 

I want to thank the panel for coming today to talk about your stories and your family. And I really appreciate it. I know it cannot 

be easy. 

So Dr. Somers, my question is can you go into further detail on 

about why you think it is important to encourage every veteran 

suffering with PTS and other combat related mental health issues 

to supply a list of points of contact and get a HIPAA waiver? 

Dr. SOMERS. Interesting that you say HIPAA. Because once 

somebody says HIPAA that sort of stops the conversation. We have 

been trying to deal with this issue because it takes a village, a 

large village, to not only treat but to recognize and to approach our 

veterans who might be in crisis. We feel it is critically important 

to expand what we call the support network. And actually at this 

point a HIPAA change would be wonderful. We really, we ran a 

medical practice and Jean can tell you that what we have come to 

learn is what HIPAA really says is not what, is not how, well is 

not how it is practiced. People are afraid of HIPAA. So they take 

the regulation that is actually there and they take it to the nth deVerDate Aug 31 2005 14:28 Mar 25, 2015 Jkt 000000 PO 00000 Frm 00017 Fmt 6633 Sfmt 6633 Y:\89378.XXX PAT

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gree. And really you do have some options under HIPAA, especially 

if you feel that somebody is a threat to himself or to his family or 

to the community where you can reach out to family members or 

a caregiver in a situation like that. 

But we feel it is absolutely critical to identify prior to deployment, certainly during deployment, and after deployment what we 

call the support network so that these people can be educated as 

to what experiences their loved one, or maybe it is not even a loved 

one. Maybe it is a high school football coach, or maybe it is your, 

you know, math teacher, or maybe it is your best friend from the 

second grade. But so these people can be educated as to what the 

experiences might have been, what the signs and symptoms of crisis might be, and educated to the fact that you do not take no for 

an answer. And if you see that somebody is in trouble that you can 

direct them to the proper treatment, to the proper authority, to the 

proper medical facility. And that is not actually something that you 

have to worry about with HIPAA. So that is one way that we feel 

that HIPAA does not even come into the equation. 

HIPAA would come into the equation when you are in treatment. 

And we really feel that if you are treatment and there is an issue, 

then the therapist should certainly take the opportunity to contact 

the closest people to the patient. 

Mr. MICHAUD. Thank you. My second question related to HIPAA, 

because actually I heard a case where even though it is the Department, the Veterans Administration, where VHA employees could 

not talk to VBA employees and they used the excuse of HIPAA. 

Have you heard that, have you had that problem with your son? 

Dr. SOMERS. Well we have not heard that that was a HIPAA 

issue. We just felt that it was a total communication break down 

issue, the fact that the computer systems were not compatible 

within the VA system itself. And the fact that as far as we know 

Phoenix still uses a postcard system for appointments. And nobody 

could document the fact that postcards were even sent. And we 

know for a fact that after Daniel died, and the suicide prevention 

coordinator contacted his widow, and they were talking, and they 

were going to send her some information as to what kind of counseling facilities were available for her, and she asked where are 

you going to send it? They in their system had an address that was 

four years old. And he had been involved with the VBA and with 

the VHA over that entire period of time. 

Mr. MICHAUD. Thank you. I guess my time is quickly running 

out. For Mr. and Mrs. Selke, how long had Clay been taking medication for his PTS and how long was he denied medication through 

the VA? 

Mrs. SELKE. He began taking medication in 2007 when he was 

back at Twenty nine Palms recuperating from the gunshot wound 

in Iraq. My understanding is that he, again, received medication 

that he needed when he was active duty. His care seemed to be 

good and he felt comfortable with it. When he transitioned to VA 

care he was never denied medication. What happened when he 

moved to Houston he was told that they could not refill his prescription that had, that followed him from the L.A. VA and he had 

been in Grand Junction, Colorado for a short time. He basically 

was having to start over as a new patient. And I had this reinVerDate Aug 31 2005 14:28 Mar 25, 2015 Jkt 000000 PO 00000 Frm 00018 Fmt 6633 Sfmt 6633 Y:\89378.XXX PAT

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forced yesterday in a meeting, that it was, that was one of his 

major frustrations and that I have heard from fellow veterans of 

his. That when they go to another facility they have to go back 

through everything. All the, you know, just recounting everything. 

And it, that seems ridiculous to have to have that type of redundant system. 

When he was told in Houston that they could not refill his prescription, he was told you need to call the VA that prescribed it, 

wrote the prescription earlier, and see if they will refill it for you. 

He was leaving the country. He was going to Haiti for a couple of 

weeks and he needed to have enough medication while he was 

gone. And Clay was proactive enough and was able to do that. He 

just was determined, and he said okay, and he took care of it. And 

he did get it from the Grand Junction VA. When he came back 

from Haiti and went to his appointment in February, that was with 

a psychologist, a clinical psychologist. And my understanding was 

he was never, he was not given a new prescription until he saw the 

psychiatrist on March 15th. So his first appointment was January 

6th, second appointment February 10th or 11th, finally March 

15th, sees a psychiatrist. 

Also part of that issue was when he was active duty Lexapro was 

finally found to be the drug that worked best for him. Name brand 

drug, no generic. But they, he had been on Paxil, he had been on 

Zoloft, he had been on just a variety of drugs. Lexapro seemed to 

work the best with the least side effects. When he came out of active duty and into the VA system, apparently generic drugs are the 

drugs of choice and he was given. I believe it is the generic for 

Celexa, which is close but it is not the same thing. At that time 

there was not a generic for Lexapro. When he arrived at the Houston VA and asked for a refill, and also somewhere in those first 

couple of appointments he said that he would like to go back on 

Lexapro as that worked better for him with less side effects, when 

he met with the psychiatrist he said, okay, I understand from your 

background that that has worked before. And he did give him a 

prescription for Lexapro. 

So Clay leaves on March 15th the psychiatrist’s office, goes 

downstairs to the pharmacy at the VA to fill his prescriptions. He 

spent two hours in the pharmacy. He was called up to the pharmacy desk to pick up his prescriptions and given the Ambien for 

sleep. I have more on that that I want to share with you. And then 

given, told that they cannot give him Lexapro, they do not stock 

it because it is not a generic, that it will have to be mailed to him. 

So it was mailed to him sometime within the next week, I think 

they told him a week to ten days that he would get this. 

A couple of issues there. If you know about anti-depressant, antianxiety medications, you cannot stop them cold. You cannot wait 

for it to come in the mail and then expect that it is going to work 

quickly. It takes a while for these to work. They have to stay built 

up in your system. He was extremely frustrated. He called me, as 

I said in my testimony, on the way home and said, ‘‘I just, I cannot 

go back there.’’ 

The doctor at the Houston VA, I have spoken with him several 

times since Clay’s death. He has been very forthcoming. I appreciate very much the information that he has given me. Something 


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in our last conversation, which was just a couple of weeks ago that 

I had not heard before, I had been concerned about Ambien. There 

have been just a lot of conversations among parents and spouses 

and family members of veterans who have died of suicide and they 

have been on Ambien for sleep problems. Whether there is a connection or not, I do not know. But it is a high number that are 

given that when they have sleep problems. And sleep problems are 

a common, huge problem with Post Traumatic Stress. The doctor 

the other day in talking about specifically Ambien and sleep medications, he said, well actually Ambien would not be the best drug 

for the type of sleep problems, and I believe the term is 

hyperarousal but I am not 100 percent sure on that, for the type 

of sleep problems that come from Post Traumatic Stress. The nightmares, and flashbacks, and that sort of thing. There is another 

drug, it starts with a P. I do not have it with me. It is like—— 

Sergeant Renschler Prazosin. 

Mrs. SELKE. Prazosin. And he said that really is the drug that 

actually works best for that type of sleep difficulty. And I was so 

stunned that I could not ask the question, well why did you not 

prescribe that drug for him as opposed to Ambien that he had been 

given over and over different times before? So that haunts, that 

has been something that has haunted us for three years. 

Because in that two-week window, something went wrong. Clay 

had moved back home. He had just returned from Haiti doing volunteer work, which gave him great, just great hope. That was great 

therapy for him. He had started a job. He had bought a truck. The 

Friday before he had called and asked me to meet him and he 

bought a truck for work. And by Thursday the next week, he was 

dead. We were with him over the weekend on that Saturday. The 

whole family at various points during the day saw him. He had 

lunch with his dad. We went to a movie, Richard and I went to a 

movie with him that evening. I could, I just, I just could not believe 

it, that within five days he was dead. 

So we know he suffered Post Traumatic Stress, we know he was 

treated for it. He was very open about it, sought help. And that, 

that two-week window is just a mystery that haunts us. And we 

have done everything we can to try to find out answers. So—— 

The CHAIRMAN. Thank you. Mr. Lamborn for five minutes. 

Mr. LAMBORN. I want to thank you all for being here. You have 

given so much. And I thank you, I know the committee thanks you, 

and I know our country thanks you. 

I would like to ask about the role of families in treatment and 

therapy. I have a constituent who came to me and her husband 

was stationed with the 10th Special Forces at Fort Carson, Colorado, where I represent. And he took his life. And she is an advocate for a program that has a holistic approach involving families, 

whether it is parents or spouses. And I would like to ask any one 

of you who has insight as to whether there should be more of a role 

for families in the treatment programs that are offered through the 

VA? Or is there a lack there? 

Mrs. SOMERS. We certainly during the time that Daniel was with 

the VA, certainly feel that there was a lack. And again, we feel it 

has a lot to do with fear of repercussions under the HIPAA law and 

also a total misunderstanding of what the law currently is. And I 


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would like to take your point further and say it should not just be 

family. I think we would all like to say we did not have dysfunctional families, but we know that there are dysfunctional families 

out there and that is why we started using the term support network. A lot of young men and women undoubtedly joined the service to get away from families, but it does not mean that they do 

not have a support network. So we would kind of like to get away 

from the whole blood, kinship viewpoint and say it is a support network. 

I think it goes without saying, I recently read a report by National Association of Mental Illness. There is no question that family involvement is beneficial. There is just no question. It becomes 

more of an issue I believe, and it is why Howard and I have actually been trying to work with the DoD to get them to identify a 

support network. Because certainly in Daniel’s case, Daniel was a 

geek. But he was at his absolute healthiest, mentally and physically, after he joined the Army. And he went through basic training, he was in great shape. If they could have identified right then, 

and said, Daniel, give us a support network for you. Who would 

you write down? You know, I mean, he had really, really good 

friends. We hope we would have been on it. Certainly his wife 

would have been on it. His mother-in-law probably would have 

been on it, his brother-in-law. It would have been so helpful to 

have that list then. Because when he got back home he was not 

capable of that anymore. I like to say, you know, not from a legal 

standpoint, but he had diminished capacity. He was not making 

correct decisions. 

Mr. LAMBORN. Okay, okay. Anyone else? Mr. Selke. 

Mr. SELKE. Thank you. Our experience, like most, probably a lot 

of families is, we did not know what PTS was. We had no idea. 

Clay was again very open about it, told us that he had been diagnosed with it, told us that he was on medication, seeking counseling. But we did not know the ramifications of that. And like 

most of our warriors, they are strong. And so he was, you know, 

put on a real good act. Had we known the extent of even what he 

talked to his counselors about, the idea that the Somers have 

broached about regardless of the HIPAA legalities of that, for if in 

fact somebody has that conversation with their, that counselor, 

somebody outside of that counselor and the patient needs to know. 

The patient could identify somebody who would then be able to be 

aware of what is going on and to say, you know, this person needs 

help. 

Clay, looking back, there was all kinds of things going on in his 

life that were just red flags. And we did not know. And there is 

a lot of literature out there, there is a lot of information. I believe 

that any family who has an individual involved in the military 

after they come back, or really kind of anytime, they should probably just assume that there may be some sort of PTS involved 

there. 

The suicide deal, Clay actually had a conversation with Susan. 

And said, ‘‘Hey Mom, you know, I thought about it but I would 

never do that to you all.’’ You know, he actually addressed the 

issue and then lied about it, you know, to us. So the family plays 

a huge part in really being advocates for the individual and being 


VACREP180 with DISTILLER
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able to just watch, and watch for signs, and then maybe be able 

to do something about it. 

Mr. LAMBORN. Well in conclusion I would just have to say the VA 

needs to learn best practices and have programs available that include families everywhere. 

Mrs. SELKE. If I could add something to that? Going back 

through Clay’s medical records, for whatever reason when he died 

I immediately wanted his medical records. I just wanted to read everything I could and try to grasp what was going on. He had apparently as early as November or December of 2009 spoken to someone in the VA in the L.A. VA about suicidal ideation, suicidal 

thoughts. That is on one of his reports at the end of 2009. He had 

separated from the Marines at the end of April, 2009. I knew nothing of that. We did not learn until the Fall of 2010 when he told 

us. He said, ‘‘I have struggled with this thought, but I could never 

do that to you all. I just cannot.’’ And I do not think, I think in 

his mind he believed, ‘‘I am thinking these thoughts but I could 

never do that.’’ As far as we know there were two times during the 

Fall of 2010 that he did have enough serious suicidal thoughts that 

he did reach out. One time he called and talked with me. Another 

time he spoke with a close friend. And then after that second time 

he shared with me, you know, that, or with all of us. 

So we knew, in 2010 at the end of the year we knew that he had 

struggled with suicidal thoughts and we also knew that he was on 

medication and were assuming that with Post Traumatic Stress 

and suicidal thoughts and that the VA knew best how to take care 

of him. I begged him, ‘‘Please, let us go to private care. We will pay 

for it. We know great psychiatrists, counselors in Houston. Let us 

do that.’’ He would not do that. He was adamant. He said, ‘‘I have 

served in the Marine Corps for four years. My medical care is to 

come from the VA. They owe that to me. I do not want to go to 

private care. I want to talk to someone who has either been in War 

or knows about War and Post Traumatic Stress and the things that 

I have seen and done in War. I do not want to go to private care.’’ 

And that was just his personal feeling. We have heard that from 

other veterans as well. That is, as difficult as the system is, that 

is their comfort zone and they need to be, feel that they can be 

taken care of. 

Mr. LAMBORN. Thank you so much. Thank you. My hearts go out 

to you. 

The CHAIRMAN. Mr. Takano, you are recognized for five minutes. 

Mr. TAKANO. Thank you, Mr. Chairman. It is very difficult to listen to your stories and I am very touched by them. So I definitely 

want to thank all of the families for being here today. 

So let me ask this, Ms. Selke, I believe a lot of veterans have 

that same feeling. And therefore I do believe that we have to, it is 

incumbent upon us to make sure that we get it right at every facility. Because veterans are expecting that. They do not want to see 

this be a burden to their families financially. I am very much open 

to making it easier for non-VA care to be available and with that 

I wanted to ask Dr. Somers, you are also a medical doctor, Dr. 

Somers.? 

Dr. SOMERS. I am a urologist. 


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Mr. TAKANO. Okay. Can you, can you tell me about the state— 

you are from the Phoenix area? 

Dr.SOMERS. Actually, I practiced in Phoenix. We currently live in 

San Diego. 

Mr. TAKANO. Oh, in San Diego. I am from Riverside, which is 

north of San Diego, as you know. I went to visit my own VA in 

Loma Linda. They are able to get veterans to see a family practitioner in 24 hours if need be. I am not so sure about mental health 

care or a psychiatrist. They indicated to me there is a shortage of 

psychiatrists. And I recently visited a new Kaiser facility and the 

director of that Kaiser facility told me that, I asked him if there 

was a, what shortages he was experiencing, and he identified behavioral health and psychiatry. Can you tell me if there is, if there 

are general shortages in your area of these kinds of practitioners? 

Dr. SOMERS. There is a shortage of mental health professionals 

nationwide. And there are many issues that go into it. Certainly reimbursement is one. We know one of the people that Daniel has 

been seeing because, and this is another issue of continuity of care, 

he was forced to go outside the VA system just because he could 

not be seen in Phoenix. There was just no availability, no mental 

health available. And I think you have to divide psychiatry and 

psychology. And I think with these people who are suffering from 

PTSD, it is the psychologists and the psychiatric social workers 

who are providing most of the care as opposed to the psychiatrists 

themselves. But psychiatry and psychology are incredibly important and what happens is if we try to recruit into the VA then the 

community is losing that mental health component. And it is a 

huge issue. It is an issue that has to be addressed by our medical 

schools, by society in general. But it is not just an issue here and 

there. 

Mr. TAKANO. Well here is the thing. Dina Titus and I, Representative Titus and I, and O’Rourke have offered a bill that would increase the number of residencies at VA hospitals. And of course I 

expect a number of those residents, if we approve it, a number of 

those residents would stay—— 

Dr. SOMERS. Right. 

Mr. TAKANO [continuing]. And practice at the VA, but also some 

of them would go into the community as well. 

Dr. SOMERS. Right. 

Mr. TAKANO. You know, my thing is if, even if we do approve 

non-VA, make it more easy, easier for—— 

Dr. SOMERS. Right. 

Mr. TAKANO [continuing]. Vets to use that areas like mine, they 

are still going to have trouble finding that care, you know, in the 

community. 

Dr. SOMERS. They will. And they are going to have trouble, even 

if you have people in the community you are going to have trouble 

finding people in the community who are aware of military culture, 

and who are aware of the issues that veterans face. And again, 

that just brings up another whole issue, a whole other series of 

issues. 

Mr. TAKANO. Well, I wish I had more time. Maybe I could get 

your information to my staff. 

Dr. SOMERS. Absolutely. 


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Mr. TAKANO. Because I am trying to understand also your criticisms of the Vista medical records. There is also an issue of the 

interoperability with the VA and non-VA practitioners, right? 

So—— 

Dr. SOMERS. Right. And then that is something that we address 

also, especially if we are going to be trying to, with the PC3 program, and with the other issues that are being promulgated now, 

there has to be communication between the VA and the providers 

who are seeing the veterans who are being referred out. So huge, 

huge—— 

Mr. TAKANO. Huge issues. 

Dr. SOMERS. [continuing]. Issues that have to be addressed. 

Mr. TAKANO. Sergeant, I think I understand your point of view 

as well about your doubts about, you know, radically restructuring 

it. We have got to try to get it right in the VA facilities because 

of that expectation that the Selkes’ son had, you know, that was 

their comfort zone. So we have got to, I think, do both things at 

once. Make sure that every VA center has, you know, excellent 

mental health care as well as try to provide some options. 

Sergeant RENSCHLER. Yes, sir. My concern with a bill that just 

increases the number of practitioners at a hospital, we are not solving the issue with effectiveness of care. So it really has to be a systematic approach to solve the efficacy of what care is being provided as well as the numbers to accommodate the sheer overwhelming amount of veterans that are trying to access that already 

broken system. So I just wanted to add that, sir. 

Mr. TAKANO Thank you. Mr. Chairman? 

The CHAIRMAN. Dr. Roe, you are recognized for five minutes. 

Dr. ROE. Thank you, Mr. Chairman. And I think as a father of 

three and a veteran I appreciate your courage to come here today 

and speak. It is really heartwarming. And I know that it is very 

difficult for you to do, and it has been difficult to sit and listen to 

the testimony. There are a good number of veterans sitting up 

here. I am a veteran of the Vietnam era. And I just want to thank 

you for that, and being here. And I can tell you this past weekend 

I returned to something very joyous for me. It was a reunion of a 

bunch of young boys growing up in the sixties who were all Eagle 

Scouts. And all but one was there that, of our friends, and he did 

not make it out of Vietnam. So I can tell you that this loss that 

you have, that you are sharing with us, is very, very helpful. But 

that loss will go with you, as it does for my friend of almost 50 

years. So thank you for your courage to be here. I know it is very 

difficult. 

And Sergeant Renschler, I think you bring up a great point, all 

of you have today, in the coordinated effort that you brought forward. That team approach I think was very good and I certainly 

do understand what the VA was saying was that if this works for 

the OEF veterans, it should work for all veterans. And the majority 

of the suicides that are occurring are veterans of my age. So I think 

that this needs to be expanded if that method that you put forward, it looked like it worked extremely well, should be looked at. 

Dr. and Mrs. SOMERS. bring up an incredible point. I know Dr. 

Somers you probably dealt with some, as I did, some primary care 

in your practice when you were a urologist. You do not just get to 


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be a urologist. Your patients get to know you. And they share a lot 

of things with you. And dealing with this is very complicated. As 

you all point out, and Ms. Selke so eloquently pointed out, is that 

this approach of caring for people with PTS or chronic mental illness is extremely difficult. Dr. Somers and I can go into the operating room and remove a tumor. That is easy. This is much more 

difficult to do. And those signs and symptoms are very difficult to 

spot. Because Ms. Selke, you saw your son when he was actually, 

you thought, doing very well that week before he passed. And I 

think as a doctor that has been one of the things that troubled me 

all of my career, was trying to figure out when you would have a 

patient that would take their life was why did this happen? And 

many times that week or two before things seemed to be going 

well. You thought things were getting better. 

I think, Dr. Somers, you and your wife brought up something I 

think that is extremely important, that a good friend is probably 

as important as a good doctor. A good person to lean on. And I 

think you have to do what Sergeant Renschler was talking about, 

to have this very sophisticated team together for people in need. 

But you also just need someone. It may not be a family member, 

like you pointed out, it could be a coach, or a pastor, or whomever 

it might be in your life. It could be a family member. And I think 

putting all that together is a real challenge. And I know we will 

hear later from the VA about what they plan to do. But any further 

thoughts along that line would be helpful. If anybody would like to 

share just some of your thoughts about what we could do. 

Ms. PORTWINE. I think it is important for the transition program. 

I know that before Brian went to Iraq, the first tour, he went to 

California where they have a base where they teach them, like they 

make it like a Iraqi town. So they learn how to control crowds, take 

buildings, and all that. But when they come back, it is just boom, 

you are there for a week and then you are out in the community. 

There is no transition. Why cannot they use those centers that they 

use to send them where they could have psychiatrists, psychologists, and look at them, give them assignments, see if anybody has 

poor concentration, poor memory. You know, and use these resources that we have. You know say, okay, now you need to go do 

laundry, give them a list of things to do. See if they are able to do 

that and observe them. We cannot just take them like cattle and 

put them through a bunch of questions and then let them go in the 

community where they do not have their brothers to confide in. 

When they come back they have put their life on the line to trust 

these other brothers. They would die for them. They come home, 

they do not have anybody they are going to trust that much. And 

nobody that has not been in war is going to understand so they do 

not open up. The most people they open up to is their brothers. 

Michigan has a program called Buddy to Buddy that they put together one veteran, you know, that has been home with the veteran so that if they have any problems they are going to open up 

to that person much more than they are a therapist. Or have group 

therapy. Let the veterans talk among themselves. They could, you 

know, have a group of eight, ten veterans and then have group 

therapy. And maybe they could confide in each other. Because it is 

going to take a while to build up trust with a therapist, if you do. 


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Dr. ROE. I totally agree. Thank you very much for your courage 

in being here today. Mr. Chairman, I yield back. 

The CHAIRMAN. Ms. Brownley, you are recognized. I apologize. 

Ms. Kirkpatrick, you are recognized for five minutes. 

Ms. KIRKPATRICK. Thank you, Mr. Chairman. I want to thank all 

of your for your courage in being here today. And I appreciate what 

you said about once a diagnosis is made and medication is prescribed, staying on that medication. And I really want to know how 

often our veterans have to refill those prescriptions. And I would 

just like to hear from each of you what you have learned about that 

experience. Are they given a 30-day supply? They have to go constantly back? Sergeant, can we start with you? And then we will 

just work our way down the panel. 

Sergeant RENSCHLER. Yes, ma’am. So at our facility in Washington State, medications are given on a 30-day supply. There is 

an option for mail refills. The system is pretty confusing and I normally mess it up pretty well so my wife has to manage that for me 

for the most part. You have to be able to put in a request three 

weeks before you need it and I usually forget until I am about to 

run out. And so then I am off my meds for a long period of time, 

which is never good. 

As far as the other medication issues that have been discussed, 

continuity of medications from one facility to the next, I am in the 

southern part of Washington State. And people who are coming up 

from Portland, Oregon, which is about an hour away, are on medications that are not transferrable to the VA facility where I am at. 

And so they have to start all over as a guinea pig, as what was 

discussed earlier, trying medications that they may have already 

tried in the past to get to the point where they are able to approve 

a non-formulary medication that they had at another facility, as 

well as the transition from DoD to VA care. It took about four 

years for the DoD to balance about nine medications for myself. 

And when we transitioned to VA care many of those medications 

were not on the formulary and we had to go back to the guinea pig 

phase again, and we ended up on 14 in order to utilize medications 

available through the VA. So it is, there are many issues as we are 

talking about that. 

Ms. KIRKPATRICK. That is just unbelievable. Any other families 

want to—— 

Ms. PORTWINE. Brian was never put on any medication. They diagnosed that he had depression, Traumatic Brain Injury, PTS, but 

he was never put on any medication. He was put on medication for 

his back when he was thrown from the Humvee, Naprosyn, and a 

muscle relaxer, and that was just temporary. But they never even 

prescribed, screaming out three times a week with nightmares and 

having your brothers wake you up, and then telling the therapist 

how embarrassing that was, I think you need to be on some medication. 

Ms. KIRKPATRICK. Agreed. 

Mr. SELKE. These medications are so subtle and they are so particular to the individual, it is just mind boggling that there is not 

an easy way to identify and work with the individual vet to determine exactly what the cocktail, if you will, looks like, and then be 

able to without, you know, to just seamlessly transfer that to wherVerDate Aug 31 2005 14:28 Mar 25, 2015 Jkt 000000 PO 00000 Frm 00026 Fmt 6633 Sfmt 6633 Y:\89378.XXX PAT

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ever that vet is. These people are young and they are on the move. 

And you know, they are all over the place. 

Ms. KIRKPATRICK. Right. 

Mr. SELKE. And so that, those barriers just need to be taken 

down. 

Ms. KIRKPATRICK. Dr. and Mrs. Somers? 

Dr. SOMERS. Yes, thank you. And thank you, Representative 

Kirkpatrick, for being such a support and a help for us. There is 

multiple issues that have to do with the medications. Just the fact 

that the formularies are not the same is a huge issue. And it just 

does not affect veterans at the VA system. There are veterans who 

are retired from the military who see physicians both at the VA 

and the DoD. So they are seeing people at both different medical 

centers and they cannot be on similar medications from one to the 

other because the formularies are not the same. 

The problem is that not only does the VA use 99 percent 

generics, but they use the cheapest generics. So Daniel, who had 

not only PTSD and TBI, but full blown Gulf War Syndrome, which 

included irritable bowel, had only certain medications that he could 

tolerate. So maybe the chemical in the medication is the same, but 

the bonding agent is different. Maybe he is on a medication that 

he only has to take once or twice a day, but the VA gets a better 

price, so now he has to take it three or four times a day. And the 

change in the medication changes everything. So I mean the issues, 

the issues are just huge. It is not only that, and the other thing 

that we have heard, and from unimpeachable sources, is that VAs 

vary, as we heard, with their pharmacy policies. There are some 

VAs where you can go and you can get a brand name medication 

with no problem. Other VAs that essentially it is possible to get a 

brand name medication. So, I mean, that just brings up this huge 

issue that we have, is why there is so much variation in the entire 

system, why we cannot have more uniformity within the VA system as a whole. 

Ms. KIRKPATRICK. Thank you, Dr. Somers. My time is up. And 

thank you. 

Dr. SOMERS. Sorry. 

Ms. KIRKPATRICK. But let me just conclude by saying your testimony is heartbreaking and I can barely hold back my tears, and 

I thank you for being here. I yield back. 

The CHAIRMAN. Thank you. Mr. Runyan, you are recognized for 

five minutes. 

Mr. RUNYAN. Thank you, Chairman. And thank all of you for 

sharing your stories and truly being great Americans and great patriots because your stories are going to help people in the future. 

And thank you for all that. 

A couple of points, and I think Dr. Somers was just talking about 

it. And I think we see it all day. And we talked about this in the 

hearing the other night. It almost seems like the VA is so fragmented that there is no overwhelming mission from the top with 

flexibility below. That is, and I think we are admitting there is a 

structural breakdown in how you are actually going to conduct 

business. And that is really where we are at, whether you are talking VHA or VBA. It is the same issue. And we have yet to hear, 


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I think next week we are digging into some of the VBA issues, also. 

It is a culture. 

And one other point and then I will ask one question. And I 

know Mrs. Somers was talking about it, and Dr. Roe also validated 

it. When you talk about community and you talk about support 

networks, these men and women are spending more time away 

from the health care facility than they are in the health care facility. So friends, family members, you know, classmates, buddies all 

have to be part of the healing process. We are not doing that. And 

I know the term holistic has come up a few times. I think Sergeant 

mentioned it a couple of times. It is part of the healing process. 

There is no silver bullet to cure somebody. You have got to be able 

to help them in many different ways. 

That being said, in the VA’s testimony they mention suicide prevention coordinators are supposedly placed at all VA medical centers and the large clinics. They are supposed to follow up with veterans that are at high risk. Were any of your sons ever contacted 

in that first month after they were designated high risk by a VA 

suicide prevention coordinator? 

Mrs. SOMERS. We are not aware of that. I mean, the fact that 

they did not even know where he lived would bear proof of that. 

Dr. SOMERS. And that is one of the issues that we are dealing 

with also, and that goes into the whole support network issue. Is 

that, and we have spoken to so many, so many families in the same 

situation, is that Daniel was married. And that basically shut us 

out of the equation. And that is where if we had the opportunity, 

if we could do some changes in this misinterpreted HIPAA regulation where we could have been more in touch with his therapist 

and they would have felt free to talk to us, where we feel that we 

could have been more help. But since he was married it was as if 

we did not exist. 

Ms. PORTWINE. I think that is an important point is like when 

Brian was injured in the tank explosion, I was notified. You know, 

it was three in the morning and they called me from Fort Hood 

saying that he was injured, where they had taken him, you know, 

he is back with his unit, you know. But yet you diagnose somebody 

with PTSD and TBI, which are, can be life threatening injuries, 

and nobody notifies you. I mean, that just does not make sense to 

me. 

Mr. RUNYAN. Anyone else? 

Mrs. SELKE. Your point or question of being flagged as a high 

risk, this is something that came up that really baffled us, I guess. 

When Clay was transitioning or moving to Houston and starting to 

go the VA in Houston, his records apparently from what I was told, 

those records were not seamlessly electronically sent. They did not 

have his records from L.A., and that is where the bulk of his time 

was once he had gotten out of the Marines. So as I looked back 

through those medical records, as I said there were at least two or 

three times in there that it is talked about, and he talks and admits to having had suicidal thoughts. So I assume that he was 

flagged, would have been flagged, as a high risk. I mean, it says 

on the medical record high risk highlighted. When he comes to 

Houston VA, nobody knows he is a high risk. The psychiatrist did 

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tory has been and this is the medication I have been on. So that 

is a great point as to when are they flagged as a high risk? Do any 

family members know that? The only way I ever knew that anybody called him a high risk was when I got his medical records and 

poured over them after he had died. 

Mr. RUNYAN. Thank you. Chairman, I yield back. 

The CHAIRMAN. Ms. Brownley, you are recognized for five minutes. 

Ms. BROWNLEY. Thank you, Mr. Chairman. And I want to join 

my colleagues in thanking all of you for being here and sharing 

your stories and certainly through your stories about your sons, it 

certainly to me I feel their patriotism through your stories, and 

their overall most sincerest commitment and service to our country. 

So thank you for being here. 

I wanted to ask Sergeant Renschler a question. And so in your 

service when you were in theater, was there any support system 

in place for you to go to get any kind of, you know, mental health 

support while you were there? Hearing Brian’s story, it was very 

gut wrenching to hear it. And, you know, just to wonder if Brian 

had a place to go to while he was in theater, how helpful that 

might have been in terms of his time there and his transition coming home? 

Sergeant RENSCHLER. Ma’am, thank you. When I deployed was 

2003. It was right after the initial surge. It was a completely different war theater. We really did not have anything set and established at that time. So to answer the question, no there was not 

anything. However, again, I work with many, many veterans currently and active duty members. And I have been told in recent deployments in Afghanistan that after major events take place there 

is sometimes availability to have a type of a crisis debrief. It is 

somewhat available. It is not streamlined, it is not across the 

board, but it has been implemented on some level. 

Dr. SOMERS. If I may? The problem is that we know that there 

is an effort in the DoD to destigmatize mental health issues. But 

if you are in theater, I would venture to guess that it is going to 

be incredibly rare for somebody to take advantage of that, because 

all of a sudden they are going to be taken off duty. And the whole 

idea to destigmatize it is to say, okay, you come in for treatment, 

but then once you are better then you will be able to rejoin your 

unit or you will be able to regain your security clearance. But while 

you are under treatment you are not with your unit and you have 

lost your security clearance. So I mean, the issue is a huge issue. 

And we know from people that we have spoken to that the people 

at the top are aware of this and they are trying to deal with it. But 

there is just so much you can do on a boots on the ground level. 

Sergeant RENSCHLER. Well, if I may? So there is two separate 

levels here. There is a crisis response, much like a CISM team that 

can go out and basically say, hey, this is what happened, these are 

the normal reactions to this type of a situation, if you experience 

this find somebody to talk to. So more of an education, immediate 

response. And that effort has been available. As he stated, most 

military servicemembers and veterans, as I stated earlier in my 

testimony, are not going to go and say, gee, that was a horrible experience, I think I should talk to somebody before I have issues. 


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They are going to wait until it becomes a crisis point in their life 

and debilitating in nature before they seek treatment. 

Ms. BROWNLEY. I just feel like if it was part of the culture being 

in theater that there is kind of constant dialogue that is going on. 

That that would have to be helpful to the men and women who are 

there. But—— 

Ms. PORTWINE. Brian did tell me one time when they were on the 

15-month tour there was one time that they lost four people in one 

mission. And when he was out there the morale was very low after 

that, because these were people that were high up, First Sergeants, 

and the Lieutenant and that. So they sent someone in and when 

the soldiers would go in and talk with them, he asked the same 

question. Well, was it sort of like a movie? And that just insulted 

them almost. As just like, why would you ask such a silly question? 

So they all shut down. And I think by not processing those 

thoughts then you are going to internalize them so they are never 

dealt with. I think even before they are in theater, I think in basic 

training, they should be taught PTSD and while they are deployed, 

and to report on each other for their own good, and in transitioning 

home. I do not think we can say it enough. That is my opinion on 

it. 

Ms. BROWNLEY. Yes, thank you, thank you. I think it just confirms that, you know, we prepare our men and women to go and 

serve, and to go to War. We do not prepare them very well to transition back. 

Dr. Somers, you talked about HIPAA and the barriers to HIPAA, 

and we have talked about the family involvement piece. You mentioned also modern technology—am I . . .? I yield back. I apologize. 

The CHAIRMAN. Thank you very much. Dr. Huelskamp, you are 

recognized for five minutes. 

Dr. HUELSKAMP. Thank you, Mr. Chairman. I just want to say 

thanks to the moms and dads and the Sergeant for your riveting 

testimony. I look forward to asking the VA some follow-up questions, and I yield back, Mr. Chairman. 

The CHAIRMAN. Thank you very much. Ms. Kuster, you are recognized for five minutes. 

Ms. KUSTER. Thank you, Mr. Chairman. And thank you to all the 

families for being with us today. I think for many of us sitting here 

today the pain is to recognize your commitment to give meaning to 

your sons’ lives. I am a mother of two sons, 22 and 25. I cannot 

fathom what you are going through. But I want you to know that 

we will do our part to give meaning to their lives. And it just 

makes me feel that personally I am becoming more and more antiwar, pro-veteran. And I think our country has had those priorities 

misplaced, getting us into conflict but not being focused on the cost, 

society costs to our country and to the population. These extraordinary young men and the promise that they held, going to Haiti, 

and making a difference right here. 

So I am going to focus in, because I think from your experience 

you can really help the VA and the DoD to understand what could 

make a difference, and I want to commend you all for the specificity of your recommendations. But in particular I have been trying to understand best practices and whether there is any effort 

within the VA where there are practices that are known, ground 


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therapy for example, or the types of medications that are helpful. 

Have any of you in any of your discussions, whether within the VA 

or since then, the experience that you have had meeting with people, have any of you come across any effort to share best practices 

with the transition, particularly around PTS and TBI, and just the 

trauma. How we can help people coming back from this level of 

trauma. And I do not know, maybe we could start with the Sergeant. If you are aware of any types of programs that are effective? 

Sergeant RENSCHLER. Thank you, ma’am. There are great things 

that are effective. But the problem is—even though we can group 

veterans together in a large sum, and combat veterans, and another category, it is hard to label one program as effective for all. 

So many find group therapy programming very successful. Many 

find combat veteran support groups very helpful. Some find one-onone peer mentoring very effective and helpful. This is why when we 

are talking about evidence-based therapies, best practices of the 

VA, pushing CBT, CPT, these things can be deemed as best practices. But many veterans are not ready to go through such intensive therapy. They would rather pace themselves. And so while it 

can be very effective at squashing the problem, I cannot really say 

that there is one thing that is straight across the board going to 

work for everybody. And that is why I stress the importance of a 

team that works together to bring together what is best for each 

individual veteran in a veteran centered care rather than a systematic care that the veteran has to adhere to. 

Ms. KUSTER. So you are looking at a more individualized approach, but a team approach. And I think, Ms. Portwine, you mentioned that others on the team may see something in the care. 

Sergeant RENSCHLER. Yes, ma’am. 

Ms. KUSTER. I also want to visit this issue of HIPAA. Because 

I am an attorney. I have worked 25 years in health care. There is 

definitely a waiver process. And this happens in private sector 

medicine. Do you, are any of you aware of, and through your review of the records after the fact, or have any of you experienced 

the VA asking the patient at any point in their service for a waiver 

to identify people that they would be willing to have their medical 

records shared with? 

Mrs. SOMERS. I know we had specific—Daniel ended up going 

outside the VA because his psychiatrist retired and they said we 

do not have anybody for you to see. And at the time he was having 

suicidal ideation so his mother-in-law, who is a private sector psychiatrist, referred him to somebody that she knew in the community. As he was seeing that person we actually asked him can we 

be a part of what is happening, he said he would ask her, but my 

guess is that he never asked her. And we never got the feedback. 

It was just embarrassing, is probably the closest word we could 

come to for him to have to share that information. 

Ms. KUSTER. Sure, I understand. 

Mrs. SELKE. I can speak to that a little bit as well. Going 

through Clay’s medical records from Houston, from the VA, there 

was a form in that assessment and there is a question that says 

do you want us to or will you allow us to, I think it just said do 

you want your family to be contacted regarding your care, and he 

had checked no. And as difficult as that was to read, I know, you 


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know, I know him. And it is, I cannot even imagine, and I really, 

I just cannot even imagine. These people are so strong in the first 

place to raise their hands and say I will go, and they go to war. 

And they have these injuries. And especially with the mental injuries, it is so difficult to feel that you are a burden on other people. 

And I know Clay felt that even though he knew how much he was 

loved, unconditionally. Any of us would do anything to help him. 

But he was 28 years old. He had been a Marine scout sniper. He, 

you know, it was, you just want to be able to take care of yourself. 

And get the medical care you need. So it did not surprise me to see 

that. But there was a question of would you allow your family. 

Ms. KUSTER. Thank you. My time is up. So I am sorry to interrupt you. Thank you, Mr. Chair. I yield back. 

The CHAIRMAN. Thank you. Mr. Coffman, you are recognized for 

five minutes. 

Mr. COFFMAN. Thank you, Mr. Chairman. And I think, first of all 

thank you so much for the service of your sons, and Sergeant, in 

your case, your own service. And my heart goes out to you for your 

losses as a veteran myself. 

A question that I have is, do you think, certainly Sergeant in 

your case, and then for the parents, in the cases of your sons, was 

VA overmedicating them in lieu of giving them therapy? Sergeant, 

why don’t I start with you? And then I will work this way. 

Sergeant RENSCHLER. Sir, thank you for that question. This is 

really a culture that begins with DoD and extends into the VA. It 

is an issue that we battle with on a daily basis as we provide support and service to veterans and active duty members where I am 

at in my local area. Part of what I do through the ministry that 

I am in is providing support groups through the chaplain’s channels. So I deal with this very closely on both sides. Medication is 

no longer being used as a tool to subdue the symptoms, but we 

work on the deeper issues. 

Mr. COFFMAN. No, what does the VA do? 

Sergeant RENSCHLER. The VA specifically utilizes medication—— 

Mr. COFFMAN. Okay, that is my question. 

Sergeant RENSCHLER [continuing]. To control it and keep them, 

suppress the symptoms—— 

Mr. COFFMAN. Okay. 

Sergeant RENSCHLER [continuing]. Without working on the deeper issues, sir. 

Mr. COFFMAN. Thank you. Please. 

Ms. PORTWINE. Brian was never put on any medication, only for 

his back when he had that problem. 

Mr. COFFMAN. Okay. Okay, yes. 

Mrs. SELKE. Yes, Clay was on quite a bit of medication. And as 

I said, he termed that he felt like a guinea pig, just constantly 

being given something different. 

Mr. COFFMAN. Do you think that they chose medications then in 

lieu of—— 

Mrs. SELKE. Sure. 

Mr. COFFMAN [continuing]. Therapy? One on one therapy? 

Mrs. SELKE. Yes. The only one on one therapy that he spoke of 

that seemed to be effective, at a certain point in L.A. he went to 


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a Vet Center and had a counselor there that he really liked, and 

felt that he finally found somebody he could talk with. 

Mr. COFFMAN. Okay. 

Mrs. SOMERS. From Daniel’s point of view, I think part of his 

problem was that he also had Gulf War Syndrome, which manifested with so many physical symptoms. So yes, he had a 24-inch 

by 24-inch drawer full of pill bottles, but I think it was because he 

was having such incredible interactions between the different drugs 

that he was taking for PTS and the Gulf War Syndrome. 

Dr. SOMERS. And Daniel was not being seen by—— 

Mrs. SOMERS. VA—— 

Dr. SOMERS [continuing]. VA psychiatrist after six months after 

he was home, just because he never got the postcard that he was 

supposed to get to assign him another provider. 

Mr. COFFMAN. How much of the stress or the factors leading to 

suicide do you think might have been related to the fact that, I 

mean, I can tell you having been to Iraq, I mean, first Iraq War, 

and then the second, that when you come home there is a huge sort 

of, I guess maybe separation anxiety. That you were with, that you 

develop these interdependent bonds and this team around you, and 

all of a sudden it is just gone. It is just gone. And people fall into 

very dark and deep depressions sometimes. And I think it is easier 

for those that come back and then they have a long period of active 

duty with the same people that they served with. And I am wondering if you might comment? We will start with this side of the 

table. 

Mrs. SOMERS. This is a problem certainly with National Guard. 

Daniel was a member of California National Guard with the military intelligence. 

Mr. COFFMAN. Mm-hmm. 

Mrs. SOMERS. They are routinely separated from their main unit 

and assigned to other units. Daniel went to Iraq with an M.P. unit 

out of Texas, so he was already not with the unit that he trained 

with. He went to Iraq. When he came back his wife had moved to 

Arizona to be with her parents, so he is California National Guard, 

deployed through Texas, and then ended up in Arizona. So he had 

no support group whatsoever close by. It would have been phone 

call and email. 

Mr. COFFMAN. Yes. 

Dr. SOMERS. And this is a known issue. I mean, Reserves and 

National Guard, it is a huge issue. And not to take away, of course, 

from regular servicemembers, and in all branches of the service. 

But it is a much bigger issue for those who do not have the opportunity to come back to a defined facility and spend time like you 

said with the people they were deployed with. 

Mr. SELKE. Great question. The bonds that these men and 

women form in combat are just incredible. And so it is very difficult 

for them to leave service and come back to their communities. Clay 

probably stayed in, he really struggled about going home to Texas 

or staying in California. I think the reason, one of the reasons he 

stayed there for a while was because his close friends, Marines, 

were staying there, and continuing in his life. 

One of the tragedies in Clay was he moved back to Texas and 

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ment, a paramedic, that sort of thing, and was having some struggles with that. After he died we found out that I think three, three 

of his group were actually in the greater Houston area. And one 

of them particularly had actually gone through all the steps, he 

was like a year ahead of him, going into the fire department. And 

it really could have helped. Just the knowledge that those people 

are there would have helped. So there is a big break there in leaving service and going back into the community. 

Ms. PORTWINE. When Brian went first he was with 1st Cav, and 

that was a deployment that was supposed to be 12 months, and 

then they extended it to 15. Of course he was very, very tight with 

all those brothers, and they still are very, very connected online 

and text and everything. When he was in college then for the year, 

then when he was called back the second time his unit was already 

home for the year. So he was put with Louisiana National Guard. 

And he had no idea, those were completely new people. So you can 

imagine then when you are already damaged, and you wake up 

screaming three times a night, and have anxiety and panic attacks, 

that, you know, very difficult. I think he did bond with the people, 

he was very social. But it was not the same type of fun he had with 

the first group. 

Sergeant RENSCHLER. I think it has been stated well. And just 

to highlight on that, the Battle Buddies system is so culturally ingrained in the military community and you really become a family 

unit with those around you that you serve with. And separating 

from that, and especially our wounded as they are shuffled from 

their units into a warrior transition battalion they are separated 

from that family unit. Even though they are with other 

servicemembers, it is different. And then they transition out and 

they lose connection all together for the most part and begin to isolate themselves after that loss. And that is a very difficult thing. 

And I think that is why programs such as the VA’s Peer Mentor 

Navigator Program are so essential, is we should look at that and 

look at the way it is being implemented, and improve upon that. 

Because servicemembers and veterans connect best with other veterans, especially those who have shared experiences and that can 

help each other navigate through the difficulties that they experience within the system. 

Mr. COFFMAN. Thank you, Mr. Chairman. 

The CHAIRMAN. Mr. O’Rourke for five minutes. 

Mr. O’ROURKE. Thank you, Mr. Chairman. And I would like to 

join my colleagues in thanking you, and just telling you that what 

you have shared with us today is so powerful. Sergeant Renschler, 

your story, the story of Brian and Clay and Daniel, I hope will force 

us and the administration and this country to treat this issue with 

the respect that it deserves, with the attention that it deserves. 

And to get the results that our veterans deserve. And beyond the 

power of the stories, which are just, it is just hard to put into 

words the effect that they are having on me and I think my colleagues on this committee, you have also come to the table with solutions and proposals to improve the system. 

I love the idea that we think about the VA restricting its responsibilities to becoming a center of excellence for war related injuries. 

I have not thought about that before. And I do not know what the 


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effect would be. And I would love to hear from other veterans and 

veteran service organizations. But I love that you are thinking 

about a big idea to transform a system that is obviously not working today but has not worked for a very long time, from everything 

that I have learned so far. This idea of an interdisciplinary approach to taking care of veterans when they return, I would like 

to know more about that. And I think it makes a lot of sense given 

your earlier testimony. The buddy to buddy system that you 

brought up, identifying a support network when these 

servicemembers are still enlisted, are all excellent ideas. 

So what I would like to ask you is, I have received so much more 

value from this testimony today than I ever have from a representative of the VA, including the reasons why we should be focused 

on this, the ideas and suggestions on how to fix it. So I would like 

to ask each of you, if there was some formal process to involve you 

in fixing the VA, would you like to participate? And then secondly 

if you have any other ideas, because there have been so many good 

ones that have come through so far that we have not raised today. 

I would love to give you an opportunity to share that. And maybe 

we can start with Dr. Somers and work down. 

Dr. SOMERS. Well you know we want to be part of, if we can, 

whatever efforts. And we submitted as part of our testimony 15 

pages of problems and potential solutions. So there are a lot of 

really good people who can be very beneficial to try to help the system. You know, we just do not have the time to get into specifics 

right now. But to answer your question, for sure we would like to 

be involved if at all possible. 

Mr. O’ROURKE. Thank you. 

Mrs. SELKE. Absolutely. We would be happy to do whatever we 

can to help. I want to kind of shift the focus a little bit off of us 

as parents who have lost sons and lost children. Words cannot describe that. But I sit here and look at Sergeant Renschler and listen to his story and we are surrounded by veterans behind us, a 

lot of them from the IAVA group. If there is any blessing or silver 

lining in Clay’s death, we have become friends with so many of 

these young veterans that have enriched our lives. I do not know 

where I would be without them. I mean that sincerely. They just 

have enriched our lives so much. So whatever we can do. We cannot do anything to bring back Clay or Brian or Daniel. But what 

we can do is do something, whatever it is, to make life better for 

Sergeant Renschler and for all these veterans behind us and all of 

them all across the country. All veterans, not just the Iraq and Afghanistan, but all of them. We should not have to be reminded of 

that. And yet we seem to have to be reminded that we need to do 

a better job. So we are happy to do whatever we can to help. 

Mr. O’ROURKE. Thank you. 

Mr. SELKE. Anytime, anyplace, we are available. Part of the process for us to heal and I think for everybody at this table is to have 

the opportunity to go beyond our personal losses and to address the 

veteran community as a whole. And to do whatever we can to take 

care of those fine men and women. And so that, the opportunity to 

be in this community here, and be able to talk, and be able to be 

heard by people who hopefully have the, I believe certainly have 


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the heart and hopefully have the ability to make some things happen. 

The VA is very, very complicated. It is a huge animal. I know 

there is a lot of things that need to be dealt with. There is a lot 

of really, really good stuff, and there are some big problems. I 

think if we can just focus on the individuals, just focus on them as 

people in need, as patients, on their care. What do they need 

today? And then build the system and modify the system, do whatever based on that. I think that will take us a long way. The focus 

needs to be these veterans, totally. 

Mr. O’ROURKE Thank you. My time is expired, but Ms. Portwine 

and Sergeant Renschler, would you like to just briefly indicate 

whether you would like to continue to be involved and perhaps in 

a more formal way to include your ideas and experiences in this 

process of reforming it? 

Ms. PORTWINE. It would be an honor. It would be an honor for 

me to help make a change for the veterans to be. It would be like 

paying it forward. 

Mr. O’ROURKE. Thank you. 

Sergeant RENSCHLER. Certainly I echo the anytime, anyplace. I 

not only bring my own battlefield perspective but that of all the 

veterans that I work with, and I can only offer that much. But 

thank you. 

Mr. O’ROURKE. Thank you. Thank you, Mr. Chair. 

The CHAIRMAN. Thank you. Mr. Cook, you are recognized for five 

minutes, sir. 

Mr. COOK. Thank you, Mr. Chair. I want to thank the group for 

being here. I know this is really, really tough. Sergeant, for your 

input, this is tough to listen to. And it is even tougher for you guys. 

The comment about the parents not knowing. I am not surprised. 

A lot of people the worst thing in the world, when, after my second 

Purple Heart I did not want my parents to know what was going 

on. And this is going to be the problem that I think all of you are 

sharing, that common denominator. You know, everybody that goes 

through these experiences are going to have huge psychological 

problems. But who are they going to share it with? Are they going 

to share with a psychiatrist or a psychologist that does not understand the military culture, the veteran culture? They are not going 

to open up. You know, you need that connection. I think the Sergeant made a great point. And your comments about the Wounded 

Warrior Program, where they have that. The actual battalion 

where when somebody has got a problem they go into that system 

there. And I just want to get your feelings. And maybe I am going 

down the wrong road. Because I think they need it, as somebody 

that has a problem they need an ombudsman. Somebody that is 

going to look out for their interests. That if they are at a particular 

hospital, they can go to the administrator. They can go to anybody 

and say, hey, wait a minute, this is an immediate situation. This 

is general quarters and we have to have a meeting right now or 

somebody is going to die on your watch. And can you comment a 

little bit more on that? It is pretty much what you were talking 

about, Buddy to Buddy, the same things over and over and over 

again. But to cut through the red tape right then and there with 

individuals that understand the severity of the problem. 


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Sergeant RENSCHLER. Yes, sir. This is a crucial element, is to 

have somebody to come alongside of the severely injured, cut 

through that red tape, and get treatment now. This is something 

that we have experienced first hand. I have experienced, I shared 

it with some of the folks from the Wounded Warrior Project recently. I had a veteran that we did a crisis intervention on attempted suicide, and we had to remove him from his primary residence. We got him to a position of stability and I found out that 

he had never accessed care at the VA facility. So I told him that 

that is the next step. He went down and he was actually denied 

treatment and told that he would be able to be seen in three 

months after telling somebody he had attempted suicide the night 

before. And I went down there and met with that veteran and we 

walked in, and I said this is an unacceptable answer. And we got 

the department head to come out and say I will intake him today. 

We have a program we can start him in next week. And that saved 

that veteran’s life that day. But there are thousands more a day 

that are getting the no and not getting that extra answer because 

they do not have somebody to advocate for them. And I am not saying that to toot my own horn. I am saying that if we had more people out there advocating for these veterans we would be able to 

save a lot of lives and get better care. 

Mr. COOK. Yes. I just got back from, I went down to Camp 

Lejeune, where I was, I spent a lot of time down there. And I saw 

some of the folks, including my platoon sergeant, who was my platoon sergeant 47 years ago. And we talked about the infantry unit, 

and you never forget the Marines that you lost. 13 May, 1967, horrible, horrible day. You never forget their names, the occasion. Just 

like you are never going to forget this. But what you have to do 

is try and make the system better. And right now I think it is broken in terms of not capturing those individuals and those thoughts, 

their morale is just down to the point where they are going to do 

something bad. And if we do not correct it now, it is our fault. 

So—— 

Dr. SOMERS. Yes, it is a systems issue within the VA. And our 

feeling that everybody who works in the VA should have only one 

purpose in mind, and that is to advocate for the veteran. And it is 

the person who sits in the corporate office to the person who cleans 

and empties the wastebaskets at night. That is the only, only 

thought that they should ever have. 

Mr. COOK. Doctor, that concept of the ombudsman, or for lack of 

a better term, somebody that is ultimately responsible or somebody 

that is that advocate for that person in trouble—— 

Dr. SOMERS. And we agree that there needs to be an ombudsman. We know about the Navigator program and that is a great 

program. We know that they are doing a much better job of that 

out in San Diego. But it is not only the ombudsman, it is not only 

the Navigator, it is every single person—— 

Mr. COOK. But it should be an SOP, totally—— 

Dr. SOMERS [continuing]. Totally, totally, totally—— 

Mr. COOK. Standard operating procedure for every hospital. I 

yield back. 

The CHAIRMAN. Thank you, Colonel. Ms. Brown for five minutes. 


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Ms. BROWN. Thank you, Mr. Chairman. First of all, let me thank 

each and every one of you. Let me just tell you recently I did some 

work with the Marines and they would just be very proud of you, 

your sons. So thank you very much for your service. 

You know, I have to say that we are talking about the VA, but 

this is not just the VA. It is DoD. And this hearing should be VA/ 

DoD. Because it is DoD that sends people over and over and over 

again to combat, and there is no transition as far as when they 

come back. So it is a bigger problem. And to sit here and just say, 

well it is the VA. That is just not true. It is just not true. And we 

need to deal with the problem. 

The fact is we have been fighting a War with the reservists and 

we have sent them over and over again, and they did not have the 

support that they need. I have gone out when they are deployed 

and they just, they do not have all of the other resources that the 

other military branches have. So we are not doing the Wars the 

way that we need to, and the system is fragmented. And so as we 

develop a comprehensive system, let us get everybody in the room. 

Let us deal with the system the way we need to deal with it. 

Now you mentioned the formulary. Now the VA and DoD, we insist that they negotiate the prices of the drugs to keep the costs 

down. Now what is wrong with the way we are doing that? Because 

in the regular market it is illegal for the Secretary to negotiate the 

price of the drugs, which I think is dumb. 

Dr. SOMERS. Well there is no problem negotiating the price of the 

drugs. The problem is the drugs are not the same. So that for example Lexapro, which is, you would definitely want the DoD formulary as opposed to the VA formulary. 

Ms. BROWN. Mm-hmm. 

Dr. SOMERS. No doubt about it. And I know firsthand that you 

can basically get anything you need with relatively little hassle 

through—— 

Ms. BROWN. But I thought the VA was the one that was doing 

a lot of the research, not the DoD—— 

Dr. SOMERS. The research has nothing to do with anything. The 

only thing that has to do with it is the actual drug that you are 

being prescribed by your provider. You can do research, and actually that was one of Daniel’s issues, is that there is a problem 

doing research because of the fear of the FDA and the DEA and 

Schedule 1 medications and things like that. So that is a totally 

different issue. The problem is the formularies are not the same. 

And as I said, you have got patients, not only veterans who are 

being discharged, but you have retired military who are being seen 

at a DoD hospital and at a VA medical center, and they are eligible 

to seen at both. 

Ms. BROWN. Mm-hmm. 

Dr. SOMERS. And they are under medication restrictions because 

the formularies are different. So that is the big issue. We need to 

make it a single formulary, bottom line. 

Ms. BROWN. Okay—— 

Mrs. SOMERS. Excuse me, and just in addition to that—— 

Ms. BROWN. Mm-hmm. 

Mrs. SOMERS [continuing]. It is like if a person is doing really, 

really well on a drug, they should be able to stay on that drug. 


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Ms. BROWN. And the doctor can override that. 

Mrs. SOMERS. Just because you can get it for ten cents cheaper, 

and it can have major effects on their body. 

Ms. BROWN. Absolutely. But the doctor can override that. 

Mrs. SOMERS. Right, and—— 

Dr. SOMERS. Ma’am, not, no but what Jean is saying is different. 

It is still a generic, but as I said before it is a different formulation 

of the generic. 

Ms. BROWN. Right, but—— 

Dr. SOMERS. So and especially as was said, I mean that is what 

is so important to have these groups of the multispecialty groups 

that are, the interdisciplinary committees, or whatever they are, 

that are going to community amongst themselves. 

Ms. BROWN. Well I definitely think that is something we could 

work on. Ms. Portwine, I think you made a very important point. 

Your son you realized was having serious problems, and yet he was 

redeployed. 

Ms. PORTWINE. yes. 

Ms. BROWN. And he was not given the medication. I mean, it 

should have been a time out at that point. 

Ms. PORTWINE. Well even on the form you can see it said no go, 

that was crossed through, and somebody stamped, the coordinator 

that sends the people, I forget what they call them, put go. 

Ms. BROWN. Well, now that is DoD. 

Ms. PORTWINE. So that tells me they had hesitation in sending 

him to begin with. 

Ms. BROWN. That was DoD. 

Ms. PORTWINE. That was DoD. 

Ms. BROWN. Yes, ma’am. Well thank you very much. 

Ms. PORTWINE. You are welcome. 

Ms. BROWN. And what I am saying is it is a lot of work that 

needs to go on, and it is not just VA. Thank you again for your 

service. 

The CHAIRMAN. Thank you very much. Ms. Walorski for five minutes. 

Mrs. WALORSKI. Thank you, Mr. Chairman. And thank you to the 

panel for being here. I can assure you that this is how things 

change in this country, it is when brave men and women step forward and say to a concerned body like this of Republicans and 

Democrats, sitting here listening to your story, I cannot even imagine, I cannot pretend to imagine how tough it is to sit here and relive this. And I think I can, I think I can safely say that we are 

committed to bringing right to all of this wrong. And every one of 

you have hit the nail on the head by saying, every one of you have 

said the story is about the individual veteran. And you know, I 

have only been on this committee for 18 months but the last three 

months the chairman and the ranking member have led an intense 

investigation into what the heck happened to the VA. From the day 

that it started to the mission today. And every layer of this onion 

that we have peeled back comes down to the same core issue: nobody is advocating for the veteran. And the culture itself, and when 

we talk about systemic problems and the culture itself and we, and 

the Secretary is removed, and a bunch of people are removed, and 

we are sitting here trying to be able to help America reset a button. 


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Because Americans believe in our veterans. They sent us here to 

fight for our veterans. And I want to just applaud your effort. 

You have made such a huge difference here today. This is how 

laws change. This is how policy becomes correct, and this is how 

we move forward in this country. We do it together. Unfortunately 

sometimes it takes the disaster that we have had in a bureaucratic 

system of the VA. But you know, the frustrating thing for me is 

I have 54,000 veterans in my district and every time I describe my 

veterans I talk about I have 54,000 veterans and their families in 

my district. And I want to applaud your effort on two huge issues 

that I think that we can address in this Congress and we can help 

move forward on this issue of mental health. The one is the support network. I cannot even tell you, and I know you know, how 

many constituents have called our office in Indiana, and the wife 

or the husband is in tears, and they are begging and they are advocating for the spouse that the VA says HIPAA prohibits me from 

allowing you to get involved in this. I have gotten personally involved in some of these mental health cases in my district, calling 

the directors and regional directors, and trying to advocate for my 

constituent on behalf of a spouse. And the answer is still no, 

HIPAA overrides. And I even asked the question, do you have a different law of HIPAA? Do you subscribe to a different definition 

than we do? And the answer was no. HIPAA overrides. And so just 

having a support network. To be able to come in and be that bridge 

between somebody who is dying and the system. And I applaud 

that effort. And I think, I mean, I am going to make sure that we 

do everything we can to get that part of the law changed. Because 

we can bring advocates into the lives of these struggling men and 

women. And for the spouses that are trying to hold the families together, we can do that, too. 

And I want to just thank you for your commitment as well on 

the issue of keeping this focus where it belongs. And, you know, I 

think someday, I do not think this is a quick turnaround. But I 

think you have brought light, transparency, and accountability to 

another layer of what America needed to hear. And while you are 

sitting here today talking to us, and while we are trying to relate 

and share your brief, and we are trying to find solutions to move 

forward, you have had an opportunity to talk to the American people today. And I guarantee you that every single person that you 

are an influence to, that has followed your story in the states that 

you are from, I am going to hear from my constituents today and 

say I am just, I relate to that mom and I relate to that father and 

I relate to my fellow serviceman. And I just think it is a tribute 

today. This is how government works. And we have a commitment 

to make sure we restore not your sons, but certainly the America 

that they have been fighting for. Certainly our trust and their trust 

in us as a government who asks them to go fight for freedom and 

fight for liberty, our finest heroes in this nation, and to be able to 

reinstitute to them by continuing to root out the bad actors and the 

bad policy in the VA, and together set a reset button. 

So I just want to applaud your efforts and thank you so very 

much for helping us reset an organization that started out as a 

great noble effort and really has run into a bureaucracy that has 

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mitment certainly that none of what you have experienced will be 

in vain. So thank you so much for being here. I appreciate it. I 

yield back my time. The Chairman Thank you. Mr. Walz, for five 

minutes. Mr. Walz I would like to yield the first minute to my colleague Mr. Peters, who represents the Somers. 

The CHAIRMAN. One minute to Mr. Peters. 

Mr. PETERS. Thank you very much. Thank you, Mr. Walz. I want 

to start by thanking the chairman and the committee for allowing 

me to be a guest. We are not members of this committee, Ms. 

Sinema and I, but I do not think there is anyplace we would rather 

be this morning. 

It takes a lot of courage to do what you are doing, and I just 

want to say thank you for that. And also to let you know beyond 

the power of your stories it is the education you provide that only 

you can provide. These are insights that only you have and so it 

has been very valuable to us. And while we are new here I can tell 

you that from time to time you see testimony that is going to make 

a difference, and that is certainly what has happened today. I 

think you can feel very confident that those brothers that you 

talked about, and sisters, will be heavily affected and helped by the 

time you put in and the effort you put in today. 

And I also just wanted to thank in particular Howard and Jean 

Somers for your leadership, for the time you put in on behalf of 

Daniel, and for the education you have given me. I look forward to 

continuing to work with you to make these issues, to resolve these 

issues and to make things right with the veterans that the VA 

sees. Thank you. 

Mrs. SOMERS. Thank you. 

Mr. PETERS. Thank you, Mr. Chairman. 

The CHAIRMAN. Mr. Walz. 

Mr. WALZ. Thank you, Chairman. And again, thank you all for 

being here. I am sorry I never got the chance to know Daniel or 

Brian. I did have the privilege and the honor to know Clay, and 

not only know him, to work with him on veterans issues. And the 

profound loss is felt by everyone who came in contact with him. 

And it shook me to the core because of someone so strong and to 

your point on we do not, you are not going to notice it, you are not 

going to see it. And these are very special individuals. And Josh, 

you and I have become friends over the years. We were in St. Paul 

a few weeks ago working with the Wounded Warrior Project. So I 

do, too, applaud you. It is, you hear it from the colleagues. And this 

is a committee of heartfelt folks that want to get this right. 

I would just mention, and I think all of you get this, at this 

point, and I think the frustration we all feel, solutions and results 

are all that matter. I am done with it as you all are. I am done 

with the talk. I am done with the pilot programs, if you will. I understand we need to do some of that, but there are suggestions that 

are concrete that can be put into this. But I want to read you something. 

I came here on the 3rd of January of ‘07, the honor of being elected to Congress. On the 9th of January I started working on a bill. 

And one of our colleagues, a Vietnam Veteran pilot Leonard Boswell put in, it was the Joshua Omvig Suicide Prevention Act. And 

here is a couple of things that it said. The Secretary of Veterans 


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Affairs should develop and carry out a comprehensive program designed to reduce the incidences of suicide among veterans. The program shall incorporate the components shown below. Staff educations for compassion amongst and recognizing risk factors, proper 

protocols for responding to crisis situations, best practices, screening of veterans receiving medical care, tracking of veterans in a 

timely manner, counseling and treatment of veterans, and designation of suicide prevention counselors throughout that, and on, and 

on, and on. 

They did not do it. It was in law. We passed it. We gave the 

speeches. We had the signing ceremonies. And we went back home 

and said, gee, we made a difference. And it is the very same things. 

And here you sit, just like Joshua Omvig’s parents sat, come up 

from Iowa to testify on this. 

So I guess the thing I would ask of all of you is that this is the 

second, the VA is the second largest government agency, behind 

DoD. Yet we have one of the smallest committees. We have committees that I do not even know what they do, they have got like 

80 staff on them, and they do it. So we can give lip services or we 

can get serious about how we are going to do it. We can have this. 

Or we can allow, if this crisis passes, and the American public’s attention focuses elsewhere, or whatever. Our veterans will be coming back. There is veterans sitting behind you from Vietnam and 

others. They have seen this movie. They have seen it before. 

Here is what I think is different. I think there is no doubt in my 

mind, the American public wants to get this right. And they are entrusting us as their representatives to get this right. And the commitment I have seen from this chairman and ranking member as 

a member of this committee, this is different. It is different than 

the seven years that I have been here. It is different in how we are 

focusing. It is different amongst the advocacy, and we cannot let 

this pass. 

So what I would tell you, Ms. Portwine and some of you asked 

on this, you mentioned, and thank you for this, Chairman Miller 

and Representative Duckworth and myself, along with IAVA, Paul, 

VFW, a bunch of folks, are going to be out there this afternoon. We 

are going to introduce Act 2182. And here is what I would say is 

different. And this was a well-intentioned bill and well-written, except look to your right, these are the folks that helped write the 

bill. So Susan was in the office and making the suggestions. Look 

to your left, Josh was there. The Somers’ suggestions are incorporated into this. And we are going out because what we have got 

here is, and this is I guess the silver lining. And you get tired of 

hearing that. There is no silver lining when your son is not coming 

home. But what you have done is ask for a solution. I would ask 

each of you as Act 2182 starts to move and Senator Walsh does it 

in the Senate, let us together make sure it does not end up as the 

Joshua Omvig Act. The Secretary had all this authority. He had it. 

The American people through us said do this, and they did not do 

it. 

So I would only just state to each of you, as my colleague Mr. 

O’Rourke said, this is how democracy can work best. This is how 

we can incorporate people in it. And this idea of wringing our 


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hands at who could have anticipated this, really? This bill was 

started in 2007. It was anticipated before and here we sit in 2014. 

So keep the faith, we have to. But again, I would say this. The 

cameras, the TV, the stuff that is there, whatever, none of it means 

a damn thing. If we do not get results this time then shame on us. 

Because here is the thing. I am not going to get to meet Daniel. 

I am not going to get to meet Brian. I am not going to see Clay 

again. But I dang sure want to see Josh. I want to see him here 

and forward. I want to see the rest of them. That is our calling. 

So you have got the right guys up here. You have go the right 

commitment from the public. You have got the right folks sitting 

behind you writing good legislation. Now it is going to be can we 

do it? With that, I yield back. 

The CHAIRMAN. Thank you. Dr. Benishek, five minutes. Dr. 

Benishek Thank you, Mr. Chairman. Well, I too would like to 

thank you for your courage to be here today. And please know that 

your efforts today will make a difference at the VA. I just really 

want to thank you. 

Mr. and Mrs. Somers, I want to thank you too for that 15-page 

primer there. That had some really good ideas. And I really appreciate you all taking the effort to put together a document like that. 

Mr. and Mrs. Selke, you mentioned, and I was disturbed by the 

comments that you found that the environment of the Houston VA 

was stressful. So could you elaborate on that? What specifically led 

to that conclusion? Have you been there since? Has it changed? 

Can you tell me a little bit more about that, when you described—— 

Mrs. SELKE. I went by myself that day and have not been back 

there since. For whatever reason I just compelled to go and quickly 

get his medical records. And I wanted to see them. And it was just, 

again, for ten weeks worth of care there, so there were not a lot. 

You drive up to the facility. It is huge, as they all are huge. 

There were so many people milling around out front, big crowds, 

lots of people that I do not know if they were there waiting for appointments or if they, you know, just do not have anywhere else 

to go and hang out there. You go inside and it is, I likened it to 

an airport terminal, in a way. You go in and it is just a hub. Very 

busy, lots of people milling around, lines, the cashier lines look like 

in an airport where you would line up to get your tickets or something. Just, it was very stressful for me. And of course I was in a 

grief mode but not a Post Traumatic Stress mode. I just could not 

imagine. I could visualize Clay going in and I could understand 

why when he left that day and he called and he said, ‘‘I cannot go 

back there.’’ 

No one was at the information desk. You walk in the front door 

and they were on a break or something. But no one was there. And 

I looked around and finally found somebody that could direct me 

to where the medical records are and went and retrieved those. Before I left I just remember standing there for a few minutes and 

just imagining—— 

Dr. BENISHEK. Right. 

Mrs. SELKE [continuing]. If I were a veteran, if this were Clay, 

how—— 


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Dr. BENISHEK. How do you negotiate this? You mentioned another thing and that was your son had voiced concerns about the 

care he was receiving. Was there specific concerns that he raised? 

Mrs. SELKE. I am not sure I am remembering what you are referring to. 

Dr. BENISHEK. All right. Okay. Well let me ask Sergeant 

Renschler a question. You wrote that the combat veterans in particular often approach mental health care as hesitantly or distrustfully. How would you suggest that we change the dynamic to ensure that veterans who need mental health care feel more comfortable accessing the care? 

Sergeant RENSCHLER. Yes, sir. Thank you. It kind of starts with 

what she was just sharing. Even at our facility we have two, Seattle, and then we also have American Lakes. Seattle is a large 

hospital building, not laid out very user friendly. And myself, I 

have a Traumatic Brain Injury that I have overcome fairly well but 

I get lost and confused in that place real bad and there is not a 

lot of friendly people there to direct me. I get better customer service at Best Buy, quite frankly. A little bit of care training would 

go a long way within the VA medical centers. 

My other medical center closest to me is a campus with many, 

many buildings. And the building numbers do not even make 

sense, so I will be in 81 and I am told to go to Building 3, which 

is right next door, and Building 61 is across the campus. And the 

numbers make so sense, and the facility is confusing, overwhelmingly packed in and not a lot of people to help guide and navigate 

a very confusing situation. So for one, just recognizing who the audience of a veteran is and making an environment that is conducive to healing would be a start. 

Another one would be as I discussed earlier and I keep bringing 

back to that interdisciplinary team, it takes rapport. It takes developing a relationship and rapport with the veteran to get him to go 

beyond surface level issues with a physician. I am going to go and 

I am going to triage myself. On active duty, especially in the infantry culture, sick call was very discouraged. And if we went to sick 

call you were a wuss, and you pretty much got crap for it for the 

rest of the day. And so we do not go to sick call unless something 

is debilitating in nature. And that just kind of sticks with you for 

the rest of your life. And so as I am muscling through ridiculous 

pain my wife will eventually stop and say when are you going to 

go see a chiropractor or get some help? And it is just that mentality 

of just suck it up and drive on. And that is what these guys are 

doing with mental health issues. And that is why when they get 

there it is a crisis and needs to be treated as such. And so there 

is a two-fold answer here. Number one, the VA needs to recognize 

that there is going to be a lot of crises and come back in three 

months is not acceptable, or come back in 14 days to intake so that 

you can intake in another 14 days to get treated in three months. 

Still not acceptable. But instead to have a team to say, hey, welcome here. This is your place. This is your team. These are the people caring for you. This is what we are going to do for you, and provide better customer service for one. But for two, develop a relationship with trust and rapport so that I can know that I can conVerDate Aug 31 2005 14:28 Mar 25, 2015 Jkt 000000 PO 00000 Frm 00044 Fmt 6633 Sfmt 6633 Y:\89378.XXX PAT

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fide in these people to provide the quality care that I know that 

they should. 

Dr. BENISHEK. Thank you. 

Sergeant RENSCHLER. I hope that answers it, sir. 

Dr. BENISHEK. Thank you very much. I am out of time. 

The CHAIRMAN. Thank you. Ms. Titus you are recognized for five 

minutes. 

Ms. TITUS. Thank you, Mr. Chairman. Thank you all for being 

here. Your stories are just tragic and heart wrenching. But I hope 

you can take some comfort in knowing what powerful advocates 

you are. I mean, you have told your stories so eloquently, so orderly, so thoroughly, that it really, it will help us to move forward. 

I have just been noting down some things that we need to address. And I think we are at a point where we really can make a 

difference. So in addition to the things that you have suggested I 

want this committee and the people in the room, and I ask you for 

your help on this, for us to address some other things that I think 

are also related to the problem. 

First, you are obviously very loving families. You were there for 

your children. But many of your veterans do not have families like 

that. There are many homeless veterans, they are sleeping on the 

streets, they do not know where to go. They do not have somebody 

they can turn to. And so we need to figure out a way how we can 

address the problem for those veterans as well as for those like 

your children. So I want us to not overlook that. 

A second thing is the VSOs are there to provide services to veterans and when they do not have that ability to bond like they do 

while they are in the military the VSO is there. They cannot be 

there 24/7 like your band of brothers and sisters can, but they are 

there. And maybe we need to look at some ways that we can help 

them to do more outreach and better fill that gap for when people 

come out. 

Also we have heard some horror stories about the medicine and 

all the different drugs. I think we begin to hear that medical marijuana is a possible way to address PTSD. Let us do not leave that 

off the table as we move forward. 

Even something as simple as the notion of companion dogs. That 

is something that you hear, too, that many vets, if they have a pet 

that helps them get through some of these troubled times. So let 

us keep that on the agenda. And you mentioned about being a firefighter. Let us also remember that when veterans come back they 

do not just need health care, both mental and physical, but they 

need to be able to transition into civilian life with easy access to 

education so some of their training counts towards college credits 

or employment to retrain and have jobs so they have something to 

look forward to that takes a little of that burden off. 

So those are all things we need to look at the big picture. And 

I just thank you very much for committing to continue to go down 

this path with us. And I would ask you, too, do not leave anything 

off the table. Anything you can think of, no matter what it might 

be, now is the time for us to address it. So I do not know if you 

want to comment. I do not want to put you through more questions 

but I want you to know that that door is open. 


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Ms. PORTWINE. I have one more comment. I know that the VA 

has the emergency crisis line, 1–800–273–TALK. But I work for an 

insurance company and we have what we call Nurse Line. And 

anytime a member can call 24/7, 365 days a year. Why do we have 

to wait until it is a crisis for anybody to talk? When they are starting to feel depressed would be a great time for a nurse to be able 

to assess and triage what care this person needs. Do they need to 

go immediately now? Can it wait until tomorrow? Can it wait the 

routine three days? What do they need? I think by waiting until 

it is a crisis line, you are more down that slippery slope. 

Mrs. SOMERS. And if I might add, we are fairly new at this whole 

political thing. But I came across something called the independent 

budget, which if I am interpreting correctly the VSOs actually put 

together for Congress. And I would ask that next time that comes 

to you, that you really look at that really, really closely. Because 

these are your veterans talking to you. Thank you. 

Mrs. SELKE. I would like to just add quickly one of the things 

that Clay said over the years that sticks with me, and it just is 

wrong. He would say over and over, ‘‘I have to grovel for my benefits.’’ And I just think we need to wake up as a country. Our veterans should not have to grovel for anything. And it just should not 

be so difficult to get the care they need, at all. 

Ms. TITUS. Thank you very much. I yield back. 

The CHAIRMAN. Dr. Wenstrup you are recognized for five minutes. 

Dr. WENSTRUP Thank you, Mr. Chairman. And I cannot thank 

you enough for being here today, and the sacrifices that you have 

made. And I pray that the sacrifices that you and your entire family have made will make us a better nation at the end of the day. 

I think most that sign up to serve have that intention, that they 

will make this a better nation at the end of the day. 

I am a physician and also a Reservist, and I served in Iraq for 

a year. That has led me to want to be here today. And one of the 

things that I know as a doctor, and I am sure Dr. Somers you can 

relate, that when you have patients with, and regardless of their 

problems, there is a level of anxiety because they have something 

wrong. Whether it is musculoskeletal or mental, it does not really 

matter. Something is wrong and there is anxiety. And it makes it 

even more difficult and it heightens the anxiety when you have all 

these administrative problems. And I know you started to deal 

with that in private practice, more so maybe than when you first 

started, where you, the prescription you think is best they are not 

allowed to have, those types of things just increase the patient 

problem and actually trying to take care of the patient. And we 

really are here, I will say on this committee, not just to complain 

but to come up with solutions. And so your input today is extremely valuable. 

And one of the things I see is if a doctor is credentialed at one 

VA, he should be credentialed at every VA. That allows him to go 

from one VA to the other if there is a deficit sometime. And if your 

prescription is good at one VA it should be good at another VA. You 

can do that if your patient is out of town. You can call another 

state and get the prescription filled. And when you cannot, think 


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of the anxiety that comes with that. These are things that we can 

fix, and these are things we have got to fix. 

And I will also contend that it is a big difference, too, being in 

uniform and out of uniform as far as care. As a Reservist, you 

know, I can just remember, you know, being with that family for 

15 months. And then all of a sudden I am the last one left at the 

airport and going home. And when I get home they say, well, you 

have got 90 days to go back to work. Well, I said, that is not going 

to work. I am going back in two weeks. You know, I am getting 

my house in order and go back to work because you have to have 

something to go to. And so when you are just wallowing out there, 

and I think we need to engage, now this is the DoD side, engage 

on what you are doing when you go home. And have the VA be part 

of that as well. And we have got to blend these two systems together. We have to engage in the post-deployment activity. And so 

when I have been in uniform I have had the opportunity to serve 

in preventative medicine, and particular suicide prevention. And 

you know, we learn a lot, and we get a lot of training, I think, in 

uniform of what to look for, and have that battle buddy, and the 

types of symptoms you are looking for. And sometimes when the 

decision is made that you are going to take your life that there is 

a calmness. And you look for somebody giving away their stamp 

collection or coin collection because they have made up their mind. 

And they spend more time with family because they have made 

this decision that their problems are going away. 

Those are the types of things we get. We get those in uniform 

but we do not get them afterwards. And for Guard and Reserve in 

particular, you just go home. And I did see, I have seen at Fort 

Lewis, for example, families being engaged with programs but that 

does not happen the same way with Guard and Reserve, and it is 

a different animal. 

But I guess more than anything else what I want to do, when 

you want to talk about solutions, we can all be trained to look for 

symptoms and look for signs, but how do we go about preventing 

the very ideation of taking one’s life? What are we doing that creates a situation where someone comes up with that ideation, that 

this is the best way to go? And that is the type of input we need. 

And that to me is really preventative medicine more than anything 

else. And I hope that through this we find our way. Because our 

suicide rate is going up in our civilian population as well. So we 

have a national problem here, not just a military problem. 

Again, I applaud all your input. It is extremely helpful to us. And 

as you have seen, this is a determined group here that wants to 

make a difference in the history of our nation as we move forward. 

And we are glad to have you as a part of it. So your input is always 

welcome, and thank you for commitment. And I yield back. 

The CHAIRMAN. Thank you, doctor. Ms. Sinema you are recognized for five minutes. Check your microphone, there you go. 

Ms. SINEMA. Thank you, Mr. Miller and Mr. Michaud, for allowing me to participate in today’s hearing. And a special thanks to 

my colleague from Arizona, Ms. Kirkpatrick, who represents our 

state’s veterans so well on this committee. 

I want to thank all of today’s panelists for joining us. In particular, thank you to Daniel’s parents, Howard and Jean for being 


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here. We worked together quite closely since learning of Daniel’s 

suicide and it is an honor and a privilege to be here with you again 

today. 

Unfortunately Daniel’s story and the story of the other young 

men who committed suicide is just all too familiar in our country, 

and 22 veterans a day are still committing suicide even after we 

have heard the tragedies of the young men who lost their lives 

here, and their brothers all across this country. And as we heard 

from Mr. Walz, Congress has addressed this issue before, has 

passed legislation before, has said they were going to fix it before. 

And yet the problem has not only not gotten better, it has gotten 

worse. 

I have heard a lot of testimony today about ideas to actually reform the system and make it better. The HIPAA issue I think is 

one that the committee would agree needs to be addressed. I am 

particularly interested in the pilot program that Sergeant 

Renschler participated in. And my question to Dr. and Jean Somers 

would be about Daniel. Daniel’s experience at the Phoenix VA, like 

many, many veterans’ experience at the Phoenix VA, was one of 

lack of concern, lack of care, lack of follow through, and a discombobulated system that did not allow veterans to get the care 

they needed. In particular one of the struggles Daniel faced was as 

an individual who had served in classified service, he was unable 

to participate in group therapy because he was not able to share 

the experiences he experienced while in service. And yet at the 

Phoenix VA he was unceremoniously put into group therapy. And 

when requested private therapy was not able to get that care. And 

of course, as we know, he took his own life as a result of being unable to get that care. 

The medical home model I believe in the private community has 

provided an opportunity to create patient centered care and allow 

civilians to get the care they need in one home, easily, that is centered directly on their needs. While the pilot program in Washington was ended because of, well I do not understand why. They 

said they did not have enough money for it, which I think is outrageous and a horrible, horrible reason to stop providing care that 

we know is effective and appropriate. My question for Dr. and Jean 

Somers is whether you believe a medical home model would work 

or could be helpful to veterans like Daniel? We know that many of 

our Post-9/11 veterans face co-occurring disorders, PTS, TBI, anxiety, depression, physical maladies. Would a medical home model 

have been a model that may have worked better for Daniel than 

what he faced? 

Mrs. SOMERS. Absolutely. As Daniel’s irritable bowel syndrome 

worsened, he did not feel he could physically leave the house. I cannot imagine that embarrassment. And then as Howard mentioned 

at the time Phoenix has the speed traps set up on the major highway to get from his home to the Phoenix VA so he actually had to 

find a way to get off of the highway so that the flashing lights 

would not affect him. So absolutely. I can see that it would have 

been very helpful to him just to have the privacy capability. 

Dr. SOMERS. I completely agree. I think not only the medical 

home model but what we talked about, the ability within the facility for the different people. Because of his IBS and his TBI and his 


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PTSD, you are being treated, as we learned here, the term being 

in silos. And what you have to do is you have to get out of the silos 

and you have to combine resources, combine knowledge. And we 

have heard of programs such as was mentioned that are very successful where people can have problems and for whatever reason 

have an optometrist or an ophthalmologist in there. And they say, 

well, you know, it sounds like it is not this, but it is this, and something that you might not have thought of. So the medical home 

model, the ability to create these panels of care, I think anything 

like that would be overwhelmingly positive. 

Ms. SINEMA. Thank you. And Mr. Chair, while Dr. Benishek has 

already left I do want to take a moment just to thank him for cosponsoring legislation that we drafted with the Somers specifically 

to address the issue of servicemembers who served in classified settings and who need appropriate care when they return to the VA. 

And I want to thank the subcommittee and the committee for supporting just a part of the solution to this issue. Thank you. I yield 

back my time. 

The CHAIRMAN. Thank you very much. Mr. Bilirakis, you are recognized for five minutes. 

Mr. BILIRAKIS. Thank you, Mr. Chairman. I really appreciate it. 

And I appreciate the panel testifying, and I appreciate your courage. 

I want to ask about alternatives to medication and I want to ask 

the entire panel. Which alternatives do you believe the VA could 

consider in addressing the mental health issue? I realize that you 

have to have some medication in most cases prescribed, but I am 

familiar with the recreational therapy. The chairman and myself 

participated in a field hearing not too long ago on recreational therapy, the equine therapy. In my district they have Quantum Leap 

Farms, I know they are all over, they travel from all over the country to go to Quantum Leaps. The service dogs do wonders, I understand, from talking to veterans, just to name a few. But can you 

maybe elaborate a little bit, whoever would like to, with regard to 

the alternatives to the medication for mental health therapy, 

PTSD, TBI, what have you? Please, thank you. 

Ms. PORTWINE. Yes. Brian had a brother that came back and he 

had PTSD and he had a friend that was doing some gardening. So 

he started just working in gardening with him. Pretty soon they realized they really liked it and their garden was pretty good, so they 

decided to make it bigger. Then they thought, well let us take these 

vegetables and take it to market and see if we can sell them. And 

so now they have this huge area and they do this. I have also 

heard of veterans going on farms, because there is not loud noises 

and flashing lights and the, you know, the sound issues that they 

have with PTSD. So those are two others. 

Mr. BILIRAKIS. Thank you. Anyone else, please? 

Sergeant RENSCHLER. We, I mean, we could just put together an 

extensive list of what veterans use to cope with these things outside of medications. Motorcycle riding, bike riding, equine therapy, 

service animals. I mean, it just, the list could go on and one. And 

that is, I would rather stress the importance of the fact that there 

is no one solution. And until the VA can get to implementing best 

practices systemwide and tailor fitting to each individual veteran’s 


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needs, and using these known best practices that exist out there, 

until they can do that we are not going to be able to fix anything. 

I mean, we can put policy in place saying that you have to provide 

access to these individual treatments that exist. But it is the implementation of that policy that is the major issue here. And yes, I 

mean there is, the list is extensive. 

Mr. BILIRAKIS. Thank you very much. And definitely, one size 

does not fit all. Anyone else? 

Mrs. SOMERS. I would like to weigh in on that. That we hear a 

lot, a lot of the excuses that we heard at Phoenix was it has to be 

evidenced-based treatment. And how do you get innovative therapy 

if everything has to be evidence-based before they will use it? I 

think they need to open up their minds a little bit and think outside the box. As you have heard, not every therapy works for every 

person. Everything does have to be individualized. And you know, 

I have heard of gardening before, too. You know, as being very 

therapeutic for people. I think it just, they need to get out of the 

mentality that this is all we can do, we have these blinders on. 

Mr. BILIRAKIS. Thank you very much. The bottom line is, we 

need to listen to the vets, just like you said. Anyone else, please? 

Mr. SELKE. I think it is, again to use the word holistic, it is a 

community, it is a lifestyle sort of approach. I mean, the VA needs 

to do what the VA needs to do the best way the VA can do it, but 

the VA cannot do everything. So there is a lot of, I mean, Clay kind 

of put together his own kind of therapy program. He got involved 

in service. That was helping him. He got involved with IAVA, you 

know, Storming the Hill, and their community. He got involved 

with Team Rubicon doing disaster relief programs. He got involved 

with Ride to Recovery riding bikes, and that was great for him to 

be able to heal but it was also great for him to be there to help 

his brothers and sisters heal. The problem, you know, for whatever 

reason when a person decides to take their life, they have given up 

hope. So what do you do about that? And Clay could do everything. 

He could go on these, you know, on these missions, and he could 

do one-week bike rides. But what got him was being alone, in his 

apartment, by himself, hopeless. And there is questions and matters of faith there, but it is a community approach. People need to 

come to government and volunteer organizations. Partner. No one 

organization, not even the government, can do it all. And everybody 

needs to realize that and come together and take care of these 

folks. 

Mr. BILIRAKIS. Thank you so very much. I yield back, Mr. Chairman. 

The CHAIRMAN. Mr. Jolly, you are recognized for five minutes. 

Mr. JOLLY. Thank you, Mr. Chairman. I want to associate myself 

with the comments of Mr. Bilirakis and Ms. Titus about alternative 

therapies. I think we know they work. Clearly they do. And Mrs. 

Somers, I appreciate your comment about evidence-based. I am not 

a doctor but I have seen evidence that non-drug therapies work. 

And to me that is good enough, and if it is good enough for the veteran, it should be good enough for the VA. 

I want to talk a little bit about the VA acknowledgment of nondrug therapies and your experience with that, understanding every 

case is going to be different. I hosted a VA intake day recently. We 


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had about 300 people come through my congressional office in the 

district. One man brought a backpack that he turned upside down 

on my desk and he dumped out surplus medications, dozens and 

dozens and dozens of bottles of them. Sergeant, you referred to 

your cocktail going from 11 drugs to 14. Mrs. Selke, I think you expressed some concerns about Ambien. The Somers have expressed 

concerns about the use of generics and otherwise. Just on its face, 

do you lack confidence in the way that VA administers pharmaceuticals? Not on the merits of pharmaceuticals, but in the experience of pharmaceutical use as administered and directed by the 

VA? 

Mrs. SELKE. I mean, I will speak to that. I spoke earlier about 

the difficulty of Clay getting a prescription refilled. But what has 

been said before, in the private world if I go to a doctor and they 

determine I need Synthroid for my low thyroid issue, I got and I 

get Synthroid and I stay on Synthroid as long as I am retested and 

that is shown to be effective. I do not understand why the DoD and 

the VA have two different pharmaceutical programs and the veteran has to suffer the consequences when you separate from the 

service and move to VA, especially on mental health drugs. You 

cannot swap them out and stop cold and all of that. Or even on 

anything physical. It makes no sense to me. I do not understand 

why one system would not work for both. Why not whatever works 

for DoD as far as pharmaceutical medications or anything, why 

does the VA have to be different? It sounds to me like it is a cost 

factor. 

Mr. JOLLY. And I—— 

Mrs. SELKE. We have to shift to the cheaper route. Well we have 

people dying everyday because we have switched to the cheaper 

route. 

Mr. JOLLY. And I ask, and I realize very much this is just a matter of personal impression and not clinical. But my concern having 

heard each of your stories is that simply because of the volume of 

patients, that million-plus volume of mental health patients, the 

21,000 employees, you have raised concern about personalized care. 

And it would seem to me there is, that is clearly lacking. I do not 

know what your impressions would be? If you could speak to that? 

And also, simply whether or not alternative therapies have ever, 

did your sons have that discussed perhaps? Or Sergeant, in your 

counseling the ability to get alternative therapy? And I say that 

based on a personal experience as well. At VA intake day I had a 

man in my office who said, ‘‘Equine therapy works.’’ Well that was 

good enough for me. But it was not good enough for the VA. So can 

you speak to any discussions about alternative therapies, availability of, your opinions to that? 

Sergeant RENSCHLER. Yes, sir. So again within the VA medical 

center they had at one point in time available to polytrauma patients or those who suffered from comorbid conditions, we were 

able to access recreational therapy and I was put on a six-month 

waiting list. And when the six months came up they lost the recreational therapist, so that was my only experience there. I never 

had a chance to engage in that because I was downgraded from 

polytrauma care when the VA determined that my Traumatic 

Brain Injury had reached a plateau of recovery and it probably 


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would get better. That is a completely separate hearing day. But 

as far as the efficacy of alternative therapies, I mean we could, 

again, it is, it really helps. And the VA currently—— 

Mr. JOLLY. The availability? 

Sergeant RENSCHLER. The availability is not there through VA 

channels. It is private community, is where you have to go. 

Mr. JOLLY. All right. Dr. and Mrs. Somers., do you—— 

Mrs. SOMERS. Yes, I would agree with that, that it is. Daniel 

himself was a musician so it was easy for him. He got a piano and 

a guitar and that was his therapy. But I would totally agree with 

that. At the San Diego VA I know they have pottery classes, which 

we were thrilled to hear about, and a guitar program. 

Dr. SOMERS. And when you talk about evidence-based it is certainly not just medications. I mean, there are these psychological 

treatments that are out there but they are only using two of them 

at this time when there are so many other potentials out there. 

And the other thing that we had mentioned was the MDMA ecstasy and LSD for pain, the MDMA for PTSD and LSD for pain. 

And because of our national phobias against these particular 

chemicals, we are making it very difficult to do trials with these 

potential, potential benefits. 

Mr. JOLLY. All right. Thank you very much. Thank you to each 

of you. Mr. Chairman, I yield back. 

The CHAIRMAN. Thank you very much, members. We thank the 

witnesses for participating. Whether or not you know it, you have 

been at that table for three hours. And we are very thankful that 

you have been willing to share your stories with us. So with that, 

thank you very much, and you are excused. 

Members, what we have done is we have asked the second and 

third panels to combine together. So we will have them appear at 

the witness table together instead of having a second and third 

separate panel. So I would like to invite the witnesses to please 

come forward. 

Joining us at the table will be from VA Dr. Maureen McCarthy, 

Deputy Chief Patient Care Service Officer. She will have Dr. David 

Carroll, the Acting Deputy Chief Consultant for Specialty Mental 

Health with her at the table. Our third panel includes Alex Nicholson, the Legislative Director for the Iraq and Afghanistan Veterans 

of America; Lieutenant General Martin Steele, the Associate Vice 

President for the Veterans Research, the Executive Director of 

Military Partnerships and the Co-Chair of the Veterans Reintegration Steering Committee for the University of South Florida; also 

Warren Goldstein, the Assistant Director for TBI and PTSD programs for the American Legion’s National Veterans Affairs and Rehabilitation Commission; and Dr. Jonathan Sherin, the Chief Executive Officer and Executive Vice President for Military Communities for Volunteers of America. Thank you all for being here. And 

Dr. McCarthy, you are recognized for your opening statement. 

STATEMENT OF DR. MAUREEN MCCARTHY 

Dr. MCCARTHY. Thank you. Good morning, Chairman Miller, 

Ranking Member Michaud, and members of the committee. I appreciate the opportunity to discuss the Department of Veterans AfVerDate Aug 31 2005 14:28 Mar 25, 2015 Jkt 000000 PO 00000 Frm 00052 Fmt 6633 Sfmt 6633 Y:\89378.XXX PAT

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fairs mental health care and services for our nation’s veterans. I 

am accompanied today by Dr. David Carroll, Acting Deputy Chief 

Consultant, as you mentioned; and Dr. Harold Kudler, our Acting 

Chief Consultant for Mental Health; and Mr. Michael Fisher, from 

the Readjustment Counseling Services have joined us as well. 

Let me begin by expressing my sorrow and regret to the families 

of Daniel, Clay and Brian. I want to thank you for coming forward 

and telling your story and their stories. We truly believe that one 

death by suicide is one too many. Thank you, Joshua, as well for 

sharing your experiences. Veterans who reach out for help deserve 

to receive that help. A veteran in emotional distress deserves to 

find there are no wrong doors in seeking help. In VA we must ensure those doors are swiftly opened, calls are returned, messages 

are responded to promptly, efficiently, and compassionately. 

Over one million veterans, servicemembers, and their family 

members have called our crisis line and received help. Suicide rates 

among those who are VA users who have a mental health diagnosis 

have decreased. The rates of suicide following a suicide attempt 

have likewise decreased. We invite veterans to entrust their care 

to us and we want to ensure them that we can provide them the 

care they need or connect them with someone else who can. 

Tragically it is true that about 22 veterans per day die of suicide. 

But another tragedy is five of those 22 veterans are veterans who 

have been in our care. We acknowledge that we have more work 

to do and we are fully committed to fixing the problems we face in 

order to better serve veterans. 

Our actions include the deployment of mobile Vet Centers with 

locations with the greatest challenges in providing timely mental 

health care. Examples include El Paso and Phoenix. We have 

begun a program to ensure veterans waiting more than 30 days for 

care may receive mental health care in the community from providers who are not VA employees. We have removed access measures but not expectations about access and are focusing on veteran 

satisfaction with the timeliness of care they have received. We have 

initiated Operation SAVE, a training program for suicide prevention delivered by our suicide prevention coordinators to VHA and 

VBA staff. We have provided suicide risk management training to 

clinicians. This is a VA-mandated training for all VA clinical staff 

which teaches about assessment, warning signs, risks, means restriction, and safety plans. And we have developed a web based 

training for clinicians specifically focusing on women veterans who 

are struggling with suicidal thoughts about how to recognize their 

distress and bring them into treatment. 

Our actions taken to meet the increasing demands for mental 

health care include the addition of over 2,400 mental health professionals and 915 peer support providers since March of 2012. We 

have expanded the Veteran Crisis Line services, renamed it from 

a suicide line to a crisis line to reach out specifically to those in 

crisis or not quite yet in crisis, and offer both text messaging and 

an online chat service in addition to receiving phone calls. We have 

partnered with the Vet Center Combat Call Center to respond to 

veterans in distress. We have greatly expanded opportunities to access mental health, including in rural areas, by telemedicine. We 

have developed mobile apps to assist veterans with their sympVerDate Aug 31 2005 14:28 Mar 25, 2015 Jkt 000000 PO 00000 Frm 00053 Fmt 6633 Sfmt 6633 Y:\89378.XXX PAT

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toms. We have developed an addition focus on improving and coordinating with care in the community for those who may not seek 

our help. We have trained community providers on military culture 

and partnered in community engagement. We have partnered with 

the Department of Defense in developing clinical practice guidelines for suicide risk assessments and intervention, and for the care 

of PTSD, depression, and substance abuse. We also reach out to 

Guard and Reserves at demobilization events to bridge the gaps in 

understanding about benefits and services. We have greatly expanded the provision of evidence-based treatments, including 

psychotherapies for mental health conditions. VA is committed to 

working with families and friends of veterans. 

We know mental health outcomes improve when families are involved in care. We now have a family services continuum that includes family education, consultation, psychoeducation and marriage and family counseling, and research remains underway to address improvement of mental health care and prevention of suicide. 

To maximize what we can provide, we have developed measures of 

provider productivity, integrated mental health care into primary 

care settings and initiated several campaigns to break down any 

barriers or stigmas that may be associated with seeking help. 

We have developed a program on college campuses where student veterans may receive needed mental health care without leaving the campus. 

Mr. Chairman, we are fully committed to ensuring accessible 

mental health care of the highest quality for our servicemembers 

and veterans who have sacrificed so much on our behalf. We are 

committed in our efforts to decrease suicide by decreasing risks we 

can identify and focusing meanwhile on improving the quality of 

life for these veterans. VA will continue to provide care in a veteran-centered manner, expanding access and breaking down barriers associated with seeking help. We are compassionately committed to serve who have served making it easier for them to ask 

for and receive the help they need. 

Mr. Chairman, this concludes my testimony. My colleagues and 

I are prepared to answer your questions as the panel proceeds. 

[THE PREPARED STATEMENT OF DR. MAUREEN MCCARTHY APPEARS

IN THE APPENDIX] 

The CHAIRMAN. Mr. Nicholson, you are recognized. 

STATEMENT OF ALEX NICHOLSON 

Mr. NICHOLSON. Thank you, Mr. Chairman, Ranking Member 

Michaud, and Members of the Committee. On behalf of the Iraq 

and Afghanistan Veterans of America, we really appreciate the opportunity to share with you our views and recommendations recommending mental health access at the VA and suicide prevention efforts. 

Combatting veteran suicide is IAVA’s top priority for 2014 and 

it is a critically important issue that affects the lives of tens of 

thousands of servicemembers and veterans, especially of the wars 

of Iraq and Afghanistan. In IAVA’s 2014 member survey, our members listed suicide prevention and mental health care as the number one issue facing our generation of veterans. In that same surVerDate Aug 31 2005 14:28 Mar 25, 2015 Jkt 000000 PO 00000 Frm 00054 Fmt 6633 Sfmt 6633 Y:\89378.XXX PAT

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vey that was just conducted in February and March of this year, 

47 percent of respondents reported that they knew an Iraq or Afghanistan veteran who had attempted suicide and over 40 percent 

knew and Iraq and Afghanistan veteran who had died by suicide. 

We have over 270,000 members. Forty percent of them know someone who is a fellow veteran of Iraq and Afghanistan who has died 

already by suicide. 

In response to the overwhelming need for action, IAVA launched 

the campaign to combat suicide this year which includes a call to 

pass comprehensive legislation that can serve as a cornerstone for 

additional efforts across government and across the country. In addition to legislation, IAVA is calling on President Obama to issue 

an Executive Order to address additional aspects of suicide prevention efforts and IAVA is working to connect more than one million 

veterans this year with mental health services across the country. 

The need to examine mental health services and suicide prevention efforts provided to veterans is even more critical in light of the 

recent VA scheduling crisis. In addition to the general delayed access to care that veterans are experiencing, as I am sure all of you 

know, investigations have also uncovered cases of significantly delayed access specifically to mental health care. While no veteran 

should have to wait months for a medical appointment of any kind, 

veterans utilizing mental health care services and especially those 

who are in crisis should never had to wait an unreasonable amount 

of time to be seen by a mental health care provider. Providing 

timely and efficient mental health care must be a much greater priority for the VA moving forward. 

Increasing the accessibility of mental health services must also 

be coupled with increasing access to care for vulnerable populations 

of veterans currently excluded from VA care. Between 2001 and 

2011, an estimated 30,000 servicemembers may have received a 

downgraded discharge characterization due to a misdiagnosis of 

personality disorder. Even more troubling, an unknown number of 

servicemembers were punitively discharged for disciplinary actions 

that may have been connected to an undiagnosed mental health injury. It is imperative that the thousands of individuals with such 

experiences are identified and their records are properly re-evaluated and rectified in order to provide access to earned VA mental 

health services and benefits. 

Examining access to care should also include a review of the current five-year special combat eligibility for VA health care provided 

to recently transitioned veterans. The five-year time period may 

not be enough time for veterans who present with mental health 

injuries symptoms later or who might delay care due to concerns 

with stigma of seeking care. Extending special combat eligibility, 

though it may be costly, will provide access to care for veterans 

when they are ready to seek it. It is important to recognize the efforts the VA has put into mental health services and suicide prevention programs in recent years, and especially, as has been mentioned already, the Veterans Crisis Line has been an enormous resource for our community and the VA has done a terrific job of promoting that and we have been happy to partner with them in helping them promote that, disseminate that, and we refer veterans in 

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ferral Program every single day. It has been a fantastic resource, 

but more, of course, needs to be done. Increasing access to care, 

meeting the demand of that care, and providing high-quality care 

with continuity and responding to veterans in crisis requires a comprehensive approach, and while there is no illusion that veteran 

suicide will be completely eradicated, implementing better approaches to mental health care and suicide prevention can and does 

save lives. 

Again, we appreciate the opportunity to share our views on this 

topic and we look forward to continuing to work with each of you 

and your staff and the Committee to improve the lives of veterans 

and their families. Thank you. 

[THE PREPARED STATEMENT OF ALEX NICHOLSON APPEARS IN THE

APPENDIX] 

The CHAIRMAN. Thank you, Mr. Nicholson. 

Now, General Steele, who is the co-chair of the Veterans Reintegration Steering Committee at the University of South Florida, 

you are now recognized for five minutes. 

STATEMENT OF GENERAL MARTIN R. STEELE 

Lieutenant General STEELE. Thank you, sir. 

Chairman Miller, Ranking Member Michaud, distinguished 

Members of the Committee, on behalf of the University of South 

Florida, thank you for holding today’s oversight hearing. By way of 

a brief background, the University of South Florida is a global research university with over 47,000 students, including over 2,200 

veterans and their families. Military Times EDGE magazine recently ranked USF the fifth best college for being veteran-friendly 

in the United States out of 4,000 colleges and universities. 

Under the leadership of our president, Dr. Judy Genshaft and 

our Senior Vice President for Research and Innovation, Dr. Paul 

Sandberg, numerous USF researchers are currently involved in 

funded studies related to such topics as: suicide prevention, traumatic brain injury, post-traumatic stress, robotics and prosthetics, 

speech pathology and audiology, gait and balance, and age-related 

disorders. We have numerous research and health care partnerships through affiliation agreements to include the James A. Haley 

Veterans Hospital, the largest polytrauma center in the VA system, 

along with the C.W. Bill Young VA Medical Center, number four 

in the system, located in St. Petersburg. We have memorandums 

of understanding with United States Central Command, U.S. Special Operations Command, and work closely with MacDill Air Force 

Base and the Pentagon. 

Our Veterans Research Reintegration Steering Committee consists of scientists from throughout USF’s faculty, staff, and students who work with veterans, along with representatives from the 

Veterans Administration, the Care Coalition of Special Operations 

Command and Draper Laboratories. We have a holistic approach in 

regards to education to provide services to our veterans and their 

families. 

In order to address the mental health needs of our veterans and 

our diverse population of at-risk students, we have embarked on a 

Collaborative Suicide Prevention Project. This is a three-year iniVerDate Aug 31 2005 14:28 Mar 25, 2015 Jkt 000000 PO 00000 Frm 00056 Fmt 6633 Sfmt 6633 Y:\89378.XXX PAT

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tiative funded by a $306,000 grant from the Substance Abuse and 

Mental Health Services Administration, SAMHSA. Some of the 

goals and measurable objectives of this project are to increase the 

number of persons involved in suicide-prevention efforts, reduce the 

stigma associated with it and the barriers, and increase family involvement in suicide prevention. 

As you are aware, the Blue Ribbon Panel of the VA Mecical 

School Affiliations was established in 2006 to look at quote, ‘‘A 

comprehensive philosophical framework to enhance VA’s partnerships with medical schools and affiliated institutions,’’ unquote. 

The panel believed that the crisis in the U.S. Health Care System 

offered a unique opportunity to explore fundamentally new and 

better models of patient care, education and research. As the panel 

revealed, currently available mechanisms for meaningful dialogue 

between the VA and academic community were inadequate. Some 

of the major challenges include credentialing, as was mentioned 

earlier, which requires considerable time, along with the research 

approval process, which is cumbersome, very time-consuming for 

both parties. The process takes months, and in some cases can take 

over a year just for approval. 

There are also many barriers to innovation. One of our professors, has an innovative approach for the treatment of post-traumatic stress and is highly unlikely, we believe, to receive approval 

by the VA health care facility. The protocol known as Accelerated 

Resolution Therapy, or ART for post-traumatic stress, has been 

shown to be effective in published research from the University of 

South Florida, yet the VA has not accepted invitations to collaborate on a pilot study for patients diagnosed with PTS. We do work 

with the Department of Defense. I have been at Fort Belvoir in Virginia and Fort Benning in Georgia and also Special Operations 

Command in Tampa to work with this protocol which has been 

proven very successful. 

We recommend streamlining the credential process and creating 

fast track approvals for collaborative pilot studies between VA and 

University research studies that involve minimal risk to the patients, but could provide significant benefits to treatment of mental 

disorders. We also are recommending developing agreements between the VA system at the national level and academic communities throughout the country. We also believe the very definition 

of academic affiliates needs to be re-examined to move beyond the 

limited focus on health care to a much more encompassing venue 

which would include employment, education, business development, 

enhanced use/lease relationships, and increased researched funding. 

In 2012, a VA research scientist from USF, along with a research 

scientist from the medical research service at James Haley, conducted a pre-clinical animal research linking post-traumatic stress, 

mild TBI, and the potential for suicides in the military. We believe 

their research needs to be extended to learn more about how the 

brain is affected by physical and emotional trauma. More importantly, we believe this type of animal research will lead to more effective treatments for post-traumatic stress and TBI, which will potentially reduce the risk of suicide in our military and veteran population and could be influential in alternative drug protocols. 


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The 2006 blue ribbon panel also noted, with concern, the aging 

VA’s research infrastructure. The panel recommended that VA enhance its research facilities by fully exploiting opportunities to 

share core resources with its academic affiliates. To that end, the 

University of South Florida recommends strong consideration of 

the development of a singular, unique, one-of-a-kind research and 

clinical outpatient treatment facility. This initiative is intended to 

be a collaborative venture between the Department of Defense, the 

Veterans Administration and USF in order to meet the health and 

welfare needs of our veterans and their families. 

USF remains committed to providing the nexus to foster research 

collaborations in pursuit of excellence in the rehabilitation, adjustment, resilience, and reintegration of wounded warriors and their 

families into civilian life. Our nation’s dedicated heroes, from all 

wars, deserve to have the benefit of the best research and services 

available in order to return to productive lives and members of our 

society with jobs and homes for the sacrifices that they and their 

families have made for our country. 

Thank you, again, for holding this hearing and the opportunity 

that I have to submit this testimony, sir. 

[THE PREPARED STATEMENT OF GENERAL MARTIN R. STEELE AP- PEARS IN THE APPENDIX]

The CHAIRMAN. Thank you, General. 

Mr. Goldstein, you are recognized for five minutes. 

STATEMENT OF WARREN GOLDSTEIN 

Mr. GOLDSTEIN. Thank you, Mr. Chairman. 

Every day in America 82 people take their own life. That is one 

every 17 and a half minutes. Since this hearing began over three 

hours ago, statistically, 12 people have chosen to end their life with 

suicide. One in four suicides is a veteran. Twenty-six percent of 

suicides are veterans and veterans only make up seven percent of 

the population. 

The stakes could not be higher. We must find a solution to this 

problem. Chairman Miller, Ranking Member Michaud, and Members of the Committee, on behalf of our National Commander, Dan 

Dellinger, and the 2.4 million members of The American Legion, I 

thank you for taking one of the most serious challenges facing 

America’s veterans: finding solutions for this mental health crisis. 

The mental health of veterans is something that The American 

Legion takes very seriously. The American Legion established a 

committee on TBI and PTSD in 2010 because of growing concerns 

of the unprecedented numbers of veterans returning home with 

what has come to be called the signature wounds of the war on terror. Since then, Legion staff, alone with senior leadership has met 

regularly with academia, medical consultants, experts in the field 

of mental health and brain science. We published the findings of 

our comprehensive three-year study of veterans, their treatments 

and therapies, in a report called The War Within, which is also 

available on our American Legion website. 

Following up on that report, we recently conducted an on line 

survey to evaluate the efficacy and availability of treatments and 

what we found was somewhat disturbing. The result of the survey, 


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conducted in coordination with the Data Recognition Corporation, 

showed that nearly a third of veterans surveyed had terminated 

their treatment plans before completion and that almost 60 percent 

of veterans reported no improvement or feeling worse after having 

undergone treatment. 

Clearly, there are problems with the current practice in place. 

The American Legion convened a symposium last month to discuss 

these findings and highlight other areas where complimentary and 

alternative treatments could prove helpful. We listened and saw 

firsthand the encouraging results for veterans who had benefitted 

from animal therapies with service dogs, art therapies, acupuncture, and a host of other non-traditional treatments. The American 

Legion believes that by exploring options such as these, we can all 

work together to help veterans get the effective treatments they 

need. 

It is devastating when a veteran cannot get timely appointments, 

but 60 percent of veterans reporting no change or worsening symptoms after treatment means that what care they are getting is just 

as important as whether or not they can access the care in the first 

place. This is not to say that access does not matter. Indeed, over 

the past several months. The difficulties veterans face, access to 

care, have been front page news and have been a major focus for 

this committee. 

For The American Legion, it wasn’t enough to sit and watch idly 

as veterans struggled to get help; we had to go do something about 

it. That is why The American Legion developed Veterans Crisis 

Command Centers that have been deployed across the country, and 

specifically where it had been reported that veterans were being 

stonewalled while trying to seek care. By utilizing American Legion 

posts already located in every community in America, The American Legion has combined town hall meetings and coordination of 

care for veterans so they can get the immediate counseling and 

medical help they have earned and desperately need without getting in the way of VA’s on-going efforts. 

We are there to assist VA’s efforts and to be a force multiplier. 

So far, Phoenix, Arizona; El Paso, Texas; and Fayetteville, North 

Carolina, we have been able to reach nearly 2,000 veterans and 

next week we will expand operations to two new locations in St. 

Louis, Missouri and Fort Collins, Colorado, with more locations to 

follow as we try to get help to veterans. 

Yes, there are things VA should be doing to ensure veterans in 

crisis get the help they need, but we now see that our veterans 

can’t just depend on VA to fix the problem, that is why The American Legion has full-time staff and a leadership committee dedicated to studying the challenges of mental health treatments to ensure the way America treats veterans is a way that will bring real 

improvements to their lives. And that is why legionnaires, veterans, VA, and local businesses across the country are supporting 

our Veterans Crisis Command Centers and donating their time and 

efforts to link the veterans with the resources they need. 

By the time this panel finishes our opening remarks, America 

will have lost another person to suicide. That is a terrible tragedy. 

We all have to work together to ensure that this rate cannot and 

will not continue. Thank you. 


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[THE PREPARED STATEMENT OF WARREN GOLDSTEIN APPEARS IN

THE APPENDIX] 

The CHAIRMAN. Thank you. 

Dr. Sherin, you are recognized. 

STATEMENT OF DR. JONATHAN SHERIN 

Dr. SHERIN. Thank you. Thank you Chairman Miller, thank you 

Mr. Michaud, and Committee for convening today and for inviting 

me to today. 

My name is John Sherin. I am a psychiatrist and neurobiologist 

by trade and currently serve as the executive vice president for 

military communities and chief medical officer at Volunteers of 

America. While I am not a veteran, my life’s calling has been to 

serve veterans. Having worked for a decade at VA as a psychiatrist 

and chief of mental health prior to joining VOA, I have been able 

to observe the VA from both the inside and out. This experience 

has given me a unique perspective as to the nature of access problems facing veterans and possible solutions. 

In general, I contend that the most immediate solutions reside 

in growing capacity through more robust partnerships between VA 

and local communities. Working alongside VA last year, VOA supported and housed more than 10,000 homeless veterans, a number 

that will increase this year. Though significant, the opportunity for 

impact in partnership with VA is much larger and can include 

helping veterans at risk of watching their unmet needs become urgent problems that evolve into health crises due to inadequate access. The VA has a golden opportunity to lead this effort right now 

by leveraging organizations like VOA to grow capacity and improve 

access. 

In contemplating partnership strategies, it is important to recognize that access barriers go way beyond wait times. Red flags in 

isolation and inadequate knowledge of available resources and unwillingness to engage in the help-seeking process, difficulty navigating complex systems and lack of care coordination all impact access. Recognizing this array of access barriers, VOA has developed 

the Battle-Buddy-Bridge program, a program rooted in trust and 

designed to mitigate access barriers through real time, peer-to-peer 

engagement and local resource navigation. 

Peer approaches, which are used by other organizations, including the Augusta Warrior Project, Team Red, White & Blue, IAVA, 

The Mission Continues, Team Rubicon, and others, transform the 

access dynamic in many cases. As such, it is my first recommendation that community-based peer-engagement and navigation programs be brought to scale with federal support as part of all out 

assault on access barriers at the VA and beyond. Leveraging this 

model further, my second recommendation is for the VA and the 

private sector to set up rally points in communities, as well as on 

VA campuses that are endowed with trained peers, vehicles, resource maps, and tightly linked to VA’s Suicide Prevention Program, the national crisis hotline, 2–1–1 exchanges, tech-based veteran community portals such as POS REP, and any other referral 

sources of relevance. Rally point networks could have a profound 

impact on access in any geography. 


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As a final point, I want to highlight a major partnership success 

story, the Supportive Services for Veteran Families Program of the 

VA. This program administered by VA’s National Center for Homelessness Among Veterans has fostered relationships between VA 

and communities that are unprecedented. In the opinion of many 

experts in both the community and the VA, the streamlined structure of SSVF offers the best means for managing partnerships 

going forward. 

As such, my third and final recommendation for resolving mental 

health access issues and improving suicide prevention going forward is for the VA to adopt an SSVF-like mechanism as the basic 

template for VA to use in developing more robust relationships. By 

using this mechanism, VA can most effectively leverage partners to 

create community-driven programs that improve access to the vast 

array of resources which address mental health conditions. 

To close, more robust partnership between the VA and community will not only help veterans enrolled in VA to get better access, 

it may also help veterans—it may also help provide access to veterans who refuse to enroll in the VA, as well as veterans who are 

located in remote areas. Let’s all take advantage of recent findings 

at VA and recognize that while inadequate access to care in the 

veteran population reflects the shortcomings of a federal agency, it 

also reflects the fundamental failure of the American community 

and process. 

It is time to roll out a new era of public, private partnership that 

grows capacity and ensures veterans have access to the resources 

they need for successful community reintegration. 

[THE PREPARED STATEMENT OF DR. JONATHAN SHERIN APPEARS IN

THE APPENDIX] 

The CHAIRMAN. Thank you very much, Doctor. 

Dr. MCCARTHY., On Tuesday evening this committee heard from 

a whistleblower that was a former chief of psychiatry at the St. 

Louis VA Medical Center. Are you aware of his testimony? 

Dr. MCCARTHY. I am aware of it, yes, sir. 

The CHAIRMAN. Okay. He stated he could not identify, within his 

clinic, the average number of patients that are seen by provider per 

day or the time a provider spends on direct patient care per day. 

When he asked other psychiatry chiefs to estimate similar data at 

their facilities, he received answers that ranged from 8 to 16 veterans per psychiatrist per day. 

When he worked with a VA database administrator and his outpatient psychiatry director, he said he was shocked to find that 

outpatient psychiatrists at the St. Louis VA were only seeing on 

average six veterans within eight hours for 30 minute appointments. There were only three 60 minute appointments of those 

each week and he could only account for three and one half hours 

of work during an eight-hour day. 

So, as we have already heard people talk about a nationwide 

shortage of mental health providers, do you feel that the utilization 

of staff at VA is appropriate? 

Dr. MCCARTHY. Sir, that is why we have what is called the 

SPARQ tool. This is something that has been developed as part of 

our physician productivity model. We can look at psychiatrists—— 


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The CHAIRMAN. I am sorry, my question is: Do you think that 

utilization of staff at this level is appropriate? 

Dr. MCCARTHY. I do not believe that what you said is an appropriate way to use staff; however, I have data that supports that 

that may not be the full story. 

The CHAIRMAN. Do you know what the mental health staffing is 

and productivity requirements throughout the system? 

Dr. MCCARTHY. I know the model, which is in terms of the number of psychiatrists and given population of veterans—— 

The CHAIRMAN. Whose model? 

Dr. MCCARTHY. It is our model, sir. 

The CHAIRMAN. VA’s model? 

Dr. MCCARTHY. Yes, sir. 

The CHAIRMAN. Should we be using what VA wants now or 

should we be looking outside of VA? 

Dr. MCCARTHY. It seems like there may not be a right answer 

to your question, but I can tell you why the model developed. It is 

a team-based model of care—— 

The CHAIRMAN. From VA? 

Dr. MCCARTHY. Yes, sir. 

The CHAIRMAN. Okay. 

Dr. MCCARTHY. And—— 

The CHAIRMAN. Do you know what the health staffing and productivity requirements are throughout the system? 

Dr. MCCARTHY. We have a quadrant-type model which looks at 

productivity and other measures to determine if we are staffing appropriately. 

The CHAIRMAN. Do you know what the standard is? 

Dr. MCCARTHY. Okay. Help me understand. 

Are you asking how many work RVUs per physician, per day— 

is that the kind of question that you would like me to answer? 

The CHAIRMAN. I guess that is good enough. 

Dr. MCCARTHY. Okay. 

The CHAIRMAN. Do you? 

Dr. MCCARTHY. I don’t have the exact expectations of the—— 

The CHAIRMAN. The other question is: Is VA meeting the standards? 

Dr. MCCARTHY. Sir, I can answer that question. If we look at our 

work value units compared to the national average for physicians 

who are psychiatrists, as well as psychologists, we are meeting the 

national average for productivity according to that standard. 

The CHAIRMAN. According to whose numbers? Are those numbers 

that VA establishes or—— 

Dr. MCCARTHY. No, they are external. 

The CHAIRMAN. No, no, I am talking about internal numbers. 

Dr. MCCARTHY. Okay. 

The CHAIRMAN. Are your folks reporting the truthful number? 

Dr. MCCARTHY. Sir, what that model is based on is the actual encounters that occur. 

The CHAIRMAN. No, no. Are your folks telling the truth? 

Dr. MCCARTHY. Yes, sir. 

The CHAIRMAN. Everywhere? 


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Dr. MCCARTHY. I can’t answer a question like that, sir. But 

about the model, I can tell you that the numbers are driven from 

a system that couldn’t be manipulated. 

The CHAIRMAN. Based on what we have seen over the past three 

or four months, do you trust the numbers that people are giving? 

Dr. MCCARTHY. If you ask me about access numbers, I don’t, and 

I think there has been evidence before this committee that shows 

that access numbers are not reliable. 

The CHAIRMAN. And so—but you think the other numbers are reliable? 

Dr. MCCARTHY. There are some numbers that are reliable, yes, 

sir. I have been looking for numbers that we can try and understand measures of our access and timeliness of care and we have, 

for instance, numbers of consults that—— 

The CHAIRMAN. Let me ask you a better question: Would you bet 

your life that the numbers that people give you are truthful? 

Dr. MCCARTHY. I am sorry, sir. Are you talking about numbers 

related to productivity? 

The CHAIRMAN. I don’t care what the number is. Would you bet 

your life on any number that somebody gives you as a truthful 

number because we just had a panel of witnesses who have lost 

their children. They lost their lives. 

Now I am asking you: Would you bet your life that the information that people are telling you is truthful? 

Dr. MCCARTHY. Sir, I would not. I would not bet my life—— 

The CHAIRMAN. That is all I need to hear. 

Dr. MCCARTHY. [continuing]. That the access numbers that you 

received are truthful. 

The CHAIRMAN. That is all I need to hear. Thank you very much. 

Mr. Michaud. 

Mr. MICHAUD. Thank you very much, Mr. Chairman. 

Dr. MCCARTHY., we heard an earlier panel issue dealing with 

HIPAA. My question as it relates to HIPAA is in the department 

and I actually did find the OIG report and I heard that the Veterans Health Administration and the Veterans Benefit Administration could not exchange information because of HIPAA problems. I 

mean they both work for the same department, so I am not sure 

why there would be any HIPAA problems with VHA talking to 

VBA. 

My question is—is the recommendation from the OIG back in 

2011 was that the VA medical center directors and VBA directors 

will meet monthly; they meet monthly and they will discuss this 

issue—had that issue about any HIPAA problems been resolved between VHA and VBA, do you know what would the outcome of that 

is; if not, could you get back to the Committee? 

Dr. MCCARTHY. I would be happy to take that one for the record, 

sir. I can give you an example. 

For instance, if I were to do a C&P (compensation & pension) 

exam on a patient, that is considered—it is not considered a VHA 

document; it is concerned owned by the veteran or by the VBA, so 

that is not something that VHA releases. There are some separations that are aimed at protecting veterans. 

Mr. MICHAUD. But if both VBA and VHA works for the Department of Veterans Affairs—— 


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Dr. MCCARTHY. Yes, sir? 

Mr. MICHAUD [continuing]. So I am not sure why there would be 

any HIPAA problems between VBA and VHA. So, yeah, if you 

could get back on that, I would appreciate it. 

Dr. SHERIN. I agree with you that VA can’t do it alone. What has 

been your experience with trying to partner with the VA to provide 

the service to, you know, in the communities, and have there been 

different, you know, outcomes depending on what region VOA has 

been around the country—involved in? 

Dr. SHERIN. That is a great question. I do believe there is variability, and getting back to my final point, I think that it is important that we look to the VA to develop a consistent mechanism that 

is responsive and that program that I have described, which I am 

sure you are familiar with, SSVF, is one that is very responsive 

and very effective. 

The bigger question, as I see it: What is VHA’s mission? Is VHA’s 

mission to deal with all reintegration problems? And I would say 

probably not, because so much is trying to stream through VHA to 

deal with reintegration issues outside of health care, it has created 

a strain on the system and has diluted its primary mission of providing outstanding health care, including mental health services. 

Mr. MICHAUD. Thank you. 

Getting back to the VA, as you—I noted in your opening remarks that VA’s spending on mental health is approaching $7 billion dollars, double the amount in 2007. What is the VA’s—what is VA 

using as a measure of success of this investment in mental health 

services? 

Mr. CARROLL. Thank you, Congressman. 

There is no single measure that we point to that is going to satisfactorily answer that question and certainly what we have heard 

today, what we have heard over the past few weeks points to the 

fact that VA has a lot more to do. At the end of the day, what matters most is whether or not we have met the needs to the individual veteran who presented himself or herself for VA mental 

health care, whether we have addressed those needs at the time 

they came in today and whether they left better off or with a clear 

plan of things that they could do to move forward. That is the ultimate outcome of our care and it has to be addressed and assessed 

for each individual at each time of care. 

I think we can point to some things in our system. We know that 

over the last seven years, there have been 37,000 rescues or saves 

that have been facilitated through the Veterans Crisis Line. On the 

one hand, that is a remarkable number and on the other hand, it 

is not enough and we know that. We can look to veterans with serious mental illness and we can look to our Mental Health Intensive 

Case Management Program and we know that they are able to live 

in the community of their choice, to find employment, and to stay 

out of the hospital. We know that when veterans drop out of care 

with serious mental illness, we can successfully re-engage them in 

care. There are multiple other examples, but I think at the end of 

the day, it is the individual veteran and whether or not we have 

addressed their needs today is the ultimate test. 

Mr. MICHAUD. Thank you. I yield. 

The CHAIRMAN. Dr. Roe. 


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Dr. ROE. Thank you, Mr. Chairman, and thank the panel for 

being here. I want to go ahead and continue along the line for just 

a moment the chairman did. 

Dr. Matthews, in the St. Louis VA, six percent of the veterans 

did not return for care and then we hear in other testimony today 

that a third of other veterans dropped out of care and 60 percent 

showed no improvement. This is difficult to treat and I understand 

that. It is a very difficult issue and it is very individualized with 

each patient that you see. But how can you explain that kind of 

drop out when these people are lost to follow-up and you don’t 

know what happens to them? Those are the folks that may be 

needing a hotline or the ones that are committing suicide at this 

astounding rate. When you have more veterans committing suicide 

that are diagnose in combat we have a true crisis, so is it—and we 

have added several thousand more providers to the VA during the 

last, I guess, couple of three years. 

Dr. MCCARTHY. Yes, sir. 

Dr. ROE. So how, exactly, in the metric that he was talking 

about, productivity, I don’t really agree with that, that it is meeting 

the same metric because what we found out with these oversight 

and investigation hearings is that time after time after time, the 

VA’s self-analysis is not true. It turns out that when it is investigated by an outside party—what we have been hearing now— 

now, let me tell you how frustrating that is for me to sit up here. 

I expect people, when they come to that dais up there, whether 

they are sworn in or not, to tell the truth, not just to make themselves look good, and that is what we have done. And let me know 

what VA has done, and as a surgeon, you have to have a lot of 

trust to have a patient lie down and let you open them up and operate on them. The VA has lost a tremendous amount of credibility 

and trust and it is going to be very difficult to put that humpty 

dumpty back together again. 

So how can you—what can we do now? That is all in the rearview mirror. How do we go forward, that is what I am asking. 

Dr. MCCARTHY. We do have a lot of work to re-build that trust. 

We absolutely do, and our department is focused on that. Our acting secretary has laid out clear expectations about ways to restore 

that trust. What we can tell you are things like for the veterans 

who seek our care and who have entrusted their mental health 

care to us, for those veterans who are receiving our services, the 

suicide rate is actually going down. For all veterans who seek VA 

care and are enrolled in our care, for all of them, not just the mental health veterans, their rate of suicide is going down. 

We do have some successes and I guess what I want to do is not 

discourage the veterans from reaching out to us who need us. 

Dr. ROE. We don’t want to do that at all. 

Dr. MCCARTHY. We want to get—— 

Dr. ROE. I don’t mean to cut you off, but my time is limited. 

Dr. Sherin, a couple of things that have interested me is that 

there are a lot of programs around, both outside, Not Alone and 

others you have heard of in what you do, how do you make—how 

does the VA help coordinate, because you are right, some veterans 

don’t want to go through and see this—go through this big maze 

of things at the VA, walk into this big building and wind their way 


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around and follow a dotted line to some place. How do you coordinate all of that? 

Dr. SHERIN. That is a great question. There are a number of efforts around the country. One where I live in LA, the Los Angeles 

Veterans Collaborative, which actually brings together roughly 250 

organizations per month, including the VA, with the aim of developing coordinated systems. 

The idea that I share with you, recommendation number two, to 

create rally points, is to get proactive by creating navigation—a 

navigation network that is operated by veterans who can function 

as a surrogate family. We heard the families that were here in the 

first panel talk about the need for a support system, that special 

relationship between the brothers and sisters in the military community. We need to leverage that. That is a way to get information 

from people that are suffering. It is a way to introduce a process 

and content expertise into communities with navigators who engage and then advocate. 

Dr. ROE. One of the things that is in my local community that 

my wife is involved in is The Humane Society. We are finding out 

that veterans sometimes won’t go to the hospital because they 

leave their animal, their dog at home, and they don’t have anyone 

to take care of them because they are alone. And so The Humane 

Society are now taking care of those animals so the veterans can 

go to the VA. It is something that I never thought of. I had no idea 

that that was even going on, that people would not get care because their companion, which is their animal, didn’t have anyone 

to care for them if they went in to seek care. So that is another 

thing that I think one of the great challenges—and I applaud your 

effort for doing that—is that there are a lot of people trying to help 

and there is no question about that, and you will see a renewed 

effort here—is how do we coordinate that? 

And with that, Mr. Chairman, I yield back. 

The CHAIRMAN. Ms. Brownley, you are recognized for five minutes. 

Ms. BROWNLEY. Thank you, Mr. Chairman. 

So, Dr. McCarthy, I wanted to follow up on I think Dr. Roe’s line 

of questioning and you were talking about some of the successes 

that you feel improvements that have been made, and, Dr. Roe was 

talking a lot about trust. I think, you know, one of the issues I 

think for me and the rest of us here is of what data are you working—you know, when you state these successes, what data are you 

looking at and is it, you know, we have heard a lot about bad information and people not telling the truth and so it is hard to believe 

that there are successes, if there are, because I don’t know—I am 

not feeling good about the data of which you would make those conclusions. 

Dr. MCCARTHY. Thank you for asking that. 

We have, in the last few years, been able to obtain data from the 

states, some with the help of the members of this committee. We 

now have suicide data from 48 states that is not VA data that we 

are using to analyze rates of suicide for veterans, including veterans who may not be seeking our care, and so the data that we 

are using include the data that we are getting from the states 

about actual suicides. We often did not hear about veterans even 


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in our care who completed suicides, and so now we have data about 

them, but also other veterans. That data doesn’t go back to 2001, 

but if you start kind of counting in 2001 after 9/11, then that is 

the data that we are following the trends for, ma’am. 

Ms. BROWNLEY. So do you believe that there is a crisis going on 

in the VA and certainly in terms of access to mental health care? 

Dr. MCCARTHY. Absolutely. 

Ms. BROWNLEY. And so what are some of your—what are your 

top three things that you are planning on doing to resolve this crisis? 

Dr. MCCARTHY. Among them are extending hours, partnering 

with care in the community. There has been an increase in funding 

for what we call fee-basis care and our vet center partners have expanded their services and their hours to also provide for care. 

Those are the three major crisis kind of interventions and some of 

that extra hour care has included partnership with The American 

Legion and we are grateful for that. 

Ms. BROWNLEY. So with partnerships, public/private partnerships, I mean I hear over and over and over again that it is very 

difficult to work with the VA and establish those partnerships with 

the community to expand services to our veterans in their communities. So what are you doing to alleviate some of those barriers to 

make it easier to create those partnerships? 

Dr. MCCARTHY. Last year we started these community summits 

which included partnerships with various—they were run locally 

and in the various medical centers. We have reached out to all 

kinds of people of goodwill in the community, people that would 

like to partner with us and they are site-specific. 

Ms. BROWNLEY. Well, reaching out, we have done that in my district where I represent and that is a good first step because quite 

frankly in my area, the VA didn’t even know about all of the services that the communities are providing for our veterans. I think 

now they do, but how are we going to eliminate the barriers, if you 

will, and just in terms of contracts and so forth to actually create 

good public/private partnerships to increase services to veterans? 

Dr. MCCARTHY. So after the summits, there are a series of action 

plans that we have engaged in to address some of the barriers that 

were identified. As far as the access to fee-basis care, we are using 

models of payment for fee-basis care that are traditional models, 

but we are also expanding kind of contracting services that would 

be available. El Paso, for example, has reached out and formed a 

relationship with the practice that provides their inpatient mental 

health care to provide more outpatient mental health care, and 

that is just one example nationwide. 

Ms. BROWNLEY. And what about alternative therapies? We 

talked about that earlier today. Are you looking at partnerships 

with alternative therapies? Equine therapy, I have a great program 

in my district, Reins of Hope, that is a very successful program. 

Veterans are coming from all over the region to utilize this program. It would be great if the VA could partner with programs like 

that. 

Dr. MCCARTHY. And there are programs like that that VA has 

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munity partnerships and the veterans are engaged as part as the 

goodwill of the community involved in helping them. 

Are you asking if every VA should have equine therapy? 

Ms. BROWNLEY. Well, I want to know how we can increase these 

partnerships. I will just use my own exactly—I am really watching 

the clock here; my time has just run out, but I will follow up with 

you on my question. 

The CHAIRMAN. I am glad that you saw that red light. 

Ms. BROWNLEY. I am learning, Mr. Chairman. 

The CHAIRMAN. Mr. Huelskamp, you are recognized. 

Dr. HUELSKAMP. Thank you, Mr. Chairman. 

A question for Dr. McCarthy, following up closely on a few others: What are the waiting times for access to mental health care? 

Dr. MCCARTHY. It is hard to give an actual number, given that 

both the members of this committee and I have said that we are 

not sure that we trust the actual numbers. What we now have, 

though, right on the VA Web site, very transparently, information 

about access. I printed and brought some of that information, but 

what is posted is for every VA medical center, what the new patient mental health average wait time is, the established mental 

health wait time, and then a running average over the last month 

for what that particular wait time has been. 

When we look over the last month, certainly for those, there are 

significant improvements over what they had been before, but—— 

Dr. HUELSKAMP. Ma’am, are those reliable data? 

Dr. MCCARTHY. I believe these are reliable. I would not stake my 

life on it, as Chairman Miller has said, but to my knowledge—— 

Dr. HUELSKAMP. Have they ever been audited by independent entities outside the VA? 

Dr. MCCARTHY. I do not know the answer to that question. I 

would be happy to take that for the record. 

Dr. HUELSKAMP. Well, yeah, I would appreciate that because we 

have heard testimony, the Office of Inspector General on June 9th, 

clearly, data has been manipulated and data has been falsified and 

actually, I think on June 23rd, the VA admitted that their data 

was not reliable and a few minutes later they talked about their 

data and what they could draw from that. 

I agree with most of my colleagues that we don’t know what the 

data is. I mean the epistemological question is: What do we know 

that we know? And right now it is clear, especially the investigations, you know, 70 investigations going on—going after or investigating retaliation against folks that are saying that this data is 

falsified. In particular, I had just one whistleblower in one hospital 

and I had asked the VA what is the range of the workload for doctors across the nation and the total range—the bottom range, I 

found out, according to one whistleblower in only one hospital was 

lower than supposed the national range. And so one independent 

source verified that all the data was inaccurate there. 

So can you tell me what the VA is doing to actually assess and 

verify and authenticate the data so folks on this committee and the 

341,000 employees at the VA can actually say, this is where we are 

heading; this is where we have been; this is how we have improved 

the system. Give me a sense of how the VA is going to actually anVerDate Aug 31 2005 14:28 Mar 25, 2015 Jkt 000000 PO 00000 Frm 00068 Fmt 6633 Sfmt 6633 Y:\89378.XXX PAT

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swer that basic question of how we are going to independently assess the data. 

Dr. MCCARTHY. Our Acting Secretary has talked about not looking at the same kinds of access measures, but instead, looking at 

patient satisfaction with the timeliness of the care that they have 

received as a measure of access and timeliness. As far as these—— 

Dr. HUELSKAMP. And that will all be done—internally handled by 

the VA? I mean who is coming in independently and saying— 

ma’am, I don’t trust the data. You apparently don’t trust your own 

data unless it serves the purpose and I am looking at an IG report 

for 2012 and said the average of 50 days—the average is 50 days 

to receive a full mental health evaluation. 

I would say today that the Office of Inspector General probably 

says, well, we don’t know; we use the data from the VA, and now 

they are telling us today that it is all made up and it could be falsified. And all we are going—and I am like many here, you are 

hearing from constituents is saying well, what you are being told, 

and I heard from a whistleblower who called my office yesterday, 

just wanted to say that what you are being told by the VA is whitewashing the situation in this particular vision because they are falsifying the data and punishing those that make that point. 

So, again, quickly, if you could tell me how you are going to 

prove to me and members of the Committee and the American public that this is our data and this is how we can prove that we are 

improving our performance to meet the needs of our veterans? 

Dr. MCCARTHY. Sir, I believe that there are audits planned, I am 

just not personally familiar with those particular audits, but I do 

invite you or anyone to go to the VA Web site and look at the data 

because you can see it and it is part of our effort at increased 

transparency. I think that looking at how long it took people in the 

last month to get care is—— 

Dr. HUELSKAMP. I can’t believe the data. 

Dr. MCCARTHY. Okay. I—— 

Dr. HUELSKAMP. Because it is not independently verified. It is 

not authenticated. There is no one on the outside. I mean my district is in four different VIZNs and some reports have come out in 

the last couple days of how they double checked. Everything is 

going fine, but I don’t think that they talked to a single veteran, 

and it is not matching up with what the whistleblowers are saying. 

So every time someone from the VA comes to our committee and 

says, Hey, we have got data—it might not be good data, but we 

have got data, I mean it is the old GIGO, garbage in/garbage out, 

and that is what is happening here and we can’t trust that. 

I would suggest that you look at independent authentication, get 

an outside assessment of what is going on at the VA. I know that 

the chairman has been pushing that. I believe that is what needs 

to happen to re-establish trust, and more importantly, to re-establish to make certain that we are getting the care that we claim 

that we are giving to our veterans. 

I yield back, Mr. Chairman. 

The CHAIRMAN. Thank you. 

Ms. Kirkpatrick you are recognized for five minutes 

Ms. KIRKPATRICK. Thank you, Mr. Chairman. 


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I recently attended a veterans stand down in Phoenix which is 

a one-stop shop for services that our veterans need and they had 

all kinds of things going on—thousands of people there—and off to 

a side was a room and I looked in and there were veterans sitting 

there with needles in their ears and maybe in the back of their 

neck and they were receiving acupuncture. So I was curious about 

it. The person delivering the acupuncture is actually a constituent 

in my district who is volunteering her time to be there. 

And to a person, every veteran that I talked to said that they 

benefitted from acupuncture. It helped relieve stress, anxiety, and 

asked me to advocate that it be an approved treatment in the VA 

system, so I am doing that. But my question—and I didn’t ask 

them if they had a PTS diagnosis, but clearly some of them in the 

room did—every one of them benefitting from this treatment. 

So my first question for every panelist is simply this: Do you 

think that acupuncture should be an option within the VA for medical treatment for every veteran, starting with Dr. Sherin? 

Dr. SHERIN. Yeah, I believe strongly in alternative approaches for 

mental health issues and pain and substance abuse. I think that 

acupuncture is a very powerful technique, so is meditation, so are 

many other, you know, well-established treatments. The question, 

though, that I go back to is: Is that something that you build into 

the VA or is it something that the VA supports in the community 

where there are already functioning systems? 

Ms. KIRKPATRICK. And my question is simply: Does the VA cover 

it? Offer it as a treatment? And because I want to hear from everyone, I need to hear quickly. 

Dr. SHERIN. Yeah. 

Ms. KIRKPATRICK. Should it be a regularly offered treatment to 

veterans regardless of where it is provided? 

Dr. SHERIN. I would say absolutely. 

Ms. KIRKPATRICK. Thank you. 

Mr. Goldstein. 

Mr. GOLDSTEIN. Congresswoman, yes, The American Legion believes that all treatments should be made available. If it is helping 

veterans, then yes it should be made available for treatment. 

Thank you. 

Ms. KIRKPATRICK. Lieutenant General. 

Lieutenant General STEELE. I fully support it, also. I think alternative treatments need to be investigated. It is part of the cultural 

shift that we have been talking about and what this panel is all 

about. We have to get to alternative treatments. If they work for 

one person, just as you experienced, Congresswoman, hyperbaric 

chamber is the only thing that works for them. It is the same 

thing. It is not evidence-based. It is not approved right now. We 

have to fix this by bringing the opportunities in to get alternative 

therapies to take care of this population. 

I would just like to make one amplifying comment. I am a Vietnam era vet. I have people who are contemporaries of mine, just 

like the congressman earlier today, who are just now coming forward with their issues about post-traumatic stress 47 years ago. 

We don’t believe that this population is really going to come forward until the year 2030, so that is why I am talking about reVerDate Aug 31 2005 14:28 Mar 25, 2015 Jkt 000000 PO 00000 Frm 00070 Fmt 6633 Sfmt 6633 Y:\89378.XXX PAT

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search here to be able to get this fixed so we don’t have the same 

thing that has happened to the Vietnam-era population. 

I am going to say one other thing. Personally, again, not USF, 

my father is a prisoner of war of World War II. He suffered his entire life from post-traumatic stress—never recovered from it. He 

was an alcoholic. It is all part of what are we doing here to be able 

to include all of these things together, all of these opportunities 

that we have to be able to bring it together to make it better to 

take care of the patient? To take care of the veteran? Thank you. 

Ms. KIRKPATRICK. Thank you. 

Mr. NICHOLSON. IAVA has been a big proponent and advocate for 

alternative and complementary medicine, so absolutely. Especially 

for the younger generation of vets who are perhaps more open to 

alternative forms of treatment, it absolutely would be beneficial. 

They are already doing it. A lot of them are already doing it and 

covering the costs out of pocket. Having help with that would definitely be a big deal to them, especially since some of them, especially the younger vets are still transitioning, you know, they have 

lower incomes as they are in area earlier career trajectories, so 

definitely. 

Ms. KIRKPATRICK. Dr. McCarthy. 

Dr. MCCARTHY. Yes, it is part of our clinical practice guideline 

the joint DoD/VA clinical practice guideline for the treatment of 

PTSD that we have been rolling out. So we are hoping to have—— 

Ms. KIRKPATRICK. Does the VA pay for it? That is my question. 

Dr. MCCARTHY. The VA is providing it at some medical centers, 

but—— 

Ms. KIRKPATRICK. But not across the board? 

Dr. MCCARTHY. Not yet. 

Ms. KIRKPATRICK. So my follow-up question is—quickly—what 

would it take for the VA to have this be part of the standard treatment offered to our veterans? 

Mr. CARROLL. We need to ensure that there are credentialed providers available either on staff in the VA or in the community that 

we could partner with. 

Ms. KIRKPATRICK. And just very quickly, would they be 

credentialed by the VA? Do you have a process for that? 

Mr. CARROLL. If they were working for the VA, they would need 

to be credentialed for providing that service within VA, otherwise 

we would need to recognize that expertise in the community. 

Ms. KIRKPATRICK. Thank you. My time is out, but I would like 

to explore at some point in a little more detail. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you, Ms. Kirkpatrick. 

Dr. Wenstrup. 

Dr. WENSTRUP. Thank you, Mr. Chairman. 

Dr. MCCARTHY., when you talked about RVUs, relative value 

units, as a measure of productivity, would it be correct that those 

RVUs are based predominately on time spent with a patient in 

mental health? 

Dr. MCCARTHY. Primarily. 

Dr. WENSTRUP. Okay. And do you feel that that is a good measure of productivity? 


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Dr. MCCARTHY. We use the WRVUs and take out the part of the 

RVU that covers malpractice and overhead costs, so it is a part of 

the RVU that we call the WRVU, and it is not ideal, but it is the 

best we have. 

Dr. WENSTRUP. Okay. But it is the measure of productivity that 

you are using? 

Dr. MCCARTHY. For mental health. 

Dr. WENSTRUP. Do you go and check to see if those RVUs match 

up with the number of patients seen? In other words, if somebody 

has RVUs that would add up to what would equal eight hours of 

patient care, are you checking to see if they really match that? In 

other words, if they have only seen three patients but they have 

RVUs that match an eight-hour day, eight hours of patient interaction, are you checking that? 

Dr. MCCARTHY. I can’t say that I personally am. I can say that 

I would hope that folks are matching that up. 

Dr. WENSTRUP. So formally, that is not being done at this point? 

Dr. MCCARTHY. It’s a relatively new model for us and it has been 

rolled out since 2011, increasing the numbers of specialties per 

year. Mental health has just been added, so we just have the data, 

but we certainly have to refine it and make sure that it is validated. 

Mr. WENSTRUP. Because that would authenticate things pretty 

well, which isn’t being done. 

And the other thing that we found that is not really being done 

is, what is the cost per RVU within the VA system—not just in 

mental health, but in anything—what are we actually spending per 

every RVU that we put out in care? And that is a key number as 

far as productivity and efficiency, and I think that we really have 

to go that way. 

The next question is: Do our doctors in mental health claim responsibility for their patients? In other words, do you look back and 

say, well, Dr. X had 10 patients that attempted suicide and he had 

six that actually committed suicide. 

Do you look at those numbers? Do doctors actually have patients 

that are their responsibility? 

Dr. MCCARTHY. Absolutely. We have a very active peer-review 

program where cases are reviewed and typically all suicides are reviewed in that particular format. In addition, we go through what 

we call psychological autopsies and root cause analyses when those 

kinds of events occur, so a very thoughtful approach to each one 

so no death was in vain. 

Dr. WENSTRUP. What happens if one provide had an abnormally 

high number? I mean is it bad luck or are you actually looking and 

saying, what are you doing as far as the type of care that you are 

administering or how much attention to detail are you paying to 

this patient? 

Dr. MCCARTHY. So a typical peer-review committee would take 

looking at the chart that the doctor—that the documentation and 

all the other factors around the patient actually projecting up on 

a screen, the peer-review committee reviews all of the components 

of the care, looks at the follow-up, looks at what appointments were 

scheduled and so forth and then an assessment of did the doctor 

do the right thing. 


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Dr. WENSTRUP. And then action is taken, that part you didn’t 

mention. 

Dr. MCCARTHY. Oh, let me keep going then. People are rated on 

a peer-review scale of one, two, or three. Three is if the case should 

have been handled differently. Two if it might have been handled 

differently. One if people felt like it was—the standard of care. 

If a provider has a level three, the provider is counseled about 

that and if there is more than one level three, certainly there is 

an intervention program followed and there is an FPPE often put 

in place. 

Dr. WENSTRUP. Any firings ever? You ever let a provider go? 

Dr. MCCARTHY. I can’t say that I have personal experience with 

the letting of a provider who had issues with mental health suicides go, because I can say that there are situations in which we 

have let people go. 

Dr. WENSTRUP. Just performance in general was my question. 

Dr. MCCARTHY. Yes, sir. 

Mr. WENSTRUP. Thank you very much. 

You know, Dr. Sherin, when I deployed, I was also concerned 

about those who received no mail during an entire year, and I always tried to encourage people at home to send this soldier something and I wondered what happened to them when they went 

home. You know, which leads me to—I just want your opinion real 

quick on the idea of when you are getting a garden reserve go 

home, you know, active duty, go back to a base or post, an opportunity for consultation for the garden reserve of what are you doing 

when you go home? What activity are you engaging? 

Because to me, the worst week was the first week home when 

I did nothing and then I went back and saw patients against. And 

so do you think that would be beneficial because you are not coming home to parades and there is not a lot of jobs? 

Dr. SHERIN. Yeah. I think I may have missed the question. 

What we try to do in the community is actually to try to generate 

lots of opportunities and one of the key features of opportunities involves, you know, kinship, support relationships, community. We 

look at individuals in terms of their well-being, and in order to 

have well-being, yeah, you need to have emotional health; you need 

physical health; you need intellectual health; need family; need a 

community and you need spiritual health. Those are the targets 

that we look at, at Volunteers of America and one of the things 

that we are actually trying to push out is a lot more recreationaloccupational activities that bring people together and help them 

knit that community fabric together for the reasons that you are 

pointing out. 

Dr. WENSTRUP. That answers my question. I really just was 

questioning if you see the great value in that, and I appreciate 

that. I yield back. 

The CHAIRMAN. Thank you very much. 

Mr. O’Rourke, you are recognized for five minutes 

Mr. O’ROURKE. Thank you, Mr. Chairman. I would also like to 

thank all the panelists for their testimony today and their service 

to our veterans throughout the country and as I represent the veterans in El Paso, I would also like to thank Mr. Goldstein. 


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The American Legion worked with the local commander, Mr. 

Briton, to set up a command center to connect veterans there with 

health services like the ones that we are talking about today, as 

well as benefits, and by every measure, most importantly, in talking directly with veterans, it was very successful, so I want to 

thank you. 

I want to thank Dr. McCarthy. She mentioned the mobile vet 

center and other resources that are being directed to El Paso, all 

of which should tell us that we had a problem in El Paso that we 

are now belatedly trying to correct and to fix. And during that time 

when, especially access to mental health care was so problematic, 

I had an opportunity to meet a young veteran named Nick D’Amico 

and his mom Bonnie, who came to a town hall meeting of mine and 

Nick was having a hard time accessing mental health care services 

at the El Paso VA and shared that with me and my team, but was 

also there to hear veterans who served as far back as Korea and 

Vietnam and the Gulf War share frustration with not being able 

to get into the VA. 

As he was driving home with his mom Bonnie from our town hall 

that night in September, he said, you know, I am having a hard 

time getting in and I am a young, new veteran. Some of these guys 

have been trying for years and can’t get in and for our five days 

later, Nick D’Amico killed himself, and I have got to connect the 

lack of access, the delay in care, which turns into denial of care 

into Nick D’Amico’s death. It is at least partially responsible. 

And yet in that time, the El Paso VHA and the national VHA 

was telling me that things were under control, and as recently as 

May 9th of this year, the director of VHA told me that there was 

zero days wait time on average for a veteran seeking mental health 

care access in El Paso, and what I take that to mean is that no 

veteran waited no more than 14 days to do that. 

The discrepancies between what we are hearing from people like 

Mr. D’Amico and the VA were so great that, as I have told this 

committee before, we initiated our own survey of mental health 

care wait times and found that the average wait time was 71 days. 

Found at that like, Dr. Matthews told us earlier this week, more 

than 40 percent of veterans stopped trying to seek mental health 

care because it was too frustrating and fully 36 percent, one-third, 

could not get an appointment at all. 

And so I want to ask you, if you had known that the average 

wait time was 71 days, or as your own VHA audit found last 

month, 60 days, but certainly much longer than 14 days, if you 

knew that as we know now, we are—we have the worst wait times 

in the country for access to mental health care for veterans, the 

worst as of June, what would you have done differently? You said 

in your opening testimony that we are fully committed to providing 

accessible care. You obviously did not have that in El Paso. If you 

had known all this, what would you have done differently? 

Dr. MCCARTHY. Congressman O’Rourke, I had the opportunity to 

visit El Paso. I had a visit there in June, the 16th and 17th, and 

I know that at some point we are going to talk to you about that 

visit. What has happened in El Paso is tragic. There were five psychiatrists that left all at once. That left a huge hole in the ability 

for them to continue to provide mental health care. 


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Mr. O’ROURKE. Here is what I am trying to ask, because I have 

limited time: What the VA was telling me and perhaps you and the 

veterans in El Paso was one thing which turned out to be untrue 

and was very different from what reality was, which was that there 

was terrible, terrible access to care for veterans who could get it 

and one-third could not get into mental health care at all. So if you 

had known that in September of 2013, what would you have done 

differently? 

Dr. MCCARTHY. I would have assisted you with a huge infiltration of kind of resources, but also telemental health services. I continue to provide care, even while I work at VA’s central office, by 

telemedicine, and that is the kind of thing that we can help for 

places that are having a hard time recruiting. So deploying a system of being able to help—— 

Mr. O’ROURKE. You would have expanded capacity. We would 

have had greater access. 

Dr. MCCARTHY. Yes. 

Mr. O’ROURKE. People like Nick would have been able to get in 

to see somebody. 

So given the fact that we were not told what the real conditions 

were and certainly the VA in El Paso and the VA in Washington, 

D.C., director of VHA reported different numbers to me to the veterans in our community, who is accountable for that and what are 

the consequences? Who is responsible? 

Dr. MCCARTHY. I am not prepared to answer that question. I am 

sorry. I would be happy to take that one for the record. 

Mr. O’ROURKE. That is my case in point. You can’t tell me who 

is accountable. There are no consequences for veterans dying. 

Nothing is going to change as long as we still have the same mentality and culture at the VA, which you exemplify today in your 

testimony. The fact that you cannot tell me who is accountable for 

this, that there are no consequences, that you agree that if you had 

known the truth, you would have done something different and arguably people would have survived who are now dead, and yet 

there are no consequences. 

I appreciate the surge in resources, the additional providers, your 

flight to El Paso in mid-June, but unless we change the culture at 

VA, this is going to be a temporary fix that will not last. 

And, Mr. Chairman, I yield back. 

The CHAIRMAN. Thank you very much. 

Mr. Jolly, you are recognized for five minutes. 

Mr. JOLLY. Thank you, Mr. Chairman, and General Steele, thank 

you for being here today. 

Why are you pessimistic about the VA embracing art as a—— 

Lieutenant General STEELE. That is a great question. 

Mr. JOLLY. It was your statement, not mine, by the way. 

Lieutenant General STEELE. That was a great question that you 

asked me. 

I just think from the experiences, sir, that we have had in regards to trying to bring it in as an alternative therapy, along with 

these other issues that we are talking about, alternative therapies, 

I believe, because I am an eternal optimist, that the pessimism 

that I have about the VA, they will be pulled into it because of 

what is happening here and what we are being able to be successVerDate Aug 31 2005 14:28 Mar 25, 2015 Jkt 000000 PO 00000 Frm 00075 Fmt 6633 Sfmt 6633 Y:\89378.XXX PAT

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ful with in the Department of Defense and the military right now 

because they are clamoring for art therapy because it works, particularly in the early stages of the Special Operations Command, 

those warriors who are having multiple deployments that are going 

back, they have come, they have sought art therapy and it has 

been very successful, returns them to the fight for Admiral 

McRaven and the special operators, and I believe that whole mechanism within DoD will result and it eventually being main 

streamed into VA if we pull all of these together, alternative therapies. So that is the reasons for that. 

Mr. JOLLY. Thank you. 

Dr. McCarthy, is there something that stands in the way—you 

know, you have a major research university partner ready to collaborate with a peer-review alternative therapy, what stands in the 

way of the VA from embracing that generally? I mean is it bureaucracy? Is it procedure? Is it regulation? Is it funding? Is it institutional bias? Is it not admitted here? 

Dr. MCCARTHY. I am sorry, I don’t have an exact answer to that. 

I would really be happy to review the program and understand it 

and then understand what the barriers might be in order to make 

those particular—make the implementation. I personally don’t 

know. 

Mr. JOLLY. Sure. And I guess I am just asking the general conceptual. We hear about all of these alternative therapies that are 

available, these non-pharmaceutical therapies that are available 

that work. In my previous profession, I tried to work with the VA 

research department on a regenerative proposal that was discovered at a non-VA center and I came up against a bias of extramural research not wanting to be, you know, be too tied to extramural research and therapies. 

I am just asking an assessment, not why not art, but is there an 

institutional bias against extramural research and solutions? 

Dr. MCCARTHY. I would not say that there is an institutional 

bias. What I can say is that VA funds in particular intramural research and some of our providers are certainly funded externally, 

but we don’t tend to fund extramural research. The way to fund 

that is to partner with someone in the VA and then it would become intramural and that would be what would allow the funding. 

Mr. JOLLY. On non-drug therapies, are there any pertinent regulations that control how a VA physician counsels a patient on pharmaceutical therapies versus non-pharmaceutical therapies? Are 

those dictated by other medical standards or are there VA regulations that address that. 

Mr. CARROLL. Congressman, that is an important question. I 

think the standard within mental health care for VA treatment is 

to provide the care that makes sense for the veteran at the veteran’s point in life. We offer a recovery model which would include 

a range of evidence-based psychotherapies, evidence-based 

psychopharmacologies, certainly supported by complementary and 

alternative medicine approaches, but it is to be an integrated package of care that makes sense for the veteran at that particular 

point in their life. So it doesn’t bias against anyone one of those 

or towards any one of those. 


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Mr. JOLLY. Then I have a capacity question, which is when it 

does come to some of the pharmaceuticals, the first 30 or 60 days— 

again, I am not a doctor, but I know it is kind of critical when you 

begin a regiment or frankly the testimony we heard earlier when 

you switch medications because DoD to VA, is there more precise 

oversight or care provided to the patient or is there a different follow-up with patients in those first 30 days or 60 days that they 

begin a pharmaceutical regiment? 

Dr. MCCARTHY. I can speak to this. It is clearly the expectation 

that people are monitored more carefully as you are making 

changes, either initiating a therapy or making increases in doses, 

yes. 

Mr. JOLLY. Okay, thank you. 

One last question: Dr. Steele, quickly, you have a distinguished 

DoD career and now working within VA, are there areas where 

DoD/VA, the transition, all of this together, given your career of experience and now with the research university, one or two things, 

quickly, that you would say could be game changers? 

Lieutenant General STEELE. The first is that accountability and 

acceptance of responsibility are the game changers, that the separation from active duty to the VA system is such that it needs to 

have all this cohesiveness to be able to ensure that everything is 

transferred over—all the HIPAA discussions we have had—it is all 

transferred over. If we could get legislation that does that and to 

ensure that there is transparency and openness, I think that we 

have got a great chance to be able to have a major game change 

in all of this. 

Mr. JOLLY. All right. Thank you very much. 

Mr. Chairman, I yield back. 

The CHAIRMAN. Thank you. 

Mr. Walz, you are recognized. 

Mr. WALZ. Well, thank you, Chairman for holding the hearing 

and to each of you. 

And I was going to say, Dr. McCarthy I was thinking, and I was 

going to say that it is not personal, but then I got to thinking that 

that is not true; there is nothing more personal than this. We had 

Daniel and Brian and Clay and this is pretty personal stuff. 

And so I guess the thing I am most amazed about is that I am 

amazed at the lack of anticipating what is going to be asked of you 

when you come here, and it shows me that it is a lack of self-reflection on this. I could have anticipated the question that the chairman was going to ask where you didn’t have an answer. I could 

have anticipated what Mr. O’Rourke was going to say. You probably could anticipate maybe what I am going to ask because I ask 

it to every one of you who sits here and yet it might be symptomatic of that why would we go to that trouble—why would we 

look? 

And my answer to you is, is because we are reflecting what the 

public is telling us. We are a reflection—if this place is working 

correctly, we should be mirroring and channeling that, and so I 

guess that is most disillusioned. 

Again, General Steele, I am, along with you, the eternal optimist, 

because on the matter of now—what the point now is nothing matters but results. Nothing matters that we get this fixed, right? The 


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American public is fully behind getting this right and we just have 

to figure out how to do that. 

Again, here is what I caution all of you is that people have sat 

there and offered up good suggestions. We even got so far as getting things into play, so Dr. Carroll You get to answer a few questions now. Here’s what the law said that was required of you. In 

carrying out the comprehensive program, the secretary shall provide for research on best practices and prevention. Research shall 

be conducted under this subsection in consultation with the heads 

of the following entities: The Department of Health and Human 

Services—what have you done with them? 

Mr. CARROLL. Sir, we are in partnership with Department of 

Health and Human Services and DoD regarding—and through The 

National Action Alliance on Suicide Prevention. 

Mr. WALZ. What has come out of that in concrete results and implementation that went forward? 

Mr. CARROLL. We have—education of the suicide prevention coordinators provide at every VA medical center. They provide at the 

veterans service organizations to veterans groups, to veteran providers, as well as all VA and VHA and VBA—— 

Mr. WALZ. How do you measure that, because I am going to go 

to this—you are responsible for doing this: In carrying out the plan, 

the secretary shall provide for outreach to and education of veterans and families for veterans with special emphasis on providing 

information to veterans of Operation Iraqi Freedom and Enduring 

Freedom of these veterans. Educate to promote mental health shall 

include the following: removing the stigma associated with, encouraging veterans to seek treatment, promote skills for coping with 

mental illness, help families with veterans understanding issues 

arising, identifying signs, and encouraging veterans. 

You just saw a family here that said they didn’t hear a damn 

thing from you. Would that not be the measure? 

Mr. CARROLL. We have failed these families, sir. There is no 

question about that. Our suicide prevention campaign last year 

was called Stand By Them. It was specifically aimed towards veterans and people aimed in the community to stand by veterans and 

to reach out and to support them to look for the signs of suicide 

and to encourage to get them into care. 

Our suicide prevention coordinators at every VA medical center 

do at least five outreach events to community organizations, veterans service organizations every month. 

Mr. WALZ. What does the peer-support counseling program look 

like? How much training are you doing and how much encouraging—are you encouraging outside people to come in and peer 

support? 

Mr. CARROLL. Absolutely. Peer support is one of the most transformative things that we have done in VA mental health care. We 

have hired 915 peer support providers over the last year. They are 

veterans. They are veterans who are in recovery from a situation 

in their own lives. We have them either trained or certified as peersupport providers or we will pay for that training. They are deployed across VA medical centers. We need more of them. We want 

them to be in primary care, as well as in mental health programs. 

They are a very transformative force in our organization, sir. 


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Mr. WALZ. So we have some things out there, and I bring these 

up because we are going to have to see how this implements moving forward as we start to do things. I fall into this camp, and I 

think it was Dr. Sherin who made the case, we certainly aren’t 

going to do it all alone. There are 40,000 non-profits out there to 

help veterans; they simply aren’t very well coordinated. 

So, Dr. Sherin, I would ask you, what level of confidence do you 

have in this time we will get there? Because—just a quick anecdote 

from me is I am a provider in the community who was fee-based. 

He mostly treats Vietnam veterans. This guy is a local legend and 

beloved in that group there, and so in the midst of all of this, of 

course, with perfect—ear, he cancelled his contract in the middle 

of this after 30 years from the VA on this. And so now I have got 

24 Vietnam veterans who are like, why the heck did you cancel 

this, this one was working? Now I got to go up to the VA and start 

again. 

So, Dr. Sherin, what do you think, is there a chance that this 

new model, in which you are advocating, which I think most of us 

intuitively know is the right way to go? 

Dr. SHERIN. I think there is. I think there is. The VA has led the 

way in the effort, but the VA is doing this internally, so this is happening within the walls of the VA and the concepts that we are 

pushing are actually to go beyond the walls. If we want to promote 

recovery and reintegration, we need veterans working with each 

other in the community. 

Mr. WALZ. So some of the things that I read out of the Josh 

Omvig Act that the VA is doing, those could be applied the same 

way and already are? 

Dr. SHERIN. Absolutely. That is right. 

Mr. WALZ. Well, I yield back. Thank you, Chairman. 

The CHAIRMAN. Thank you, Mr. Walz. 

Very quickly, and thank you Members for being here. 

Under threat of subpoena we finally got from VA the 2013 mental health employee survey, and if I can, I want to read just a few 

excerpts and ask if you will comment. 

Leadership is disrespectful, autocratic and uncaring. They are 

clear that getting bonuses is the top priority if we want to keep our 

jobs. This is the worst leadership from Senator Richter on down 

that I have ever heard of. 

The next one, poor leadership and administrative skills causing 

more confusion and disorganization at times when my superior 

does not fully find out all aspects of the issues before issuing a decree. 

And the third one, no effective leadership in mental health for 

psych nurses, abusive management practices such as control, selfselecting, choosing staff, performance roles, no transparency. 

Comments? I mean it took a long time for this committee to get 

this information. 

Dr. MCCARTHY. And I apologize for that delay. I don’t know what 

held it up. 

The CHAIRMAN. Oh, I do. Continue. 

Dr. MCCARTHY. I have had a chance to review some of the aggregated data from that particular—— 

The CHAIRMAN. You have not had a chance to review it? 


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Dr. MCCARTHY. I have, sorry. 

The CHAIRMAN. Okay. 

Dr. MCCARTHY. And that survey consisted of items that could be 

rated, as well as the free text comments, and what you shared were 

some of the free text comments, but the other side of it is there are 

some aggregated results that are significant from 2012 to 2013. As 

we hired more individuals to be part of the team, people did focus 

on a real sense of teamwork and be able to provide for the veterans. 

Could I also add that—I would just like to respond to Mr. 

O’Rourke that I would like to restate my answer to your question 

about accountability and who is responsible. I think we at VA are 

all responsible and that includes me, and I apologize for not saying 

that beforehand, but when you reframed that question to me, it became clear that I answered that wrong and I am sorry. 

The CHAIRMAN. And one other—Dr. Carroll, you made this comment just a second ago talking about peer support was one of the 

greatest things that you did. Did VA support that? 

Mr. CARROLL. Support it financially, sir? 

The CHAIRMAN. No, the concept. 

Mr. CARROLL. Yes. 

The CHAIRMAN. You did? 

Mr. CARROLL. Yes, we had—— 

The CHAIRMAN. You fought it every step of the way. You fought 

it every step of the way. This committee and other people said you 

need to bring these folks who have experienced this in their own 

lives forward and VA fought tooth and nail against it. 

Mr. CARROLL. I regret that, sir. Since I have been part of the central office team since 2007, we have been looking for ways to move 

this forward. 

The CHAIRMAN. I don’t believe—if you ask any member who has 

been sitting here for an extended period of time, they will tell you 

that VA has, in fact, fought bringing them in because they claim 

they didn’t have the right credentials, they were not specific to the 

treatment, and, in fact, you just highlighted it as one of your best 

successes. 

Dr. MCCARTHY. So thank you for your partnership in that. 

The CHAIRMAN. With that, if there are no further comments or 

questions, we thank everybody. We thank the witnesses for being 

here today. 

I would ask unanimous consent that all members would have 

five legislative days with which to revise and extend and add extraneous material. 

Without objection, so ordered. 

Once again, thanks to the witnesses and thanks to the members. 

This hearing is adjourned. 

[Whereupon, at 1:38 p.m. the committee was adjourned.] 


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APPENDIX 

Prepared Statement of Jeff Miller, Chairman 

Welcome to today’s Full Committee oversight hearing entitled, ‘‘Service should not 

lead to Suicide: Access to VA’s Mental Health Care.’’ 

Following a Committee investigation which uncovered widespread data manipulation and accompanying patient harm at the Department of Veterans Affairs (VA) 

medical facilities nationwide, this Committee has held a series of Full Committee 

oversight hearings over the last several weeks to evaluate the systemic access and 

integrity failures that have consumed the VA health care system. 

Perhaps none of these hearings have presented the all-too-human face of VA’s failures so much as today’s hearing will—a hearing that I believe will show the horrible 

human cost of VA’s dysfunction and, dare I say, corruption. 

At its heart, access to care is not about numbers; it’s about people. 

Recently, the Committee heard from a veteran who had attempted to receive mental health care at a VA Community Based Outpatient Clinic in Pennsylvania. 

This veteran was told repeatedly by the VA employee he spoke with that he would 

be unable to get an appointment for six months. 

However, when that employee left, another VA employee leaned in to tell this veteran that if he just told her that he was thinking of killing himself, she would be 

able to get him an appointment much sooner—in just three months instead of six. 

Fortunately, that veteran was not considering suicide. 

But what about those veterans who are? 

How many of the tens of thousands of veterans that VA has now admitted have 

been left waiting weeks, months, and even years for care were seeking mental 

health care appointments? 

How many are suicidal or are edging towards suicide as a result of the inability 

to get the care they have earned? 

Despite significant increases in VA’s mental health and suicide prevention budget, 

programs, and staffing in recent years, the suicide rate among veteran patients has 

remained more or less stable since 1999, with approximately twenty-two veteran 

suicide deaths per day. 

However, the most recent VA data has shown that over the last three years, rates 

of suicide have increased by nearly forty percent among male veterans under thirty 

who use VA health care services and by more than seventy percent among male veterans between the ages of eighteen and twenty-four years of age who use VA health 

care services. 

This morning, we will hear testimony from three families—the Somers, the Selkes 

[SELL–KEYS], and the Portwines—who will tell us about their sons—Daniel, Clay, 

and Brian—three Operation Enduring Freedom/Operation Iraqi Freedom veterans 

who sought VA mental health care following combat. 

Each of these young men faced barrier after barrier in their struggle to get help. 

Each of these young men eventually succumbed to suicide. 

In a note he left behind, Daniel Somers wrote that he felt his government had 

‘‘abandoned’’ him and referenced coming home to face a ‘‘system of dehumanization, 

neglect, and indifference.’’ 

VA owed Daniel—and Clay and Brian—so much more than that. 

f 

Prepared Statement of Michael H. Michaud, Ranking Minority Member 

Good morning, and thank you Mr. Chairman for holding this hearing today. 

We have had many discussions and debates about how to deliver the best health 

care services to our Nation’s veterans, and how to ensure accountability within the 

leadership ranks of the VA. 

Over the course of these recent hearings and discussions, we have touched on a 

number of important issues. But one that we haven’t zeroed in on too much yet has 

been access to mental health care and suicide prevention services for our veterans. 

That’s why this hearing today is so important. 

I’d like to thank all of our panelists for joining us today, but in particular I want 

to thank the family members joining us who have lost loved ones—Howard and 

Jean Somers, Susan Selke and Peggy Portwine. 

I know that speaking about the loss of a loved one—particularly a child—can be 

an incredibly difficult and exhausting experience. But, in this case, I believe we can 

and must honor the memories of the children of Howard and Jean, Susan, and 

Peggy. 


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We can listen to their stories, identify what went wrong, and we can take action 

to ensure those failures aren’t repeated. So thank you very, very much for joining 

us today and sharing your stories. 

Eighteen to 22 veterans commit suicide each day. In my opinion, that is 18 to 22 

brave men and women each day who our system has let down in some capacity. It 

is a totally unacceptable figure. 

When a veteran is experiencing depression or other early warning signs that may 

indicate mental health issues or even suicide, that must be treated like an immediate medical crisis, because that is exactly what it is. Veterans in that position 

should never be forced to wait months on end for a medical consult because quite 

frankly, that is time they may not have. 

We have taken steps to help put in place programs and initiatives aimed at early 

detection, and we have significantly increased our funding. VA spending on mental 

health has doubled since 2007. But it’s not working as well as we would hope, and 

we have to figure out why—and how we can correct these problems. 

Our veterans are the ones paying the price for this dysfunction. A 2012 IG report 

found that VHA’s data on whether it was providing timely access to mental health 

services is totally unreliable. 

And a GAO report from that year not only confirmed that disturbing finding, but 

also said that inconsistent implementation of VHA’s scheduling policies made it difficult—if not near impossible—to get patients the help they need when they need 

it. That is a problem we have seen repeatedly as we dig into the VA’s dysfunctions, 

and enough is enough. 

Our veterans and their families deserve a VA that delivers 

timely mental health services that cover a spectrum of needs, from PTSD, to counseling for family members of veterans, to urgent, round-the-clock responses to a veteran in need. A recent VA OIG report found that in one facility patients waited up 

to 432 days—well over a year—for care. 

So once again, we are finding that our veterans deserve much better than the care 

they are receiving. 

And of all the areas we must address, I would argue that fixing mental health 

services is among the most urgent. I look forward to a productive discussion that 

we will only begin today, but certainly continue over the coming days, weeks and 

months. 

Thank you Mr. Chairman, I yield back. 

f 

Prepared Statement of Hon. Corrine Brown 

Thank you, Mr. Chairman and Ranking Member, for calling this 

hearing today. 

A veteran’s mental health has been called many names through 

too many wars. From ‘‘soldier’s heart’’ in the Civil War, to ‘‘shell 

shock’’ in World War I and ‘‘combat’’ or ‘‘battle fatigue’’ in World 

War II and now Post Traumatic Stress Disorder. 

Other terms used to describe military-related mood disturbances 

include ‘‘nostalgia’’, ‘‘not yet diagnosed nervous’’, ‘‘irritable heart’’, 

‘‘effort syndrome’’, ‘‘war neurosis’’, and ‘‘operational exhaustion.’’ 

Yet the name is not important for the disease, but how those affected are treated. 

The men and women in our military are risking their lives to defend the freedom of this country and for them to be discarded after 

their operational usefulness has ended is inhuman and un-American. 

I cannot think of anything more important to the returning members of the wars in Iraq and Afghanistan than knowing their 

health, and especially their mental health, is uppermost in our 

minds. It has been said that TBI is the signature injury of these 

wars. It is our responsibility to make sure they are treated properly 

when they get back. 


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Suicide is epidemic among our active duty servicemembers and 

the veterans who have served this country in the past. 

More reservists and national guardsmen are serving in active 

duty now than in any other war. These men and women don’t necessarily live near a military base to get the proper and timely 

treatment they need. 

I do not think that VA and veterans mental health should be 

contracted out to the lowest bidder in an effort to rush any kind 

of care to our veterans. The VA has shown time and time again 

that they are the worldwide experts in treating PTSD and other 

mental illnesses, and that other mental health professionals, no 

matter how knowledgeable, cannot know the full range of PTSD 

symptoms unless they work regularly with veterans. 

I am reminded of the words of the first President of the United 

States, George Washington, whose words are worth repeating at 

this time: 

‘‘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.’’ 

I look forward to hearing the testimony of those panelists here 

today and learn how to best help those who have bravely served 

our nation in war. 

f 

Prepared Statement of Hon. Scott Peters 

I want to thank Chairman Miller, Ranking Member Michaud, 

and the Committee for tackling an issue that touches entirely too 

many veterans and their families in my district, and districts 

throughout the country. 

Improving access to mental health services in the VA is something I have a deep and committed interest in and while I am not 

a member of this Committee there is no place I’d rather be this 

morning. 

I also want to thank the panelists for agreeing to be here today 

to share their experiences and expertise—it takes a lot of courage 

to do what you’re doing and I want to thank you for that. 

Beyond the power of your stories, you are providing us an invaluable education. These are insights that only you have and I know 

we are all thankful to have the opportunity to learn from you, and 

to use the knowledge we gain to work toward eliminating the barriers our veterans face in receiving the care they need. 

I especially want to thank you, Howard and Jean Somers—not 

only for your participation today, but for your continued leadership 

and advocacy on behalf of Daniel, the education you’ve given me, 

and for fighting for our nation’s veterans and their families. Your 

work in the face of such a tragedy is an inspiration to all of us. 

As the father of a 20-year-old son, I can’t even imagine such as 

loss. 

Sadly, the report you have shared with us today highlights the 

struggles faced by not only your son, but the struggle faced by veterans and their families throughout the country. The number of 


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veterans who found themselves in a position similar to Daniel’s is 

unacceptably high. 

Like many, Daniel returned from his service with invisible 

wounds including Post-Traumatic Stress and Traumatic Brain Injury. He was also afflicted with Gulf War Syndrome. 

Like many, he suffered in silence because his attempts to reach 

out for help through the Department of Veterans Affairs were met 

with roadblocks and inefficiencies that left him with the feeling 

that no one cared. 

Like many, Daniel tragically took his life rather than continue to 

struggle with his wounds, his constant pain, and the burdens of his 

service. 

The truth is Daniel wasn’t and isn’t alone. Every day, 22 veterans find themselves with the same horrible choices and make the 

same decision he did. 

As a country, we have failed these men and women who sacrificed so much to serve. The Somers’ experience is evidence that 

there were steps that should have been taken and highlights systemic problems with the way the VA delivers care. 

The House and the Senate have taken the initial steps toward 

fixing these problems. We will continue to work toward achieving 

much-needed reforms. However, these reforms will take time, and 

our veterans who are suffering from the very real pain of post-war 

mental anguish, shouldn’t have to wait. 

While Congress acts, and the VA implements reforms, our veterans and their families should take advantage of the many community resources available to them. 

There are an estimated 44,000 volunteer organizations dedicated 

to helping servicemembers and their families: providing resources, 

information, and outlets for those who have kept us safe. 

Too often, servicemembers and their families are not aware of 

the services available to them. That is why the Somers initiated 

Operation Engage America. With greater visibility, the programs 

offered by extraordinary Americans can reach veterans and their 

families in time to make a difference. 

I had the opportunity to attend the inaugural event at American 

Legion Post 731 in June of this year. 

I have never met a family more dedicated to sharing their story, 

raising awareness for the invisible wounds our servicemembers suffer, and committed to making a major impact on the way we care 

for our veterans. 

Your determination and resolve in the face of sacrifice and severe 

adversity is truly inspiring. I thank you, Howard and Jean, for everything you have done, and everything you will continue to do to 

ensure that we in Congress remain committed to fixing the flaws 

in the way we treat our veterans. 

From time to time in Congress, you see testimony that you know 

is going to right away make a difference and that is certainly 

what’s happened today. You can feel very confident that our nation’s heroes will be helped by the time and effort you’ve put in 

today. 

I look forward to continuing to work with you to resolve these 

issues and to make things right with the veterans the VA treats. 


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Prepared Statement of Howard and Jean Somers 

Thank you Chairman Miller, Ranking Member Michaud, and 

Committee members. 

We are grateful for the opportunity to testify today, and it is especially good to see Representative Kirkpatrick, who has been a 

great ally to us in our effort to advance reforms of the VA based 

on the experience of our son, Daniel Somers. 

As many of you know, our journey started on June 10, 2013, 

when Daniel took his own life following his return from a second 

deployment in Iraq. At that time, he suffered from Post-Traumatic 

Stress Disorder, Traumatic Brain Injury and Gulf War Syndrome. 

Daniel spent nearly six futile and tragic years trying to access the 

VA health and benefit systems before finally collapsing under the 

weight of his own despair. We have attached ‘‘The Story of Daniel 

Somers’’ to our testimony, which provides the details of his efforts, 

and we hope you will read it if you have not already done so. 

Today, it is our hope that we can begin the process which will 

ultimately provide hope and care to the 22 veterans a day who are 

presently ending their lives. 

Four days after Daniel’s death, we sat with Daniel’s wife, who 

has a Bachelor of Science in Nursing, and his mother-in-law, who 

is a psychiatrist, and prepared a 19 page report that we titled Systemic Issues at the VA. We have shared that document with several of you over the last year, and it is also attached to our testimony. 

The purpose of this report remains the same as when we wrote 

it: to improve access to first-rate health care at the VA, to make 

the VA accountable to veterans it was created to serve and to make 

every VA employee an advocate for each veteran. (VHA) 

A1. At the start, Daniel was turned away from the VA due to 

his National Guard Inactive Ready Reserve status. 

A2. Upon initially accessing the VA system, he was, essentially, 

denied therapy. 

A3. He had innumerable problems with VA staff being 

uncaring, insensitive and adversarial. Literally no one at the facility advocated for him. 

A4. Administrators frequently cited HIPAA as the reason for 

not involving family members and for not being able to use modern 

technology. 

B1. The VA’s appointment system known as VISTA is at best 

inadequate. It impedes access and lacks basic documentation. 

B2. The VA information technology infrastructure is antiquated 

and prevents related agencies from sharing critical information. 

There is a desperate need for compatibility between computer systems within the Veterans Health Administration, the Veterans 

Benefits Administration, and the DoD. 

B3. Continuity of care was not a priority. There was no succession planning, no procedures in place for ‘‘warm handoffs’’; no contracts in place for locum tenems; and a fierce refusal to outsource 

anyone or anything. 

B4. At the time Daniel was at the Phoenix VA, there was no 

pain management clinic to help him with his chronic and acute 

fibromyalgia pain. 


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B5. There were few coordinated inter-Agency goals, policies and 

procedures. The fact that the formularies of the DoD and VA are 

separate and different makes no sense since many DoD patients 

who are stabilized on a particular medication regimen must re-justify their needs when they transfer to the VA. 

B6. There were inadequate facilities and an inefficient charting 

process. (VBA) 

There was no way for Daniel to ascertain the status of his benefits claim. 

There was no VHA/VBA appointment system interfacing, nor 

prioritized, proactive procedures. 

There was no communication between Disability Determination 

and Vocational Rehabilitation. 

This report is offered in the spirit of a call to action and reflects 

the experiences of Daniel with VA program services beginning in 

the fall of 2007 until his death last June as seen through our eyes. 

Our concern then was that the impediments and deficiencies 

which Daniel encountered were symptomatic of deeper and broader 

issues in the VA—potentially affecting the experiences of a much 

broader population of servicemembers and veterans. Unfortunately, 

this has been proven true as dramatically evidenced by recent revelations. 

Many of the reforms outlined in our report will require additional 

funding for the VA. But with that new funding should come greater 

scrutiny and a demand for better, measurable results. 

There is, however, an alternative to attempting to repair the existing, broken system. We believe Congress should seriously consider fundamentally revamping the mission of the VA health system. In the new model we envision, the VA would transition into 

a Center of Excellence specifically for war-related injuries, while 

the more routine care provided by the rest of the VA health care 

system would be opened to private-sector service providers—much 

like Tricare. That approach would compel the current model to selfimprove and compete for veterans’ business. This would ultimately 

allow all veterans to seek the best care available, while allowing 

the VA to focus its resources and expertise on the treatment of 

complex injuries suffered in modern warfare. 

We thank you for your time, and would be happy to further discuss our recommendations and suggestions. We sincerely hope that 

the systemic issues raised here will provide a platform to bring the 

new VA Administration together with lawmakers, veterans and 

private sector medical professionals and administrators for a comprehensive review and reform of the entire VA system. And if the 

VA, Committee or Congress as a whole make the decision to involve other stakeholders in a more formal reform process, we would 

be honored to be among those chosen to represent the views of affected families. 


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Prepared Statement of Susan Selke 

Chairman Miller, Ranking Member Michaud, and Distinguished 

Members of the Committee. 

Thank you for the opportunity to speak with you today about this 

critically important topic of mental health care access at the VA, 

suicide among veterans, and especially about the story and experience of our son, Clay. 

My name is Susan Selke and I’m accompanied here by my husband, Richard. I’m here today as the mother of Clay Hunt, a Marine Corps combat veteran who died by suicide in March 2011 at 

the age of 28. 

Clay enlisted in the Marine Corps in May 2005 and served in the 

infantry. In January of 2007, Clay deployed to Iraq’s Anbar Province, close to Fallujah. Shortly after arriving in Iraq, Clay was shot 

through the wrist by a sniper’s bullet that barely missed his head. 

After he returned to Twenty Nine Palms in California to recuperate, Clay began experiencing many symptoms of post-traumatic 

stress, including panic attacks, and was diagnosed with PTS later 

that year. 

Following the recuperation from his gunshot wound, Clay attended and graduated from the Marine Corps Scout Sniper School 

in March of 2008. A few weeks after graduation, Clay deployed 

again, this time to southern Afghanistan. Much like his experience 

during his deployment to Iraq, Clay witnessed and experienced the 

loss of several fellow Marines during his second deployment. 

Clay returned home from Afghanistan in October of 2008, and 

was then honorably discharged from the Marine Corps in April of 

2009. He earned numerous awards during his service in the Marine 

Corps, including the Purple Heart for the injuries he sustained in 

Iraq. 

Clay received a 30 percent disability rating from the VA for his 

PTS along with two smaller ratings for other health issues after 

separating from the military. After discovering his that PTS prevented him from maintaining a steady job, Clay appealed the 30 

percent rating only to be met with significant bureaucratic barriers, including the VA losing his files. 

The lapse in time during this appeals process left Clay worried 

about his professional and financial future. Eighteen months later, 

and five weeks after his death, Clay’s appeal finally went through 

and the VA rated Clay’s PTS 100 percent. The stresses and delays 

Clay experienced with his claim and appeal processes were also 

mirrored in his experience accessing and using VA medical care 

and educational benefits. 

Clay exclusively used the VA for his medical care after separating from the Marine Corps. Immediately after his separation 

Clay lived in the Los Angeles area and received care at the VA 

medical center there in LA. Clay constantly voiced concerns about 

the care he was receiving, both in terms of the challenges he faced 

with scheduling appointments as well as the treatment he received 

for his PTSD, which consisted solely of medication. He received 

counseling only as far as a brief discussion regarding whether the 

medication he was prescribed was working or not. If it was not, he 

would be given a new medication. Clay used to say, ‘‘I’m a guinea 


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pig for drugs. They’ll put me on one thing, I’ll have side effects, and 

then they put me on something else.’’ 

At the same time, Clay also expressed frustration with delayed 

GI Bill benefit payments. This only aggravated his PTS symptoms 

and inhibited his ability to heal and move on with his life. 

In late 2010, Clay moved briefly to Grand Junction, Colorado, 

where he also used the VA there, and then finally home to Houston 

to be closer to our family. The Houston VA would not refill prescriptions Clay had received from the Grand Junction VA because 

they said that prescriptions were not transferable and a new assessment would have to be done before his medications could be represcribed. 

Clay only had two appointments in January and February of 

2011, and neither was with a psychiatrist. It wasn’t until March 

15th that Clay was finally able to see a psychiatrist at the Houston 

VA medical center. But after the appointment, Clay called me on 

his way home and said, ‘‘Mom, I can’t go back there. The VA is way 

too stressful and not a place I can go. I’ll have to find a Vet Center 

or something.’’ 

After Clay’s death, I personally went to the Houston VA medical 

center to retrieve his medical records, and I encountered an environment that was highly stressful. There were large crowds, no one 

was at the information desk and I had to flag down a nurse to ask 

directions to the medical records area. I cannot imagine how anyone dealing with mental health injuries like PTS could successfully 

access care in such a stressful setting without exacerbating their 

symptoms. 

Just two weeks after his appointment with a psychiatrist at the 

Houston VA medical center, Clay took his own life. The date was 

March 31, 2011. The cause of death—a self-inflicted gunshot wound 

to his head. 

Clay was consistently open about having PTS and survivor’s 

guilt, and he tried to help others coping with similar issues. He 

worked hard to move forward and found healing by helping people, 

including participating in humanitarian work in Haiti and Chile 

after devastating earthquakes. 

He also starred in a public service advertising campaign aimed 

at easing the transition for his fellow veterans, and he helped 

wounded warriors in long distance road biking events. Clay fought 

for veterans in the halls of Congress and participated in Iraq and 

Afghanistan Veterans of America’s annual Storm the Hill campaign 

to advocate for legislation to improve the lives of veterans and their 

families. 

Clay’s story details the urgency needed in addressing this issue. 

Despite his proactive and open approach to seeking care to address 

his injuries, the VA system did not adequately address his needs. 

Even today, we continue to hear about both individual and systemic failures by the VA to provide adequate care and address the 

needs of veterans. 

Not one more veteran should have to go through what Clay went 

through with the VA after returning home from war. Not one more 

parent should have to testify before a congressional committee to 

compel the VA to fulfill its responsibilities to those who served and 

sacrificed. 


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You all, especially here in the House of Representatives, have 

been aggressive, courageous, and vigilant in holding the VA accountable and trying to equip it with the resources it needs to care 

for veterans. But given the magnitude and extent of the problems 

at the VA, more is needed. 

Mr. Chairman, I understand that today you are introducing the 

Suicide Prevention for America’s Veterans Act. The reforms, evaluations, and programs directed by this legislation will be critical to 

helping the VA better serve and treat veterans suffering from mental injuries from war. Had the VA been doing these things all 

along, it very well may have saved Clay’s life. 

Mr. Chairman, Richard and I again appreciate the opportunity to 

share Clay’s story and our recommendations for how we can help 

ensure the VA will uphold its responsibility to properly care for 

America’s veterans. 

Thank you. 

f 

Prepared Statement of Peg Portwine 

I am here before you to tell the testimony of my son Spc. Brian 

Portwine. Brian was an infantryman and serve in Operation Iraqi 

Freedom in 2006–2008 and in Operation Enduring Freedom in 

2010. 

During his first tour he was deployed to Baghdad and his job 

was to patrol Haifa street, which was a very dangerous area. This 

was before the surge of troops. During this tour, Brian lost 8 brothers. 

While in Iraq in 2006 Brian was in a Bradley tank that was 

struck by a RPG. The tank was immediately engulfed in flames 

and the driver was knocked unconscious. Due to the driver being 

able to hydraulically let down the ramp the 5 soldiers had to 

scramble thru the fire to manually lower the ramp and miraculously they were able to get out, all with injuries. Brian suffered 

a blast concussion and had lacerations to his face and legs from 

shrapnel. This was Brian’s first episode of Traumatic Brain Injury. 

During another mission Brian and his 1st Sgt were on patrol in 

a Humvee and had switched seats so Brian was now in the passenger seat. Twenty minutes later an IED hit the Humvee and his 

1st Sgt was killed and Brian was thrown from the Humvee and injured his back. Besides these 2 incidents Brian was involved in 5 

other IEDs during his 15 month deployment. 

After coming home after his 1st deployment Brian had trouble 

with short term memory. When his friends were going somewhere 

he would often say ‘‘where are we going again, you know I have 

scrambled brains’’ To help cope with this he would post everything 

he had to do on his calendar or computer. 

In 2010 Brian was recalled to the Army and deploying from Fort 

Shelby, Miss. During this deployment Brian did not email or call 

home or to his friends. Little did we know how he was struggling 

with PTSD and TBI. He had panic attacks being on the same roads 

he had traveled on the 1st tour where IEDs went off often. He had 

nightmares 3 x a week and would wake up his unit and someone 

would have to wake him up. He suffered with anxiety, depression, 


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insomnia, poor concentration, and hypervigilance. But he was 

never sent home. 

After returning from his 2nd deployment in Dec. 2010 to Daytona 

Beach he did not want to return to school. We did not know he had 

applied for disability due to his PTSD/TBI. He knew the stigma of 

saying you had PTSD so he kept it to himself. 

During out processing from Fort Shelby in 2010 Brain was diagnosed with PTSD, TBI, depression, and anxiety. During one assessment the counselor stated ‘‘Pt cannot remember questions asked’’. 

He had guilt, anxiety, hypervigilance, poor concentration, rage and 

anger but the VA/DoD told him to follow-up with the local VA outpatient. 

I am horrified by this. All his symptoms are classic symptoms of 

PTSD and TBI. He should have been sent to the National Intrepid 

Center for excellence at Fort Hood, TX where they have a 3–4 week 

program for those with TBI and PTSD. 

Brian deteriorated quickly from Dec, 2010 to May 2011. He could 

not stand how he acted but had no coping methods or treatment. 

It took a toll on his relationships with friends. 

If the DoD and VA assessed Brian at high risk for suicide it is 

their duty to treat him. But he got nothing. 

Brian’s unit has lost 3 others to suicide, one just June 21st, 2014. 

It is a very slippery slope from PTSD and TBI and the VA should 

realize this. 

Our soldiers never hesitated in their missions to protect, serve, 

and sacrifice for our country. 

Now it is time for the VA to prove their commitment to our solders. 

I never knew of Brian’s PTSD and TBI or high suicide risk. I 

would think a life threatening event like this should be told to the 

emergency contact person. 

The VA needs to work the service organizations and include the 

families in the plan of care. 

I beg this Committee to pass act 2182, the Suicide Prevention for 

Americans Act 

As a mother I have lost my only miracle child to suicide. It is 

devastating! 

I would like to close by saying a quote from Rose Kennedy. It 

says, ‘‘time heals all wounds.’’ 

I disagree. The wounds remain. In time the mind to protect its 

sanity covers them with scar tissue and the pain lessen. But it is 

never gone. Thank you. 

f 

Prepared Statement of Josh Renschler 

Chairman Miller, Ranking Member Michaud, and Members of 

the Committee: 

I am honored to have the opportunity to speak to you today regarding VA mental health care. 

I proudly served as a United States Army Infantryman for 51⁄2

years, and was medically retired due to severe injuries from a mortar blast in Iraq. Working now with a non-profit in Washington 

state, I assist servicemembers, veterans and their families who are 


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struggling due to deployment-related trauma. I have a great deal 

of experience with VA medical facilities and VA mental health 

care—not just as a patient, but as an advocate for many other warriors I’ve mentored, and through dialogue with veteran leaders 

from across the country. Recently VA leadership invited me to participate in an online learning session through VA’s eHealth University to share my perspective as a veteran accessing VA care, so VA 

clinicians and staff could have the opportunity to learn from my experience. 

That experience with the VA health care system began in 2008. 

As I explained in testifying before the Subcommittee on Health last 

year, that experience began badly. At the time I was being treated 

for anxiety, sleep problems, migraines, pain, and seizures, and it 

had taken Army doctors 3 years to determine the right medications 

and dosages to treat those conditions. Because several of those 8 

different medications were not on the VA formulary, my primary 

care provider at the American Lake VA Medical Center substituted 

different medications, despite the urging of my wife due to the failure of these medications in the past. The side effects caused me so 

much difficulty that I began to backslide in my recovery. I was 

soon on 13 medications (some to simply counter the effects of others); and soon all my conditions worsened and I had a severe panic 

attack at work. 

Since then, with my multiple medical and surgical issues and my 

work with other warriors, I’ve had extensive experience with VA 

care. As to VA mental health care in particular, I’ve benefitted 

from excellent care at a VA medical center that for a period of time 

made that care a priority and staffed it accordingly. The facility 

provided easy one-stop access to OEF/OIF/OND veterans through 

a ‘‘Deployment Health Team’’ that brought together in one spot 

medical, mental health, pharmacy and social work providers. Unfortunately, medical center leadership concluded that providing 

this excellent, well-staffed interdisciplinary care was too costly. 

With budget considerations trumping patient-centered care considerations, the team’s providers were reassigned. (While the facility 

still has a unit called the ‘‘deployment health team’’ it now provides 

only primary care and social work services. Having only a skeleton 

staff, the team manages a huge caseload and, as a result, has long 

wait times and shorter appointments.) Instead of seeing an interdisciplinary team, GWOT veterans now go through an impersonal 

intake/assessment process. From there they are channeled into a 

conventional system where providers do not work as a team, and 

where veterans have to navigate their way to the different services 

scattered across the sprawling, complex campus to get the care 

they need. For many of the warriors with whom I’ve worked, just 

navigating around the many buildings housing different treatment 

services in this complex facility is anxiety-provoking. 

Interdisciplinary, Team-Based Care: Key to Mental Health 

Care and Suicide Prevention 

I cite my and other veterans’ very positive experience with this 

interdisciplinary, team-based-care approach (and the effective demise of that program) because it highlights some very important 

points. First, veterans with mental health issues are seldom going 


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1Keith Hawton, ‘‘Suicide prevention: a complex global challenge,’’ 1(1) The Lancet (June 

2014), 2. 

to open up to a clinician they’ve never met and begin discussing 

painful, private issues. They’re more likely to skirt those deeper 

issues and simply report that they’re experiencing difficulty sleeping, having headaches, or some more general problem, with the 

hope that there’s medication to provide relief. It takes time to build 

trust to open up to deeper problems or even to recognize them. And 

not every clinician is necessarily skilled at eliciting that trust or insightful enough to gauge from a veteran’s demeanor that there are 

deeper issues, and to ask the probing questions that might begin 

to identify them. Working with a team increases the likelihood that 

one or more will see things that others missed. 

Interdisciplinary care has profound implications for suicide-prevention. Veterans will rarely volunteer to clinicians that they’re 

contemplating suicide, and there aren’t obvious signs by which a 

mental health provider can reliably identify a veteran as a suicide 

risk. And we certainly won’t prevent suicides by having physicians 

go down a mandatory checklist and mechanically asking a veteranpatient a series of questions like ‘‘have you thought recently about 

harming yourself?’’ While people who commit suicide often have a 

mental health condition, that alone is seldom an explanation for a 

suicidal act. Life events and problems are often important catalysts.1 But in a treatment system, where, for example, I’m sent to 

Building 3 to see the neurologist for severe back pain, to Building 

61 to see a psychiatrist for medication to help with sleep problems, 

and to Building 81 to see my social worker for serious relationship 

problems, no one is getting a full picture and no one can see and 

put together the red-flag signs that may point to the fact that my 

life is spinning out of control. This isn’t just a problem in VA. But 

as an integrated health care provider, VA can provide the kind of 

care I got from the interdisciplinary deployment health team in the 

past. There, the team members shared observations, and could see 

potential problems as they had begun to develop and question veterans about issues before they became explosive. In my view, therefore, it is much less fruitful to press VA to establish or re-design 

‘‘suicide prevention programs’’ than to improve VA health and mental health care delivery. 

‘‘Access’’ Is Only Half the Equation 

When we discuss mental health care, it’s not enough to talk 

about ‘‘access.’’ One has to get to the question, ‘‘access to what?’’ 

Access to a system in which I go to three different buildings to see 

three different providers for health issues which are all related to 

my mental health—pain, lack of sleep, and relationship issues—is 

a real problem when those providers aren’t working as a team, and 

aren’t even given the needed time to coordinate their observations 

and treatment approaches with one another. In other words, access 

to mental health care isn’t enough unless that mental health care 

is also effective. 

This is particularly important as it relates to combat veterans; 

having been trained to tough it out and soldier through pain, they 

often come into treatment hesitantly and even distrustfully. A provider needs to understand that warrior mentality, and often must 


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work hard to win that veteran’s trust. A clinician who doesn’t understand that warrior culture or isn’t permitted the time needed to 

develop that relationship of trust is unlikely to have success in 

helping that warrior overcome his or her demons. In my experience, veterans have a greater likelihood in the VA of working with 

a clinician who has some understanding of that warrior experience 

and of working with combat-related mental health problems than 

they would ‘‘outside.’’ But a veteran who has to work with a provider who lacks cultural awareness or whose patient care load 

doesn’t allow time will inevitably become frustrated (whether in the 

VA or outside) and often drop out of treatment. Similarly, many 

veterans who aren’t ready for an often very traumatic exposurebased therapy have dropped out of these intense multi-week treatment programs, even though they are hailed as an ‘‘evidence-based 

therapy.’’ I question the wisdom of evaluating facilities, as VA does, 

based on the percentage of veterans with PTSD who complete these 

evidence-based therapies. While the underlying intent has merit, 

there are many reasons that veterans don’t complete those programs: for some, they’re just too intense, for others, it’s too difficult 

to come in for treatment that often. The bottom line is that this 

performance requirement, like others, can not only be ‘‘gamed,’’ it 

fails to take the patient’s preferences into account. VA has often 

cited the importance of a veteran-centered approach to mental 

health care. But if care is to be veteran-centered, as it must be, it’s 

critical to recognize each veteran’s unique situation, and their individual treatment preferences, and build systems to meet their 

needs and preferences, not the other way around. That seems to 

me, to be essential to providing effective care, whether in the VA 

or elsewhere. 

The warriors I’m describing—and I’ve worked with many of 

them—very often don’t come into treatment for PTSD or anxiety or 

depression when the textbooks say they should, at an early stage 

when the problems can be most easily dealt with. They finally come 

into treatment when things have gotten really bad. Sometimes 

that’s when their spouse is threatening to leave. In some cases, it’s 

when they’ve gotten into trouble with law enforcement, often involving substance abuse. Or it might be when the veteran has experienced a panic attack or overwhelming thoughts of self-harm, to 

cite some common examples. Timeliness is obviously critical in 

those kinds of instances, and they’re not at all isolated occurrences 

among OEF/OIF veterans. Clearly a veteran in distress who finally 

asks for help for a combat-incurred mental health condition needs 

to get into treatment. VA policy did establish the expectation that 

veterans were to be afforded initial appointments for mental health 

care within 14 days. But—just as with the challenges many VA facilities faced in meeting that requirement for primary care appointments, limitations in mental health staffing at many facilities have 

made provision of timely mental health care either very challenging or impossible to meet. What I saw facilities do was to reconfigure their staffing to meet the technical requirement of the 14- 

day rule. At these facilities, warriors with mental health issues 

were assessed within the 14-day window; in that way they were 

‘‘seen,’’ even though facility staffing wouldn’t permit an initial 

treatment appointment itself until many weeks later. UnderstandVerDate Aug 31 2005 14:28 Mar 25, 2015 Jkt 000000 PO 00000 Frm 00093 Fmt 6621 Sfmt 6602 Y:\89378.XXX PAT

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2 Hyde, P., ‘‘Report to Congress on the Nation’s Substance Abuse and Mental Health Workforce Issues,’’ Substance Abuse and Mental Health Services Administration (Jan. 24, 2013), 5. 

Accessed at http://store.samhsa.gov/shin/content/PEP13-RTC-BHWORK/PEP13-RTCBHWORK.pdf 

3 Id., 10. 

ably, warriors who are at the end of their rope and finally seek 

help at a VA medical facility often experience deep frustration and 

even despair if they are told to wait six weeks or longer to begin 

therapy. Deferred treatment can set the stage for potentially tragic 

outcomes. 

I do believe that there are VA facilities that are providing veterans timely access to effective, patient-centered mental health 

care. But that’s certainly not the case systemwide. Unfortunately 

there are no measures in place to assess patient outcomes. (In that 

regard, I would suggest that the Committee look into the rates at 

which OEF/OIF veterans drop out of PTSD treatment programs, 

surely one relevant indicator). But with what appear to be widespread disparities in the timeliness of VA care (but not necessarily 

the same focus on care-effectiveness), I understand that some have 

called for expanding veterans’ access to care from non-VA providers. 

Purchased Care: No Silver Bullet 

It seems doubtful that that step by itself can be the ‘‘silver bullet’’ solution for veterans’ mental health care. For one thing, it assumes first that the private sector holds a key to meeting VA’s 

mental health workforce ‘‘supply’’ problem. But a 2013 report to 

Congress warns of ‘‘an already thinly stretched [behavioral health] 

workforce.’’ 2 The report points to longstanding concerns about a 

national shortage of behavioral health workers, cited in previous 

publications, including the following: 

• A 2009 Study that found that 77 percent of counties had a 

severe shortage of mental health workers, both prescribers and 

non-prescribers and 96 percent of counties had some unmet 

need for mental health prescribers; 

• A 2012 Government report that found there were 3669 areas 

of the country with shortages of mental health professionals; 

• A 2007 Report that 55% of U.S. counties, all rural, had no 

practicing psychiatrists, psychologists or social workers; and 

• A 2010 Government report finding that more than two-thirds 

of primary care physicians who tried to obtain outpatient mental health services for their patients reported they were unsuccessful due in part to shortages in mental health care providers.3

Not only is there a real issue in terms of a national mental 

health workforce shortage, but there are real quality of care issues 

to contend with. According to the 2003 report of a presidential commission on mental health care in this country, ‘‘not only is there 

a shortage of [mental health providers, but those providers who are 

available are not trained in evidence-based and other innovative 

practices. This lack of education, training, or supervision leads to 

a workforce that is ill-equipped to use the latest breakthroughs in 


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4 ‘‘Achieving the Promise: Transforming Mental Health Care in America,’’ The President’s New 

Freedom Commission on Mental Health (July 2003), 70. Accessed at http://store.samhsa.gov/ 

shin/content//SMA03-3831/SMA03-3831.pdf. 5 Id., 68. 

6 Institute of Medicine, ‘‘Improving the Quality of Health Care for Mental Health and Substance-Use Conditions,’’ National Academies Press, 2006, 35. 

modern medicine.’’ 4 The Commission found that ‘‘too few benefit 

from available treatment’’ because ‘‘state-of-the-art treatments vital 

for quality care and recovery . . . are not being used.’’ 5 A 

later report by the Institute of Medicine that focused on improving 

the quality of behavioral health care cited ‘‘numerous studies [that] 

document the discrepancy between the [mental health and substance use] care that is known to be effective and the care that is 

actually delivered.’’ 6

A Better Purchased-Care Model 

Years ago, Washington State’s Department of Veterans Affairs, 

recognized the unique needs of Wartime Veterans and their families and established a PTSD Counseling Program to provide access 

to best practices of care for those who otherwise couldn’t get that 

care through VA because of service-unavailability or distance. 

Under the Department’s program, 30 licensed practitioners across 

the state provide counseling services at State expense; importantly 

each has a minimum of 24 years of experience and all providers are 

veterans or are trained to be military and veteran culturally competent. Veterans need only contact the program director who will 

determine the best practitioner for the individual situation and 

connect the Veteran with that office. Given the counselor’s experience and backgrounds, the veterans I’ve referred to the program 

have found it very helpful. (For the same reasons, veterans with 

whom I’ve worked and whom I’ve met around the country have 

similarly positive experiences with VA’s Vet Centers.) But in the 

most recent instance, the veteran I referred to the Washington 

State program was informed that all the providers in his area had 

full case loads and were not taking new clients. 

I don’t want to suggest that VA could not benefit from greater 

use of purchasing care, where that care is available and where it 

offers promise of being effective. But it would not be particularly 

helpful simply for veterans to be ‘‘seen’’ outside the VA by a provider who is not equipped to provide effective care—for lack of 

training in treating combat- or MST-related PTSD, for lack of ‘‘cultural competence,’’ or any other shortcomings. In short, it is pretty 

clear that providing an avenue to mental health care, even if there 

is a source, does not assure that veterans will get effective care. 

Improving VA Mental Health Care 

So what’s the answer? It’s important to appreciate that the VA 

health care facilities do have caring, dedicated providers. I know, 

for example, that some of my own health care providers are coming 

in on weekends and staying late at night to keep up with their 

work. I don’t believe the answer to improving VA mental health 

care is to demand more of those clinicians. 

But I think we have to demand that VA mental health care—especially for veterans with service-incurred mental health conditions—become a top priority. VA leaders have, of course, repeatedly 


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7 Institute of Medicine, ‘‘PTSD in Military and Veteran Populations,’’ National Academies 

Press, 2014, 6. 

stated that it is. But if that were so, why would my VA medical 

center in Washington State have effectively eliminated—for reasons of cost—the one program through which OEF/OIF veterans 

got excellent mental health care? Why, given strong policies on 

PTSD care would there be variability on PTSD management from 

facility to facility, and why would it be ‘‘unclear whether VA leaders adhere to [VA PTSD] policies,’’ as a recent Institute of Medicine 

study reported.7 And why would veterans in facilities across the 

country be having problems getting timely and effective VA mental 

health care? 

From this veteran’s perspective—with staggering numbers who 

have come back from war with psychic wounds and PTSD—the 

starting point for improving VA mental health care lies with VA 

leadership at all levels embracing the principle that providing timely, effective mental health care for those with service-incurred mental health conditions—whether due to combat, military sexual trauma, or otherwise—MUST be a top priority! These are not just 

words. We’ve seen with the example of VA’s efforts to combat veteran homelessness, that this Department can have a real impact 

when the direction and priority are clear, when artificial performance requirements don’t create distortions, and when clinicians 

have latitude to provide good care. Improving mental health care 

may be as or more complex a challenge, but it surely requires a 

comprehensive approach. I don’t think legislation is necessarily the 

path through which to meet the challenge, although there are important steps Congress can take. These might include: 

• Providing incentives to help increase the mental health 

workforce; 

• Funding training programs for non-VA mental health providers on treating service-incurred PTSD and on military culture to improve clinicians’ expertise and cultural competence in 

working with military and veteran populations; and 

• Increasing VA funding for research to find better treatments 

for PTSD. 

But I believe that there is much that VA should, and with the 

right leadership, can do itself. First, I would reiterate the point I 

made above about instituting interdisciplinary, team-based treatment. While VA’s PACT program employs that approach in the primary care arena, it shouldn’t end there. There is also much to be 

learned from the Vet Center program, and why veterans—who 

have to feel safe and trust their provider if they are to engage in 

mental health care—are comfortable in that setting. Vet Center 

counsellors are typically veterans, and often combat veterans. Having a connection with peers is critical. And Vet Centers engage 

family members as well. I believe VA medical centers and clinics 

would have far greater success in treating veterans for PTSD and 

other mental health conditions—and keeping them in treatment— 

if they routinely engaged the family at the same time. 

Many of the problems with which this Committee has wrestled 

in overseeing VA seem to relate to management practices. Perhaps 

it’s time for VA to change course and rely more on the dedicated 


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clinicians in this health care system, and less on arbitrary performance requirements and metrics. As the ones who are closest to the 

patients, the clinicians are probably best able to develop veterancentered programs—like the Deployment Health Team I described 

earlier. 

Finally I would draw on my own experience working with other 

warriors as a peer-mentor. As a former infantryman who was badly 

injured and experienced psychic wounds too, I can say things to 

other warriors that a clinician can’t and I can assure those warriors from my own experience that mental health treatment can 

work. To its credit, VA has hired and provided for the training of 

more than 800 peer-specialists, to work as members of VA mental 

health treatment teams. That is a great concept, but with the numbers of veterans coming to VA for mental health care, I would recommend that that number be greatly expanded. 

I hope my experiences, observations, and recommendations are of 

some help, and would be pleased to answer your questions. 

f 

Prepared Statement of Maureen McCarthy 

Good morning, Chairman Miller, Ranking Member Michaud and 

Members of the Committee. Thank you for the opportunity to discuss the provision of mental health care to Veterans, particularly 

those who are at risk for suicide. I am accompanied today by Dr. 

David Carroll, National Mental Health Program Director for Program Integration, Dr. Harold Kudler, Acting Chief Consultant for 

Mental Health Services and Mr. Michael Fisher, Operation Enduring Freedom/Operation Iraqi Freedom Specialist. My written statement will provide a brief overview of VA’s mental health care system and programs for suicide prevention. 

Mental Health Care Overview 

Since September 11, 2001, more than two million 

Servicemembers have deployed to Iraq or Afghanistan. Long deployments and intense combat conditions require optimal support 

for the emotional and mental health of Veterans and their families. 

Accordingly, VA continues to develop and expand its mental health 

system. The number of Veterans receiving specialized mental 

health treatment from VA has risen each year, from 927,052 in Fiscal Year (FY) 2006 to more than 1.4 million in FY 2013. We anticipate that VA’s requirements for providing mental health care will 

continue to grow for a decade or more after current operational 

missions have come to an end. VA believes this increase is partly 

attributable to proactive screening to identify Veterans who may 

have symptoms of depression, posttraumatic stress disorder 

(PTSD), substance use disorder, or those who have experienced 

military sexual trauma (MST). In addition, VA has partnered with 

the Department of Defense (DoD) to develop the VA/DoD Integrated Mental Health Strategy to advance a coordinated publichealth model to improve access, quality, effectiveness, and efficiency of mental health services for Servicemembers, National 

Guard and Reserve, Veterans, and their families. 

VA has many entry points for VHA mental health care, through 

150 medical centers, 820 Community-Based Outpatient Clinics 


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1http://www.healthquality.va.gov/guidelines/MH/ptsd/cpg-PTSD-FULL-201011612.pdf. 

(CBOCs), 300 Vet Centers that provide readjustment counseling, 

the Veterans Crisis Line, VA staff on college and university campuses, and other outreach efforts. To serve the growing number of 

Veterans seeking mental health care, VA has deployed significant 

resources and increases in staff toward mental health services. 

Since March 2012, VA has added 2,444 mental health full-time 

equivalent employees and hired 915 peer specialists and apprentices. As of January 2014, VHA has 21,128 Mental Health full-time 

equivalent employees providing direct inpatient and outpatient 

mental health care. VA has expanded access to mental health services with longer clinic hours, telemental heath capability to deliver 

services, and standards that mandate immediate access to mental 

health services to Veterans in crisis. Starting in FY 2012, site visits have been conducted to the mental health programs in each VA 

facility. All facilities were visited in the initial round, and subsequently one third are being visited each year by a survey team 

from VHA’s Office of Mental Health Operations. The site visits are 

informed by ratings on performance measures; findings from the 

visits are used to develop action plans; and improvements are evaluated by following performance measures as well as the milestones 

and deliverables included in the plans. In an effort to increase access to mental health care and reduce any stigma associated with 

seeking such care, VA has integrated mental health into primary 

care settings. From the beginning of FY 2008 to March 2014, VA 

has provided more than 3.6 million Primary Care-Mental Health 

Integration (PC–MHI) clinic visits to more than 942,000 unique 

Veterans. This improves access by bringing care closer to where the 

Veteran can most easily receive these services, and quality of care 

by increasing the coordination of all aspects of care, both physical 

and mental. Among primary-care patients with positive screens for 

depression, those who receive same-day PC–MHI services are more 

than twice as likely to receive depression treatment as those who 

did not. 

VA has made deployment of evidence-based therapies a critical 

element of its approach to mental health care and offers a continuum of recovery-oriented, patient-centered services across outpatient, residential, and inpatient settings. State-of-the-art treatment, including both psychotherapies and biomedical treatments, 

are available for the full range of mental health problems, such as 

PTSD, substance use disorders, and suicidality. While VA is primarily focused on evidence-based treatments, we are also assessing 

complementary and alternative treatment methodologies that need 

further research, such as meditation and acupuncture in the care 

of PTSD. VA has trained over 5,900 VA mental health professionals to provide two of the most effective evidence-based 

psychotherapies for PTSD, Cognitive Processing Therapy and Prolonged Exposure Therapy, as indicated in the VA/DoD Clinical 

Practice Guideline for PTSD 1 VA operates the National Center for 

PTSD, which guides a national PTSD mentoring program, working 

with every specialty PTSD program across the VA health care system. The Center has begun a PTSD consultation program for any 

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less Program coordinators) who request consultation regarding a 

Veteran in treatment with PTSD. So far, over 500 VA practitioners 

have utilized this service. 

We know that there have been Veterans with complaints about 

access. We take those concerns seriously and continue to work to 

address them. Receiving direct feedback from Veterans concerning 

their care is vitally important. During the fourth quarter of FY 

2013, a survey of 26 questions was mailed to over 40,000 Veterans 

who were receiving mental health care. This survey shows VHA’s 

effort to seek direct input from Veterans in understanding their 

perceptions regarding access to care. We recognize that this is data 

only from those who chose to respond. We will bear those responses 

in mind as we strive to improve the timeliness of appointments; reminders for appointments; accessibility, engagement, and responsiveness of clinicians; availability and agreement with clinician on 

desired treatment frequency; helpfulness of mental health treatment; and treatment with respect and dignity. 

Programs and Resources for Suicide Prevention 

Overall, Veterans are at higher risk for suicide than the general 

U.S. population, notably Veterans with PTSD, pain, sleep disorders, depression, and substance use disorders. VA recognizes that 

even one Veteran suicide is too many. We are committed to ensuring the safety of our Veterans, especially when they are in crisis. 

Our suicide prevention program is based on enhancing Veterans’ 

access to high quality mental health care and programs specifically 

designed to help prevent Veteran suicide. 

In partnership with the Substance Abuse and Mental Health 

Services Administration’s National Suicide Prevention Lifeline, the 

Veterans Crisis Line/Military Crisis Line (VCL/MCL) connects Veterans and Servicemembers in crisis and their families and friends 

with qualified, caring VA responders through a confidential tollfree hotline that offers 24/7 emergency assistance. August will 

mark seven years since the establishment of the initial program, 

which was later rebranded to show its direct support for 

Servicemembers. It has expanded to include a chat service and 

texting option. As of March 2014, the VCL/MCL has rescued 37,000 

actively suicidal Veterans. As of March 2014, VCL/MCL has received over 1,150,000 calls, over 160,000 chat connections, and over 

21,000 texts; it has also made over 200,000 referrals to Suicide Prevention Coordinators (SPCs). In accordance with the President’s 

August 31, 2012, Executive Order titled, ‘‘Improving Access to Mental Health Services for Veterans, Servicemembers and Military 

Families,’’ VA completed hiring and training of additional staff to 

increase the capacity of the VCL/MCL by 50 percent. 

VA has a network of over 300 SPCs located at every VA medical 

center and the largest CBOCs throughout the country. Overall, 

SPCs facilitate implementation of suicide prevention strategies 

within their respective medical centers to help ensure that all appropriate measures are being taken to prevent suicide in the Veteran population, particularly Veterans identified to be at high risk 

for suicidal behavior. SPCs receive follow-up consults from the 

VCL/MCL call responders after immediate needs are addressed and 

any needed rescue actions are made. SPCs are required to follow 


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up on consults received from the VCL/MCL within one business 

day to ensure timely access to care for Veterans callers who need 

additional support, treatment, or other services, including enrollment into VA’s health care system. SPCs also plan, develop, implement, and evaluate their facility’s Suicide Prevention Program to 

ensure continual quality improvement and excellence in customer 

service. SPCs are responsible for implementing VA’s Operation 

S.A.V.E (Signs of suicidal thinking, Ask the questions, Verify the 

experience with the Veteran, and Expedite or Escort to Help). This 

is a one-to-two hour in-person training program provided by VA 

SPCs to Veterans and those who serve Veterans to help prevent 

suicide. Suicide prevention training is provided for every new VHA 

employee during Employee Orientation. 

SPCs participate in outreach activities, which remain critically 

important to VA’s goals of reducing stigma for mental health issues 

and improving access to service for all Veterans. Examples include 

community suicide prevention training and other educational programs, exhibits, and material distribution; meetings with state and 

local suicide prevention groups; and suicide prevention work with 

Active Duty/National Guard and Reserve units as well as college 

campuses. To date, each SPC is required to complete five or more 

outreach activities in their local community each month. 

Veterans may be at high risk for suicide for various reasons. Determination of suicide risk is always a clinical judgment made after 

an evaluation of risk factors (e.g., history of past suicide attempts, 

recent discharge from an inpatient mental health unit), protective 

factors, and the presence or absence of warning signs. VHA Handbook 1160.01, ‘‘Uniform Mental Health Services in VA Medical 

Centers and Clinics,’’ requires inpatient care be available to all 

Veterans with acute mental health needs (including imminent danger of self harm), either in a VA medical center or at a nearby facility through a contract, sharing agreement. 

To ensure that high-risk Veterans are being monitored appropriately, SPCs manage a Category I Patient Record Flag (PRF) 

with a corresponding High-Risk List. The primary purpose of the 

High Risk for Suicide PRF is to communicate to VA staff that a 

Veteran is at high risk for suicide, and the presence of a flag 

should be considered when making treatment decisions. Once a 

Veteran is identified as high-risk, the SPC ensures that weekly 

contact is made with the Veteran for at least the first month, and 

that continued follow-up is made, as clinically appropriate. The 

SPC works with the treatment team to ensure that patients identified as being at high risk for suicide receive follow up for any 

missed mental health and substance abuse appointments at VA. 

Clinicians are required to initiate at least three attempts to contact 

Veterans on the High-Risk List who fail to appear for mental 

health appointments and ensure appropriate documentation. If attempts to contact the Veteran are unsuccessful, the SPC collaborates with the Veteran’s treatment team to decide what further action is appropriate involving a range of options from continued outreach efforts to the Veteran and/or family members up to requesting local law enforcement perform a welfare check in-person. 

SPCs ensure that all Veterans identified as high risk for suicide 

have completed a safety plan that is documented in their medical 


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2http://www.mentalhealth.va.gov/communityproviders. 

3http://www.mentalhealth.va.gov/communityproviders/clinic-suicideprevention.asp. 

record, and that the Veteran is provided a copy of his or her safety 

plan. 

National suicide prevention outreach efforts continue to expand 

and include targeted efforts for Veterans, Servicemembers, families, and friends. VA has sponsored public service announcements, 

rebranded and optimized the VCL/MCL Web site for mobile access 

and viewing, and developed social and traditional media advertisements designed to inform Veterans and their families of VA’s VCL/ 

MCL resources including phone, online chat, and text services. 

In addition, VA has established an online Community Provider 

Toolkit 2 for individuals outside of VA who provide care to Veterans. This Web site features key tools to support the mental 

health services provided to Veterans including information on connecting with VA, understanding military culture and experience, 

and working with patients with a variety of mental health conditions. There is also a comprehensive Suicide Prevention Mini-Clinic 

which provides clinicians with easy access to useful Veteran-focused treatment tools, including assessment, training, and educational handouts.3

In 2010, DoD and VA approved plans for a Joint Suicide Data 

Repository (SDR) as a shared resource for improving our understanding of patterns and characteristics of suicide among Veterans 

and Servicemembers. The combined DoD and VA search of data 

available in the National Death Index represents the single largest 

mortality search of a population with a history of military service 

on record. The DoD/VA Joint SDR is overseen by the Defense Suicide Prevention Office and VA’s Suicide Prevention Program. 

On February 1, 2013, VA released a report on Veteran suicides, 

a result of the most comprehensive review of Veteran suicide rates 

ever undertaken by VA. With assistance from state partners providing real-time data, VA is now better able to assess the effectiveness of its suicide prevention programs and identify specific populations that need targeted interventions. This new information will 

assist VA in identifying where at-risk Veterans may be located and 

improving the Department’s ability to target specific suicide interventions and outreach activities in order to reach Veterans early 

and proactively. These data will also help VA continue to examine 

the effectiveness of suicide prevention programs being implemented 

in specific geographic locations (e.g., rural areas), as well as care 

settings, such as primary care, in order to replicate effective programs in other areas. VA continues to receive state data which is 

being included in the SDR. VA plans to update the suicide data report later this year. 

In 2011, the most recent year for which national data are available, the age-adjusted rate of suicide in the U.S. general population 

was 12.32 per 100,000 persons per year. At just over 12 for every 

100,000 U.S. residents, the 2011 rate of suicide has increased by 

approximately 15 percent since 2001. Rates of suicide in the United 

States are higher among males, middle-age adults, residents in 

rural areas, and those with mental health conditions. 


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4www.mentalhealth.va.gov/docs/Suicide-Data-Report-Update-2014.pdf. 

The most recent available data shows that suicide rates are generally lower among Veterans who use VHA services than among 

Veterans who do not use VHA services. In 2011, the rate of suicide 

among those who use VHA services was 35.5 per 100,000 persons 

per year; a decrease of approximately 6 percent since 2001. Rates 

of suicide among those who use VHA services have remained relatively stable; ranging from 36.5 to 37.5 per 100,000 persons per 

year over the past 4 years. Despite evidence of increased risk 

among middle-aged adults (35–64 years) in the U.S. general population, rates of suicide among middle-aged adults who use VHA 

services have decreased by more than 16 percent between the years 

1999–2010. For males without a history of using VHA services, the 

rate increased by more than 60 percent, whereas for males with a 

history of using VHA services, the rate decreased by more than 30 

percent. Decreases in suicide rates and improvements in outcomes 

were also observed for some other high-risk groups. Between 2001 

and 2010, rates of suicide decreased by more than 28 percent 

among VHA users with a mental health or substance abuse diagnosis, and the proportion of VHA users who die from suicide within 

12 months of a survived suicide attempt has decreased by approximately 45 percent during the same time period.4

Comparisons of rates of suicide among those with use of VHA 

services and the U.S. general population are ongoing. However, in 

2010, rates of suicide were 31 percent higher among males who 

used VHA services when compared to rates of suicide among males 

in the U.S. general population. During that same year, women who 

used VHA services were more than twice as likely to die from suicide when compared to women in the U.S. adult population. Increases in rates of suicide have also been identified for younger 

males who use VHA services. Over the last three years, rates of 

suicide have increased by nearly 44 percent among males under 30 

years of age who use VHA services and by more than 70 percent 

among males who use VHA services between 18 and 24 years of 

age. 

In response to these findings, VA has been focusing on public 

health and community programming. This includes increased and 

targeted outreach efforts throughout the country to Veterans and 

their family members with significant emphasis on safety. We encourage Veterans and their families to learn more about mental illness and to take precautions particularly during times of stress 

(e.g., properly storing weapons and medications). Being alert to 

items in the environment that offer potential means of suicidal behavior can make a life-saving difference during a crisis. Messaging 

and interventions are geared toward those who are most at risk for 

suicide, including our younger male Veterans, women Veterans, 

Veterans with mental health conditions, and established patients 

who are known to be at high risk for suicide. Strategies include 

specialized training for VHA staff to enhance their recognition and 

treatment of those at risk, and offering Veterans skills-building 

and other preventive strategies to address major stressors in their 

lives. Furthermore, VA is engaged in ongoing research to determine 

the most effective mental health treatments and suicide prevention 


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strategies. Finally, VA has established the Mental Health Innovations Task Force, which is working to identify and implement early 

intervention strategies for specific high-risk groups including Veterans with PTSD, pain, sleep disorders; depression, and substance 

use disorders. Through early intervention, VA hopes to reduce the 

risk of suicide for Veterans in these high-risk groups. 

Readjustment Counseling Service (RCS) 

VA’s RCS provides a wide range of readjustment counseling services to eligible Veterans and active duty Servicemembers who have 

served in combat zones and their families. RCS also provides comprehensive readjustment counseling for those who experienced military sexual trauma, as well as offering bereavement counseling to 

immediate family members of Servicemembers who died while on 

active duty. These services are provided in a safe and confidential 

environment through a national network of 300 community-based 

Vet Centers located in all 50 states (as well as the District of Columbia, American Samoa, Guam, and Puerto Rico), 70 Mobile Vet 

Centers, and the Vet Center Combat Call Center (877–WAR–VETS 

or 877–927–8387). In FY 2013, Vet Centers provided over 1.5 million visits to Veterans, active duty Servicemembers, and their families. The Vet Center program has provided services to over 30 percent of OEF/OIF/Operation New Dawn Veterans who have left active duty. 

Closing Statement 

Mr. Chairman, VA is committed to providing timely, high quality 

of care that our Veterans have earned and deserve, and we continue to take every available action and create new opportunities 

to improve suicide prevention services. We appreciate the opportunity to appear before you today, and my colleagues and I are prepared to respond to any questions you may have. 


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PREPARED STATEMENT OF JONATHAN SHERIN

Greeting 

Thank you Mr. Chairman, ranking member and committee for 

convening today’s hearing on the critical issues of mental health 

access and suicide prevention challenges in the Veteran community. I am deeply honored to testify on these topics. Aside from 

being core drivers of my mission in life they represent national imperatives of the highest order. 

Preface 

Let me preface my testimony by stating that to manage serious 

mental health issues and to prevent suicide in any population requires not only identifying those who are suffering and dismantling 

any barriers that may be interfering with their access to treatment, 

but also creating enriched and cohesive communities in which all 

comers belong, in which opportunities to live purposefully are cultivated, in which wellbeing is nourished broadly and in which 

human flourishing is an articulated, promoted and attainable goal; 

in other words, we need proactive systems set up to disrupt suicidal thinking on the front end. 

My Expedience, Current Role and Perspective 

After completing my graduate work in medicine and neurobiology 

I was fortunate to be selected by UCLA as a psychiatry trainee. On 

the first day of residency orientation I drove myself to the majestic 

and hallowed grounds of the WLA VA campus, a primary clinical 

venue affiliated with UCLA’s training program, and parked myself 

at the golf course where I watched Veterans come and go for hours. 

This experience changed me as it became clear in this one afternoon that my life’s work would revolve around caring for our nation’s Veterans. Four years later, the VA hired me straight out of 

training and my dream became a reality. Over the course of the 

next decade I served as a clinician, teacher, researcher and administrative leader at VA with my last stop as Chief of Mental Health 

for the Miami VAHS. 

Since leaving the VA 2 ‡ years ago to join Volunteers of America 

(VOA) as Executive Vice President for Military Communities and 

Chief Medical Officer, this mission has continued. VOA is a large 

direct human service provider whose legacy of work with Veterans 

dates back to the post-Civil War era. We currently employ over 

16,000 staff working in over 400 communities around the country 

and provide a broad array of programs to the Veteran community 

including services to well over 10,000 homeless Veterans through 

VA grants and contracts alone. It is VOA’s national priority to do 

anything and everything we can for the Veterans of our Nation 

which we do not only through programs funded specifically for Veterans, but through any resources we can bring to bear for the mission. One of these programs, the Battle-Buddy-Bridge (B3), which 

leverages Veterans as peers in service to one another, is particularly relevant to solving access problems that are under review 

today (see B3 Concept Proposal, attached). 

My experience working on this mission from inside the VA and 

now outside the VA gives me a great deal of perspective as to the 

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tions. It is my contention that a great deal can be done to improve 

access to the resources that will help improve mental health outcomes and decrease suicides by aligning VA and community in a 

manner that mutually leverages existing infrastructure and expertise to increase the depth, breadth and efficacy of our efforts. 

The Access Problem 

One of the primary challenges facing VA as well as the health 

and human service sector in general, is dealing with broken systems of access to services. Access barriers are present in essentially 

every community today and affect vulnerable individuals as a rule, 

but they are particularly problematic for Veterans in need who can 

be hard to reach for any number of reasons: some are unaware of 

available services and opportunities; many are reluctant to seek 

help as a consequence of military culture and/or mistrust of the 

system; others are too sick to advocate for themselves or have been 

rebuffed or delayed in seeking assistance; and too many have fallen 

through the cracks as a consequence of poorly coordinated and 

overly complex bureaucratic systems. Though not unique to the 

Veteran community, a massive amount of unnecessary suffering is 

endured, lives are broken, and in some cases lives are taken as a 

result of suboptimal access. Access problems simply cannot continue to plague our Veteran population. 

A Holistic Approach 

The ultimate goal of our work with Veterans facing emotional 

challenges involves accessing not only mental health treatment but 

also interventions targeting other factors that mitigate mental distress and thereby protect against mental illness and suicide. For 

example, it is possible to improve mental status by providing access 

to resources such as peer navigation, case management, housing, 

education, training, employment, legal services, benefits assistance 

and family support when indicated. 

Given the vulnerabilities conferred on any number of these factors by the military experience, Veterans in particular must receive 

care in a holistic manner that extends well beyond mental health 

treatment. Along these lines, the familial relations found in peerpeer programs, the community experience provided by a respectable job and the spiritual benefits obtained by engaging in missionoriented endeavors are salves for disruptions in life that can occur 

during enlistment, service and separation. 

The Need 

As the offerings needed in the Veteran community are myriad, 

the resources limited, and the processes for accessing them frustrating to navigate, urgent problems sometimes go unaddressed, 

worsening mental states evolve and devastating life circumstances 

such as homelessness or life-threatening emergencies such as suicidal behavior emerge. Keeping in mind the principles of overcoming 

access barriers and broadly targeting needs to mitigate mental distress as well as suicide, Veterans with urgent problems (such as 

worsening family dynamics, spiraling substance-abuse, housing instability, health crises, progressing financial problems, acute legal 

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sources that can keep them on a road toward community reintegration. 

For these reasons, a caring advocate such as a fellow Veteran 

functioning as a battle buddy in the community who is trained, 

equipped, deployed and supported to provide expert hands-on engagement and local resource navigation can make all of the difference. We must immediately scale this type of solution as part of 

a full frontal assault on the barriers to access that face our nation’s 

Veterans. 

The Current Situation 

Access to mental health services is suboptimal. In light of recent 

findings from investigations of scheduling practices at VA as well 

as a plethora of testimonials regarding wait times and inadequate 

service availability, there is clearly a need to develop strategies for 

improving real-time responsiveness to Veterans reaching out for 

help. 

Suicide rates are unacceptably high, especially in the younger 

and older Veteran populations. Though discrepancies exist regarding the rates of suicide in different subpopulations, rates have 

climbed in the Veteran community and require the highest level of 

attention that our nation can muster to improve access. 

The VA reaches less than half of the Veteran population. While 

it is clear that receiving care at VA benefits Veterans and mitigates 

suicidal behavior, many Veterans at risk never connect with these 

programs. Though many Veterans never connect with these programs because of outreach limitations, many others refuse to use 

the VA system. 

Receiving care at the VA can be difficult due to time and distance constraints. Many of those who are reached by the VA find 

travel and wait times problematic which deters their interest in ongoing treatment, especially in the face of rapidly developing crises. 

Community providers are woefully under leveraged as resources 

to support mental health and mitigate suicide risk. Due in part to 

the VA’s noble tradition of trying to serve all the needs of all Veteran and in part to the constraints that complicate public-privatepartnership, communities have not been fully engaged to assist in 

getting services to Veterans. 

Recommendations for VA 

The VA alone cannot provide all services to all Veterans in all 

geographies and must partner vigorously with appropriate providers to improve access to services as has been done to house 

homelessness Veterans by partnering with and embracing the community. 

1. Promote pubic-private partnerships (PPP) across all sectors to 

increase agency reach and expand access opportunities for Veterans. 

2. Use grant mechanisms straight out of VACO (such as 

NCHAV’s SSVF) to avoid layers of bureaucracy and improve overall efficiency. 

3. Identify partnerships to push out services as below that strategically supplement, complement and create synergy with VA operations to increase access through outreach, engagement and resource navigation according to a B3-like program model. 


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a. Place Veteran Peer Specialists (VPS) in the community to 

function as ‘‘battle buddies’’. 

b. Connect Veterans in need to VPS thru suicide prevention coordinators, crisis line, 211. 

c. Retrofit VA campuses with, and transform service centers into, 

reintegration centers that host VPS, a modicum of services and a 

map of all available community resources. 

d. Leverage technology to amplify access to VPS (for example, 

PosRep). 

Requests of Congress 

Assistance from Congressional leadership in moving forward is 

critical. 

1. Visit the trenches of your local VA and community providers 

to better understand the opportunities available through partnership between VA and other organizations. 

2. Review the structure of VA and its strategy for facilitating 

Veteran reintegration in partnership with the community with special focus on considering the SSVF grant mechanism as a gold 

standard for how to manage organizational relationships. 

3. Lobby for and support demonstration projects that employ Veterans to work as peer specialists who can expand outreach, facilitate engagement and lead navigation efforts for Veterans with 

acute needs. 

4. Push reform where possible and develop new legislation where 

necessary to facilitate partnerships with the community. 

Closing 

Time is a conspiring enemy in what is becoming a domestic war. 

The resolve and urgency that our country mounts to win foreign 

wars must be employed to achieve victory at home. With the help 

of Congressional leaders, bureaucratic barriers must be torn down 

aggressively so that solutions can be erected. Most importantly, facile mechanisms that foster relationships across all sectors of the 

American collective must be developed with unprecedented efficiency to implement a shared process for promoting the wellbeing 

of our noble military community. 


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Statement For The Record 


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REPORT BY CITIZENS COMMISSION ON HUMAN RIGHTS INTERNATIONAL

Questions For The Record 

LETTER AND QUESTION FROM: HVAC, TO: VA 

July 17, 2014 

The Honorable Sloan Gibson 

Acting Secretary 

U.S. Department of Veterans Affairs 

810 Vermont Avenue, NW 

Washington, DC 20420 

Dear Mr. Secretary: 

Committee practice permits the hearing record to remain open to 

permit Members to submit additional questions to the witnesses. In 

reference to our Full Committee hearing entitled, ‘‘Service Should 

Not Lead to Suicide: Access to VA’s Mental Health Care’’ that took 

place on July 10, 2014, I would appreciate if you could answer the 

enclosed hearing questions by the close of business on August 29, 

2014. 

In preparing your responses to these questions, please provide 

your answers consecutively and single-spaced and include the full 

text of the question you are addressing in bold font. To facilitate 

the printing of the hearing record, please email your response in 

a Word document, to Carol Murray at 

Carol.Murray@mail.house.gov by the close of business on August 

29, 2014. If you have any questions please contact her at 202–225– 

9756. 

Sincerely, 

MICHAEL H. MICHAUD 

Ranking Member 

Questions Submitted by Ranking Member Michaud: 

Ranking Member Michaud 

1. How is a call from a veteran in crisis handled by the phone 

system or personnel of VA facilities during working hours? 

2. Is a veteran in crisis currently able to be transferred directly 

to the VA crisis hotline by automated system during off hours 

when he or she calls any VA facility, that is, without having to 

hang up and dial another number? 

3. Has the VA analyzed what resources would be needed to provide an automated system that would allow a veteran in crisis to 

be directly transferred to the crisis hotline if he or she calls any 

VA facility? 

4. Has the VA analyzed what resources would be needed to provide a ‘‘warm handoff’’ to the crisis hotline to a veteran in crisis 

calling a VA facility during non-working hours? 

REP. BROWN

1. There are 22 veterans who commit suicide every day. The 

treatment most accessible to veterans is psychiatric drugs and the 

most commonly prescribed are the SSRI anti-depressants. The FDA 

placed a black box warning on these drugs noting the particularly 

high risk of suicide in those 24 years old and younger taking them. 

Are the veterans who are prescribed SSRI anti-depressants told the 

drug may greatly increase their risk of suicide? What is the VA 


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doing to ensure veterans are receiving full informed consent (which 

includes all information about risks and alternative treatments)? 

A study in the Journal of Clinical Psychiatry titled, 

‘‘Pharmacotherapy of PTSD in the U.S. Department of Veterans Affairs: diagnostic- and symptom-guided drug selection,’’ found that 

80% of veterans diagnosed with PTSD received psychotropic medication, with 89% prescribed anti-depressants, 61% anxiolytics/sedative-hypnotics, and 34% antipsychotics. 

According to Department of Defense Instruction, Number 

6000.14, September 26, 2011, entitled, ‘‘DoD Patient Bill of Rights 

and Responsibilities in the Military Health System (MHS),’’ military personnel are entitled to informed consent for any treatment 

and to refuse to receive treatment. That regulation states, in part, 

under the section, ‘‘PATIENT RIGHTS’’: 

‘‘f. Informed Consent 

‘‘Patients have the right to any and all necessary information in 

non-clinical terms to make knowledgeable decisions on consent or 

refusal for treatments, or participation in clinical trials or other research investigations as applicable. Such information is to include 

any and all complications, risks, benefits, ethical issues, and alternative treatments as may be available.’’ 

2. A UCSF professor once explained: ‘‘The mechanism of action 

of SSRI anti-depressants is to block the normal re-absorption of Serotonin, which leaves it firing at the receptor site over and over, 

artificially creating the effect of elevated Serotonin in the brain. It 

is possible to have an initial positive response to the drug, but 

shortly thereafter the brain recognizes the unnatural excess firing 

of Serotonin at the receptor sites. As a result, the brain adapts and 

tries to regain its equilibrium by shutting down production of Serotonin. If the SSRI anti-depressant continues to be taken, the brain 

will then move to shut down some of the receptor sites in a bid to 

regain normal. This mechanism of action is why the drugs stop 

working and why people have a hard time coming off them and 

why people get depressed when they come off the drug. The SSRI 

altered the normal brain chemistry and created a chemical imbalance. This is evidence-based. The use of SSRIs leads to chronic depression.’’ 

a. This is creating more need for treatment and overburdening 

the system. Has the VA done any outcome studies? What percentage of patients treated with SSRIs recover and are able to successfully discontinue the drug? Where is the evidence of SSRI effectiveness? 

3. The VA is relying heavily on psychotropic drug treatments. 

Adverse reactions of psychotropic drugs include a long list of medical symptoms and conditions including weight gain, diabetes, metabolic syndrome, liver damage. Has the VA done any studies on 

iatrogenic illnesses caused by psychotropic drugs? 


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Æ 


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