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S. HRG. 112–236 

EXAMINING THE LIFETIME COSTS OF SUPPORTING 

THE NEWEST GENERATION OF VETERANS 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED TWELFTH CONGRESS 

FIRST SESSION 

JULY 27, 2011 

Printed for the use of the Committee on Veterans’ Affairs 

( 

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

(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

PATTY MURRAY, Washington, Chairman 

JOHN D. ROCKEFELLER IV, West Virginia 

DANIEL K. AKAKA, Hawaii 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

JIM WEBB, Virginia 

JON TESTER, Montana 

MARK BEGICH, Alaska 

RICHARD BURR, North Carolina, Ranking 

Member 

JOHNNY ISAKSON, Georgia 

ROGER F. WICKER, Mississippi 

MIKE JOHANNS, Nebraska 

SCOTT P. BROWN, Massachusetts 

JERRY MORAN, Kansas 

JOHN BOOZMAN, Arkansas 

KIM LIPSKY, Staff Director 

LUPE WISSEL, Republican Staff Director 

(III) 

C O N T E N T S 

JULY 27, 2011 

SENATORS 

Page 

Murray, Hon. Patty, Chairman, U.S. Senator from Washington ........................ 1 

Brown, Hon. Scott P., U.S. Senator from Massachusetts ..................................... 3 

Tester, Hon. Jon, U.S. Senator from Montana ...................................................... 4 

Johanns, Hon. Mike, U.S. Senator from Nebraska ............................................... 4 

Begich, Hon. Mark, U.S. Senator from Alaska ..................................................... 5 

Isakson, Hon. Johnny, U.S. Senator from Georgia ............................................... 55 

Boozman, Hon. John, U.S. Senator from Arkansas .............................................. 57 

WITNESSES 

Rieckhoff, Paul, Executive Director, Iraq and Afghanistan Veterans of America .......................................................................................................................... 7

Prepared statement .......................................................................................... 9 

Posthearing questions submitted by Hon. Mark Begich ............................... 12 

Hosek, James, Senior Economist, RAND Corporation ......................................... 12 

Prepared statement .......................................................................................... 14 

Nicely, Crystal, Caregiver and spouse of OEF veteran ........................................ 18 

Prepared statement .......................................................................................... 20 

St. James, Lorelei, Director, Physical Infrastructure Issues, United States 

Government Accountability Office ...................................................................... 22 

Prepared statement .......................................................................................... 23 

Posthearing questions submitted by Hon. Patty Murray .............................. 27 

Response to request arising during the hearing by Hon. Patty Murray ..... 59 

Golding, Heidi L.W., Principal Analyst for Military and Veterans’ Compensation, Congressional Budget Office ....................................................................... 27 

Prepared statement .......................................................................................... 29 

Posthearing questions submitted by Hon. Patty Murray .............................. 49 

APPENDIX 

Wersel, Vivianne Cisneros, Au.D., Chair, Government Relations Committee, 

Gold Star Wives; prepared statement ................................................................ 67 

Sullivan, Paul, Executive Director, Veterans for Common Sense; letter ............ 72 

Whitehouse, Sheldon; prepared statement ............................................................ 77 

(1) 

EXAMINING THE LIFETIME COSTS OF SUPPORTING THE NEWEST GENERATION OF 

VETERANS 

WEDNESDAY, JULY 27, 2011 

U.S. SENATE, 

COMMITTEE ON VETERANS’ AFFAIRS, 

Washington, DC. 

The Committee met, pursuant to notice, at 10:04 a.m., in room 

562, Dirksen Senate Office Building, Hon. Patty Murray, Chairman 

of the Committee, presiding. 

Present: Senators Murray, Tester, Begich, Isakson, Johanns, 

Brown of Massachusetts, and Boozman. 

OPENING STATEMENT OF HON. PATTY MURRAY, CHAIRMAN, 

U.S. SENATOR FROM WASHINGTON 

Chairman MURRAY. Good morning, and welcome to today’s hearing where we are going to examine the lifetime costs of supporting 

our newest generation of veterans. 

As we all know, when our Nation goes to war, it is not just the 

costs of fighting that war that must be accounted for. We must include the cost of caring for our veterans and families long after the 

fighting is over. And that is particularly true today, at a time when 

we have more than half a million Iraq and Afghanistan veterans 

in the VA health care system. That is an over 100 percent increase 

since 2008. 

This presents a big challenge, and one that we have no choice 

but to step up to meet if we are going to avoid many of the same 

mistakes we saw with the Vietnam generation. But it is more than 

just the sheer number of new veterans that will be coming home 

that poses a challenge for the VA. It is also the extent of the 

wounds, both visible and invisible, and the resources it will take 

to provide our veterans with quality care. 

Through the wonders of modern medicine, servicemembers who 

would have been lost in previous conflicts are coming home to live 

productive and fulfilling lives. But they will need a lifetime of care 

from the VA. 

Today, we will hear from the Congressional Budget Office, the 

Government Accountability Office, the RAND Corporation, and 

Iraq and Afghanistan Veterans of America in an effort to help us 

quantify and understand these costs and to ensure that we can 

meet the future needs of our veterans and their families. 

And today we are so fortunate to be joined by one of those brave 

family members, Crystal Nicely, who is not only a wife but also a 

2 

caregiver to her husband, Marine Corporal Todd Nicely. Todd was 

seriously injured by an IED in the southern Helmand Province of 

Afghanistan. Since that time, he has come home to fight every day, 

focus on his recovery, and I even heard yesterday that he is already 

starting to drive again, and I want to take a moment to say thank 

you so much for your service to our country. You have shown bravery not only as a Marine in Afghanistan, but also through the courage you have displayed during your road to recovery. 

I invited Crystal here today because I think it is incredibly important that we hear her perspective. The costs we have incurred 

for the wars in Iraq and Afghanistan—and will continue to incur 

for a very long time—extend far beyond dollars and cents. 

When I first met Crystal last month while touring Bethesda 

Naval Base, her story illustrated that. Crystal is here today to talk 

about the human cost, and that cost is not limited exclusively to 

the servicemembers and veterans who fought and are fighting our 

wars, but it is also felt by the families of these heroes who work 

tirelessly to support their loved ones through deployments and rehabilitation day in and day out. Many, like Crystal, have given up 

their own jobs to become full time caregivers and advocates for 

their loved ones. 

Last month, while testifying before the Senate Appropriations 

Subcommittee on Defense, Chairman of the Joint Chiefs of Staff, 

Admiral Mullen, told me that ‘‘without the family members we 

would be nowhere in these wars.’’ I could not agree more; and after 

you hear Crystal’s story, that will be even more clear. 

As the Members of this Committee know, over the course of the 

last few hearings we have examined how the veterans of today’s 

conflicts are faced with unique challenges that VA and DOD are 

often falling short of meeting. 

We have explored mental health care gaps that need to be filled, 

cutting-edge prosthetics that must be maintained, a wave of new 

and more complex benefit claims that are taking too long to complete, the need to fulfill the promise of the Post-9/11 GI Bill, and 

the need to support veterans who are winding up out-of-work and 

on the streets. 

All of these unmet challenges come with costs. Some costs we 

will be able to calculate. Some will not be fully known for decades. 

But today’s hearing will be a reminder that in order to meet 

these costs we must safeguard the direct investments we make in 

veterans care and benefits. We must get the most value out of 

every dollar we spend, and we must start planning today at a time 

when critical long-term budget decisions are being made. 

As we all know, there is no question that we need to make smart 

decisions to tighten our belts and reduce our Nation’s debt and deficit. But no matter what fiscal crisis we face, no matter how divided we may be over approaches to cutting our debt and deficit, 

no matter how heated the rhetoric in Washington D.C. gets, we 

must remember that we cannot balance our budget at the expense 

of the health care and benefits our veterans have earned. 

Their sacrifices have been too great. They have done everything 

that has been asked of them. They have been separated from their 

families through repeat deployments. They have sacrificed life and 

limb in combat. They have done all of this selflessly and with 

3 

honor. And the commitment we have to them is non-negotiable, not 

just today but far into the future. 

So, thank you all of our witnesses for being here today and our 

Committee Members. I will now turn to Senator Brown for his 

opening statement. 

STATEMENT OF HON. SCOTT P. BROWN, 

U.S. SENATOR FROM MASSACHUSETTS 

Senator BROWN OF MASSACHUSETTS. Thank you, Madam Chair, 

for holding this important hearing. I want to recognize Corporal 

Nicely and his wife Crystal for taking time and obviously, Crystal, 

for you to be here and for your devoted service to our country and 

the Corp. 

As you know, today we are here also to discuss the resources the 

VA will need in the future to care for current generations of 

wounded warriors and, as the Chairwoman noted, out of the total 

of 2.3 million servicemembers who have been deployed, 45,000 have 

been wounded in action; and as we look to the future and beyond 

for the next 10 years, it is important to understand where we have 

been and what we have learned because, as over the last 10 years, 

we have seen a large increase in the VA’s medical care accounts. 

And since 2001, the VA medical care budget has grown by $27 billion or 130 percent. 

Last October, the Congressional Budget Office published an analysis on this topic, and their analysis indicates that, you know, we 

have some very real challenges coming up; and we all agree that 

we must provide the funding needed to support this generation of 

wounded warriors and continue caring for those who have previously borne the visible and hidden scars of war. 

And as you know, this morning we will hear from Crystal, the 

wife of a wounded warrior, and her husband Todd who was severely injured in March 2010 when he stepped on IED while on patrol in Afghanistan that left him as a quadruple amputee. 

He has been able to move on with his life somewhat and yet he 

ran into and, I believe, continues to run into bureaucratic hassles 

and delays in trying to complete the integrated disability evaluation system, a process that was supposed to alleviate these types 

of problems. And if a prompt determination cannot be made for 

someone who has lost all four limbs, what hope is there for the others who have lesser wounds or invisible wounds. 

Members of the RAND Corporation will talk about the gaps in 

access to mental health services at the VA, in particular the long 

wait times for appointments. 

I am disappointed, however, that the VA, our friends at the VA, 

will not be here to offer their testimony. I am sure we will follow 

up with them, Madam Chair, with your leadership. 

There are a few problems. These are just a few problems that we 

have and they continue to persist. As we have all learned as Members of the Committee and have all noted these throughout our 

time here. 

So, we have to look at the costs for caring for injured troops, and 

we should keep in mind that money cannot be the only solution to 

the problems that they face. If that were the case, Corporal Nicely 

4 

would have breezed through the IDES process, and Loyd Sawyer 

would have gotten an appointment at the VA without any delay. 

With our country’s current financial crisis, we need to reassess 

every dollar that we spend to make sure that it is being used effectively to deliver the services and benefits that our wounded warriors and veterans need in order to give them an opportunity to live 

healthier and more productive lives. 

So, thank you, Madam Chair. I look forward to hearing the testimony. 

Chairman MURRAY. Thank you very much, Senator Brown. 

Senator Tester. 

STATEMENT OF HON. JON TESTER, 

U.S. SENATOR FROM MONTANA 

Senator TESTER. Well, thank you, Madam Chairman. I want to 

thank you for convening this hearing. 

I want to welcome all the witnesses. I very much appreciate you 

all being here. I am going to single out Paul Rieckhoff. Thank you 

very much for being here, but more importantly thank you for your 

advocacy for the veterans. I very much appreciate it. You have 

been a bulldog. 

Crystal Nicely, thank you very, very much for being here. We always say when a soldier goes to war, their spouse goes with them 

and their family goes with them too. We appreciate you being here 

to tell your story. It is going to be a great perspective to hear. 

The welfare of the young men and women who defend this country is always at the forefront of our minds and the question whether to send them into harm’s way to begin with is something that 

can never be taken lightly. In doing so, we have to prepare ourselves for the human and the monetary costs of these decisions. 

It is not just about providing the troops armaments and the 

equipment that they need and the tools they have to be successful 

in their missions, it is about ensuring that we are fully capable of 

caring for them and their families when they return home. 

To quote the VFW commander, ‘‘The day this Nation cannot afford to take care of her veterans is the day this Nation should quit 

creating them.’’ 

A very true statement. Something we should keep in mind as our 

veterans come home in need of care with injuries both seen and unseen. 

I very much look forward to this hearing and I appreciate, 

Madam Chair, you convening these folks. 

Chairman MURRAY. Thank you very much. 

Senator Johanns. 

STATEMENT OF HON. MIKE JOHANNS, 

U.S. SENATOR FROM NEBRASKA 

Senator JOHANNS. Madam Chair, let me also express my appreciation, and thank you for having this hearing. 

To the members of the panel, thanks for being here and thanks 

to your commitments. 

Let me, if I might, just associate myself with comments that 

have been made both by the Chair and by the Ranking Member. 

I believe they are hitting the nail on the head. 

5 

In my view of the world, part of the cost of war is caring for our 

veterans. There will be a point at which the uniform is set aside 

and they come home and need to find a place if you will. If they 

have medical needs, then we need to find a way to address those 

needs. 

One of the things that is also enormously perplexing to me is the 

inability to transition so many veterans into the workforce. I appreciate the economic times are difficult and challenging. We all know 

that, but it is so disheartening when I talk to veterans and I go 

around the room and try to figure out where they are out in their 

life and how they are transitioning into the workforce. 

So many of them say, well, I have not been able to find a steady 

job. And the remarkable thing for me is that is in a State where 

our unemployment is actually quite low, 4.1 percent. 

So, if I might just cue something for those who are going to testify today and maybe, Paul, I will point to you specifically. I am 

especially interested to hear testimony about the challenges our 

veterans are experiencing in transitioning from military life into a 

civilian job. It just seems to me we can do a better job here. 

I know that Hiring A Hero Act includes several provisions to address these issues. That is good. I applaud any efforts that have 

been made that might make this situation a little bit better, but 

I am especially interested in where we are not meeting the issues 

of training and in some cases rehabilitation so veterans can be prepared to enter the workforce. 

With that, to all of you who advocate for veterans to those who 

have served and those families who have been such an important 

part of that service, I do want you to know how much I appreciate 

your commitment to our country. 

Thank you, Madam Chair. 

Chairman MURRAY. Thank you. 

Senator Begich. 

STATEMENT OF HON. MARK BEGICH, 

U.S. SENATOR FROM ALASKA 

Senator BEGICH. Thank you very much, Senator Murray, for putting this forum together today, and I want to thank the witnesses 

for being here. I will not be able to stay. I have to chair an Oceans, 

Fisheries, and Coast Guard Subcommittee hearing in about 12 

minutes. 

But I want to at least let you know, first, I received all of your 

written testimony. I appreciate that. I have some questions that I 

will submit for the record. 

I will tell you, in my short time here in the Senate as a Member 

of this Committee, I have heard the incredible testimony from our 

brave warriors and families over the last two and a half years, and 

I want to be clear that examining the lifetime costs in supporting 

this new generation of veterans does not mean that we will not be 

there for you. You answered the call of duty. You have been there 

for our country, and we will be there for you. 

The costs that veterans and the families have suffered as the 

consequences associated with the scars of war, both financially and 

emotionally, place burdens that can last a lifetime. 

6 

With Alaska having the highest number of veterans per capita 

of any State in this country, I have seen these impacts firsthand, 

and I will tell you what I tell every time I see a veteran when I 

am at home, ‘‘Thank you, thank you, thank you for the service and 

the sacrifice, not only as an individual but also as a family. And 

we promise to continue to fight every day to do what we can to 

make sure that those services are there.’’ 

One of the issues that I will submit for the record for you all 

hopefully to answer is the question that I know I face, like Senator 

Tester, and Senator Johanns with rural veterans, veterans that 

have an extremely difficult time accessing health care. 

More and more veterans are choosing to live in rural communities. In my State, 80 percent of the rural communities cannot be 

accessed by road. So, it is very difficult for them to access the 

health care they need. It may be physical or mental services that 

they may need. 

I think I would be interested in your comments, if you have 

them, that you can put on the record again or I will submit as I 

am for the record a written question about how do we figure out 

the access points to ensure that the quality care no matter where 

you live as a veteran, it does not matter if you live in a small village in Alaska of 50 people or a large urban city, how we make 

sure we get the health care they need, they are owed in a timely 

basis. 

So, I would be anxious for your comments. I know it is a question 

that we have a piece of legislation we are talking about, the Alaska 

Heroes Card, to create some access points again for roadless areas 

that are just impossible for our veterans to get the quality service 

they need. So, I would be interested in your comments on that. 

Again, Madam Chair, thank you for holding this important hearing because, as we engage in wars, it is a two-parts cost. One is 

the action of the war and the actions after. And sometimes, and I 

can tell you as a new Member here, my personal opinion is when 

we engaged in the wars of Iraq and Afghanistan, not a lot of people 

thought about the next cost. 

And so, I am glad this hearing is here. It is a commitment we 

have to make, and it is owed to the veterans and the families of 

veterans. So, thank you again for all of you being here. And again, 

thank you, Madam Chair. 

Chairman MURRAY. Thank you very much. 

So at this time we will now turn to our witnesses. We will first 

hear from Mr. Paul Rieckhoff, the Executive Director and founder 

of Iraq and Afghanistan Veterans of America. 

Next we will hear from Dr. James Hosek, a senior economist 

from the RAND Corporation. We will then hear from Mrs. Crystal 

Nicely who, as I mentioned in my opening statement, is a caregiver 

and spouse of an Operation Enduring Freedom veteran. 

Following her testimony, we will hear from Mrs. Lorelei St. 

James, the Director of Physical Infrastructure for the Government 

Accountability Office; and closing out our panel this morning will 

be Mrs. Heidi Golding, who will be testifying on behalf of the Congressional Budget Office. She is CBO’s principal analyst for military and veterans’ compensation in the National Security Division. 

7 

So thank you again to all of you for being here this morning for 

this important hearing. 

Mr. Rieckhoff, we will begin with you. 

STATEMENT OF PAUL RIECKHOFF, EXECUTIVE DIRECTOR, 

IRAQ AND AFGHANISTAN VETERANS OF AMERICA 

Mr. RIECKHOFF. Thank you, Madam Chair, Members of the Committee. On behalf of IAVA, Iraq and Afghanistan Veterans of 

America, and over 200,000 of our members and supporters, many 

of whom are here today, thank you for inviting us to testify on the 

long-term costs of war for our generation of veterans. 

I served in Iraq from 2003 to 2004 as a platoon leader with the 

Third Infantry Division. When my unit returned and I came home 

from war, we returned to a country confused by and a bit uncomfortable with its warriors. People wanted to help. They just did not 

know how. So bringing to light the true costs of these wars is part 

of the reason we formed the IAVA in a cramped studio apartment 

back in 2004. 

This hearing comes at a critical time. Right now our Nation teeters on the edge of default and servicemembers and veterans are 

left concerned and a bit scared. 

IAVA members from across the country have contacted us in the 

past few days. They still do not know if they will get disability, retirement, GI Bill checks that day so rightfully earned, or even their 

base pay. They have enough to deal with already, and they deserve 

the answers to these questions. It is up to Congress and the President to get us these answers. 

But we are here today to examine the lifetime costs of this new 

generation of vets, and I will start with the bottom line up front, 

something I learned to do in the Army. It is going to be expensive 

and it is going to be complex, but history shows us that it will be 

less expensive and less complex if we invest as a Nation in our veterans now. 

Doing so also has the added bonus of cultivating a new generation of leaders, future teachers, doctors, CEOs, and maybe even a 

few Members of Congress. They will lead our Nation the only way 

they know how, from the front. 

The current condition of new veterans’ readjustment into civilian 

society is not pretty. Officially, 13.3 percent are unemployed as of 

this past June, more than 4 percentage points higher than the national average. 

We see numbers in our membership closer to 20 percent. In Indiana, it is 24 percent. In Michigan, it is nearly 30 percent. Nationwide that means approximately 260,000 people in real numbers are 

out of work. That is about the same size as the entire Marine 

Corps. 

It does get worse. The military and veterans communities also 

are facing a suicide epidemic. In 2010 alone, there were 468 suicides throughout the military. It is estimated between 2005 and 

2009 one servicemember committed suicide every 36 hours, and 

more committed suicide in 2010 than died in combat. 

These numbers, while bleak, are really just the tip of the iceberg. 

The legacy of these wars will be the cumulative impact of the multiple deployments year after year, a burden of many carried by few. 

8 

And as these wars wind down, the military will likely downsize 

just as it has done in all postwar periods. 

A new surge of veterans is already returning to local communities nationwide and cost will be a word thrown around a lot. Investment, though, probably will not be and it should be because 

these are not just costs; they are investments. 

This Committee and the public sector in general have done many 

good things for new veterans returning home. The best example, of 

course, was the Post-9/11 GI Bill, which has provided close to 

500,000 returning servicemembers with educational opportunities 

they otherwise they would not have dreamed of, and the exciting 

and urgently needed Hire Heroes Act, which the Members of this 

Committee are certainly familiar with, proves that you have not 

rested on your laurels. 

This bill can and should be the first jobs bill passed by this Congress. But legislation and government can only do so much. The 

private sector must do its part too. Companies that commit to hiring veterans will find it is not charity. It is a smart investment. 

It is good for their bottom line. 

Veterans are entrepreneurial by nature; and although they represent less than 1 percent of Americans, 9 percent of American 

firms are veteran owned. Many have specific skills that relate directly to the civilian trades: logistics, operations, communications, 

medicine and engineering. 

If folks really want to support the troops, they should hire them. 

Something companies and organizations have already realized. For 

example, IAVA has been proud to partner with companies like 

Google, JCPenney’s, CBRE, Schwab, and the Chamber of Commerce in efforts to turn the tide on veteran employment. 

These are not just government problems or business problems or 

nonprofit problems; they are American problems. Take the experience of specialist Nick Colgin. 

While serving in Afghanistan with the 82nd Airborne Division as 

a medic, Colgin proved himself over and over again. He saved the 

life of a French soldier that was shot in the head and was ultimately awarded a Bronze Star for his actions over the course of his 

deployment. He also suffered a Traumatic Brain Injury due to an 

RPG attack. 

He was honorably discharged 2 months after he left the war. Unable to find a job anywhere in the medical field, he was looking to 

work as a first responder, which was the equivalent of what he did 

overseas, but employers said he lacked the proper certificates. 

While waiting many months for the VA to process his disability 

claim, he was forced to collect unemployment checks to make ends 

meet. But Colgin turned things around. The VA eventually did 

process his disability claim. He got the right paperwork to be a 

first responder; and after using some of the GI Bill benefits, he will 

begin his senior year at the University of Wisconsin Stevens Point 

this fall. 

Not all new veterans have the happy ending of a Nick Colgin, 

though sometimes we must all remember as we plan for the future. 

Long-term it is estimated the cost of these wars will be between 

$600 billion and $1 trillion. 

9 

Those are imposing numbers to be sure especially in this time of 

economic recession and spiraling debt. Those numbers will only increase with time if we slash veterans programs in the shortsighted 

rush. 

The costs are clear and they are tremendous but so are the sacrifices that our men and women have made for our Nation and so 

is the potential for return. 

Before I deployed to Iraq, I worked on Wall Street. If I were analyzing the potential return on this investment, I would say my generation gets a strong buy rating. Investing in the innovation generation is like buying shares of Apple in 1980. I am here to tell you 

to put your money where your mouth is. Please invest in this generation. We are worth it. We will deliver, and we will not let America down. We never have, and we never will. 

Thank you for your time, and I look forward to your questions. 

[The prepared statement of Mr. Rieckhoff follows:] 

PREPARED STATEMENT OF PAUL RIECKHOFF, EXECUTIVE DIRECTOR AND FOUNDER, 

IRAQ AND AFGHANISTAN VETERANS OF AMERICA

Chairman Murray, Ranking Member Burr, and Members of the Committee, on behalf of Iraq and Afghanistan Veterans of America’s over 200,000 Member Veterans 

and supporters, thank you for inviting us to testify on the long-term costs of war 

for our new generation of vets. 

My name is Paul Rieckhoff and I am the Executive Director and Founder of IAVA. 

I served in Iraq from 2003 to 2004, as an infantry platoon leader in the U.S. Army 

National Guard. When my unit and I returned home from war, we returned to a 

country confused by and uncomfortable with its warriors. People wanted to help, 

they just didn’t know how. Bringing to light the true costs of these wars is part of 

the reason we formed IAVA in my cramped New York studio apartment in 2004. 

We are here to ‘‘Examine the Lifetime Costs of a New Generation of Vets.’’ I’ll 

start with the bottom line up front, something I learned in the Army—it’s going to 

be expensive. And it’s going to be complex. But history shows us that it will be less 

expensive and less complex if we as a nation invest in our veterans now. Investing 

in these brave men and women now has the added bonus of cultivating a new generation of battle-born leaders, future teachers, doctors, business leaders and maybe 

even a few Members of Congress, that will lead our Nation the only way they know 

how—from the front. The alternative—missing critical investments, shortchanging 

their benefits and services—will cost our country terribly. 

The current condition of new vets’ readjustment into civilian society isn’t pretty. 

Officially, thirteen-point-three (13.3) percent are unemployed as of this past June, 

more than 4 percentage points higher than the national average. We see numbers 

in our membership closer to 20%. In Minnesota the number is 22.9%. In Indiana, 

23.6%. And in Michigan, it’s 29.4%. So nationwide, that means approximately 

260,000 people in real numbers are out of work—about the same size of the entire 

Marine Corps. To use a military term, that is un-sat. 

Not only are younger veterans at a greater risk of homelessness than the general 

population, but even when compared to the older veteran population, their risk is 

higher. Over 11,000 homeless vets officially listed as homeless in 2009 were between 

the ages of 18 and 30. That’s a full Army Division. 

It gets worse. The military and veteran community is also facing a suicide epidemic. In 2010 alone, there were 468 suicides throughout the military. It’s estimated that between 2005 and 2009, 1 servicemember committed suicide every 36 

hours. And more committed suicide in 2010 than died in combat. But that’s just part 

of the mental health problem, because once individuals separate from the military, 

it’s impossible to track them unless they enroll in the VA—something only 51 percent of separated OIF and OEF veterans have done. 

And these numbers, while bleak, are really just the tip of the iceberg. The legacy 

of these wars will be cumulative impacts of the multiple deployments, year after 

year; a burden of many carried by few. Personal issues that are delayed for the 

needs of a unit can be put off temporarily, for another deployment, but they can’t 

be put off forever. As these wars wind down, the military will likely downsize, just 

as it has done in all postwar periods. As a result, this new surge of veterans is already returning to local communities nationwide. Those initial months back home 

10 

are key to the transition process; veterans will either return home to a job opportunity or an unemployment check, either have their own roof over their head or 

move from shelter to shelter, and either feel included in the community they fought 

for or feel isolated from it. And our Nation will either repeat the mistakes of the 

way we treated veterans after Vietnam, or it will turn the page. The public, private, 

and nonprofit sectors must work together to ensure it’s the positive return our servicemembers experience—and not the slap in the face of patchwork or non-existent 

real support. 

This Committee, and the public sector in general, have done many good things 

for new veterans returning home. The best example, of course, was the Post-9/11 

G.I. Bill in 2008, which has provided close to 500,000 returning servicemembers 

with educational opportunities they otherwise wouldn’t have dreamed of. In 2009, 

advance funding for VA healthcare was passed into law. In 2010, the Caregivers Bill 

joined it. And the exciting and urgently needed Hiring Heroes Act, which the Members of this Committee are certainly familiar with, proves that you haven’t rested 

on your laurels this year. This bill can and should be the first jobs bill passed by 

this Congress. 

Creative thinking for these complex issues is being used off of Capitol Hill, too. 

Veterans’ courts are a great example. Designed to try cases of non-violent offenses 

and to deal with the invisible wounds of war, over 59 courts have been established 

since 2008, spanning at least 24 states. As part of the sentencing process, veterans 

in these courts agree to appropriate treatment that can include mentoring sessions 

and counseling. And it works. Big time. Of the veterans enrolled in the first year 

of the original veterans’ court in Buffalo, New York, roughly 90 percent successfully 

finished it and none have committed any more crimes. 

But legislation and government can only do so much. The private sector must do 

its part, too. Companies will need to play a huge role in the hiring of new vets. That 

can’t happen in a meaningful way until civilian employers better understand how 

military service and skill-sets translate into the civilian sector—something 60 percent of human resource managers said was a challenge. The civilian and military 

divide is very much alive, and it’s a shame. Companies that commit to hiring veterans will find it’s not charity. It’s a smart investment. Vets are entrepreneurial by 

nature; although they represent less than 1 percent of Americans, 9 percent of 

American firms are veteran-owned. And yet the unemployment numbers for Iraq 

and Afghanistan veterans continue to rise. If folks really want to support troops, 

they should hire them—something some companies and organizations have already 

realized. For example, IAVA has been proud to partner with leaders like Google, 

J.C. Penney, CBRE, Schwab and the Chamber of Commerce, in efforts to turn the 

tide on vet unemployment. 

Jobs are the horse that drives this cart of solutions. The U.S. Government invested hundreds of thousands, if not millions, of dollars and training in these men 

and women for war. Many have specific skills that relate directly to civilian trades, 

such as logistics and operations, communications, medicine, and engineering. And 

they have worked in teams with a mission-focused approach, and in dynamic, highstakes environments that require flexibility and adaptation. They are entrepreneurial. They are innovative. And they are tough. As a society with an all-volunteer 

force, and one trying to invigorate our economy, we have an obligation (and an opportunity) to seek out these incredibly valuable civic assets, and engage and empower them in our domestic workforce. They’ve had our back overseas. When times 

were tough, they delivered for America. And they can do it again back home. 

These aren’t just government problems, or business problems, or nonprofit problems. They are American problems. Take the experience of Army Specialist Nick 

Colgin. While serving in Afghanistan with the 82nd Airborne Division as a combat 

medic, Colgin proved himself over and over again. He saved the life of a French soldier that was shot in the head. His quick decisionmaking also led to 42 locals being 

rescued from a flooding river, and he was ultimately awarded the Bronze Star for 

his actions over the course of his deployment. He also suffered a Traumatic Brain 

Injury due to an RPG-attack on his convoy. 

Colgin was discharged honorably from the Army two months after he returned 

from war. He was unable to find a job anywhere in the medical field. He was looking to work as a first responder in Wyoming, which was the equivalent of what he 

did overseas, but employers said he lacked the proper credentials and certificates. 

While waiting for many months for the VA to process his disability claim, he was 

forced to collect unemployment to make ends meet. He readily admits to having serious readjustment issues, something brought on by a sense of isolation, a lack of 

daily purpose like he found in the military, and a lack of structural support for new 

vets in his community. 

11 

But Colgin got things turned around. While the private sector failed him, the public sector did eventually process his disability claim (but after he waited for six 

months). He also got linked up with nonprofits like ours and the Wounded Warrior 

Project, where, on a fishing trip, he came face-to-face with veterans ‘‘like him’’ for 

the first time. This had a very positive effect on him, he said, as he realized that 

it was OK that the war had changed him. He eventually got the right paperwork 

to be a first responder, after using some of his New G.I. Bill benefits, and will begin 

his senior year at the University of Wisconsin-Stevens Point in the fall. Not all new 

veterans have the happy ending of a Nick Colgin, though. It’s important to remember that those numbers I referenced earlier are living, breathing people just like 

Nick, or anyone at this testimony, with hopes and dreams and ambitions of their 

own. And every single one will have a cost. But every single one is worth it. 

Folks, we are at a crossroads in terms of veterans care. We can turn to history 

for some guidance on what to do and what not to do. World War II veterans returned to a nation fully engaged and invested in the war effort. Ticker-tape parades 

occurred across the country to celebrate the vets’ victories in Europe and the Pacific. 

VA loans for homes and farms were made available at low interest rates. Approximately 50 percent of the ‘‘Greatest Generation’’ of veterans used their educational 

benefits provided by the original G.I. Bill. All of this played a huge role in the economic prosperity of the post-World War II years. 

Compare that, then, to Vietnam. Instead of returning to parades celebrating their 

sacrifices, they came home one by one in the middle of the night, all too often hiding 

their uniforms and crew cuts. The struggles to transition back home didn’t end 

there. Long after the end of that war, in the 1980s, Vietnam vets earned about 15 

percent less than their civilian counterparts. And even as late as 1991, they made 

up 49 percent of the veteran inmate population. While factors like these did lead 

to the formation of some wonderful nonprofit organizations, like our friends at Vietnam Veterans of America, the overall contrast of their experience with that of the 

World War II generation couldn’t be more evident. They deserved better. And 

they’ve fought to ensure guys like me have gotten it. But we still have a long way 

to go. 

Which brings us to today, when a new group of 2.3 million combat-tested veterans 

return home from their own battles abroad. American society has finally learned to 

separate politics from the warrior. There’s a ‘‘sea of goodwill’’ for the returning vet, 

which is a great thing. But now comes a harder task—tapping into that sea, channeling it, directing it into supporting the troops in a meaningful, lasting way. Into 

more than just yellow ribbons and care packages. Long term, it’s estimated that it’ll cost between $600 billion and $1 trillion to care 

for them alone. Those are imposing numbers, to be sure, especially in this time of 

an economic recession and spiraling debt. But those numbers will only increase with 

time if we slash veteran program funding in a shortsighted rush. 

But of course paying the bills is only a part of the solution. In 2010, the U.S. Government spent $57.5 billion on veterans’ benefits. The government programs that 

used that money can only ask the following question: was that money spent as efficiently and deliberately as possible? As these vets learned trying to rebuild villages 

and cities in Iraq in Afghanistan, money itself is a weapons system. But it’s a precision weapon, not an area weapon, and we’d all be wise to remember that as we go 

forward. 

The Department of Defense has recently explored various ‘‘resiliency models’’ for 

its servicemembers and families, most notably the Army’s Comprehensive Soldier 

Fitness program. The stated goal of this program is to ‘‘master the skills necessary 

to achieve balance in their lives and build resilience in order to thrive in an era 

of high operational tempo and persistent conflict.’’ This is a great example of the 

military’s can-do spirit and something that can be—and should be—applied to their 

lives after they leave the military. But the right tools and training need to be available for that to happen. It’s a tough world out there right now, for everyone, vets 

and civilians alike. But this country will bounce back, just like it always has in 

times of difficulty. And it will be the military veterans that lead the way. The stage 

is set for the Next Greatest Generation—the Innovation Generation—if, during this 

formative time in their lives, the proper resources are provided for them to reach 

their full potential. Investing in Iraq and Afghanistan veterans now saves us money 

in the future and plants the seeds for continued national prosperity. We are at the 

crossroads. Now, where do we go? Will we make the easy turn and slash veteran 

program funding, or the hard turn, and invest in the future? 

The costs are clear. And they are tremendous. But so is the sacrifice these men 

and women have made for our Nation. And so is the potential for return. Before 

I deployed to Iraq, I worked on Wall Street for a bit. And if were analyzing the potential for return on this investment, my generation of veterans would get a ‘‘strong 

12 

buy’’ rating. Investing in the Innovation Generation is like buying shares of Apple 

stock in 1980. 

In some ways, the battles on the homefront will be more challenging than those 

fought in Iraq and Afghanistan. If there were an easy way to reincorporate the 1 

percent into the other 99 percent, someone would’ve done it by now. But that doesn’t 

make it impossible. We’re up to the challenge, America has done it before. But it’s 

going to take everyone, from Capitol Hill to Wall Street to Main Street, to make 

it happen. 

The upside is huge. And the time is now. And we are the closest thing you’ll ever 

have to a sure thing in this town. On behalf of our generation of veterans around 

the world, I am here to tell you to put your money on the table. We are worth it. 

We will deliver. We won’t let America down. We never have and we never will. 

Just watch. 

Thank you for your time. I look forward to your questions. 

POSTHEARING QUESTIONS SUBMITTED BY HON. MARK BEGICH TO PAUL RIECKHOFF, 

EXECUTIVE DIRECTOR AND FOUNDER, IRAQ AND AFGHANISTAN VETERANS OF AMERICA

Question 1. In examining the long-term costs we cannot forget the rural veterans. 

You may know that I introduced an Alaska Hero’s Card which would offer Alaska 

veterans services in their most rural communities. I recently visited the Sunshine 

Clinic in Talkeetna, Alaska, over a hundred miles from Anchorage. They told me 

they are getting a lot of new rural vets. These young vets are more and more coming 

back and settling into rural areas. 

• Do you have any suggestions or do you know of plans regarding how the VA 

is going to take care of so many vets that live far away from a VA facility? 

[Responses were not received within the Committee’s timeframe 

for publication.] 

Chairman MURRAY. Thank you very much, Mr. Rieckhoff. 

Dr. James Hosek. 

STATEMENT OF JAMES HOSEK, SENIOR ECONOMIST, 

RAND CORPORATION 

Mr. HOSEK. Thank you. I would like to thank Chairwoman Murray, Ranking Member Burr, and the Committee for the opportunity 

to testify. 

During the nearly 10 years since 9/11 more than 2.2 million active and reserve members have been deployed. Hallmarks of the 

era are the growing public recognition of the stresses borne by 

servicemembers and their families, and the invisible wounds that 

can haunt servicemembers who deployed. 

In my written testimony, I have given an overview of RAND’s of 

studies on deployment, and this morning I hope to highlight selected findings. 

These touch on the following topics: The importance of total 

months on deployment in understanding the effects of deployments, 

the prevalence of PTSD and major depression among those who 

have deployed, the barriers to care they face, the importance of providing evidence-based care, and unemployment. 

In our research we found that extended length of deployment can 

have family and societal impacts ranging from the financial and 

emotional stress of increased divorce rates, academic and emotional 

consequences for children, to burdens of reduced reenlistment within the Armed Services. Here are some specifics. 

Exposure to combat trauma is the single best predictor of PTSD, 

major depression, and Traumatic Brain Injury, and the chance of 

exposure increases with months deployed. 

13 

High months of deployments put negative pressure on Army and 

Marine Corps reenlistment that they countered with bonuses. This 

meant that personnel with high months of deployment who otherwise would have left were kept in service and were at risk of further deployment and exposure to combat trauma. 

We found that military divorces increase with total months of deployment. Deployment probably causes additional divorces among 

veterans but this has not been studied. 

More months of deployment were associated with more behavioral and emotional problems for children. For instance, 30 percent 

of the children had elevated symptoms of anxiety, twice the rate 

found in other studies. We do not know if children’s problems abate 

when the servicemember leaves the military and becomes a 

veteran. 

We found that almost one in five returning servicemembers has 

symptoms of PTSD or major depression, problems that may affect 

veterans for years to come. 

In our survey, 18.4 percent of all returning servicemembers in 

the spring of 2008 met criteria for either PTSD or major depression. Applying this percentage to the 2.2 million servicemembers 

who had deployed by last September implies that 405,000 met criteria for PTSD or depression. We do not know the lifetime prevalence of these problems as some will develop later and others may 

diminish. 

Servicemembers and veterans in our studies reported barriers to 

care. Efforts are underway to reduce these barriers but more research may be needed on why veterans do not seek care and what 

might induce them to do so. 

We found that about half of those with probable PTSD or depression had not sought care in the prior year. Their reasons include 

concerns about confidentiality, potential negative career repercussions if care was sought, long wait times, and the side effects of 

medications. 

Other barriers were the diverse, seemingly disorganized and incomplete sources of information about where to seek care, what 

services were available, who was eligible and how to apply. 

Further, much of the care provided was not evidence-based care. 

Evidence-based care is care that statistical analysis has shown to 

be effective. Of those who had PTSD or depression and sought 

treatment, just over half received minimally adequate treatment, 

and the number who received evidence-based care would be even 

smaller. 

In our cost analysis, we found that delivering high-quality, evidence-based care to all veterans who have PTSD or major depression would save money on net for society and improve the outcomes 

for those treated. 

Finally, veterans’ transitions from the military to nonmilitary life 

often involve finding a job or going to school. As many realize, 

steps to assist in job search or in obtaining educational benefits can 

make the transition smoother. 

RAND studied unemployment among returning reservists. We 

found that many chose not to return to their pre-activation jobs but 

instead drew unemployment compensation for ex-servicemembers. 

14 

1The opinions and conclusions expressed in this testimony are the author’s alone and should 

not be interpreted as representing those of RAND or any of the sponsors of its research. This 

product is part of the RAND Corporation testimony series. RAND testimonies record testimony 

presented by RAND associates to Federal, state, or local legislative committees; government-appointed commissions and panels; and private review and oversight bodies. The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that 

address the challenges facing the public and private sectors around the world. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. 2This testimony is available for free download at http://www.rand.org/pubs/testimonies/CT367/. 

Although aimed at helping reservists who did not have a job, these 

benefits were also helping reservists to search for better positions. 

Also, we have identified difficulties in the early implementation 

of the Post-911 GI Bill. This research may help the VA and institutions of higher education focus their efforts to make these benefits 

more accessible and easier to use. It would be helpful to have research taking an integrated view of the job search, education, and 

health care of servicemembers who are transitioning from the military, particularly those with behavioral health conditions. Studies 

in this area, including RAND studies, have not taken an integrated 

view. 

Thank you once again for the opportunity to address the Committee. I hope that RAND’s work on these subjects can be helpful 

to the Committee in fulfilling its important mission of serving our 

Nation’s veterans. 

[The prepared statement of Mr. Hosek follows:] 

PREPARED STATEMENT OF JAMES HOSEK,1 THE RAND CORPORATION

INSIGHTS FROM EARLY RAND RESEARCH ON DEPLOYMENT EFFECTS ON U.S. SERVICEMEMBERS AND THEIR FAMILIES 2

PUBLICATION CT–367

I would like to thank the Committee for the opportunity to testify. As the Committee has requested, I will address my comments to findings from the recent 

RAND publication, How is Deployment to Iraq and Afghanistan Affecting U.S. Servicemembers and Their Families? I will also touch on more recent research that 

builds on and extends these findings. 

September 11, 2011, will mark ten years since the terrorist attacks that precipitated the war on terrorism and the military operations in Iraq and Afghanistan 

that continue today. During these ten years more than 2.2 million servicemembers 

from the active and reserve components have deployed for hostile duty. Each war 

has unique features, and the unique features of the current operations have included the absence of massed forces and a recognizable front line, the use of opportunistic small arms attacks and improvised explosive devices, and the religious and 

cultural currents that have led to shifting alliances and raised concern about the 

nature of the peace when it comes. But apart from these battlefield and diplomatic 

realities, another unique feature has been the public recognition of the stresses 

borne by servicemembers and their families in wartime and, equally important, the 

recognition of invisible wounds that can haunt our servicemembers who have deployed and that can follow them after they leave the military. Let me review some 

of what we know from our early studies on deployment and its effects. 

We found that experiencing a deployment affects a servicemember’s willingness 

to reenlist. Interestingly, if deployment is not too extensive, deployment increases 

reenlistment over what it would have been in the absence of deployment. But extensive deployment causes reenlistment to decrease. In Iraq and Afghanistan, soldiers 

and marines have borne the majority of ground combat. Soldier tours have typically 

been 12 months (but some have been 15 to 18 months or longer) and marine tours 

have been 7 months, and many servicemembers have had more than one tour. We 

found that total months of deployment was a key variable in understanding the relationship between deployment and reenlistment. For soldiers, deployment of 11 or 

fewer months in the 36 months preceding their reenlistment decision had a positive 

effect on reenlistment, but 12 or more months had a negative effect—and 18 or 

months had a still more negative effect. By 2006, two-thirds of those facing a reenVerDate Nov 24 2008 16:34 Feb 02, 2012 Jkt 000000 PO 00000 Frm 00018 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\67837.TXT SVETS PsN: PAULIN
15 

listment decision had 12 or more months of deployment. The high percentage of 

troops with long months of deployment coupled with the negative effect on reenlistment of long months of deployment put serious downward pressure on overall reenlistment. This was perilous as a drop in reenlistment would jeopardize the Army’s 

ability to maintain its battlefield strength and would accelerate the deployment 

cycle, creating a vicious circle. Fortunately, the Army was able to stabilize its reenlistment rate by the extensive use of reenlistment bonuses. The same basic story 

held for the Marine Corps. Earlier RAND research on deployment also found that 

deployment, if not too long, led to higher reenlistment, while lengthy deployment 

decreased this positive effect and could make it negative. This pattern held across 

the services. 

Deployment brings a variety of stressors. As early as 2003, a survey of soldiers 

and marines serving in Iraq found that 89 percent of soldiers and 95 percent of marines reported having been attacked or ambushed. Deployed troops have had to face 

snipers, suicide bombers, improvised explosive devices (IEDs), and they have seen 

their fellow soldiers and friends killed or shattered by blasts, and may have had to 

kill enemy fighters, handle human remains, and may have inadvertently killed or 

injured civilians. Average temperatures in Iraq are over 120 degrees in July and August and below freezing in January. Sandstorms pelt personnel and equipment with 

fine grit, and camel spiders are a lurking danger of sleeping in the open. Extensive 

research shows that stress in moderation can actually improve performance, but extreme stress can hurt performance, leading to mistakes and bad decisions and possibly to failed missions and unnecessary casualties. A person under constant excessive stress may screen out peripheral stimuli and lose the ability to process information and analyze complicated situations. However, research also shows that training 

and other moderators can reduce the negative effects of stress. Training, for example, can decrease the likelihood that a given stressor will actually cause an elevated 

level of stress, and it can increase the likelihood that a stressed person can nevertheless perform effectively. 

Having well trained, experienced personnel available to deploy helps to maintain 

the fighting effectiveness of deploying units, yet at the same time the personnel who 

re-deploy are subject to further combat-related stressors as well as separation from 

family and friends. RAND’s Invisible Wounds of War study found that in the of 

spring 2008, 18.4 percent of all returning servicemembers currently met criteria for 

either Post Traumatic Stress Disorder (PTSD) or major depression. This may be 

compared with a more recent RAND study, A Needs Assessment of New York State 

Veterans, that found 22 percent of the sample (Iraq and Afghanistan veterans who 

had separated from the military and were eligible for VA care) met criteria for probable PTSD or major depression. The Invisible Wounds of War study also found that 

19.5 percent reported experiencing a probable Traumatic Brain Injury (TBI) during 

deployment. For all these conditions, exposure to combat trauma was the single best 

predictor even after controlling for the number of months deployed and time since 

deployment return. It is reasonable to expect that the chance of exposure to combat 

trauma increases with the number of months deployed. Since 2003, a number of 

studies have been done to examine the extent of PTSD and depression among returning troops. Percentages of returning servicemembers with PTSD, depression, or 

the percent reporting that they experienced a TBI may vary depending on the study 

population as well as the method and timing of the assessment. However, studies 

of similar populations and methodologies consistently show that the rate of post-deployment mental health problems among returning servicemembers is about 15–20 

percent at any given point in time. For the sake of illustration, if one wanted to 

understand the size and scope of the problem at a given point in time, applying the 

estimate of 18.4 percent to 2.2 million deployed servicemembers implies that about 

405,000 Iraq and Afghanistan veterans meet criteria for with PTSD or depression. 

The number who may have experienced a probable TBI during deployment would 

be roughly similar, and there is significant overlap between those who experience 

PTSD, depression, and a probable TBI. It is important to note that these figures 

represent a snapshot of the size of the problem at a given point in time. We do not 

know yet the life-time prevalence of these problems among returning veterans, as 

some will develop problems later and others may recover. 

In our 2008 study, about half of the returned servicemembers with probable PTSD 

or depression had not sought care for a mental health problem in the prior year, 

and only 43 percent of those with probable TBI during deployment reported that 

they had been clinically evaluated. The chief reasons for not seeking care were related to access and organizational and cultural factors, including concerns about 

confidentiality and potential negative career repercussions that they may experience 

if they sought care. Access barriers included long wait times for appointments, particularly in facilities resourced primarily to meet the demands of older, more chronVerDate Nov 24 2008 16:34 Feb 02, 2012 Jkt 000000 PO 00000 Frm 00019 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\67837.TXT SVETS PsN: PAULIN
16 

ically ill veterans. The long wait times in part reflected the limited availability of 

providers. While significant efforts have been implemented to increase the supply 

of mental health providers, access barriers remain a concern for veterans. The more 

recent study on New York veterans’ needs also pointed to the diverse and seemingly 

disorganized and incomplete sources of information about where to seek care, what 

services were available, who was eligible and how to apply, and to concerns about 

the side effects of medications. From the VA’s perspective, perhaps the key lesson 

here is to increase awareness of the benefits of mental health treatment, as well 

as to continue to improve the application process and the capacity to deliver care. 

Studies consistently show that evidence-based treatment for PTSD and major depression is more effective than non-evidence based care. Our work documented a 

number of therapies that have been shown effective in treating these conditions, including cognitive behavioral therapy. However, of those who had PTSD or depression and also sought treatment, only slightly over half received minimally adequate 

treatment, and the number who received high-quality care would be even smaller. 

Thus, in addition to improving access and increasing the number of providers it is 

important that the providers be trained and supported to provide evidence-based 

care. In a cost-analysis, the Invisible Wounds of War study found that delivering 

high quality, evidence-based care to all veterans who have PTSD or major depression on net would save money for society and improve outcomes for those treated. 

The importance of providing healthcare to our servicemembers and veterans is 

without question, but the cost of doing so is not inconsequential. A challenge is how 

to organize the healthcare delivery system in an efficient way. This is partly a VA 

responsibility, but the healthcare system extends beyond the VA, bearing on both 

VA and non-VA providers, with the goal being to provide access to high quality care 

for veterans. Many, but by no means all, veterans may have health insurance 

through their employers and obtain healthcare through private providers. Structuring incentives so that veterans take full advantage of their other coverage and 

working with provider groups to promote evidence-based treatment will reduce the 

strain on the VA system and likewise help to hold down VA cost growth. At the 

same time, it will promote quality care for all veterans, whether or not they live 

near a VA facility. Similar points are discussed in recent RAND research on 

TRICARE Reserve Select. 

The extensive use of the reserve components in Iraq and Afghanistan has demonstrated the prowess of reserve forces and substantiated the role of the reserves 

as one that is both strategic and operational. It has also raised questions about reserve earnings and family support. Both survey data and editorials have suggested 

that reservists who had deployed took a cut in earnings. A loss in earnings was 

thought to be unfair for reservists and could lead some reservists to leave the military earlier than planned and cause potential enlistees not to join the reserves. 

RAND approached this question by using actual pay records and precise definitions 

of earnings. The pay data came from privacy-protected individual-level military pay 

files and Social Security earnings records. The analysis found that most reservists— 

upwards of 83 percent—actually earned more when they were deployed than they 

did at their civilian job. It is true that on average a reservist’s civilian earnings decreased, but deployed earnings were roughly two dollars for each lost dollar of civilian earnings. The average reservist deployed for nine months or longer in a year 

gained over $19,000 on net. These findings helped to allay concerns about reservists’ 

earnings losses. 

Another concern has been whether reservists returning from deployment would be 

able to transition back to their previous job, and more generally, whether their job 

security and career prospects within a firm were safely protected by the Uniformed 

Services Employment and Reemployment Rights Act (USERRA). The complementary side of this is whether employers are adversely affected by the more frequent 

use of reservist employees. RAND has a project underway on the latter topic with 

the objective of determining the implications of worker protections under USERRA 

for employers with different characteristics, and if needed, recommending possible 

changes to USERRA, potential improvements to DOD and service policies and practices governing reserve activation and utilization, and ways to modify Employer 

Support to the Guard and Reserve (ESGR)’s to provide better support to employers. 

From the perspective of the returning reservist, RAND studied the 75 percent increase in enrollment in Unemployment Compensation for Ex-Servicemembers (UCX) 

that occurred during 2002 to 2004. Part of the increase occurred simply because 

more reservists were being activated than in previous years. Also, significant numbers of reservists chose not to return to their pre-activation jobs. At the risk of speculating why that was so, it could be that many returning reservists were seeking 

new job or career opportunities, and UCX benefits, though initially aimed at helping 

17 

reservists who did not have a job, were also helping reservists search for better 

positions. 

Further research on earnings is underway at RAND for the 11th Quadrennial Review of Military Compensation. This research focuses on the employment and earnings of wounded warriors and asks two questions: did they experience an earnings 

loss in the years following their injury relative to their expected earnings, and did 

disability compensation payments offset the loss? The analysis, which will be published this fall, takes into account the severity of the injury, and again is based on 

military pay and Social Security earnings records, and factors in the effects of their 

injury on their spouse’s earnings. 

Other recent RAND research has looked into the Post-9/11 GI Bill. This legislation increases the generosity of the GI benefit and, like the GI Bill of World War 

II, holds the promise of allowing veterans to pursue and complete higher education. 

By identifying difficulties in the early implementation of the Post-9/11 GI Bill, this 

research may help the VA and institutions of higher education focus their efforts 

to make these benefits more accessible and easier to use. 

In 2007, RAND research on the needs and support of reserve families found that 

most reserve families (62 percent) reported coping ‘‘well’’ or ‘‘very well’’ with deployment. Deployment brought challenges to the family yet also had positive aspects. 

The mention of problems related to deployment varied by type of respondent. Reservists frequently cited disruption to employment or education as problems. Reservist spouses cited personal and emotional problems, household responsibilities, and 

children’s issues. Reserve experts cited financial, legal, and healthcare issues. On 

the positive side, reservists mentioned financial gain while reservist spouses mentioned family closeness; patriotism, pride, and civic duty; and independence, confidence, and resilience. The resources the families relied upon during deployment included TRICARE, family support organizations, and extended families. Deployment 

affected the reservists’ intentions to stay in the military. About 30 percent had an 

increased desire to stay, 40 percent had no change, and 30 percent had a decreased 

desire to stay. RAND continues to study reserve component families and ways to 

improve reintegration support. 

The study of reserve family needs and support, like the studies above, pointed to 

the importance of understanding family readiness for the full cycle of deployment 

and family resilience in the face of the challenges and uncertainties it would bring. 

RAND has now has begun longitudinal studies of family resilience and coping in 

each of the services. This series, called the Deployment Life Study, will be a landmark analysis that will follow a cohort of military families, from all service components, across a full deployment cycle. These studies are in an early phase and expect to have results over the next several years. 

The deployment of a servicemember parent affects children on the homefront. In 

2008–2009, RAND surveyed parent caregivers, usually the mother, and their children ages 11 to 17 who had applied to Operation Purple Camp, a summer camp for 

children of servicemembers. We found that the children in the study experienced behavioral and emotional difficulties at rates above the national average. This finding 

was apparent in the first survey and remained much the same in the follow-up surveys at 6 and 11 months. 

• Anxiety was a specific problem. Anxiety is characterized by feeling frightened 

or having difficulty sleeping, for example. 30 percent of the children in the study 

sample had elevated symptoms of anxiety, which is twice the rate found in other 

child studies. In contrast, the children in the study were similar to the national average in peer and family functioning, academic engagement, and risk behaviors. 

• Older teens experienced more difficulties such as having to take on more household responsibilities, take care of siblings, and missing school activities, and had 

trouble getting to know their deploying parent again and adjusting to the parent 

fitting back into the household routine. 

• Girls reported more difficulties during the parent’s reintegration into the family, including worrying about the parent’s next deployment, dealing with the parent’s mood changes, and worrying about how parents were getting along. 

• Children in families where the non-deployed parent is coping with emotional 

health issues tended to experience more difficulties. 

• Also, just as longer total months of deployment were found to have a negative 

effect on reenlistment, they were associated with more problems for children. This 

held true across the services and in both active and reserve components. 

Overall, the results suggest that because children with a deployed parent are experiencing more emotional and behavioral difficulties, they may need more assistance in addressing their needs. Further, it might be useful to target the assistance. 

Perhaps families can be screened for emotional problems during routine healthcare 

18 

visits. Also, support might be targeted on families facing more cumulative months 

of deployment, with the support being provided across the deployment cycle and not 

just at the start or end. 

Finally, related to the findings on the children of deployed parents and on family 

effects more generally, RAND has recently done research on the effect of deployment 

on military divorce. We find that the probability of divorce increases as total months 

of deployment increases. 

Thank you once again for the opportunity to address the Committee. 

Chairman MURRAY. Thank you very much, Dr. Hosek. 

Now, I will now turn to Mrs. Crystal Nicely. 

STATEMENT OF CRYSTAL NICELY, CAREGIVER AND 

SPOUSE OF OEF VETERAN 

Ms. NICELY. The morning, Chairman Murray and Members of 

the Committee. Thank you for inviting me to share me and my 

husband Todd’s experiences with you today. 

My hope, through my testimony today, that those looking in will 

understand my frustration and heartache. 

Ever since my husband was injured, I have assumed a higher responsibility to care for him and support him as we transition into 

a new life. 

My husband lost his arms and his legs while serving his country 

in Afghanistan. During a combat patrol through the village of 

Lakari, which is in the southern Helmand Province, Todd was hit 

by an IED. 

It has been a long journey since that day in early 2010, and you 

would think that it would be quite easy for someone to lose hope 

and motivation after such a catastrophic injury. But my husband 

has been a fighter since day one. 

In recovery he displayed the same irresistible warrior spirit for 

which the Marines are so beloved, first, fighting off infection and 

disease, and then working aggressively with his physical medicine 

and rehabilitation. He continues fighting through progression in 

prosthetic training and also fighting for me and our future 

together. 

The community of wounded warriors at Walter Reed is diverse, 

and each Marine has their own particular needs. Many of them are 

fortunate enough to be accompanied by their loved ones. For most 

of the family members, we were thrown into this new role unexpectedly and unprepared. We have discovered that we could never 

have prepared ourselves for what we face on a day-to-day basis 

while caring for our loved ones. 

Many of us left our lives back home and assumed a new role at 

Walter Reed. Life here is not a picnic. There is not much my husband can do without me or someone assisting. Without his prosthetics Todd is unable to perform many of the very basic activities 

of daily living that people take for granted. 

We attempt to function independently, but the reality of his injuries requires that I or someone be at his side continuously. This is 

our new norm. For me, I am not only my husband’s caregiver, nonmedical attendant, appointment scheduler, cook, driver, and 

groomer, but I am also his loving wife faced with my own stresses 

and frustrations. 

To be clear, this is not an issue of being overwhelmed with caring 

for my husband, but what is upsetting is the lack of support, comVerDate Nov 24 2008 16:34 Feb 02, 2012 Jkt 000000 PO 00000 Frm 00022 Fmt 6633 Sfmt 6601 H:\112TH HEARINGS\67837.TXT SVETS PsN: PAULIN
19 

passion, and benefits for these individuals. It needs to be just a little bit easier. 

For the family members, we must go through a very tedious process to serve as a nonmedical attendant, especially at a time when 

we must oversee all other parts of our households and our lives, 

that I have to continually re-apply to keep serving as a nonmedical 

attendant, feels as though I am being judged on my loving care for 

Todd. 

Helping him through his treatment is what I want to do but I 

need the system to work with me to do that. It is almost disheartening to think that they believe someone else, no matter how willing they can be, can care for my husband more than I can. 

As caregivers, we leave our jobs and schools and there are those 

who have children to look after as well. We leave all of this to inherit another full-time job. I rely on compensation that is provided 

to nonmedical attendants to assist maintaining my household. 

With Todd’s injuries, the bills do not stop coming and, in fact, it 

has gotten more expensive. We are grateful for what assistance we 

do get from the Marine Corps, but had we not been greeted by a 

host of people who wanted to assist, we would have been lost in 

the recovery process. 

Although my husband is one of only four surviving quadruple 

amputees, his struggles and hardships are very similar to many 

wounded warriors. 

The process in transitioning out of the military has been particularly difficult. Todd has been a part of an integrated disability evaluation system, which I understand is supposed to be faster—a 

more efficient way to complete evaluations and transition out of the 

military service. 

That has not been our experience. At one point, a simple summary of my husband’s injuries sat on someone’s desk for almost 70 

days waiting for approval. I thank Chairman Murray for helping 

get the issue resolved but it should not take me talking to a U.S. 

Senator to help my husband. More importantly, what about all the 

other wounded Marines who have not had the chance to ask for 

that kind of help. 

Coordination of care for Todd has also been a problem. There 

seems to be so many coordinators that they are actually not all on 

the same page at this time doing opposite things. Though she was 

trying to help, I rarely saw my Federal recovery coordinator who 

seemed to have too many people she was responsible for. 

This lack of communication has also extended to benefits and 

programs. I have received very little information on how to participate or enroll in what is offered by the VA. 

For the benefits we know about, we are faced with problems in 

actually receiving them. For instance, periodically the stipends stop 

which makes things very difficult. I do not know why this occurs, 

and it is especially difficult to get a clear definite answer. But we 

need help. 

Chairman Murray, I appreciate all that is currently being done 

to assist future wounded warriors and their families. As for me I 

will never be able to fully express my appreciation for what assistance we do get and for what is available to us now because every 

little bit counts. 

20 

I hope my testimony today has been helpful to you as you continue working to resolve these issues. Thank you very much, and 

I am happy to answer any questions you have. 

[The prepared statement of Ms. Nicely follows:] 

PREPARED STATEMENT OF CRYSTAL NICELY, CAREGIVER AND

SPOUSE OF AN OEF VETERAN

Good Afternoon. Chairman Murray, Ranking Member Burr, Members of the Committee, Thank you for inviting me to share my and my husband Todd’s experiences 

with you today. 

I hope, through my testimony today, that those looking in will feel my frustration 

and heartache. Ever since my husband was injured I have assumed a higher responsibility to care for him and support him as we transition into a new life. I’m sharing 

my personal experiences and feelings which I hope will be useful to you in creating 

a better system of support for wounded warriors and their families. My husband lost 

his arms and legs while serving his country in Afghanistan. During a combat patrol 

through the village of Lakari, which is in the southern Helmand Province, Todd was 

hit by an IED. 

It has been a long journey since that day in early 2010. Under normal circumstances, one would think that it would be quite easy for someone to lose hope 

and motivation after such a catastrophic injury. But my husband has been a fighter 

since day one. In recovery he displayed the same irresistible warrior spirit for which 

the Marines are so beloved. First fighting off infection and disease, then working 

aggressively with his physical medicine and rehabilitation, through progression in 

prosthetic training, and also fighting for me and our future together. 

Although my husband is one of only three surviving quadruple amputees in the 

Marine Corps, his struggles and hardships are very similar to other Wounded Warriors, regardless of their injuries. I am here today, not only on behalf of my husband, but also the countless other wounded Marines and their caregivers. 

COORDINATION AND TRANSITION

The process of transitioning out of the military has been particularly difficult. 

Todd has been part of the Integrated Disability Evaluation System (IDES), which 

I understand is supposed to be a faster, more efficient way to complete the evaluations and transition servicemembers. That has not been our experience. At one 

point, a very simple narrative summary of my husband’s injuries sat on someone’s 

desk for almost 70 days waiting for a very simple approval. I thank Chairman Murray for her help in getting that resolved, but it should not take my talking with a 

United States Senator to make that happen. More importantly, what about all the 

other wounded Marines who have not had the chance to ask for that kind of help? 

Coordination of care for Todd has also been a problem. There seem to be so many 

coordinators that they are actually not all on the same page and sometimes doing 

things opposite of each other. Though she was trying to help, I rarely got to see our 

Federal Recovery Coordinator, who seemed to have too many people she was responsible for. The lack of communication also extended to benefits and programs. While 

I’m optimistic for the new VA caregiver program, I have gotten hardly any information on how to participate. There has been a similar lack of information about a variety of VA and other benefits. 

For the benefits we know about, we are also faced with problems in actually receiving them. Periodically the stipends stop, which makes things very difficult. I do 

not know why this occurs, especially as it is difficult to get a clear and definitive 

answer, but we need help. 

CAREGIVER NEEDS

The community of wounded Marines at Walter Reed is diverse, and each has their 

own particular needs. Many of them are fortunate to be accompanied by their loved 

ones. For most of the family members, we were thrown into this new role unexpectedly and unprepared, but we have taken it in stride with determination and hope 

of the future. What we have discovered is that we could never have prepared ourselves for what we face on a day to day basis while taking care of our loved ones. 

For me, I am not only my husband’s caregiver, non-medical attendant (NMA), appointment scheduler, cook, driver, and groomer, but I am also his loving wife faced 

with my own stresses and frustrations. To be clear, this is not an issue of being 

overwhelmed with caring for my husband for there is no other place on earth I want 

be other than by his side. I am sure that many of the other caregivers would agree. 

21 

What is upsetting is the lack of support, compassion, and benefits for these individuals. It needs to be just a little bit easier. Many of us, left our lives back at home, 

and assumed a new role and life at Walter Reed, as many caregivers have done 

across the country. Simply put, life here isn’t a picnic. It is a bittersweet struggle 

of coping with new identities and new norms, whatever those may be. 

I first wish to address the most difficult and disheartening issue that continues 

to be a problem and barrier at Walter Reed. There is not much these days my husband can do without me or someone at his side. We attempt to function independently, but the reality of his injuries requires that I be close to his side, and even 

if I am away for only short periods someone must be there. This is part of our new 

normal. Without his prosthetics Todd is unable to perform many of the very basic 

Activities of Daily Living (ADL) that are taken for granted by so many. 

The process to serve as an NMA is tedious, particularly at a time when we must 

oversee all the other parts of our household and our lives. I am not enlisted so it 

is frustrating when I’m expected to carry on as if I were, when the circumstances 

I have now are so much bigger than that. This is an additional and unnecessary 

burden for the spouses and family members. 

This continual process of reapplying to be an NMA feels as though I am being 

assessed on my love and care for Todd, or my value to him and his condition. But 

helping him through his treatment is what I want to do. How could I ever ask someone else to step away from their lives to come do what we so proudly do, loving and 

caring for our husbands. It’s almost disheartening to think that someone no matter 

how willing they may be can care for my husband more than I can. It hurts just 

to consider having someone else there instead of me sharing and growing in this 

experience with my husband. A lot of us come from jobs or school, and there are 

those that have children to look after as well. Personally, I was attending school 

before this. Now I have to consider the very expensive life that lies ahead for my 

husband and me. However, none of these factors would change my decision or take 

me away from my involvement in helping Todd’s recovery. I believe it is helpful 

when we can be there learning together to learn these new life skills so, in the near 

future, I can step away without worry knowing that he can perform everyday activities safely and, eventually, without someone else there. 

Many of us caregivers are unable to work, there just are not enough hours in the 

day, and in my case, leaving my husband’s side is just not an option. Thus, I do 

rely on the compensation that comes with being an NMA to assist with maintaining 

my household and saving for our future. With Todd’s injury the bills did not stop 

coming and, to be honest, things have become more expensive. We are grateful for 

what assistance we do get from the Marine Corps, but had we not been guided by 

our case managers, other volunteers like the Semper Fi Fund, and other families 

of wounded warriors, we would have been lost in this recovery process. 

WARRIOR TRANSITION UNITS

Frequent rotation of section leaders in the warrior transition units is another 

problem area. When the new leaders take over, they know less about what is required than the spouses. This is no fault of their own, for most of these individuals 

that are sent here to support the wounded come from military occupational specialties that are unrelated to what there are about to be asked to do. So it is a learning 

process, but by the time they understand, it is time for new section leaders to take 

over, again without the requisite skillsets, and the challenges continue. I have to 

seek out other sources and individuals to assist me. Additionally, in these situations, trust is a key part of an effective relationship, but the continual turnover 

hinders the development of that trust. 

CONCLUSION

It should not take a newspaper article or appearing at a Senate hearing to address these problems, but I am glad to have the opportunity to express this to you 

and seek your help. I want to take a moment to express my appreciation for what 

is being done now to aid in future assistance of the wounded and their families. I 

know that issues are being worked toward and I will never be able to fully express 

my appreciation for what assistance we do get and for what is available to us now, 

for every little bit counts. I hope my testimony today has been helpful to you as 

you continue working to address these issues. Thank you very much and I would 

be happy to answer any questions you have. 

Chairman MURRAY. Crystal, thank you so much for your courage 

in being here today and sharing your story. I really appreciate all 

you and your husband have done to help educate me about what 

22 

you are going through and so many others are. So thank you for 

being here. 

Mrs. Lorelei St. James. 

STATEMENT OF LORELEI ST. JAMES, DIRECTOR, PHYSICAL INFRASTRUCTURE ISSUES, UNITED STATES GOVERNMENT ACCOUNTABILITY OFFICE 

Ms. ST. JAMES. Chairman Murray, Senator Brown, and Members 

of the Committee, I am pleased to be here today to talk about 

GAO’s recent work on VA’s approaches to estimating future capital 

and health care budgets. 

For the aging veteran population and for younger veterans returning from Afghanistan and Iraq, it is vital that VA effectively 

estimate the facilities and health care that veterans may need. 

Let me first talk about VA’s capital planning process. VA has 

thousands of facilities to provide health care and other services to 

millions of veterans estimating the type and location of facilities 

and services is a complex process; and as we recently reported, VA 

over the course of several years has changed its approach to this 

planning. 

VA’s current planning process is the Strategic Capital Investment Planning Process or SCIP. However, I cannot tell you if SCIP 

is an effective planning tool. It is too early to tell. But I can say 

that VA incorporated a number of leading practices into SCIP. 

For example, VA now considers capital investments across the 

organization using weighted criteria and expanded its 5-year planning horizon to 10 years. 

Also prior to SCIP, VA’s planning process appeared to be moving 

in the right direction. For example, VA reduced the number of hospitals and opened 82 community-based outpatient clinics, but it is 

not all good news. VA faces a daunting backlog of repairs, about $10 billion; and as 

we reported in January, 24 ongoing construction projects needed an 

additional $4.4 billion to complete. 

Moreover, the VA continues to face age-old challenges such as 

getting stakeholders to agree on needed changes, legal and budgetary limitations, and getting rid of excess or underutilized 

property. 

Let me now turn to VA’s approach to developing its health care 

budget estimate. In January of this year, we reported that VA used 

the Enrollee Health Care Projection model and other methods to 

estimate its health care budget for fiscal years 2011 and 2012. 

We found the model uses data reflecting the types of health care 

that veterans might need, the projected or potential costs, and the 

number of veterans who might enroll for health care. 

Overall, the model projects the resources to meet demand for 

over 60 health care services that account for about 83 percent of 

the VA’s health care cost estimate. 

The model’s projections only provide a starting point for the 

budget. Throughout the budget process, the health care estimate is 

reviewed and weighed against other VA and OMB priorities; and 

in June we reported that VA’s budget estimate using the model for 

2012 and 2013 changed as it moved throughout the budget formulation process. 

23 

1See GAO, VA Real Property: Realignment Progressing, but Greater Transparency about Future Priorities Is Needed, GAO–11–197 (Washington, DC: Jan. 31, 2011). 

In general, at the end of the process, VA’s estimate or the President’s request to Congress could be higher or lower than the model’s estimate as VA and OMB weigh the estimate against other priorities or initiatives. 

Along the way VA has a voice in the process. For example, if the 

OMB estimate for nonrecurring maintenance is lower than the 

amount that the model projects, VA determines the impact on 

health care services and decides what action, if any, it will take up 

with OMB. VA could also propose a lower estimate for nonrecurring maintenance than the model projects based on other VA 

priorities. 

For example, compared to the models estimate, nonrecurring 

maintenance was $904 million lower for 2012 and $1.27 billion 

lower for 2013. 

But before that, one has to recognize that the model is based on 

imperfect data and assumptions that change. Also projections are 

made three to 4 years into the future and budgets are developed 

months in advance. 

In summary, VA uses sophisticated and complex methods to estimate its capital planning and health care budget. These methods 

do help to provide transparency into VA’s methods; but the estimates they produce, like the processes and models themselves, are 

not perfect and all must compete for funding and sometimes unforeseen priorities. 

Thank you. I am happy to answer any of your questions. 

[The prepared statement of Ms. St. James follows:] 

PREPARED STATEMENT OF LORELEI ST. JAMES, DIRECTOR, PHYSICAL INFRASTRUCTURE

ISSUES, U.S. GOVERNMENT ACCOUNTABILITY OFFICE

Madam Chairman Murray, Ranking Member Burr, and Members of the Committee: I am pleased to be here today as you examine the lifetime costs of supporting the newest generation of veterans. The Department of Veterans Affairs (VA) 

operates one of the largest health care delivery systems in the Nation, providing 

care to a diverse population of veterans. VA operates about 150 hospitals, 130 nursing homes, and 820 outpatient clinics through 21 regional health care networks 

called Veterans Integrated Service Networks. VA is responsible for providing health 

care services to various populations—including an aging veteran population and a 

growing number of younger veterans returning from the military operations in Afghanistan and Iraq. Budgeting for this vital health care mission is inherently complex. It is based on current assumptions and imperfect information, not only about 

program needs, but also on future economic and policy actions that may affect demand and the cost of providing these services. Adding to this complexity, VA has 

recognized over the years the need to plan and budget for facility modernization, 

and realign its real property portfolio to provide accessible, high-quality, and costeffective access to its services. 

My statement today addresses VA’s real property realignment efforts and VA’s approach to developing budget estimates for health care. It is based on our prior real 

property realignment work, where we examined the extent to which VA’s capital 

planning efforts resulted in changes to its real property portfolio, helped VA identify 

facility planning priorities, and reflected leading Federal practices for real property 

management.1 It is also based on our prior budget estimate work, where we examined how VA develops its health care budget estimate, addressed what VA identified 

as the key changes that were made to its budget estimate to develop the President’s 

budget request for fiscal years 2012 and 2013, and explained how various sources 

of funding for VA health care and other factors informed the President’s budget reVerDate Nov 24 2008 16:34 Feb 02, 2012 Jkt 000000 PO 00000 Frm 00027 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\67837.TXT SVETS PsN: PAULIN
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2GAO, Veterans’ Health Care Budget Estimate: Changes Were Made in Developing the President’s Budget Request for Fiscal Years 2012 and 2013, GAO–11–622 (Washington, DC: June 14, 

2011); and GAO, Veterans’ Health Care: VA Uses a Projection Model to Develop Most of Its 

Health Care Budget Estimate to Inform the President’s Budget Request, GAO–11–205 (Washington, DC: Jan. 31, 2011). 3The Veterans Health Care Budget Reform and Transparency Act of 2009 provided that VA’s 

annual appropriations for health care include advance appropriations that become available 1 

fiscal year after the fiscal year for which the appropriations act was enacted. Pub. L. 111–81, 

§ 3, 123 Stat. 2137, 2137–38 (2009), codified at 38 U.S.C. § 117. The act provided for advance 

appropriations for the Medical Services, Medical Support and Compliance, and Medical Facilities 

appropriations accounts. 4The Medical Services account funds health care services provided to eligible veterans and 

beneficiaries in VA’s medical centers, outpatient clinic facilities, contract hospitals, state homes, 

and outpatient programs on a fee basis. The Medical Support and Compliance account funds 

the management and administration of the VA health care system, including financial management, human resources, and logistics. The Medical Facilities account funds the operation and 

maintenance of the VA health care system’s capital infrastructure, such as costs associated with 

nonrecurring maintenance, utilities, facility repair, laundry services, and groundskeeping. 5 VA’s budgets for new construction exist in two accounts—Major Construction and Minor Construction—which are funded as separate line items within VA’s appropriation. Major construction projects are those estimated to cost more than $10 million, while minor construction 

projects are those estimated to cost $10 million or less. See 38 U.S.C. § 8104(a)(3)(A). Nonrecurring maintenance projects that may result in a change in space function or a renovation 

of existing infrastructure are funded through the VHA Medical Facilities budget account. 

quests.2 To perform the work related to real property realignment efforts, we reviewed leading capital planning practices and data on VA’s real property portfolio 

and future priorities. We also interviewed VA officials and veterans service organizations, and visited sites in 5 of VA’s 21 Veterans Integrated Service Networks. To 

perform the work related to budget estimates for health care, we reviewed VA documents on the methods, data, and assumptions used to develop VA’s health care 

budget estimate that informed the President’s two most recent budget requests for 

fiscal year 2011, 2012 and 2013.3 Our review of those most recent budget requests 

focused on the three appropriations accounts for VA health care services: Medical 

Services, Medical Support and Compliance, and Medical Facilities.4 We also interviewed VA officials responsible for developing this estimate and staff from the Office 

of Management and Budget (OMB). Our work was performed in accordance with 

generally accepted government auditing standards. More detailed information on 

our objectives, scope and methodology for this work can be found in the issued 

reports. 

SUMMARY

Through its capital planning efforts, VA has taken steps to realign its real property portfolio from hospital based, inpatient care to outpatient care, but a substantial number of costly projects and other long-standing challenges remain. For example, VA reported in its 5-year capital plan for fiscal years 2010–2015 that it had 

a backlog of $9.4 billion of facility repairs. The 5-year plan further identified an additional $4.4 billion in funding to complete 24 of the 69 ongoing major construction 

projects. We also found that VA, like other agencies, has faced underlying obstacles 

that have exacerbated its real property management challenges and can also impact 

its ability to fully realign its real property portfolio. We have previously reported 

that such challenges include competing stakeholder interests, legal and budgetary 

limitations, and capital planning processes that did not always adequately address 

such issues as excess and underutilized property. Furthermore, we found that VA’s 

capital planning efforts generally reflected leading practices, but lacked transparency about the cost of future priorities that could better inform decisionmaking. 

VA concurred with our recommendation to improve the transparency of its budget 

submissions. We have not yet assessed the extent to which VA has implemented our 

recommendation in relation to the President’s 2012 budget.5

VA uses what is known as the Enrollee Health Care Projection Model (EHCPM) 

to develop most of its health care budget estimate and uses other methods for the 

remainder. The EHCPM’s estimates for these services are based on three basic components: projected enrollment in VA health care, projected use of VA’s health care 

services, and projected costs of providing these services. The EHCPM makes a number of complex adjustments to the data to account for characteristics of VA health 

care and the veterans who access VA’s health care services. For example, these adjustments take into account veterans’ age, gender, geographic location, and reliance 

on VA health care services compared with other sources, such as health care services paid for by Medicare or private health insurers. VA officials identified changes 

made to its estimate of the resources needed to provide health care services to reVerDate Nov 24 2008 16:34 Feb 02, 2012 Jkt 000000 PO 00000 Frm 00028 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\67837.TXT SVETS PsN: PAULIN
25 

flect policy decisions, savings from operational improvements, resource needs for initiatives, and other items. The President’s request for appropriations for VA health 

care for fiscal years 2012 and 2013 relied on anticipated funding from various 

sources, including new appropriations, collections, unobligated balances of multiyear 

appropriations, and reimbursements VA receives for services provided to other government entities. 

REAL PROPERTY REALIGNMENT EFFORTS PROGRESSING, BUT GREATER

TRANSPARENCY NEEDED ABOUT FUTURE PRIORITIES

In January 2011, we reported that through its capital planning efforts, VA had 

taken steps to realign its real property portfolio from hospital based, inpatient care 

to outpatient care, but a substantial number of costly projects and other long-standing challenges also remain. Several of VA’s most recent capital projects—such as 

community based outpatient clinics, rehabilitation centers for blind veterans, and a 

spinal cord injury center—were based on its Capital Asset Realignment for Enhanced Services (CARES) efforts and subsequent capital planning. VA officials and 

veterans service organizations we contacted agreed that these facilities have had a 

positive effect on veterans’ access to services. However, VA had identified several 

high-cost priorities such as facility repairs and projects that have not yet been funded. For example, VA reported in its 5-year capital plan for fiscal years 2010–2015 

that it had a backlog of $9.4 billion of facility repairs. The 5-year plan further identified an additional $4.4 billion in funding to complete 24 of the 69 ongoing major 

construction projects. Besides substantial funding priorities, we also found that VA, 

like other agencies, has faced underlying obstacles that have exacerbated its real 

property management challenges and can also impact its ability to fully realign its 

real property portfolio. We have previously reported that such challenges include 

competing stakeholder interests, legal and budgetary limitations, and capital planning processes that did not always adequately address such issues as excess and underutilized property. 

Furthermore, we found that VA’s capital planning efforts generally reflected leading practices, but lacked transparency about the cost of future priorities that could 

better inform decisionmaking. For example, VA’s 2010–2015 capital plan linked its 

investments with its strategic goals, assessed the agency’s capital priorities, and 

evaluated various alternatives. Also, VA’s new Strategic Capital Investment Planning (SCIP) process strengthened VA’s capital planning efforts by extending the horizon of its 5-year plan to 10 years, and providing VA with a longer range picture 

of the agency’s future real property priorities. VA officials told us that the SCIP 

process builds on its existing capital planning processes, addresses leading practices, 

and further strengthens VA’s efforts in some areas. We have not fully assessed SCIP 

and it remains to be seen what impact SCIP will have on the results of VA’s capital 

planning efforts. While these changes were positive steps, we found that VA’s planning efforts lacked transparency regarding the magnitude of costs of the agency’s 

future real property priorities, which may limit the ability of VA and Congress to 

make informed funding decisions among competing priorities. For instance, for potential future projects, VA’s 2010–2015 capital plan only listed project name and 

contained no information on what these projects were estimated to cost or the priority VA had assigned to them beyond what was then the current budget year. 

Transparency about future requirements would benefit congressional decisionmakers by putting individual project decisions in a long-term, strategic context, and 

placing VA’s fiscal situation within the context of the overall fiscal condition of the 

U.S. Government. It is important to note that providing future cost estimates to 

Congress for urgent, major capital programs is not without precedent in the Federal 

Government. Other Federal agencies, such as the Department of Defense, have provided more transparent estimates to Congress regarding the magnitude of its future 

capital priorities beyond immediate budget priorities. 

We concluded in our report that billions of dollars have already been appropriated 

to VA to realign and modernize its portfolio. Furthermore, VA had identified ongoing and future projects that could potentially require several additional billion dollars over the next few years to complete. Given the fiscal environment, VA and Congress would benefit from a more transparent view of potential projects and their estimated costs. Such a view would enable VA and Congress to better evaluate the 

full range of real property priorities over the next few years and, should fiscal constraints so dictate, identify which might take precedence over the others. In short, 

more transparency would allow for more informed decisionmaking among competing 

priorities, and the potential for improved service to veterans over the long term 

would likely be enhanced. To enhance transparency and allow for more informed 

decisionmaking related to VA’s real property priorities, we recommended that the 

26 

6 In addition, expansion, renovation, and infrastructure improvements can be categorized as 

minor or major construction and funded by the respective appropriations accounts. The Minor 

Construction account funds projects estimated to cost as least $500,000 but not more than $10 

million, and the Major Construction account funds projects estimated to cost more than $10 million. 

Secretary of Veterans Affairs provide the full results of VA’s SCIP process and any 

subsequent capital planning efforts, including details on the estimated cost of all future projects, to Congress on a yearly basis. VA concurred with the recommendation. 

We have not yet assessed the extent to which VA has implemented our recommendation in relation to the President’s 2012 budget. 

VA USES A PROJECTION MODEL TO DEVELOP MOST OF ITS HEALTH CARE BUDGET ESTI- MATE AND CHANGES WERE MADE TO THE ESTIMATE FOR FISCAL YEARS 2012 AND 2013

We reported in January 2011 that VA uses what is known as the Enrollee Health 

Care Projection Model (EHCPM) to develop most of its health care budget estimate 

and uses other methods for the remainder. Specifically, VA used the EHCPM to estimate the resources needed to meet expected demand for 61 health care services that 

accounted for 83 percent of VA’s health care budget estimate for fiscal year 

2011.The EHCPM’s estimates for these services are based on three basic components: projected enrollment in VA health care, projected use of VA’s health care 

services, and projected costs of providing these services. To make these projections, 

the EHCPM uses data on the use and cost of these services that reflect data from 

VA, Medicare, and private health insurers. The EHCPM makes a number of complex adjustments to the data to account for characteristics of VA health care and 

the veterans who access VA’s health care services. For example, these adjustments 

take into account veterans’ age, gender, geographic location, and reliance on VA 

health care services compared with other sources, such as health care services paid 

for by Medicare or private health insurers. VA uses other methods to develop nearly 

all of the remaining portion of its budget estimate for long-term care and other services, as well as initiatives proposed by the Secretary of VA or the President. Longterm care and other services accounted for 16 percent and initiatives accounted for 

1 percent of VA’s health care budget estimate for fiscal year 2011. 

In June 2011, we reported on the President’s budget request for fiscal years 2012 

and 2013. We reported that VA officials had identified changes made to its estimate 

of the resources needed to provide health care services to reflect policy decisions, 

savings from operational improvements, resource needs for initiatives, and other 

items to help develop the President’s budget request for fiscal years 2012 and 2013. 

One of the changes that VA identified was in its estimates for non-recurring maintenance to repair health care facilities. Non-recurring maintenance funds are used for 

expansion, renovation, and infrastructure improvements that cost more than 

$25,000.6 VA’s estimate for non-recurring maintenance was reduced by $904 million for fiscal year 2012 and $1.27 billion for fiscal year 2013, due to a policy decision 

to fund other initiatives and hold down the overall budget request for VA health 

care. VA’s estimates were further reduced by $1.2 billion for fiscal year 2012 and 

$1.3 billion for fiscal year 2013 due to expected savings from operational improvements, such as proposed changes to purchasing and contracting. Other changes had 

a mixed impact on VA’s budget estimate, according to VA officials; some of these 

changes increased the overall budget estimate, while other changes decreased the 

overall estimate. 

The President’s request for appropriations for VA health care for fiscal years 2012 

and 2013 relied on anticipated funding from various sources. Specifically, of the 

$54.9 billion in total resources requested for fiscal year 2012, $50.9 billion was requested in new appropriations. This request assumes the availability of $4.0 billion 

from collections from veterans and private health insurers, unobligated balances of 

multiyear appropriations, and reimbursements VA receives for services provided to 

other government entities. Of the $56.7 billion in total resources requested for fiscal 

year 2013, $52.5 billion was requested in new appropriations, and $4.1 billion was 

anticipated from other funding sources. The President’s request for fiscal year 2012 

also included a request for about $953 million in contingency funding to provide additional resources should a recent economic downturn result in increased use of VA 

health care. Contingency funding was not included in the advance appropriations 

request for fiscal year 2013. As mentioned earlier, budgeting for VA health care is 

inherently complex because it is based on assumptions and imperfect information 

used to project the likely demand and cost of the health care services VA expects 

to provide. The iterative and multilevel review of the budget estimates can address 

some of these uncertainties as new information becomes available about program 

needs, Presidential policies, congressional actions, and future economic conditions. 

27 

7GAO, Veterans Affairs: Limited Support for Reported Health Care Management Efficiency 

Savings, GAO–06–359R (Washington, DC: Feb. 1, 2006). 

As a result, VA’s estimates may change to better inform the President’s budget request. The President’s request for VA health care services for fiscal years 2012 and 

2013 was based, in part, on reductions to VA’s estimates of the resources required 

for certain activities and operational improvements. However, in 2006, we reported 

on a prior round of VA’s planned management efficiency savings and found that VA 

lacked a methodology for its assumptions about savings estimates.7 If the estimated 

savings for fiscal years 2012 and 2013 do not materialize and VA receives appropriations in the amount requested by the President, VA may have to make difficult 

tradeoffs to manage within the resources provided. 

Madam Chairman Murray, Ranking Member Burr, and Members of the Committee, this concludes my prepared remarks. I would be happy to answer any questions that you may have. 

POSTHEARING QUESTIONS SUBMITTED BY HON. PATTY MURRAY TO MS. LORELEI

ST. JAMES, DIRECTOR, PHYSICAL INFRASTRUCTURE, GOVERNMENT ACCOUNTABILITY

OFFICE

Question 1. Please provide more information on the true depth of VA’s backlog in 

construction projects involving improvements needed to protect the privacy and safety of women veterans? 

Question 2. How will the lack of investment in keeping up with ongoing maintenance and repairs affect VA’s utilization of limited resources and future proposals 

of its infrastructure portfolio? 

Question 3. Especially in the context of current fiscal issues, all aspects of VA operations must be assessed for their potential to operate most efficiently. With respect to VA’s capital planning process, please provide an assessment of how underutilized property can be of best use. 

[Responses were not received within the Committee’s timeframe 

for publication.] 

Chairman MURRAY. Thank you very much, Ms. St. James. 

And we will turn to Ms. Heidi Golding. 

STATEMENT OF HEIDI L. W. GOLDING, PRINCIPAL ANALYST 

FOR MILITARY AND VETERANS’ COMPENSATION, CONGRESSIONAL BUDGET OFFICE 

Ms. GOLDING. Thank you. Madam Chairman, Senator Brown, 

and Members of the Committee, thank you for the opportunity to 

appear before you today to discuss the health care of our veterans 

returning from overseas contingencies operations in Iraq and Afghanistan, which I will refer to as OCO. 

I will address some of the medical conditions they have, their use 

of health care provided by the Veterans Health Administration, 

VHA, and that CBO’s projections of future potential costs to treat 

them. All costs will be expressed in 2011 dollars. 

About 2.3 million active and reserve personnel have deployed to 

overseas operations through March 2011. The medical conditions 

resulting from their participation affect the numbers of veterans 

who will require medical care in the future, including that provided 

by be VHA. 

In total, about 69,000 servicemembers have been evacuated from 

the combat theaters because of injuries and other medical conditions and diseases. Many more seek care in-theater or after returning home. 

Traumatic Brain Injury, TBI, and Post Traumatic Stress Disorder, PTSD, are conditions whose treatment could result in subVerDate Nov 24 2008 16:34 Feb 02, 2012 Jkt 000000 PO 00000 Frm 00031 Fmt 6633 Sfmt 6601 H:\112TH HEARINGS\67837.TXT SVETS PsN: PAULIN
28 

stantial future costs for VHA. However, the problems of TBI and 

PTSD, that is, the proportion of people with those conditions, 

whether diagnosed with them or not, is uncertain partly because 

the conditions can be challenging to identify. 

This makes resource planning for treatment of OCO veterans 

more difficult. Nonetheless, data helpful to resource planning does 

exist. For example, through March 2011 DOD had diagnosed a 

total of 35,000 TBI’s among OCO servicemembers. About 90 percent of those were classified as mild TBI’s, which typically heal 

quickly within weeks or months with relatively little medical intervention. 

Both DOD and VHA have implemented programs to clinically 

screen for TBIs. VHA screening indicates that about 7 percent of 

its new OCO patients have TBI with ongoing symptoms. 

In addition, VHA as diagnosed about 27 percent of OCO patients 

with PTSD. That rate is relatively high compared to published 

studies of prevalence that generally range from about 5 to 25 percent, but it is not surprising if veterans who have health problems 

are more likely than other veterans to seek care. 

The number of veterans who are eligible for VHA benefits and 

the extent to which they use those services will affect future VHA 

costs. About 1.3 million OCO veterans have become eligible for 

health care through VHA. Just over half of them have sought that 

care through March 2011. The number of OCO veterans who have 

ever used VHA has grown by about 100,000 per year since 2005. 

Roughly half of those, those who have used a VHA, began using 

it within about 12 months of separating from service. Their use is 

typically highest in the months immediately after they enroll in 

that system. 

VHA spent almost $1.9 billion or $4800 per OCO patient in 2010, 

and a cumulative total of $6 billion to treat OCO veterans through 

2010. Although OCO veterans were 7 percent of all veterans treated in 2010, they represented 4 percent of VHA spending. 

CBO has projected the resources that VHA would need between 

2011 and 2020 to treat all of OCO veterans who seek care. CBO 

examined two scenarios. 

Under scenario one, CBO assumes that the number of deployed 

servicemembers drops to 30,000 by 2013 and remains there 

through 2020. In addition, VHA’s health care expenditures per 

OCO enrollee grow at about the same rates as the national 

averages. 

Under this scenario, VHA would treat 1.3 million OCO veterans 

at least once before the end of the decade. The annual cost for their 

care would nearly triple over the decade, rising from $1.9 billion in 

2010 to roughly $5.5 billion in 2020 for a 10-year total of $40 

billion. 

The largest growth would be early in the projection period due 

to a large influx of new enrollees. Because OCO patients are less 

expensive to treat than the average VHA patients, OCO veterans 

would consume 8 percent of VHA’s total spending in 2020. 

For scenario two, CBO assumes that the number of servicemembers deployed drops to 60,000 in 2015 and remains there. In addition, CBO assumes VHA’s expenditures per OCO in enrollee grow 

29 

at an annual rate that is about 30 percent higher than in scenario 

one. 

Under scenario two, the cost to treat OCO veterans in 2020 is 

more than 50 percent higher than in scenario one, $8.4 billion. 

Costs over 10 years would total $55 billion. Almost 2/3 of the cost 

difference is due to the faster growth in expenditures per enrollee. 

Thank you very much. I am happy to answer any questions. 

[The prepared statement of Ms. Golding follows:] 

PREPARED STATEMENT OF HEIDI L. W. GOLDING, PRINCIPAL ANALYST FOR MILITARY

AND VETERANS’ COMPENSATION, CONGRESSIONAL BUDGET OFFICE


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POSTHEARING QUESTIONS SUBMITTED BY HON. PATTY MURRAY TO MS. HEIDI

GOLDING, PRINCIPAL ANALYST, NATIONAL SECURITY DIVISION, CONGRESSIONAL

BUDGET OFFICE

Question 1. Please provide more information regarding how addressing excess and 

duplication at VA will raise efficiency and maximize a return on resources without 

negatively impacting services? 

Question 2. Many of the deficit and debt reduction proposals included across the 

board spending cuts and caps. Please provide any information your agency has regarding what impact such a cap will have on VA’s ability to provide health care for 

over 8.3 million veterans in the coming years? 

[Responses were not received within the Committee’s timeframe 

for publication.] 

Chairman MURRAY. Thank you very much. Thank you again to 

all for your testimony today. It is really appreciated. 

Mrs. Nicely, I want to start with you. When I first met you up 

at Bethesda, I was really disconcerted when you told me that you 

had been waiting forever for your husband to finish his joint disability evaluation process. You had to wait almost 70 days for approval of a simple narrative summary. 

Now, I went and checked. What I understand is that the summary only needed to state the obvious, that your husband was indeed missing two legs and two arms, and that essentially sat on 

somebody’s desk for more than 2 months. That is just really unacceptable, and my apologies to you and your family on behalf of everyone for that. 

But I wanted you, as you shared with me, to talk to me a little 

bit about what you were going through for those 70 days while this 

country essentially bureaucratically put you on hold. 

Ms. NICELY. I think Todd’s therapy is very important but he got 

to a point in his therapy where he was able to do more stuff more 

independently which did not require his therapist to be there I 

guess during the whole time. 

So, it is a requirement. I do not know if it is just Marine Corps 

procedure or whatever that they go into therapy; and if Todd was 

not being taught new things or it was just getting redundant, he 

was doing the same things over and over again, so he had pretty 

much accomplished much of what he has wanted to within that 

timeframe, which meant he was taking up more space that other 

people could have been utilizing the therapist. 

So, I guess why pay for his therapy or why if you could be paying 

it for somebody else. So, it was just a waste of time I guess. 

Chairman MURRAY. What were you spending your time doing? 

Ms. NICELY. Support. Taking Todd back and forth to therapy and 

just helping him with the daily living. 

Chairman MURRAY. You talked to me a little bit about coordinators of care, that they were coming through changing every 2 

months and that you knew more than they did and they left and 

you were training the coordinators of care. 

Can you share with us a little bit about that? 

Ms. NICELY. I do not want to say that all of them are at fault 

due to the situation because of the way it is. But the way that the 

military side has the liaisons coming in and out is very frustrating 

because they are not MOS specific. They are not trained in the jobs 

to get done that are being asked of them. 

50 

So, they come here without the knowledge of what they are expected to do and take the time while they are here to learn what 

they are doing, and by the time that they have adjusted and maybe 

have absorbed some of it, it is time for them to leave again, and 

new individuals come in who are not still not MOS specific. 

So, that does not help us with what they are here for is the frustration and helping them take the stress off of the families and 

able to do the things that are necessary. 

Instead me personally had to look for outside assistance from 

whether it was other family support or my case manager but was 

not assisted on the military side of things. 

That also does not aid, and for me in the beginning of the family 

process, it is really hard to open up to people and trust individuals. 

So, to be able to get a connection with somebody and have somebody there for that short period of time and then transition out and 

give us somebody else new is not allowing us to have that connection or allow us to want to open up to them because we are like, 

OK, if we come to you what are you going to do for me because I 

know more than you do. 

So, it is extremely frustrating. I know that they are working on 

it but it is still frustrating. 

Chairman MURRAY. You are a tremendous advocate for your husband, and I am extremely impressed what Todd is capable of doing, 

and I know that you are proud of that as well. I also know that 

he needs you at his side, and you are there every single minute 

doing that. 

You met many people through this process. What does somebody 

do that does not have a wife or a live-in caregiver? 

Ms. NICELY. That is hard because you do see it. In some cases 

the family support is maybe not there or maybe not there for the 

right reasons. I think because of the lack of, I do not want to say 

lack of knowledge but their ability to assist in a lot of ways and 

the lack of compassion when it comes to a lot of these guys, their 

next choice would be to reach out to somebody I do not know 

whether it is through the military side of things or through the 

hospital because the hospital staff is wonderful. I guess there is not 

really a way to say that. 

Chairman MURRAY. Maybe if you can share with this Committee, 

as you did with me, a little bit about what your day is like. 

Ms. NICELY. Well, here recently a lot easier than normal because 

Todd has strived to become very independent with his prosthetics. 

Without his prosthetics, I would be doing the work for two people 

every day. And with his prosthetics and because of his knowledge 

and what he has been able to absorb through his therapist and his 

daily work in putting into therapy, I basically just observe and 

watch and, if he needs assistance, then I assist him if he asks, of 

course. 

Chairman MURRAY. Thank you. And thank you for your courage 

in being here again too. 

Mr. Rieckhoff, our government’s ability to fulfill the sacred responsibility has been called into question by the ongoing debt crisis 

that is in front of us today. 

If the debt limit is not raised, some have speculated that the government will not have enough money to provide veterans’ benefits 

51 

checks. As you can imagine, and I am sure you know this, this uncertainty has caused an incredible amount of anxiety among our 

veterans and, of course, their families. I understand that the IAVA 

was at The White House yesterday, and I wanted to ask you if you 

can describe what the impact of a default would be on veterans. 

Mr. RIECKHOFF. We do not know, and that is what we hoped to 

find out at The White House yesterday. We came back with no real 

additional information for our members. 

So, I would ask you all what the impact will be. I think the bottom line for our members right now is they do not know what is 

going to happen August 1. They do not know what is going to happen September 1. They do not know if disability checks are coming. 

They do not know if paychecks are coming. They do not know if GI 

Bill checks are coming, and they are extremely concerned. They are 

scared. 

Some of these folks who are 100-percent disabled have gotten no 

additional information and we have been getting quite a few emails, tweets, Facebook posts. People are more and more concerned 

by the day. And I think they understand generally where the debate is. They do not understand the specifics of how it will impact 

them. No one has been able to project with any kind of certainty 

how they should plan for their next 60 days. 

Chairman MURRAY. I assume there is a lot of frustration. 

Mr. RIECKHOFF. Incredible frustration, just devastating disappointment. And it has become demoralizing. I mean, not even 

from folks just here Stateside but overseas. There is a guy on a 

checkpoint in Afghanistan right now who does not know for certain 

what is going to happen to him and his family in 30 days. 

That is ridiculous and it is outrageous and our members are beyond upset, and so, I would ask this Committee if you can help us 

get certainty. We have e-mails standing by. I can send it out to 

them within an hour and let them know what is going on but we 

need clarity and guidance from you all in this town about what to 

tell them. We have not gotten it yet. 

Chairman MURRAY. Thank you. Thank you for much. 

Senator Brown. 

Senator BROWN OF MASSACHUSETTS. Thank you very much. 

Crystal, I was concerned a little bit. You mentioned in your initial testimony about you have to go and get recertified on a regular 

basis to be in your position as a home care? 

Ms. NICELY. Yes, sir. 

Senator BROWN OF MASSACHUSETTS. Can you tell me a little bit 

about that? Like what they have told you, what is the process, how 

long does it take, why have they told you that you need to do it? 

Ms. NICELY. In the beginning, from my understanding, it requires a doctor’s approval. So, like a re-evaluation of the military 

servicemembers’ health and how they are getting better on a dayto-day basis. 

So, the use of or the need of a medical attendant, I believe, is 

why they make us re-apply for it, and it takes quite a long time. 

In the beginning, I do not know, months almost. I know there was 

a waiting list for a nonmedical attendant assistants. 

From my understanding, they are working on it to improve that 

and it has improved speedwise, but going about how to get apVerDate Nov 24 2008 16:34 Feb 02, 2012 Jkt 000000 PO 00000 Frm 00055 Fmt 6633 Sfmt 6601 H:\112TH HEARINGS\67837.TXT SVETS PsN: PAULIN
52 

proved and the stipulations, and a better understanding of its is a 

need I would have to say. 

Senator BROWN OF MASSACHUSETTS. So, how long does your certification actually last? 

Ms. NICELY. I think the longest that you can request a nonmedical attendant is 6 months. 

Senator BROWN OF MASSACHUSETTS. So, how many times have 

you had to recertify? 

Ms. NICELY. I have only actually had to do it once for myself due 

to, I guess, the stipulations or the requirements of the law that due 

to I am transferred by record book to where my husband is that 

I no longer rate it. So, but I know certain from other family members and other individuals that have gone through it had to reapply many times. I do not know if that is due to the process, the 

loss of paperwork, or—— 

Senator BROWN OF MASSACHUSETTS. So, thank you for that. I am 

wondering how long has Todd been part of the IDES? 

Ms. NICELY. What do you mean by that? 

Senator BROWN OF MASSACHUSETTS. Well, he has been going 

through I know the expedited disability system. 

In listening to your testimony, you said it was very frustrating, 

and there were breakdowns. I have a sense that you did not want 

to blame anybody because you are thankful obviously for the things 

that you have. 

But on the other hand, you are upset at the fact that no one 

seems to be coming and saying, hey, listen, this is what you have, 

this is how you get it, and this is where you go, and this is, you 

know, how much you are going to get or the assistant. Has anyone 

ever done that and actually sat down and laid it all out to you on 

a piece of paper so you can actually almost have a flowchart? 

Ms. NICELY. Before Senator Murray spoke to us, nobody sat 

down and gave us a better understanding of how the med board 

process works, nor what was to be expected of it, except that it was 

going to take a very long time. That was what we were informed 

of. 

Senator BROWN OF MASSACHUSETTS. So how long was it from 

point ‘‘A’’ to Senator Murray getting involved? 

Ms. NICELY. It started, Todd’s Med Board I would say January 

timeframe because they said that there was a possibility that it 

would take quite a long time. So, by the time Todd was ready, and 

therapy was completed and he was ready to leave the hospital that 

it should be completed. 

Senator BROWN OF MASSACHUSETTS. So you mentioned just a 

summary took 7 months, it was on somebody’s desk you said. 

Ms. NICELY. 70 days. 

Senator BROWN OF MASSACHUSETTS. I am sorry. 70 days. Thank 

you. 70 days. Were you given any reason for that? 

Ms. NICELY. Officially that it was just sitting on someone’s desk. 

I believe that is what we were informed of that it was just sitting 

and waiting. 

Senator BROWN OF MASSACHUSETTS. That is certainly not acceptable. Are you recognizing any additional hassles or problems of 

things moving along more expeditiously now? 

53 

Ms. NICELY. Oh, yes. She, as in Senator Murray, really put, kick 

them in the butt and we have not had any issues since. 

Senator BROWN OF MASSACHUSETTS. That is great. 

It is interesting because, according to our original estimates, it 

is 42,000. Does it take a Senator to kick people’s butts to get help 

for the other soldiers and family members that are having very 

similar problems? 

You have a husband who is obviously extremely injured. For him 

to have to go through this stuff and you as well, I just find once 

again, you know, we are getting back to the fact that the VA is not 

here. I would suggest, I am just sitting in as the Ranking Member 

today but with Senator Burr’s consideration also that we find out 

like why. 

Chairman MURRAY. Senator Brown, I appreciate that. I will say 

that the military was responsible at this point, and Secretary Lynn 

is personally involved. 

Senator BROWN OF MASSACHUSETTS. Great. Thank you. My time 

is up and there are other Members. I will come back. Thank you. 

Chairman MURRAY. Thank you very much. 

Senator Tester. 

Senator TESTER. Thank you, Madam Chair and thank you all for 

your testimony. Crystal, thank you especially. 

You talked about your gratitude for Chairwoman Murray, and 

we all are grateful for Chairwoman Murray but the fact is our gratitude goes the other way. We thank you for what you do. We thank 

you for the sacrifices that your husband and you have given this 

country. We cannot repay you. That is just the way it is. There is 

nothing we can do to repay what you sacrificed. 

And I think the VA is probably listening to this hearing, and I 

think the constructive criticism you have given is very positive. The 

questions about the IDES process, the section leader, the NMA recertification were already asked. I am not going to ask them again. 

I think you did a fine job. 

Obviously, there needs to be more education done. There needs 

to be some streamlining because, quite honestly, with the number 

of disabled vets that are out there, the action of a Senator, there 

is no way we can do it all. So, the VA has to step up in a bigger 

way, and I think they are hearing that message through C-SPAN 

or whatever means it might be today. 

Paul, I would like to echo your testimony. I think that the lifetime costs are huge but I think intervention in the beginning can 

save money and make quality-of-life better for our veterans. 

It seems like a lot of the problems stem from access. A lot of 

problems stem from education. It is particularly difficult in rural 

America. We have tried to do some things. We have tried to enhance mileage. We tried to get more clinics out there, tried to get 

telemedicine going. More employment counselors in rural America. 

The challenges are many. This is not a fair question, but I am 

going to ask it anyway. If you are going to look from my rural 

America perspective, the challenges that are out there, we have 

made some improvements. 

Is there more we need to be doing and what areas would you invest in if you were sitting in this chair? 

54 

Mr. RIECKHOFF. Yes, sir. There is a lot of room for improvement, 

and that is what we hear consistently from our members. One 

thing that I think is important for this Committee and for this entire town to really wrap their heads around is that right now only 

52 percent of our generation of veterans are enrolled in VA health 

care. Only half. 

So we have got to think more creatively. The country thinks that 

the VA is a one-stop, the only solution, the silver bullet that is 

going to solve all the problems of this generation, and the VA I 

know is improving. 

Obviously, we are disappointed they are not here. They have a 

long way to go. But we have also got to think more creatively. And 

I think we have to have a sustained effort that invests in community-based nonprofits, that enrolls the private sector, that involves 

the faith-based community, the people who are in those rural communities, because the VA has not innovated as a nationwide model. 

It is still catching up from 30 years ago in every way shape or 

form. 

So, what we have seen as successful is involving those communities, leveraging technology especially. That is how you can get to 

those folks where they have decent access to the Internet, but that 

does give you a tremendous opportunity for innovation and for impact. You are not going to be able to bring everybody 400 miles to 

the nearest facility. 

So, we have got to think creatively and find ways to invest in the 

community-based solutions that are working, you know, find those 

pilots and then take them to scale, because that is where we see 

in the field the most consistent entrepreneurial attitude. 

It is that community-based church group or VFW hall or folks 

who are at the point of attack who are trying to deal with those 

problems. We have not seen a lot of innovation that has really been 

encouraged and taken to scale outside of the VA. 

So, that is kind of I think a big bite of the apple that we as a 

Nation have to start to take on. The President has got to reframe 

it as well. He has to talk about more than the VA when we talk 

about veterans. 

Senator TESTER. Thank you. I want to talk about local contracting. I guess initially it would be for Ms. St. James but whoever 

would like to answer this. 

It is a huge issue in my State. The inability for the VA to recruit 

and retain doctors and surgeons is a big, big, big issue. We have 

not had a full-time orthopedic surgeon in Montana for several 

months. The VA is trying to recruit one. They cannot get them. 

Now, we have got veterans who have to travel out of State, outof-pocket care, quality-of-life goes down. There are 400 veterans on 

a wait list now that is approaching 2 years for orthopedic surgeries. 

It is completely unacceptable, and I know Montana is not the only 

State in this boat. 

I do not think it is cost-effective to ship somebody miles and 

miles, hundreds of miles away from their home for surgery when 

it could be contracted locally in areas where we cannot get docs in 

the VA. 

55 

Can you tell me if this makes sense to you, to locally contract if 

you cannot get a doctor that is a specialist? If it is not you, Mrs. 

St. James, somebody else can answer the question. 

But it appears to me that this could help solve any problem 

where we have need and we cannot fill the positions, it just seems 

to me that it would be a natural follow-on, to contract locally, take 

care of it so you do not have to travel halfway across the western 

United States and back again. 

Ms. ST. JAMES. I think that is more appropriate for someone else 

on the panel. 

Senator TESTER. OK. Anyone else want to take a shot at it. If 

not, it is yours, Paul. 

Ms. GOLDING. All I can say on that, because I am not an expert 

on that aspect, is that I know there is some fee-based care in VHA. 

I do not know how they decide when it goes to fee-based care or 

not. 

Senator TESTER. Paul. 

Ms. GOLDING. I am shooting it back to you, Paul. 

Mr. RIECKHOFF. Sir, when you are in the fight and you need 

ammo, you put your hand back and you want ammo, OK, these 

folks are out in the fight. You have heard from Mrs. Nicely. They 

need immediate care. 

Senator TESTER. Right. 

Mr. RIECKHOFF. And I think whether or not it is a contract is 

like DC talk to folks in the field. 

Senator TESTER. Right. 

Mr. RIECKHOFF. They want to know, who can I call right now 

that can help me. 

Senator TESTER. Right. 

Mr. RIECKHOFF. And I think whatever it takes to creatively deliver to that point of impact is what we need to come up with. 

Senator TESTER. Right. That is my perspective too. I think that 

having people that need knee or hip replacement on a list for 2 

years, it is not a good way to run a ship. I understand the problem 

with recruitment in rural America. It is in the private sector and 

in the public sector both. So, it is really important. 

My time has run out long past, and I thank you all for your testimony and appreciate your perspectives. 

Chairman MURRAY. Thank you very much. 

Senator Isakson. 

STATEMENT OF HON. JOHNNY ISAKSON, 

U.S. SENATOR FROM GEORGIA 

Senator ISAKSON. Well, I want to compliment Crystal on her 

courage and their bravery to be here, and I want to take the presumptive position of recommending to the Chairman and the Ranking Member that our testimony be mailed to every Member of the 

U.S. Senate as required reading because I think it is a story that 

needs to be told over and over. 

Sometimes, we get so busy doing things like we are doing right 

now, which is running around in circles, we do not really take into 

consideration those who are meeting tremendous challenges in life 

because of what they have to do. 

56 

You are a real hero to me, and I hope the Chair will do that and 

make sure every Member of the Senate at least gets the opportunity to read what a true American hero and Crystal and her husband really are. 

Chairman MURRAY. I would hope that all of America hears it. 

Senator ISAKSON. Absolutely. 

Paul, I appreciate you being a very articulate spokesman on behalf of our Iraqi and Afghanistan veterans. They are going to need 

it over the years. There are a lot of them, and the challenges just 

like Crystal has described are greater. 

The advances we have had in health care are wonderful but it 

also means there are a lot of people surviving battlefield injuries 

that did not before that require a tremendous amount of help and 

support. So, I appreciate what you are doing. 

Crystal, on the nonmedical attendant, when you were answering 

Senator Brown, you said the VA provides one for up to 6 months. 

I thought I heard you say. 

Ms. NICELY. I think it is actually military compensation because 

the VA does not pick you up until after the servicemember has retired. So, it is military compensation. It is up to 6 months. I think 

that is the requirement from my understanding. 

When I first initially applied for the nonmedical attendant, they 

did it for a year, and then I was informed that it could only be 6 

months, and then I was informed before applying it again that I 

did not rate it because I was transferred with Todd by record book. 

Senator ISAKSON. So you are compensated by the VA as a nonmedical attendant during that period of time? 

Ms. NICELY. Not yet, no, sir. 

Senator ISAKSON. What I was trying to get at, Scott’s question 

was right on point with me, why in the world you would have to 

continue to re-apply to the main nonmedical attendant over and 

over again. 

Ms. NICELY. It is frustrating, I guess, if the servicemember does 

need the assistance and the family is here to care or a friend or 

whatever the case may be. I do not know. I just know that they 

do require you to re-apply. 

Senator ISAKSON. Walter Reed is being closed in the next 30 

days, if I am not mistaken. Have you had any consultation with the 

new move to Bethesda? I guess Todd will be going to Bethesda. Is 

that right? 

Ms. NICELY. Actually, due to Senator Murray’s kick in the 

butt—— 

Senator ISAKSON. She is good at that by the way. 

Ms. NICELY. Yes, she is. We actually have a date on which he 

is going to retire. So, we actually will not have to do the move. But 

they are, they just recently had a town hall meeting for servicemembers to come to so that way they could explain the move and 

ask questions if need be. 

Senator ISAKSON. Thank you very much again, Crystal. 

Mrs. St. James, I know you are in the physical evaluation which 

means the bricks and mortar, that type of thing. Do you feel like 

the VA is making adequate plans in terms of that? 

And going to Senator Tester’s statement about contract services, 

particularly in States like Montana and take South Georgia where 

57 

we have 63 counties where we do not have a physician private or 

VA for that matter. 

Do you think the VA is making adequate plans to deal with what 

is going to be a higher volume of services because of the veterans 

of Iraq and Afghanistan in terms of the physical plant? 

Ms. ST. JAMES. We looked at their planning process both on the 

part of bricks and mortar, as you mentioned, as well as looking at 

their enrollee health care projection model. 

And on the physical infrastructure side, the new planning process that they have, which is called SCIP, we have not had time 

really to evaluate that, and to know whether or not it is taking into 

account what needs to be done. 

VA appears to take into account the overall plan of what needs 

to be done on the health care side for those services. But quite honestly, the SCIP process is new. We have not had time to evaluate 

it. 

I can only say that VA appears to have progressed from its earlier days of capital planning, but the SCIP process was just used 

to inform the 2012 budget. 

So, we do not know how effective it is going to be. 

Senator ISAKSON. Thank you. 

Thank you, Madam Chairman. 

Chairman MURRAY. Thank you. 

Senator Boozman. 

STATEMENT OF HON. JOHN BOOZMAN, 

U.S. SENATOR FROM ARKANSAS 

Senator BOOZMAN. Thank you, Madam Chair. 

And again, Crystal, we really do appreciate your testimony. You 

have done a good job. It has been very informative. 

You represent your family and your husband very, very well, and 

more importantly, I think all of the other families that are in the 

same situation. So, give yourself a pat on the back. Like I say, you 

have done very, very well and very helpful. 

Here so much comes from the top down, and it is so important 

and I just appreciate you, Madam Chair, having her here in the 

sense that, you know, we do not dwell from the bottom up meaning 

relating to the people that are actually out there fighting the battle, like you are doing, on a daily basis. It really is very helpful to 

hear. 

Paul, I think the comments you made about the faith-based communities or the faith-based interaction in the communities, not just 

the faith-based but just all of the, you know, the nonprofits, the 

charitable organizations are trying to do a good job. 

One of the problems that we have we see all of these deployments from our guard units, and they are going off with a regular 

unit and then coming back, you are still with your buddies and life 

goes on, but just all of a sudden you are thrown back and many 

times, myself representing a southern State, many times going 

back and I think that is probably true throughout the country, 

going back to small communities where there is not a lot of 

resources, you know, very limited with the VA, and then just the 

nature of the beast of how they are separated, it really is real 

important. 

58 

So, we would like to work with you to strengthen, you know, 

your ideas on how we strengthen those relationships and encourage 

that to flourish. 

Could you comment about that for a second? 

Mr. RIECKHOFF. Yes, sir. I think it is about wrapping the communities around these veterans when they come home. What is so unprecedented is the small percentage of people who are serving relative to the overall population. So, if we can find creative ways to 

galvanize around those veterans, it would be a worthy investment. 

I think what I see—in the local communities and in the rural 

areas especially—is a patchwork of services. If someone calls me 

from rural Montana and says my husband is suicidal, the services 

available to them are going to be dramatically different than Kansas or Florida or somewhere else. 

And so, our team has a really difficult time of being able to deliver or even connect them with reliable services because they are 

so fragmented. I really firmly believe there has not been a significant investment nationwide in community groups of all kinds. 

The comparison that we have started to draw on recently is that 

what veterans face right now is kind of like AIDS 25 or 30 years 

ago when you did not have existing infrastructures. 

There is no massive philanthropic investment. There is no corporate investment. A lot of the nonprofits only started seven, 8 

years ago. Some of them out of people’s trunks. So, we are really 

in the earliest stages of creating an entire national network around 

a totally new set of issues, whether it is multiple amputations, or 

traumatic brain injury or women’s issues. 

A lot of the stuff is new, and there is not a system in place nationwide to tackle it. So, I think we have really got to issue a national call over and over again on some of the issues that Senator 

Tester talked about earlier. 

The fact that we still do not have enough qualified mental health 

care workers is ridiculous. I have been coming here every year 

talking about this. If the President stood up tomorrow and said if 

you want to serve your country, be qualified as a mental health 

care worker, go work at the VA, go work at the DOD and we are 

going to pay you and we are going to support you and we are going 

to train you, that is a great way for people to serve their country, 

and I think they would step up. 

We have got to make those calls clear and we have to think more 

creatively than outside of the existing bureaucracies. 

Senator BOOZMAN. Very good. I agree. We have to put that infrastructure in place and then another problem, and you might comment on this, Crystal, is the fact that we do have stuff in place now 

and yet families do not know about it. It is not readily accessible. 

If you can comment on that or ways that we can improve that. 

But I see that as something that we really need to get aggressive 

with. 

Ms. NICELY. Like many have said that the strides that have been 

made are amazing because many years ago you did not have what 

we have now. 

But I think that, as that being said, what should be focused on 

now is these things and the improvements that are going to be 

59 

1GAO, VA Real Property: Realignment Progressing, but Greater Transparency about Future 

Priorities Is Needed, GAO–11–197 (Washington, DC: January 31, 2011). 

there for the future because the war is not going away and people 

are still going to be wounded. 

So, the accessibility to the things that the servicemembers are 

needing. In my husband’s case, prosthetics are a big thing. So, if 

we did move to a small town or a small area, would we have to 

go further away from our home due they did not have the technology or the things needed to be able to assist him with what he 

does need to make life easier on a daily basis. 

So, those drives are amazing and great and improvement is always something to be proud about. But it is a problem that is not 

going away, and the improvements will always be needed. 

Senator BOOZMAN. Good. Thank you, Crystal. Thank all of you 

for being here. We appreciate your testimony. 

Chairman MURRAY. Thank you very much. 

Mrs. St. James, I want to ask you while you are here, I recently 

heard some were disturbing complaints from a female veteran. She 

told me she had a great deal of difficulty in accessing appropriate 

safe care for herself. She had some exams from a doctor where he 

left the exam room open to a crowded hallway, had been harassed 

by male veterans while trying to get mental health care and other 

concerns. 

I am concerned about the lack of separate women-only inpatient 

mental health care units that we are hearing about as well. So, I 

am very concerned that the VA is not strategically planning for the 

increasing number of women veterans. Something Mr. Rieckhoff 

mentioned as one of the costs of this war. 

Can you share with this Committee how many of VA’s backlogged construction projects involve improvements needed just to 

protect the privacy and safety of women veterans? 

Ms. ST. JAMES. I really do not have that specific information. I 

do know that there are initiatives that VA includes in its planning 

process but I do not know specifically if that is one. 

Chairman MURRAY. Is that something you can find out for us? 

Ms. ST. JAMES. We can certainly get back to you on that. 

Chairman MURRAY. I would really appreciate that. 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. PATTY MURRAY TO

LORELEI ST. JAMES, DIRECTOR, PHYSICAL INFRASTRUCTURE ISSUES, U.S. GOVERNMENT ACCOUNTABILITY OFFICE

Question 1. Can you share with this Committee how many of VA’s backlogged construction projects involve improvements needed just to protect the privacy and safety of women veterans? 

Response. GAO’s current work on Department of Veterans’ Affairs (VA) facilities 

and health care issues does not directly include a total number of projects that involve improvements to protect the privacy and safety of women veterans. We asked 

VA to provide a more specific total, but the agency was unable to provide an answer 

by the Committee’s August 17, 2011, deadline. We will forward that information to 

the Committee as soon as it is available from VA. While we do not know the number 

of backlogged construction projects that relate to the privacy and safety of women 

veterans, our past work has identified that VA drafted a set of weighted criteria by 

which it plans to evaluate capital investment projects, one of which is to assess 

whether capital investments address selected key major initiatives and supporting 

initiatives identified in VA’s strategic plan.1 VA’s strategic plan outlines its major 

60 

2Department of Veterans Affairs, VA Strategic Plan Refresh FY 2011–2015, (Washington, DC: 

Undated). 3GAO, VA Health Care: VA Has Taken Steps to Make Services Available to Women Veterans, 

but Needs to Revise Key Policies and Improve Oversight Processes, GAO–10–287 ( Washington, 

DC: March 31, 2010). 4GAO, VA Health Care: Improvements Needed for Monitoring and Preventing Sexual Assaults and Other Safety Incidents, GAO–11–736T (Washington, DC: June 13, 2011). 

initiatives, including a goal to enhance veterans’ access to health care.2 For example, the strategic plan calls for continued realignment of the VA health care delivery 

system because of a shift in demographics, specifically an increase in the number 

of women veterans. 

We have also found that VA identified a number of key challenges in providing 

health care services to women veterans. For example, in our report on services 

available to women veterans, officials at VA medical facilities told us that space constraints have raised issues affecting the provision of health care services to women 

veterans particularly related to ensuring their privacy and safety.3 According to VA 

officials, most VA medical centers have planned renovation, construction, or relocation projects as part of their efforts to expand services and implement comprehensive primary care for women veterans. In our recent report regarding sexual assaults and other safety incidents, VA medical facilities we visited used a variety of 

precautions intended to prevent sexual assaults and other safety incidents.4 However, we found some of these measures were deficient, compromising medical facilities’ efforts to prevent such incidents. For example, medical facilities used physical 

security precautions, such as closed-circuit surveillance cameras, to actively monitor 

areas, and locks and alarms to secure key areas. However, at the five sites we visited, we found significant weaknesses in the implementation of these physical security precautions, including poor monitoring of surveillance cameras, alarm system 

malfunctions, and the failure of alarms to alert both VA police and clinical staff 

when triggered. Further, inadequate system configuration and testing procedures 

also contributed to these weaknesses. To address vulnerabilities in physical security 

precautions at VA medical facilities, we recommended that VA ensure that alarm 

systems are regularly tested and kept in working order and that coordination among 

stakeholders occurs for renovations to units and physical security features at VA 

medical facilities. VA concurred with our recommendations and provided an action 

plan to address them. 

Chairman MURRAY. Ms. Golding, you testified that the medical 

costs for Iraq and Afghanistan veterans between 2011 and 2020 

could total between $40 billion and $55 billion. That number, of 

course, does not take into account the cost of paying for our previous generations of veterans that we are still responsible for. 

Ms. GOLDING. Correct. 

Chairman MURRAY. CBO did another report earlier this year on 

possible ways to reduce the deficit where they made a couple of recommendations about veterans programs. 

I do not support those specific proposals because they negatively 

impacted benefits, which I believe we should not be touching. But 

I do believe there are some ways that we can be more effective with 

taxpayer dollars but not diverting it from direct delivery of services 

and health care. 

I wanted to ask you this morning: do you believe there is enough 

excess and duplication that can be addressed to make VA more efficient without negatively impacting services? 

Ms. GOLDING. Just one or two points that I want to make on 

that, and the first is that we also had projections for the 2011–2020 

timeframe for VHA for all veterans; and the budget would grow, 

not the budget but the amount of the cost to treat those individuals 

would rise from the $48 billion in 2010 to, under the one scenario, 

$69 billion, and in the much higher scenario which includes higher 

medical inflation and so forth, I think it was $85 billion. 

61 

So, in the lower case we are talking about an increase of about 

45 percent over the next 10 years, which is a substantial increase 

in order to be able to provide the health care for all enrolled 

veterans. 

Now, we do not make policy recommendations, and we have not 

in that paper looked at options for cutting that growth. We have 

not looked at efficiencies. 

So, I cannot tell you about that specifically. I mean, you are 

aware of our budget options apparently. So, we do have a couple 

of options in that but it may also involve not just efficiencies but 

it may involve shifting some costs or some other things. 

Chairman MURRAY. If we just do efficiency and shifting costs, 

will we meet that projection that you just made? 

Ms. GOLDING. I cannot tell you unfortunately. 

Chairman MURRAY. Mr. Hosek, a 2008 RAND study concluded 

that there is a possible connection between having PTSD, TBI, and 

major depression and being homeless. 

Last month, Admiral Mullen expressed concern about repeating 

the mistakes we made after the Vietnam War and he said, we are 

generating a homeless generation, many more homeless female veteran; and if we are not careful, we are going to do the same thing 

we did last time, unquote. 

Can you walk me through the costs, both budgetary and human, 

of caring for veterans after they become homeless and of using care 

as a tool to prevent homelessness? 

Mr. HOSEK. Unfortunately, I cannot give you estimates of the 

cost. 

Chairman MURRAY. Do you want to turn on your mike. 

Mr. HOSEK. Thanks. Unfortunately, I cannot give you estimates 

of the cost. My concern, which I foreshadowed in my testimony, is 

that there may be a value in being more proactive in guiding people as they leave the service. 

Right now when servicemembers leave the service, they receive 

an outbrief. That outbrief covers, among other things, the benefits 

they are entitled to and advises them, of course, that they will have 

a post-deployment health assessment and a 6-month follow-up of 

that if they are still in the service and then leave later on. 

But this information comes at them very fast; and even though 

it is provided, which is a good thing, I am afraid that many of them 

do not really absorb it at the time. And when they leave the military and go out and need care or need to learn about their VA benefits or need to learn about job search support, they really do not 

know where to turn. 

They have not necessarily absorbed or remembered what they 

were told, and our research indicates that there are not readily 

available cohesive, easily accessible sources of information. 

Now, people absorb information in two ways, when it is pushed 

at them or when they pull for it. And a lot of the discussion that 

we have received has to do with the push of information, that is, 

just making it available. 

But the fact that there are not readily available cohesive sources 

of information, something that Paul referred to, I think is important too. 

62 

I mention in my testimony that one thing we really do not know 

much about are people who leave the service. We do not know 

about their joint seeking of educational benefits and further education or work and their health care. And we are particularly interested in, or particularly concerned about servicemembers—— 

Chairman MURRAY. Are you looking at the cost of that? Is that 

something—— 

Mr. HOSEK. These are simply ideas I am responding to you for 

your questions. These are not, to my knowledge, studies we have 

underway at RAND. I realize the importance of this, and I wish I 

could give you a specific estimate. 

It is important, I think, to think about this sort of jointly occurring set of concerns that servicemembers have. If there happen to 

be roughly one in five, perhaps fewer, servicemembers who leave 

with major depressive disorder or Post Traumatic Stress Disorder 

and they also want to find a job or they want to seek health care, 

we are finding a lot of them are having trouble finding jobs. 

The lot of them are not seeking care. We have talked about the 

barriers to care. That has come up in several of the testimonies 

today, and I know in your hearing last week. All of those things 

come together. 

Trying to make things easier for veterans to provide that information, this is something that Paul’s outfit is particularly concerned with but it is not only something that should be left to volunteer organizations. 

It is possible that more effective support could be provided by the 

services or by contractors, or simply by making more effective Webbased services available. 

For example, the Military OneSource source of information has 

been a big boon to servicemembers, providing them with information on many service-related resources for servicemembers and 

their families before, during, and after the deployment. 

Developments in that direction for veterans are likely to be helpful. As I mentioned in my testimony, veterans have reported difficulty knowing where services are offered, what kind of services 

are available, how to apply for them, who is eligible. Those are fundamental questions. 

The fact that half of those with probable PTSD or MDD had not 

seen a physician and had not been evaluated within the prior year 

or two to our survey was striking. These are individuals who arguably ought to be evaluated. 

There are certainly many veterans who leave, who can do well 

on their own. But for people with these probable symptoms—and 

sometimes individuals do not report their symptoms, so that is one 

of the reasons for the wide variance in estimates of PTSD and 

MDD—they should be incentivized and have the information to 

seek help. 

We clearly have in the VA system an issue of surge capability. 

The VA caseload largely consists of older veterans, and VA handles 

many individuals who need health care. 

The immediate growth of the new generation of veterans, as you 

have referred to it here in the hearing, is a challenge for them because they need to adapt their provider mix, and those are growth 

problems. 

63 

To the extent that there are also providers available in the private sector, I will suggest, without the basis of research, that it is 

certainly worth thinking about trying to figure out how to make 

use of extant capacity in the private sector. 

Chairman MURRAY. And I appreciate that. One of the points of 

this hearing is the cost of war, just providing it in the private sector is not free. It is still a cost, and we have to keep focused on 

that. 

Senator Brown. 

Senator BROWN OF MASSACHUSETTS. Thank you. 

Crystal, I just want to go back to you, and I apologize. I had to 

go down to a HSGAC hearing, and I will have some questions. So, 

if you have answered this, I apologize. 

But during your time going through what you were going 

through, did you ever go to any outside agencies, outside the military, outside the VA to get some additional assistance? 

If so, could you kind of explain what you did and what that response was like? 

Ms. NICELY. Well, in the beginning, I really did not know of what 

was available. But due to my case manager, Jordan Hall, he gave 

us some information in regards to some foundations that could 

help; and when we sought those foundations, they were able to assist us like the Semper Fi Fund, Operation Homefront, and Soldiers’ Angels. I mean there are so many that are great foundations, 

that help and assist. Yes. 

Senator BROWN OF MASSACHUSETTS. Great. Thank you. 

Mr. Rieckhoff, in your written testimony you state that longterm, it is estimated it will cost between $600 billion and $1 trillion 

to care for OEF/OIF veterans alone. I am interested in learning a 

little bit more about your estimate. 

Is this a study conducted by you folks or any other organization 

that would come up with those figures? 

Mr. RIECKHOFF. I think this is actually to the doctor’s earlier 

point. Estimates are all over the place, and in part because we do 

not have real good research on a lot of things. 

So, these are high-end, low-end estimates that come from a variety of places ranging from RAND to Harvard researchers to veterans’ groups. I think two things we have to identify are accurate 

numbers for homelessness and suicide. VA just released their new 

numbers of 10,000 homeless veterans. 

Those numbers are really fuzzy. Places like New York do not 

even count veterans when they go out to count homeless people. So, 

we really do not know what the cost of that is going to be. 

On suicide specifically, we do not know how many veteran suicides there are. That is really troubling. We hear anecdotally about 

suicides from the community on a regular basis that are not counted. If you separate from the military and you are a veteran who 

doesn’t use the VA, you do not get counted. And we cannot even 

begin to calculate those costs. 

So, I think it is important that we recognize that some of the 

best research that came from the RAND study back in 2008 is still 

the best research now. And that was privately funded. 

64 

So, to answer your question, sir, is we do not know and I do not 

think anybody knows. And anybody who tells you they do know, let 

us see the research. 

Across this industry, as you guys try to think in the next couple 

of years about how to spend money and how to support different 

programs, we need much more research and we all have a hard 

time I think finding really good data. 

And I think the suicide is the best example. We have no idea 

how many veterans have committed suicide since 9/11. Nobody 

knows because there is nobody counting the veterans population. I 

think that is a major problem when we tried to forecast any kind 

of cost. 

Senator BROWN OF MASSACHUSETTS. Thank you. 

Dr. Hosek, did you notice at all a difference between active 

Army, active military versus Guard and Reserve in terms of getting 

the materials, because you indicated that when somebody leaves, 

they have an outbriefing obviously? 

I know being from Massachusetts that not only do we, as a 

Guard and Reservist, not only do you get an outbrief, you have to 

go through basically a total top to bottom exit interview. They give 

you the packet. They give you everything so when you are saying 

they do not have anywhere to go, quite frankly I would suggest 

that they look in the packet that they have been given as we do 

it in Massachusetts. 

What are your observations in that? 

Mr. HOSEK. Well, to begin with a specific answer, I have not seen 

any research whatsoever comparing the outprocessing support for 

active versus Reserve. So, I am not sure what that difference would 

be. 

I agree with you that individuals actually receive briefings. They 

receive materials. They basically should have a starting point on 

where to go, and that is good. At the same time, the recently done 

RAND New York State Veterans Needs paper, as well as the earlier paper on invisible wounds, indicated that many of the respondents were not sure where to turn, what to seek. 

This could reflect differences among individuals in their capacity 

to remember and recall information or to process complicated information. 

So I think, as I said a minute or two ago, while I think that what 

is being done right now is probably very helpful, it is not totally 

effective. There is a question about how to continue to reach people 

after they leave the service and begin actively seeking some sort 

of support or assistance, health care, GI Bill benefits, what have 

you. 

Senator BROWN OF MASSACHUSETTS. Thank you. 

Ms. St. James, in your analysis of the VA’s 5-year capital plan 

for 2004 to 2009, GAO noted VA’s real property portfolio changed 

to with an increase in leases and leased spaces. This was VA’s efforts to adjust their real property portfolio to match the agency’s 

overall mission to move the delivery of care toward more outpatient 

facilities. 

Beyond CBOCs and Vet Centers, in what ways can the Veterans 

Health Administration expand their inventory of leased buildings, 

65 

and also, is there any effort to have these buildings within already 

government on properties to, in fact, save money? 

Ms. ST. JAMES. There were improvements in the use of space and 

I believe our report indicated that there had been some improvements in that. 

Leasing is part of an initiative that is included in their planning 

as is the need for the planning of community-based outpatient clinics which is directly tied to trying to give care to the more rural 

community. 

So, leasing is a factor in their planning. More could be done in 

terms of better use of all space. I think it is an issue governmentwide of having more space than is actually needed, coupled with 

the need to take care of historical properties that are quite expensive to take care of. 

So, if I have not answered your question, let me know and I will 

get back to you. 

Senator BROWN OF MASSACHUSETTS. Thank you. 

Chairman MURRAY. Thank you very much, Senator Brown. I 

have some questions that I will submit for the record. If you have 

any, you can as well. 

Senator BROWN OF MASSACHUSETTS. Thank you. 

Chairman MURRAY. I want to thank each of our witnesses for 

their testimony on the lifetime costs of caring for our newest generation of veterans, and I especially again, Crystal, want to thank 

you and Todd for being here and for Todd’s service to the country. 

You have shown incredible courage again in sharing your story 

with us. 

You are really an example to a lot of other veterans, their families who are traveling down this road to recovery, and I really believe that your testimony today will go a long way in helping us 

do a better job. 

As I said at the beginning of this hearing, caring for veterans is 

a cost of war that we have to account for. As today’s hearing has 

really made clear, the cost of caring for this new generation of veterans is not going to end when they come home. It will be incurred 

over a lifetime. 

So, as we are here today and the deadline for reaching a debt 

ceiling agreement quickly approaches and various proposals to cut 

or cap spending are out there, we have got to remember the sacred 

responsibility we have to care for our veterans and servicemembers. We as a Nation must honor our obligations in good times and 

in bad. 

So, I appreciate all of you being here today to participate and 

share your perspectives on the lifetime costs of this war. 

Thank you very much. This hearing is adjourned. 

[Whereupon, at 11:39 a.m., the Committee adjourned.] 

(67) 

A P P E N D I X 

PREPARED STATEMENT OF GOLD STAR WIVES OF AMERICA, INC., PRESENTED BY

VIVIANNE CISNEROS WERSEL, AU.D., CHAIR, GOVERNMENT RELATIONS COMMITTEE

With malice toward none; with charity for all; with firmness in the right, as God 

gives us to see right, let us strive to finish the work we are in; to bind up the Nation’s wounds, to care for him who has borne the battle, his widow and his orphan.’’ 

∼President Abraham Lincoln, Second Inaugural Address, March 4, 1865 

Chairman Murray, Ranking Member Burr, and members of the Senate Veterans’ 

Affairs Committee, thank you for the opportunity to submit testimony for the record 

on behalf of Gold Star Wives of America pertaining to ‘‘Examining the Lifetime 

Costs of Supporting the Newest Generation of Veterans.’’ 

Gold Star Wives of America, an all volunteer organization founded in 1945, is a 

congressionally chartered organization of spouses of servicemembers who died while 

on active duty or who died as the result of a service-connected disability during 

World War II, the Korean War, the Vietnam War, the first Gulf War, the wars in 

Iraq and Afghanistan, and every period in between. 

Gold Star Wives is an organization of those who are left behind when our Nation’s 

heroes, bearing the burden of freedom for all of us, have fallen. We are that family 

minus one; we are spouses and children, all having suffered the unbearable loss of 

our spouses, fathers or mothers. We are those to whom Abraham Lincoln referred 

when he made the government’s commitment ‘‘* * * to care for him who shall have 

borne the battle, and for his widow, and his orphan.’’ 

For the purpose of this specific testimony, Gold Star Wives will include the silent 

cost of the war as well as the measurable cost of legislative inequities affecting surviving families of today’s veterans; however the legislative inequities include survivors of previous wars. 

According to the Department of Defense, as of December 2010, approximately 

6,128 of our Nation’s military heroes have given the ultimate sacrifice during Operation Iraqi Freedom, Operation Enduring Freedom and Operation New Dawn. It’s 

estimated approximately 49% left behind a family to carry on without them. After 

the flag is folded, the surviving spouse is left to carry on the duties of their family 

despite the tragic loss of their loved one. The long term cost of the war for Gold 

Star Families is unfortunately not included in the Congressional budget nor is it 

a line item in the President’s budget. The lifetime cost of survivors has to be included in the DOD budget to include the survivors of the military, regardless of circumstance of death. 

Surviving spouses are faced with inequities in their survivor benefits as well as 

the emotional challenges of raising a family alone after the death of their spouse, 

or having the missed opportunity to even start a family. 

For the purpose of testimony I will review both the quantitative and qualitative 

costs of this war pertaining to ‘‘Examining the Lifetime Costs of Supporting the 

Newest Generation of Veterans.’’ 

Presently the lifetime costs of supporting the newest generation of veterans does 

not include survivors and their benefits; only the living veteran. The lifetime costs 

for supporting the surviving spouse are only projected in legislative bills that have 

not passed and/or are not calculated as a reality despite the overwhelming congressional support of cosponsors. However the life time cost for the surviving spouses 

not receiving their entitled benefits can be estimated depending on the individual. 

These estimates reflect the lifetime quality of life for the surviving spouse and their 

family. These benefits include the calculation change of the Dependency Indemnity 

Compensation, removing the Survivor Benefit Plan (SBP) offset by the Dependency 

Indemnity Compensation (DIC), Education, and the dental plan for children. 

For the surviving spouse of today’s veterans, financial challenges arise when benefits are not provided as intended. Congress created two programs for survivors of 

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our military members. In 1956, Dependency and Indemnity Compensation (DIC) 

was established by the Servicemen’s and Veteran’s Survivor Benefit Act. The purpose of DIC is an indemnity payable to survivors when a military member dies as 

a result of a service-connected cause yet Congress enforces a dollar for dollar offset. 

It is very apparent that financial stability is the overriding concern of these families. Gold Star Wives believes the most significant long-term advantage to the family’s financial security would be to end the Dependency Indemnity Compensation 

dollar for dollar offset to the Survivor Benefit Plan. This cost should be considered 

as a cost of war for legislation. This is not a new subject for us to testify about before Congress. For the survivors with children, feel forced to assign the SBP to their 

children to avoid the offset; however, they’re placing a shelf life on the benefit as 

it terminates when the child becomes of age. We recognize that jurisdiction resides 

elsewhere, but we know each Member of this Committee can and should be concerned within the context of your own jurisdiction that this inequity should be fixed, 

and fixed immediately. 

In 1972, Congress created the Survivor Benefit Plan (SBP). The purpose of SBP 

is to insure that a portion of the military member’s retirement will be provided to 

the surviving widow after the military member’s death. Two different plans, one 

paid by retiree premiums or an active duty military member’s life and the other 

paid by the Department of Veterans Affairs. 

The financial hardships of losing a military spouse are also coupled with the emotional strain of losing a loved one and parenting their children alone. There is a silent cost of war that is not projected in any military budget nor is it considered in 

legislation when addressing survivor benefits for the family of today’s veteran. 

The following is a letter from a Gold Star wife in Florida named Jennifer. She 

wrote this letter back in 2009, No changes have been made since that time, so 

therefore a letter of complaint written four years ago is still applicable to our discussion today: 

‘‘I have to begin by asking why our sacrifice as military families, not 

spouses alone but whole families, being devalued. I am the widow of a Marine killed in Iraq. I have three very young children to raise. At the time 

of his death, our children were 7, 5 and 1, the eldest have required therapy 

from the time that they lost their father. As the benefits we receive do not 

fully cover this I was happy to pay the rest to ensure my children would 

be able to cope with all of the devastation to their lives. From the day I 

received the phone call about my husband’s injury through to his death my 

children lost me as well. I was beside him in Germany then Bethesda for 

two months. After my husband’s passing I was so scared I was no longer 

the Mom they had always known. I was now the only thing they had to 

cling to and I was falling apart. I needed help with almost everything just 

to keep them safe and well. I am still scared, I have many years ahead of 

me where I have to provide for my children and myself. I am confused by 

the arguments that seem to play back infinitely when the questions regarding SBP/DIC offset are raised, ‘We can’t afford to do it’ or ’We can’t find 

the mandatory spending offsets’ due to other more important issues’ Do we 

lack importance? Some of these programs deemed ‘more important’ are 

$250 billion sometimes $300 billion. Where is the $6 billion for military 

widows? When do we become worth it? When do our children become worth 

it? When do you turn around and say you deserve it for your sacrifice? We 

are simply asking for what is due to us. If this were a civilian insurance 

policy they would have to pay. An offset would never enter the discussion. 

The government, ironically would make them, so why then does the government relinquish itself from this responsibility of payment by way of exercising this ‘‘offset’’? 

‘‘By my understanding DIC is a compensation paid for Military members 

who were killed while on active duty or died from service-connected physical problems after retirement. It was clearly created for a very different 

reason than was SBP. SBP is a benefit for servicemembers to ensure that 

their family is cared for in the event of their death.’’ 

She further stated that it appears that Congress gives with their right hand for 

everyone to see but they take out of our back pocket with their left. 

She continues in her letter ‘‘I don’t think there is any recipient of the 

‘special allowance’ who perceives getting $50 (now $60) a month as adequate compensation when they are entitled to over 20 times that amount.’’ 

‘‘It makes me ill to reduce my husband’s sacrifice, his life, to a dollar 

amount but I can’t raise his children on letters, flags and Veteran’s Day 

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speeches. If any of the words that I hear are to ring sincere then remove 

this offset and speak to us, impact us through your actions.’’ 

For your consideration, very sincerely, 

Jennifer 

Losing a spouse is devastating; however, when a child loses a parent, the impact 

is greater than anyone can grasp. We continue to hear of studies regarding the effects of war on children. We put to you there is no greater cost than that of a 

parentless child. Approximately 4,300 children have lost a parent in the Iraq and 

Afghanistan wars. The numbers are higher when including service-connected deaths 

or line of duty non-hostile deaths. 

It is a known fact that a wartime death presents unique hardships for children. 

Many families relocated shortly after a death and lost their network of support. For 

boys, besides losing a father, they lost their male role model to guide them through 

their lives. It is a consensus of our organization that today’s surviving spouses have 

significant challenges with raising boys alone without their dad. Again, this cannot 

be found on a CBO score card and is not considered a financial cost of war, but a 

ripple effect of war. 

According to my son, the day he lost his father was also the day he also lost his 

mother; I was not the same mother to him and he wanted her back. No solution 

for this problem has been found since it was identified during the Vietnam war era 

as noted in the book After the Flag has been Folded, A Daughter Remembers the 

Father She Lost to War and the Mother Who Held The Family Together by Karen 

Spears Zacharias. Again, the cost of holding the family together as well as lost opportunities for these children for a lifetime is immeasurable. 

Kristen, whose husband was recently killed in Afghanistan, spoke about the challenges of raising a 12 year old son alone. According to Kristen, ‘‘Children of the Fallen as they try to move forward in their lives, they want to be a normal child. However, I think when I take my son to events like a baseball game they always thank 

the servicemembers and first responders, but never say anything about the fallen 

soldiers or children that could be there.’’ Measuring the cost of missed opportunities 

going to a sporting event with dad cannot be scored. 

Many of our children have been treated for depression and unfortunately some of 

our members’ children have attempted suicide. One child, five years out from death 

shared with his counselor that he had few memories of his Dad because he was perpetually deployed prior to his death. It is difficult to measure the dynamic challenges of a child grieving the loss of a parent as it can change as they age. The 

lack of access to local VA care for mental health requires some members to seek 

services from the public sector with a cost involved. 

When Congress improves survivor benefits, not all survivors are included. The 

practice of selective benefit entitlement for different circumstances and eras must 

stop. Every time Congress institutes a cutoff period for a program, some child, or 

some surviving spouse is left behind wondering when the servicemembers’ death 

will count. 

Many of our members are not able to return to work after an unexpected death, 

yet their benefits are not significant enough to pay their existing mortgage and or 

rent. Some of our young members have been diagnosed and treated for Post Traumatic Stress Syndrome (PTSD) yet awareness is not prevalent. Others suffer and 

cope with their loss while raising their children, frustrated and worried about the 

future, the clock ticking until their SBP terminates when the children become of 

age, if they chose child option. 

Costs are measured in dollars, there is another cost that is not calculated; the silent cost. The question asked is what are the long term costs of war? The child who 

sits solemnly alone while other fathers visit the school classroom already knows. 

The young daughter walking down the marital aisle without her loving father already knows. The young surviving spouse who is so exhausted from serving in the 

roles of both mother and father already knows. The family with the empty seat at 

a meal already knows. The long term caregiver who suffers from secondary PTSD 

and caregiver stress, whose own health has failed already knows. The military commander who sends someone to knock on the door to notify the family of the Fallen 

already knows. 

This testimony provides you with information about the cost of war for the Gold 

Star Family and should be considered when determining passing legislation as a 

line item for the cost of war. The mission of the VA is clearly stated ‘‘To care for 

him that has borne the battle his widow and his orphan.’’ We are waiting for this 

statement to be evident. The issues affecting surviving spouses and children need 

to be remedied. Long standing queued issues such as the SBP/DIC offset elimination, requests to increase DIC to 55 percent of 100% disability compensation, inVerDate Nov 24 2008 16:34 Feb 02, 2012 Jkt 000000 PO 00000 Frm 00073 Fmt 6601 Sfmt 6621 H:\112TH HEARINGS\67837.TXT SVETS PsN: PAULIN
70 

creases in education benefits (in line with other Federal survivor programs), programs to assist with dental and vision remain unimplemented. 

Secretary of Veterans Affairs, Eric Shinseki, stated, ‘‘Taking care of survivors is 

as essential as taking care of our Veterans and military personnel. By taking care 

of survivors, we are honoring a commitment made to our Veterans and military 

members.’’ We’re asking you to honor that commitment. 

Thank you for this opportunity to testify. The families of the Nation’s fallen have 

already suffered the greatest loss; there is no need to make these families struggle 

further. 

Gold Star Wives appreciates the compassionate work the Members of this Committee and the staff do on our behalf. We always stand ready to provide this Committee with any additional you may need. 

Gold Star Wives Legislative Issues: 

I. Increase Dependency and Indemnity Compensation (DIC) 

In 1956, Dependency and Indemnity Compensation (DIC) was established by the 

Servicemen’s and Veteran’s Survivor Benefit Act. The purpose of DIC is an indemnity payable to survivors when a military member dies as a result of a service-connected cause. 

GSW seeks parity with other Federal survivor programs when calculating DIC. 

This affects more than 330,000 widows. DIC is currently paid to widows at 43% of 

the VA Compensation received by the veteran with a 100% service-connected disability. Other Federal survivor programs provide 55% of the disability pay of the 

Federal employee to the widow. Bringing DIC’s computation to 55% would provide 

parity with other Federal survivor programs and would increase DIC by approximately $300 per month. Why military widows are forced to accept a lower percentage than other Federal survivor programs is incomprehensible to GSW. In addition, 

DIC has had no increase since 1993, 18 years since the flat-rate replaced the 

ranked-based DIC. 

The continued economic stresses our country is now enduring places widows one 

step away from a car that stops running or an unpaid house payment or utility bill. 

Many of our elderly widows are in financial distress, unable to pay for food and utilities. Equalizing the computation of DIC would offer some relief from worry and 

would improve financial independence and confidence for GSW members. The increase in DIC should not subject the SBP to further offset. 

GSW recently received a call from an elderly DIC widow inquiring why the DIC 

payment has not changed in years. When explained that DIC would increase if there 

was a Cost of Living Allowance (COLA) increase, she stated that whoever determines COLA apparently never visited her town because her rent, gas and electric 

has increased and so has the price of milk and bread. She then said, ‘‘I can’t cut 

any more corners.’’ These types of calls are received frequently from our members. 

Congress should make the ethical decision now to change the DIC compensation 

to 55% which is afforded other Federal survivors. 

II. Eliminate the Dependency and Indemnity Compensation (DIC) Offset to the Survivor Benefit Plan (SBP) 

GSW encompasses approximately 10,000 DIC recipients. Some of our members 

are eligible for and receive SBP. For those widows who receive SBP, either the retired military member chose to purchase SBP upon retirement or the military member died while on active duty. 

When a widow is eligible for both SBP and DIC, the widow becomes subject to 

the ‘‘widow’s tax’’—a dollar-for-dollar reduction in the SBP by the amount of DIC 

received. Military members dying on active duty did not pay premiums. (Prior to 

9/11, a servicemember dying on active duty had to be retirement eligible for his survivor to receive SBP without payment of premiums.) Their surviving spouse became 

eligible for SBP on the date of the active duty death. Retired military members 

chose to purchase SBP and pay premiums with hard-earned retirement. Until 2005 

and the implementation of concurrent receipt, some disabled retirees received no retirement pay with which to pay premiums. Many were forced to pay from disability 

compensation. The offset, never mentioned to the military member, only becomes 

visible to their widow once the military member has died. 

Surviving spouses impacted by the DIC offset to their SBP are quite often shocked 

to learn they are subject to an offset. Completely unaware of the offset and how it 

would affect them financially forces them to make many hard adjustments in their 

day-to-day lives to accommodate the offset’s effects. 

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Attempts to Fix the Offset 

Congress has chosen not to eliminate the offset for eleven years for the small 

group of widows impacted by the offset. Instead, Congress further divided and subdivided this small group with Band-Aid fixes for the offset. Three of the Band-Aid 

fixes, also called options, create even more confusion about benefits and who is eligible and often do little to eliminate the financial distress initially caused by the offset 

in the first place. Even reporting these options and their consequences to Congressional members is difficult as they do not understand the impact, ramifications and 

end-result these options caused. The options are outlined below. 

First, the reassignment of a spouse’s SBP to her children. In 2003, a new law 

passed, Public Law 108–136, authorizing active duty widows the ability to assign 

the SBP annuity to their children, if any, permanently forfeiting any right the 

widow had to SBP. This reassignment allows full receipt of SBP by the child(ren) 

without offset until they reach the age of majority, when the benefit terminates. The 

widow is forced to make this decision very soon after notification of her spouse’s 

death and her decision then becomes irrevocable. Complications from this new law 

often require that the widow be granted guardianship of her own child(ren) by a 

court of law. A widow whose husband died in retirement is not eligible for this 

option. 

Second, remarriage. In August 2009, the U.S. Court of Appeals in the matter of 

Sharp, et al. v. The United States, 82 Fed. Cl. 222 (2008), ruled that DIC payments 

may not be deducted from SBP annuities if a person, entitled to both benefits has 

remarried after age 57. It does not make sense to have two separate standards in 

the law, one that allows payment of full SBP and DIC for widows who remarry after 

age 57 and another forcing a dollar-for-dollar offset between the SBP and DIC for 

all others. GSW is concerned that the Federal Government now requires a remarriage in order for an annuity to be paid in full. 

Third, Special Survivor Indemnity Allowance (SSIA). The NDAA FY 2008 established a Special Survivor Indemnity Allowance for widows who are the beneficiary 

of the SBP annuity and their SBP annuity is partially or fully offset by the DIC. 

The SSIA also applies to the widows of members who died on active duty whose 

SBP annuity is partially or fully offset by their DIC. SSIA began at $50 per month 

and increases each fiscal year until 2017, when the SSIA terminates. 

GSW understands that Congress does not permit the private sector or other Federal benefit programs to reduce or terminate retired annuities because the survivor 

is also eligible for DIC. So it begs the question, how can the full receipt of SBP and 

DIC be considered double dipping when in 2004 it was determined by Congress that 

the 100% disabled would receive their full retirement and disability compensation 

payments? Survivor compensation is provided to widows based on the military member who is rated at 100% disabled. There is no greater disability than death. 

III. Education Benefits 

GSW seeks an increase in the monthly stipend for Chapter 35 benefits as it has 

not kept current with the increases in educational tuition and fees. While tuition 

increases vary state-by-state, all have increased, some dramatically. A housing allowance also should be included with the Chapter 35 education benefits. 

GSW further requests that the New G.I. Bill allow the transfer of educations benefits to a qualified widow or child who is not eligible for the Gunnery Sergeant John 

David Fry Scholarship Program (Fry Scholarship). 

GSW is greatly encouraged by the Fry Scholarship and requests this program be 

included in the Yellow Ribbon Education Program (Yellow Ribbon Program). The 

Yellow Ribbon Program does not currently apply to children of the fallen, yet it 

would help ensure these children have a brighter future. We believe this was an 

oversight when the Fry Scholarship was created with the intention of matching education benefits to the New G.I. Bill. 

Additionally, many encounter a problem transitioning from Chapter 35 education 

benefits to the Fry Scholarship that greatly delays payments. We are willing to 

work with both the Senate and House VA Committees to help rectify this unique 

problem and the backlog experienced with the Chapter 35 education benefit. 

GSW is grateful and appreciates that surviving children have access to an education program that is above and beyond Chapter 35 through the Fry Scholarship. 

However, many other surviving children do not qualify for this scholarship and are 

in need of more adequate support. We would appreciate the opportunity to work 

with the VA to help remedy these issues and avoid future problems with the benefits. 

GSW requests that the time period for eligibility to utilize Chapter 35 education 

benefits for military widows of retirees who died of a service-connected cause be extended from ten (10) to twenty (20) years. This extension would allow all military 

72 

widows a greater opportunity to use the education benefit and improve their quality 

of life. In addition, it brings into alignment the time period for widows of both active 

duty deaths and widows of retirees who died of a service-connected cause. 

PREPARED STATEMENT OF PAUL SULLIVAN, EXECUTIVE DIRECTOR, 

VETERANS FOR COMMON SENSE

INTRODUCTION

Veterans for Common Sense (VCS) thanks Committee Chairman Patty Murray, 

Ranking Member Richard Burr, and Senators on the Senate Committee on Veterans’ Affairs for allowing us to submit this written statement for the record for 

your hearing, ‘‘Examining the Lifetime Costs of Care for the Newest Generation of 

Veterans,’’ specifically the enormous escalating human financial consequences of the 

Iraq and Afghanistan conflicts for the United States. 

VCS is a non-profit based in Washington, DC, focusing on the causes, conduct, 

and consequences of war. We provide public relations and government relations advocacy for our servicemembers, veterans, and families. 

VCS LEADERSHIP

VCS continues leading the national effort uncovering the human and financial 

costs of the Iraq and Afghanistan wars. Our servicemembers, veterans, families, and 

the American public have a right to know the facts about the costs of war. In their 

groundbreaking book published in 2008, The Three Trillion Dollar War: The True 

cost of the Iraq Conflict, Linda Bilmes and Joseph Stiglitz wrote: 

By now it is clear that the U.S. invasion of Iraq was a terrible 

mistake * * *. Understanding the costs of the war has not been easy, and 

it would not have been possible without the help of many. The fact that so 

much of the data and information that should have been publicly available 

was not meant that some critical pieces of information have had to be obtained through the Freedom of Information Act (FOIA). We thank Paul Sullivan of Veterans for Common Sense, who helped us to understand the situation facing returning Iraq and Afghanistan war veterans, and who provided us with crucial data from the Defense Department and Department 

of Veterans Affairs obtained under FOIA. 

In the past year, VCS was honored to provide DOD and VA reports to Catherine 

Lutz at Brown University for her larger study on the costs of the Iraq and Afghanistan wars. Please see the web site http://costsofwar.org/ for further details. 

KEY FACTS: ONE MILLION PATIENTS BY 2013, WITH A 40-YEAR COST OF $1 TRILLION

VCS begins by presenting the Committee with the most current and salient official government statistics about the human and financial costs of the current conflicts. These are facts VA and DOD refuse to provide on a consistent, complete, or 

transparent manner to the Congress or the public. 

As of December 2010, VA reports reveal 654,384 new, first-time veteran patients 

were treated VA hospitals and clinics since 2001. Based on an average of nearly 

10,000 new patients each month, VCS estimates the count of new Iraq and Afghanistan war veteran patients treated by VA will exceed 720,000 on July 31, 2011. 

According to their September 30, 2010, testimony before the House Committee on 

Veterans’ Affairs, Linda Bilmes and Joseph Stiglitz now estimate the financial cost 

of the Iraq and Afghanistan wars to be in the trillions of dollars. Bilmes and Stiglitz 

have criticized the government for failing to collect current and future cost data. 

Using data obtained by VCS, it is estimated that: 

Taking these costs into account, the total budgetary costs associated with 

providing for America’s war veterans from Iraq and Afghanistan approaches $1 trillion. 

VCS REQUEST FOR ACTION BY CONGRESS

VCS has two major requests today. We urge Congress to pass a new law mandating the Administration collect robust, consistent, and accurate data in a transparent manner so DOD, VA, and Congress can accurately estimate, monitor, and 

plan for the influx of post-war casualties from the current wars as well as any future wars. 

73 

Furthermore, VCS urges Congress to establish a Trust Fund so future generations 

of veterans are protected from unwarranted assaults on funding for VA healthcare 

and benefits. 

RECENT OFFICIAL STATISTICS

Government statistics pieced together from several reports paint a disturbing picture of enormous human suffering among our Iraq and Afghanistan war servicemembers and veterans. VCS obtained the following facts from DOD and VA using 

FOIA: 

According to DOD: 

• At the end of June 2011, a total of 6,098 U.S. servicemembers died in the Iraq 

War and Afghanistan War combat zones; this includes 289 confirmed suicides. • At the end of June 2011, a total of 100,600 U.S. servicemembers wounded in 

action or medically evacuated due to injuries or illnesses that could not be treated 

in the war zones. • The grand total of U.S. battlefield casualties reported by DOD is nearly 

107,000. 

According to VA: 

• As of December 2010, VA treated and diagnosed 654,384 new, first-time Iraq 

War and Afghanistan War veteran patients. Based on our analysis of 10,000 new 

patients per month, VCS estimates VA will have treated 720,00 patients as of 

July 31, 2011. • Please note that VA’s report excludes veterans who sought private care, retired 

veterans treated by the military, and student veterans treated at campus clinics. 

VA’s count also excludes medical treatment for wounded, injured, or ill civilian contractors from the U.S. deployed to the war zones. • As of December 2010, VA received 552,215 disability compensation and pension 

claims filed by our Iraq War and Afghanistan War veterans. 

VCS Analysis: 

• When VA and DOD reports are viewed side-by-side, VA data reveals more than 

100 new, first-time veteran patients for each battlefield death reported by DOD. • At the current rate of nearly 10,000 new veteran patients and claims entering 

the VA medical and benefits systems each month, VCS estimates a cumulative total 

of one million patients and claims by the end of 2013. 

VCS Sources: 

DOD, ‘‘Global War on Terrorism—Operation Enduring Freedom, By Casualty Within Service, Oct. 7, 2001, Through July 5, 2011’’ (Afghanistan War). 

DOD, ‘‘Global War on Terrorism—Operation Iraqi Freedom, By Casualty Category 

Within Service, Mar. 19, 2003, Through July 5, 2011’’ (Iraq War, Mar. 2003 

through Aug. 2010). 

DOD, ‘‘Global War on Terrorism—Operation New Dawn, By Casualty Within Service, Sep. 1, 2010 Through July 5, 2011’’ (Continuation of Iraq War since Sep. 

2010). 

VA, ‘‘VA Benefits Activity: Veterans Deployed to the Global War on Terror,’’ 

Through Sep. 2010, Feb. 2011. 

VA, ‘‘Analysis of VA Health Care Utilization Among US Global War on Terrorism 

Veterans, 1st Quarter, Fiscal Year 2011,’’ Apr. 2011. 

VA, ‘‘VA Facility Specific OIF/OEF Veterans Coded with Potential PTSD Through 

1st Quarter FY 2011,’’ Apr. 2011. 

MISSING FACTS PROMPT NEED FOR REPORTS

In order for VA and DOD to properly manage the human and financial cost of 

providing medical care for our casualties, more robust data must be collected by the 

Administration and then and analyzed immediately by the Administration, Congress, academics, and advocates in a transparent and easy to understand manner. 

In short, the best policies for our servicemembers and veterans are designed, implemented, and then evolve over time with the best available information. 

• VA must be able to answer simple, straightforward questions. For example, 

what is the total number of unique deployed Iraq and Afghanistan war veterans 

who have received any VA benefit since returning home? The list of benefits includes, but is not limited to healthcare at VA clinics and hospitals, counseling at 

VA Vet Centers, disability compensation, life insurance benefits, home loan guaranty, and vocational rehabilitation. VCS remains highly alarmed VA remains incapable and unwilling to answer these easy questions. Congress can and must fix 

this now with a new law mandating reports. 

74 

• DOD and VA must prepare an official accounting of the financial costs for VA 

benefits. What did taxpayers pay for treatments and benefits? For the past several 

years, VCS has requested this information from VA and DOD using the Freedom 

of Information Act. VA has not provided any cost data. Starting in 2001, VA employees urged VA leaders to begin tracking war-related benefit use and costs, and nearly 

all requests were refused by political appointees of the previous administration. • DOD must provide an accounting of all discharges by type and branch of service, sorted by year, to monitor trends for both deployed and non-deployed servicemembers since 1990. Two prior hearings by Congress documented how the military 

improperly discharged tens of thousands of servicemembers. In many cases these 

veterans were at high risk of readjustment challenges due to Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD). As the number of less than 

fully honorable discharges increases, additional highly vulnerable veterans flood 

into society. Many of these veterans either don’t seek VA assistance or are refused 

VA help, instead turning to private, state, local, or university campus programs for 

assistance that should have been provided by the Federal Government. VCS also believes the military, in many cases, releases servicemembers from active duty with 

less than fully honorable discharges in an effort to avoid long-term healthcare and 

disability benefit costs. • VA should monitor negative post-deployment outcomes, such as homelessness, 

suicides, divorce, and crime, as well as state, local, and privately funded expenditures on veterans. The most important oversight remains the Administration’s inability to provide complete and accurate active duty, Reserve, National Guard, and 

veteran suicide data. Every year DOD has set new, and highly disturbing, records 

of active duty suicides. Most of the initial monitoring began with FOIA requests 

from advocacy organizations or journalists investigating patterns of disturbing developments such as suicides, homicides, unemployment, and homelessness. VA and 

DOD only began limited monitoring and research after repeated advocacy organization, media, and Congressional inquiries. • The Department of Labor should monitor unemployment and underemployment, 

both for veterans and families. Veterans often move from the military installation 

to their home town shortly after discharge. Often, these cross-country moves uproot 

spouses from their jobs. The use of the Post-9/11 GI Bill, legislation introduced by 

Senator Jim Webb of Virginia, by hundreds of thousands of Iraq and Afghanistan 

war veterans may be masking already alarming reports of high unemployment 

among returning veterans. 

• VA and DOD should monitor and report on the positive post-combat, post-deployment, and post-military outcomes of our veterans. For example, new businesses 

started by veterans, higher wages earned by veterans, diplomas earned by veterans, 

increased homeownership among veterans, and other signs of a vibrant post-war adjustment to civilian life. We ask for this information because our Nation remains 

woefully ignorant of the tremendous positive benefit of the Post-World War II ‘‘GI 

Bill’’ social programs that provided government funded assistance for higher education and home purchases, creating a post-war economic recovery that lasted decades. 

• VA and DOD are urged to sort the data. For example, National Guard and Reserve status are often overlooked as key demographic factors among returning veterans. In addition, standard sorting methods, such as age, gender, rank, and branch 

of service should be available, too. 

URGENT NEED FOR TRUST FUND AND NATIONAL PLAN

In September 2010, VCS testified before the House Committee on Veterans’ Affairs in support of a National Trust to provide care and benefits for veterans. We 

believe our Nation must learn from the past so we do not repeat mistakes. VCS endorses the Vietnam Veterans of America, when they remind us that, ‘‘Never again 

shall one generation of veterans abandon another.’’ 

This is why Veterans for Common Sense fully endorses the proposal by Linda 

Bilmes and Joseph Stiglitz to create a Trust Fund to make sure our veterans receive 

the healthcare and benefits they earned. 

As a non-profit advocacy organization, VCS uses FOIA to obtain data from DOD 

and VA to monitor and publicize the needs of our veterans. VCS was honored to 

provide our data to Linda Bilmes and Joseph Stiglitz for their book. The authors 

called for the creation of ‘‘A Veterans Benefit Trust Fund * * * so that veterans’ 

health and disability entitlements are fully funded as obligations occur.’’ In their 

book, the experts stated: 

There are always pressures to cut unfunded entitlements. So, when new 

military recruits are hired, the money required to fund future health care 

75 

and disability benefits should be set aside (‘‘lockboxed’’) in a new Veterans 

Benefit Trust Fund. We require private employers to do this; we should require the Armed Forces to do it as well. This would mean, of course, that 

when we go to war, we have to set aside far large amounts for future health 

care and disability costs, as these will inevitably rise significantly during 

and after any conflict (‘‘Reform 12,’’ page 200). 

The issue of establishing a Trust Fund is timely because we have now endured 

nearly ten years of war in Afghanistan, and more than seven years of conflict in 

Iraq. In 1995, Congress was forced to intervene and appropriate $3 billion in emergency funding for VA. One of the main reasons cited by VA for the funding crisis 

was the unexpected and unanticipated flood of Iraq and Afghanistan war veterans. 

Thanks to the strong pro-veteran leadership of Senator Patty Murray, the daughter 

of a World War II veteran, VA was given additional resources to meet the tidal wave 

of new, first-time Iraq and Afghanistan war veteran patients flooding into VA. With 

her leadership, and the efforts of this Committee and staff, there has been a sustained and deeply appreciated effort to fund VA at a higher level to meet the obligation of our country to our veterans. 

The threat against veterans in Congress is real. As recently as July 2011, Senator 

Tom Coburn introduced an amendment to eliminate the presumption of service connection for Vietnam War veterans exposed to the poison Agent Orange. Fortunately, 

for veterans, the proposal was defeated. Similarly, in January 2011, Representative 

Michele Bachmann proposed cutting $4.3 billion from VA’s healthcare and benefits 

budget. After an outcry from veteran organizations led by VCS, she withdrew her 

plan. PRIOR ADMINISTRATION FAILURES

The significant post-deployment statistics about our veterans must be contrasted 

with serious mistakes made during 2002. Nine years ago the previous Administration prepared no casualty estimate for the Iraq War. There was no plan to monitor 

or estimate fatal or non-fatal casualties, even though VA staff sought to create such 

systems. There was no plan to provide long-term medical treatment and disability 

compensation for non-fatal casualties. 

Honoring and remembering our fallen, our wounded, our injured and ill, VCS 

quotes the eloquent poetry of Archibald MacLeish, a World War I veteran and 

former head of the Library of Congress. During World War II, MacLeish wrote: 

They say, We leave you our deaths: give them their meaning: give them 

an end to the war and a true peace: give them a victory that ends the war 

and a peace afterwards: give them their meaning. 

As an organization of war veterans, Veterans for Common Sense is here today to 

give meaning to all of our Nation’s fallen, wounded, injured, and ill who deployed 

to Southwest Asia since 1990: Our Nation must learn the painful lessons from prior 

wars and take care of our veterans who enlist in our military to protect and defend 

our Constitution, even when the American public does not support the war. This 

also means monitoring post-war activity among veterans so their needs are promptly met. 

VCS tried to inform our Nation about past government mistakes. On March 10, 

2003, as our Nation prepared to re-invade Iraq, VCS petitioned for calm and reason. 

As war veterans who actually served on Iraqi battlefields during 1991, VCS wrote 

a detailed letter to President George W. Bush co-signed by 1,000 veterans: 

Over the long term, the 1991 Gulf War has had a lasting, detrimental 

impact on the health of countless people in the region, and on the health 

of American men and women who served there. Twelve years after the conflict, over 164,000 American Gulf War veterans are now considered disabled 

by the U.S. Department of Veterans Affairs. That number increases 

daily * * * . Further, we believe the risks involved in going to war, under 

the unclear and shifting circumstances that confront us today, are far 

greater than those faced in 1991. Instead of a desert war to liberate Kuwait, combat would likely involve protracted siege warfare, chaotic streetto-street fighting in Baghdad, and Iraqi civil conflict. If that occurs, we fear 

our own nation and Iraq would both suffer casualties not witnessed since 

Vietnam. 

We regret to inform you the White House never answered our letter. Our veterans 

who raised serious, legitimate concerns about escalating the Gulf War with another 

invasion of Iraq were brushed aside in the rush to war. This must not happen again. 

Earlier, on October 12, 2002, our VCS Executive Director, Charles Sheehan Miles, 

published an editorial criticizing the Congressional Budget Office (CBO) for failing 

76 

to estimate the cost of caring for war and post-war casualties. The decorated Gulf 

War veteran wrote: 

In a surprisingly rosy cost estimate of something which can’t be accurately estimated, the Congressional Budget Office Monday released an analysis of what Gulf War II might cost in real dollars paid by U.S. taxpayers. 

Only they left out the most important part: the casualties. The CBO estimate is naive and unrealistic when you consider the kind of war we are 

preparing to enter—an open-ended war of regime-change and occupation 

and empire building that may involve heavy casualties in an urban setting 

such as Baghdad. The CBO report is illuminating and instructive for what 

it avoids. CBO uses the word ‘‘assume’’ 30 times, ‘‘uncertain’’ 8 times, ‘‘unknown’’ 4 times. Finally, twice it says there is ‘‘no basis’’ for an estimate 

on key items. In other words, it’s a wild guess: kind of like taking your broker’s advice to buy Enron or WorldCom last summer. CBO states up front: 

‘‘CBO has no basis for estimating the number of casualties from the conflict,’’ therefore, any discussion of casualties was simply excluded. 

VCS advocates pre- and post-deployment exams, as required by the 1997 Force 

Health Protection Act (PL 105–85) as well as hiring more DOD medical professionals to provide exams and treatment. VCS believes early evaluation and treatment are best because treatments are the most effective and often the least expensive. Recently published medical research conducted by Dr. Susan Frayne, of the VA 

Palo Alto Health Care System and Stanford University supports our VCS advocacy. 

Dr. Frayne told Businessweek on September 24, 2010: 

Looking to the future, the impetus for early intervention is evident. If we 

recognize the excess burden of medical illness in veterans with PTSD who 

have recently returned from active service and we address their health care 

needs today, the elderly veterans of tomorrow may enjoy better health and 

quality of life. 

As of July 2010, the military began implementing the Force Health Protection Act 

on a limited basis. VCS urges full DOD compliance with the law: universal face-toface medical exams and prompt treatment for our servicemembers when needed. We 

also thank the President for sending condolence letters to the families of our servicemembers who completed suicide in the war zone. President Barack Obama has improved understanding of war-related mental health conditions and reduced stigma 

and discrimination against veterans with a stroke of his pen. 

There are very serious lessons to be learned from the Administration’s failure to 

monitor returning veterans. As of 2009, the widely respected and credible Institute 

of Medicine, part of the National Academy of Science, estimated as many as 250,000 

Gulf War veterans remain ill after exposures to toxins while deployed to Southwest 

Asia during Desert Shield, Desert Storm, and Provide Comfort between 1990 and 

1991. This research, mandated by the ‘‘Persian Gulf Veterans Act of 1998,’’ is confirmed by VA’s Research Advisory Committee on Gulf War Veterans’ Illness. If DOD 

and VA had not fought so viciously against Gulf War veterans and scientific research, then facts and research would have been found sooner. Sadly, despite extensive scientific researcher, a few top officials at DOD and VA still deny the existence 

of Gulf War illness. 

CONCLUSION

Thank you for the opportunity to submit this statement for the record. VCS hopes 

to hear from this Committee as well as individual Senators about how they intend 

to force DOD and VA to prepare reports about the consequences of the war. We also 

hope to hear from Senators about establishing a Trust Fund so veterans never again 

face attacks to cut our earned healthcare and benefits. 

If we are to truly demonstrate our Nation cares for our veterans, then we must 

do more than provided funding, care, and benefits. Our nation must also assure our 

servicemembers, veterans, families, and citizens the government is constantly paying attention to the needs for those who protect and defend our Constitution. VCS 

wants future generations of Americans to want to server our Nation and know our 

Nation will care for them when they return home. 

Contact Information: Veterans for Common Sense 

900 Second Street, NE, Suite 216 

Washington, DC 20002 

Phone: (202) 558–4553 

E-Mail: Paul@VeteransForCommonSense.org 

Web Site: www.VeteransForCommonSense.org 

77 

PREPARED STATEMENT OF SHELDON WHITEHOUSE

Chairman Murray, Ranking Member Burr, and distinguished Members of the 

Committee, I thank you for the opportunity to weigh in on such an important issue. 

I commend the Chairman for her passionate advocacy on veterans’ issues and her 

tireless efforts to ensure that our veterans get the care they need and the benefits 

they deserve. 

Today’s hearing is crucial to understanding the extent to which the current wars 

are impacting the newest generation of veterans and their families and determining 

what it will take to meet their needs as they return home. Our veterans have given 

so much for our country, and they deserve our steadfast support. 

For the last ten years, hundreds of thousands of our women and men in uniform 

have been making enormous sacrifices on our behalf. They have asked for little in 

return, despite the high operational tempo, which has required repeated deployments and unprecedented use of our Reserve components. These repeated deployments often put severe strain on families and broader communities. I have seen the 

impact firsthand in my home state of Rhode Island, where our Guard and Reserve 

members are, per capita, the second most deployed from any state. 

From working closely with the military and veterans community in my state, I’ve 

learned that we must identify and address the emergent needs of our returning servicemembers in all aspects of their transition back to civilian life. We must ensure 

that returning servicemembers have access to the best medical care, and that they 

have the training and resources to find good jobs in the civilian economy. We also 

must make sure that our military families have ample time to get their finances 

in order. To that end, I was pleased to work with Chairman Murray and other Members of this Committee to better protect servicemembers against wrongful foreclosures. 

In addition, we must be cognizant of the mental and emotional effects that repeated tours of duty in tense combat conditions can have on our returning veterans. 

All too often, complications from combat related trauma, such as Post-Traumatic 

Stress Disorder (PTSD), can contribute to criminal offenses committed by veterans. 

For many of these individuals, their offending behavior would not have occurred 

prior to their repeated deployments. As a former prosecutor, I have focused close 

attention on the increasing numbers of veterans and active duty military personnel 

entering the criminal justice system. 

In my home state, a coalition of leaders from the legal and veterans communities 

are developing a pilot program for veterans who enter the criminal justice system. 

The Rhode Island veterans’ court program, which is led by Chief Judge Jeanne 

LaFazia of the Rhode Island District Court, seeks to identify and address the underlying causes of criminal behavior by referring veterans to treatment programs or 

providing other alternatives that can keep them out of jail and help them to lead 

safer, more productive lives. Last month, U.S. Attorney General Eric Holder joined 

me in Rhode Island for a roundtable discussion on the program. 

I also held a hearing in my Judiciary Subcommittee on Crime and Terrorism last 

week to examine how specially designed veterans courts can be cost-effective solutions for protecting public safety and reducing recidivism. We heard from Chief 

Judge LaFazia and several other witnesses, who testified that veterans’ courts are 

a cost-effective and safe way to rehabilitate low-level offenders, and to provide those 

who have served dutifully a chance for a future. Today, as the Senate Veterans’ Affairs Committee examines the costs of supporting today’s generation of veterans, I 

urge members to consider how veterans courts can provide cost savings and other 

benefits for our veterans and our country. 

I thank the Committee for the opportunity to submit this statement for the 

record, and thank the Chairman and Ranking Member for their leadership. 

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