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61–761 2011

THE TRUE COST OF THE WAR 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

SEPTEMBER 30, 2010

Serial No. 111–103 

Printed for the use of the Committee on Veterans’ Affairs 

( 


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COMMITTEE ON VETERANS’ AFFAIRS 

BOB FILNER, California, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

MICHAEL H. MICHAUD, Maine 

STEPHANIE HERSETH SANDLIN, South 

Dakota 

HARRY E. MITCHELL, Arizona 

JOHN J. HALL, New York 

DEBORAH L. HALVORSON, Illinois 

THOMAS S.P. PERRIELLO, Virginia 

HARRY TEAGUE, New Mexico 

CIRO D. RODRIGUEZ, Texas 

JOE DONNELLY, Indiana 

JERRY MCNERNEY, California 

ZACHARY T. SPACE, Ohio 

TIMOTHY J. WALZ, Minnesota 

JOHN H. ADLER, New Jersey 

ANN KIRKPATRICK, Arizona 

GLENN C. NYE, Virginia 

STEVE BUYER, Indiana, Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

BRIAN P. BILBRAY, California 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

VERN BUCHANAN, Florida 

DAVID P. ROE, Tennessee 

MALCOM A. SHORTER, Staff Director 

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

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

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

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

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

is further refined. 


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C O N T E N T S 

September 30, 2010 

Page 

The True Cost of the War ....................................................................................... 1 

OPENING STATEMENTS 

Chairman Bob Filner ............................................................................................... 1 

Prepared statement of Chairman Filner ........................................................ 39 

Hon. Ciro D. Rodriguez ........................................................................................... 4 

WITNESSES 

Batiste, Major General John, USA (Ret.), Rochester, NY .................................... 20 

Prepared statement of General Batiste .......................................................... 53 

Bilmes, Linda J., Daniel Patrick Moynihan Senior Lecturer in Public Policy, 

John F. Kennedy School of Government, Harvard University, Cambridge, 

MA ......................................................................................................................... 8 

Prepared joint statement of Ms. Bilmes and Dr. Stiglitz .............................. 40 

Disabled American Veterans, Joseph A. Violante, National Legislative Director .......................................................................................................................... 12 

Prepared statement of Mr. Violante ............................................................... 50 

Gibson, Corey, Terre Haute, IN ............................................................................. 34 

Prepared statement of Mr. Gibson .................................................................. 68 

Knight-Major, Lorrie, Silver Spring, MD .............................................................. 32 

Prepared statement of Ms. Knight-Major ....................................................... 64 

Nash, Major General William L., USA (Ret.), Washington, DC .......................... 25 

Prepared statement of General Nash ............................................................. 57 

Stiglitz, Joseph E., Ph.D., University Professor, Columbia University, New 

York, NY ............................................................................................................... 5 

Prepared joint statement of Dr. Stiglitz and Ms. Bilmes .............................. 40 

Van Derveer, Lieutenant Colonel Donna R., USA (Ret.), Ashville, AL ............... 37 

Prepared statement of Colonel Van Derveer .................................................. 70 

Veterans for Common Sense, Paul Sullivan, Executive Director ........................ 29 

Prepared statement of Mr. Sullivan ............................................................... 58 

Veterans’ Outreach Center of Rochester, NY, Colonel James D. McDonough, 

Jr., USA (Ret.), President and Chief Executive Officer .................................... 22 

Prepared statement of Colonel McDonough ................................................... 54 

SUBMISSION FOR THE RECORD 

Swords to Plowshares, statement ........................................................................... 70 


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THE TRUE COST OF THE WAR 

THURSDAY, SEPTEMBER 30, 2010 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON VETERANS’ AFFAIRS, 

Washington, DC. 

The Committee met, pursuant to notice, at 10:00 a.m., in Room 

334, Cannon House Office Building, Hon. Bob Filner [Chairman of 

the Committee] presiding. 

Present: Representatives Filner, Mitchell, Teague, Rodriguez, 

McNerney, and Space. 

Also Present: Representatives George Miller of California, Jones, 

and Moran of Virginia. 

OPENING STATEMENT OF CHAIRMAN FILNER 

The CHAIRMAN. Good morning. Welcome to this hearing of the 

House Veterans’ Affairs Committee. 

Let the record show that Members in attendance besides the 

Chair are Mr. Mitchell of Arizona; Mr. Teague of New Mexico; Mr. 

Rodriguez of Texas; and Mr. McNerney of California. 

And I would ask unanimous consent that our colleague, the gentleman from North Carolina, Mr. Jones, be allowed to sit at the 

dais and participate as a Member of the Committee for this hearing. 

Hearing no objection, Mr. Jones, thank you for joining us. We 

know of your great interest and leadership on the issues we are 

discussing. Thank you again for being here today. 

We have titled the hearing ‘‘The True Cost of the War.’’ It struck 

me, as I looked at a lot of the facts and data that we see across 

our desk, that, as a Congress and as a Nation, we really do not 

know the true cost of the wars we are fighting in Iraq and Afghanistan. 

I also want the record show that Mr. Space from Ohio is here. 

I ask unanimous consent that Mr. Moran from Virginia be allowed to sit at the dais and participate as a Member of the Committee for today. Hearing no objection, so ordered. 

Thank you very much, Mr. Moran, for your leadership and interest on these issues. 

We all look at the data that comes from these wars. It struck me 

one day that the official data for the wounded is around 45,000 for 

both wars; and, yet, we know that 600,000 or 700,000 of our veterans of these wars, of which there are over a million already, have 

either filed claims for disability or sought health care from the U.S. 

Department of Veterans Affairs (VA) for injuries suffered at war— 

45,000 versus 800,000. This is not a rounding error. I think this 


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is a deliberate attempt to mask what is going on, in terms of the 

actual casualty figures. 

We know there is denial of post-traumatic stress disorder 

(PTSD). It is considered a weakness among Marines and soldiers 

to admit mental illness, so we don’t even have those figures until 

it is possibly too late. 

We all know that women are participating in this war in a degree never before seen in our Nation’s history, and yet, an estimated half or two-thirds have suffered sexual trauma. The true 

cost of war. 

We know that over 25,000 of our soldiers who were originally diagnosed with PTSD got their diagnosis changed—or their diagnosis 

was changed as they had to leave the Armed Forces, changed to 

personality disorder. Now, not only does that diagnosis beg the 

question of why we took people in with a personality disorder, it 

means that there is a preexisting condition and we don’t have to 

take care of them as a Nation. It is the cost of war. 

There have been months in this war where the suicides of activeduty members have exceeded the deaths in action. Why is that? 

When our veterans come home from this war, we say we support 

troops, we support troops, we support troops, but there is a 30-percent unemployment rate for returning Iraq and Afghanistan veterans. That is three times an already-horrendous rate in our Nation. Guardsmen find difficulty getting employment because they 

may be deployed. 

Now, a democracy has to go to war sometimes, but people have 

to know what is the cost? They have to be informed of the true nature not only in terms of the human cost and the material cost but 

hidden costs that we don’t know until after the fact, or don’t recognize. 

Why is it that we don’t have the mental health care resources 

for those coming back? Is it because we failed to understand that 

the cost of serving our military veterans is a fundamental cost of 

the war? Is it because we sent these men and women into harm’s 

way without accounting for and providing the resources necessary 

for their care if they are injured, wounded, or killed? 

Every vote that Congress has taken for the wars in Iraq and Afghanistan has failed to take into account the actual cost of these 

wars by ignoring what will be required to meet the needs of our 

men and women in uniform who have been sent into harm’s way. 

This failure means that soldiers who are sent to war on behalf of 

their Nation do not know if their Nation will be there for them tomorrow. 

The Congress that sends them into harm’s way assumes no responsibility for the long-term consequences of their deployment. 

Each war authorization and appropriation kicks the proverbial can 

down the road. Whether or not the needs of our soldiers injured or 

wounded in Iraq and Afghanistan will be met is totally dependent 

on the budget priorities of a future Congress, which includes two 

sets of rules: one for going to war and one for providing for our veterans who fight in that war. We don’t have a budget for the VA 

today, as we are about to enter the new fiscal year. 

We are trying to provide for those involved in atomic testing in 

World War II, even after we were told there would be no problems, 


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and yet they can’t get compensation for their cancer. This Committee and this Congress has a majority of people who believe that 

we should fully compensate the victims of Agent Orange for injuries in Vietnam. Yet we have a PAYGO rule on bills coming out 

of this Committee. They say it is going to cost roughly $10 billion 

or $20 billion over the next 10 years but we don’t have it—why 

don’t we have it? They fought for this Nation. We are still trying 

to deal with Persian Gulf War illness, not to mention all the casualties from this war. 

We have to find a PAYGO offset, but the U.S. Department of Defense (DoD) doesn’t have to. The system that we have for appropriating funds in Congress is designed to make it much easier to 

vote to send our soldiers into harm’s way than it is to care for them 

when they come home. 

This Committee and every one of the people here has fought 

tooth and nail to get enough money for our veterans. We have to 

fight for it every day. We have been successful in the last few 

years, but we won’t if that rate of growth continues. 

This is morally wrong, in my opinion, and an abdication of our 

fundamental responsibility as Members of Congress. It is past time 

for Congress to recognize that standing by our men and women in 

uniform and meeting their needs is a fundamental cost of war. We 

should account for those needs and take responsibility for meeting 

them at the same time we send these young people into combat. 

Every Congressional appropriation for war, in my view, should 

include money for what I am going to call a Veterans Trust Fund. 

The Fund will assure the projected needs of our wounded and injured soldiers are fully met at the time they’re going to war. 

It is not a radical idea. Businesses are required to account for 

their deferred liability every year. Our Federal Government has no 

such requirement when it comes to the deferred liability of meeting 

the needs of our men and women in uniform, even though meeting 

those needs is a moral obligation of our Nation and a fundamental 

cost. It does not make sense fiscally; it does not make sense ethically. 

If, in years past, Congress had taken into account this deferred 

fiscal liability and moral obligation of meeting the needs of soldiers, 

we would not have the kind of overburdened delivery system that 

we have today in the Department of Veterans Affairs. Would veterans and their advocates on Capitol Hill have to fight as hard as 

they do every year for benefits that should be readily available as 

a matter of course? Would they have to worry as much as they do 

today that these benefits will become targets in the debate over reducing the Federal budget? 

Listen to this statement by the Co-chair of the National Commission on Fiscal Responsibility that is trying to figure out how we 

balance our budget. Former Senator Simpson said, ‘‘The irony is 

that veterans who saved this country are now, in a way, not helping us to save the country in this fiscal mess.’’ That is, they should 

defer their health and welfare needs because of a budget problem. 

So we are going to examine this. I thank the gentlemen who are 

here today. The Congress did adjourn early this morning, and it is 

good to have you all here on this important issue. 

[The prepared statement of Chairman Filner appears on p. 39.] 


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The CHAIRMAN. Would anybody like to make opening remarks? 

Mr. Rodriguez. 

OPENING STATEMENT OF HON. CIRO D. RODRIGUEZ 

Mr. RODRIGUEZ. Yes, Mr. Chairman, let me first thank you for 

allowing us to be here. As you indicated, we have adjourned, and 

I first have a flight I am going to be taking, but I do want to thank 

you for focusing our attention on this major issue. 

I also want to mention that this might be probably the last time 

we meet this year, and I want to just thank you for your leadership 

in the last 4 years in making a huge difference to our veterans. 

Having served on this Committee probably, of the ones that are 

here today, the longest, next to you—I know that we have had 

some frustrating situations, and the last 4 years has been very rewarding to at least make some inroads into some of the problems. 

And I am hoping that, as we move forward, that you will continue 

to bring up the importance of reaching out to these veterans. 

I know that one issue that I just want to again mention is the 

one where we dealt with Project 112, which was the studies that 

were done in the 1960s and 1970s, and where at first, the Department of Defense denied having even done the studies. Later on, we 

found that there was about 20-something studies, and then there 

was 30-something. I guess the last figure was about 50-something 

studies in the 1960s and 1970s where we used nerve gas and used 

specially other things on our own soldiers and then actually experimented with them, a lot of the Marines and people in the Navy. 

And still we haven’t done the right thing with a huge number of 

them. 

And so I am hoping that, as we move forward, we do the right 

thing for those veterans who suffered. Our veterans were there for 

us, and we need to be there for them now as they reach their twilight years. 

Thank you very much for your leadership in this area. 

The CHAIRMAN. Thank you, Mr. Rodriguez. 

Mr. Jones or Mr. Moran, any opening remarks? 

Mr. JONES. No, thank you, Mr. Chairman. I am just anxious to 

hear from the witnesses—— 

The CHAIRMAN. Great. We are going to hear from them after I 

give another hour of opening remarks. 

We are going examine these questions today. We are pleased and 

honored to have with us Nobel Laureate Joseph Stiglitz of Columbia University, Linda Bilmes of Harvard, the authors of ‘‘The Three 

Trillion Dollar War,’’ which was a groundbreaking book that 

brought a healthy but sobering dose of reality into our public debates about the wars in Iraq and Afghanistan and the long-term 

consequences of those decisions. 

We are also, in the following panels, going to have distinguished 

military leaders, veterans of the wars in Iraq and Afghanistan, veterans advocates, and families of veterans to help us put into focus 

this question of how we deal with our veterans who have served 

us. 

It is time for open and honest discussion about the moral obligations for our Nation. It is time to reflect on the need to reform a 

process that systematically denies the connection between fighting 


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a war and meeting the needs of those we send into harm’s way. 

Our veterans deserve better. 

Professor Bilmes joins us from Harvard University. Dr. Stiglitz 

joins us from Columbia University, and Dr. Joe Violante—I have 

just given you an honorary doctorate—is here representing the Disabled American Veterans (DAV). 

Thank you for being here today. 

Dr. Stiglitz, are you first up? We will include all of your written 

statements in the record. 

I don’t know who is first, Dr. Stiglitz or Ms. Bilmes? Okay, Dr. 

Stiglitz, proceed please. 

STATEMENTS OF JOSEPH E. STIGLITZ, PH.D., UNIVERSITY 

PROFESSOR, COLUMBIA UNIVERSITY, NEW YORK, NY 

(NOBEL LAUREATE); LINDA J. BILMES, DANIEL PATRICK 

MOYNIHAN SENIOR LECTURER IN PUBLIC POLICY, JOHN F. 

KENNEDY SCHOOL OF GOVERNMENT, HARVARD UNIVERSITY, CAMBRIDGE, MA; AND JOSEPH A. VIOLANTE, NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS 

STATEMENT OF JOSEPH E. STIGLITZ, PH.D. 

Dr. STIGLITZ. Well, thank you very much, Chairman Filner, 

Members of the House Veterans’ Affairs Committee. Thank you for 

convening this hearing today and for inviting us to testify on the 

true cost of the war. 

Congressman Filner outlined some of the costs of war, the 

human costs, that go beyond the budgetary costs that so much of 

the attention has been focused on. I want to thank you for your 

commitment to deal with these problems. 

There is no such thing as a war for free. The repercussions of 

war and the costs of war persist for decades after the last shot is 

fired. As Congressman Filner mentioned, the inevitable costs, the 

economic consequences, and the long-term welfare of the troops are 

seldom mentioned at the start of a conflict. 

The budgetary problems facing the United States today remind 

us that even the richest country in the world faces constraints and 

must make choices. Limitations of resources, both budgetary and 

military, have to be confronted. But we can only make intelligent 

choices if we have the relevant information. Analysis of costs and 

benefits provide some of the critical pieces of information. 

Today, we have a better view of both the benefits and the costs 

of war than we did at the outset. The benefits of the war center 

on the value of additional security obtained by the war. This is a 

subject on which reasonable people may disagree. It requires assumptions typically unverifiable about what would have happened 

in the absence of the conflict. 

Estimating the cost of the war is more straightforward. There is 

no doubt that wars use up resources. The question is how to estimate the full magnitude of the resources used and assign values 

to them. Any estimates have to be comprehensive, not only the direct budgetary cost today but the long-term budgetary cost, some 

of which are felt outside of the Department of Defense, as well as 

the overall cost to our economy and our society. 


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Looking at the long-run cost for war is especially important because the cost lasts so long. For instance, disability claims for 

World War I veterans did not peak until 1969. 

It is obvious now that the wars in Iraq and Afghanistan have 

been far more costly, both in terms of blood and treasure, than its 

advocates suggested at the outset. The absence of reliable estimates meant there was no opportunity for a meaningful debate before we embarked on this war of choice. 

Two years ago, we published ‘‘The Three Trillion Dollar War: The 

True Cost of the Iraq Conflict,’’ in which we estimated that the 

total cost to the U.S. through 2017, including lifetime health care 

and disability costs for returning troops, as well as the economic 

impacts to the country, would be $3 trillion. This price tag dwarfed 

previous estimates, but subsequent investigations by both the Congressional Budget Office (CBO) and the Joint Economic Committee 

of Congress found our estimate to be broadly correct. 

This morning we will focus on three issues. First, we will discuss 

some of the costs that the war has imposed on the U.S. economy. 

Second, we will provide an updated estimate for the single-biggest long-term budgetary cost of the current war, which is the cost 

of providing medical care, disability compensation, and other benefits to veterans of the Iraq and Afghanistan conflicts. 

Thirdly, we will argue that such costs are inevitable and can be 

estimated, to some extent, in advance. This means the U.S. should 

be making provisions for its war veterans at the time we appropriate money for going to war. We will recommend steps that can 

be taken to address this unfunded financial liability. 

Before turning to the cost to the U.S. economy, let me make a 

few introductory comments about the difficulties of estimation. 

What makes this analysis challenging is that government accounting systems do not document most items in a way that would enable an easy assessment of the resources directly used or the full 

budgetary impact. Congressman Filner has pointed out the discrepancies between the 45,000 casualties and the number of individuals 

making use of our VA medical facilities and claiming disabilities. 

The way we account for our troops is an essential example of the 

way economic costs typically exceed budgetary costs. For example, 

from the sole perspective of military accounting, the cost of a soldier’s life is valued at $500,000. This doesn’t include the cost to the 

military of recruiting and training a replacement troop and the impact on morale and mental health of the rest of the unit. It also 

does not reflect the economic loss of a young man or woman. By 

contrast, when civilian agencies, such as the Environmental Protection Agency and the Food and Drug Administration, are evaluating 

proposed regulation, when they compare the cost of imposing a regulation to the potential life saved, they estimate the value of a life 

between $6 million and $8 million. 

In addition to the known cost of conducting current and future 

military operations and caring for war veterans, which Linda will 

discuss later, the most sobering costs of the conflict are in the category of ‘‘might have beens,’’ what economists call opportunity 

costs. 

Specifically, in the absence of the Iraq invasion, would we still 

be mired in Afghanistan? Would oil prices have risen so rapidly? 


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Would the Federal debt be so high? Would the economic crisis have 

been so severe? Arguably, the answer to all four of these questions 

is ‘‘no.’’ 

Between 2003 and 2006, we have spent five times as much 

money in Iraq as in Afghanistan. The Iraq invasion diverted our 

attention from Afghanistan, a war that is now entering its 10th 

year and which threatens to destabilize nuclear-armed Pakistan. 

While success in Afghanistan might always have been elusive, we 

would probably have asserted control over the Taliban and suffered 

less expense and loss of life if we had maintained our initial momentum and not been sidetracked in Iraq. 

The second cost is the higher price of oil, which has had a devastating effect on our economy. When we went to war in Iraq, the 

price of oil was under $25 a barrel, and future markets expected 

it to remain around that level. With the war, prices started to soar, 

by 2008 reaching $140 a barrel. In our conservative $3 trillion estimate, we attribute only $5 to $10 of the per-barrel-price increase to the war. However, we now 

believe that a more realistic estimate of the impact of the war on 

the oil price over a decade is at least $10 to $15 per barrel. That 

translates into at least an additional $250 billion increase in the 

cost of war above the numbers in our book. 

Thirdly, the war added substantially to the Federal debt. It is 

the first time in America’s history where a government cut taxes 

as it went to war, even in the face of continued government deficits. When the crisis began, the global financial crisis, the debt reduced our room to maneuver. It does so even more today, with the 

results of a deeper and longer recession. 

But the link between the war and the crisis is even stronger than 

that. The crisis itself was, in part, due to the war. The increase in 

oil prices reduced domestic aggregate demand. Money spent buying 

oil abroad was money not available for spending at home, for instance. Loose monetary policy and lax regulations kept the economy going through a housing bubble, whose breaking brought on 

the global financial crisis. 

Counterfactuals, what might have happened if we had not gone 

to war, are always difficult, and especially so with complex phenomena like a global financial crisis with so many contributing factors. What we do know is that one of the true costs of the war is 

its contribution to a worse economic recession, higher unemployment, and larger deficits than might have otherwise occurred. 

Let me conclude with a few general observations. The large disparity between budgetary and the full economic cost of war means 

that there is a need for a comprehensive reckoning to the cost of 

the economy as a whole. The fact that we have been able to construct estimates underlines the fact that this exercise can be done 

once there is a will to do it. 

Without good information, there cannot be good decisions about 

going to war, about exiting the war, and about the conduct of the 

war. But even more is at stake, as we face intense budgetary pressures in coming years. We have an implicit contract with our veterans, who have served their country so well. 

But the way the political and budgetary process is conducted 

today fails to recognize this. Veterans expenditures are subject to 


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the same PAYGO rules as any other expenditure. This puts our 

commitments to veterans in jeopardy. This is even more important 

as these costs soar in response to this war. 

Professor Bilmes will discuss these costs and the reforms that 

are necessary to ensure that we fulfill our commitments. 

Thank you. 

The CHAIRMAN. Thank you. 

Ms. Bilmes. 

STATEMENT OF LINDA J. BILMES 

Ms. BILMES. Chairman Filner, Members of the Committee, thank 

you for inviting us to testify today. 

My father was a World War II veteran who served in the Army 

and earned his college and graduate degrees under the GI Bill. I 

am grateful to our country for honoring its commitment to him. 

I would like to discuss two issues in my statement. First, I will 

explain our revised cost estimates for veterans’ medical care and 

disability benefits. Second, I will recommend that we develop a financial strategy for meeting this obligation. 

The largest long-term budgetary cost of the wars is providing 

medical care and disability benefits to veterans who have served in 

Iraq and Afghanistan. As of this month, 5,700 U.S. servicemen and 

women have died, and over 90,000 have been wounded in action or 

injured seriously enough to require medical evacuation. A much 

larger number, over 565,000, have already been treated in VA medical facilities. 

The evidence from previous wars shows that the cost of caring 

for war veterans peaks in 30 to 40 years or more after a conflict. 

The costs rise over time as veterans get older and their medical 

needs grow. 

Two and a half years ago, we estimated the likely cost of providing medical care and disability benefits to Iraq and Afghanistan 

veterans based on historical patterns. We now have the actual 

record of 400,000 recent veterans, and we have revised our estimates based on this new information. 

The most striking finding is that veterans from the recent wars 

are utilizing VA medical services and applying for disability benefits at much higher rates than in previous wars. The higher medical usage is the result of several factors, including higher survival 

rates for seriously wounded troops, higher incidence of post-traumatic stress disorder and other mental health problems, more veterans who are willing to seek treatment for mental health ailments, more generous medical benefits, more presumptive conditions, and higher benefits in some categories. 

The high incidence of PTSD means that the medical cost of current conflicts will continue to rise at a rapid rate for many decades. 

This was the experience with Vietnam veterans diagnosed with 

PTSD. 

And recent studies have documented that PTSD sufferers are at 

a higher risk for heart disease, rheumatoid arthritis, bronchitis, 

asthma, liver, and peripheral arterial disease. PTSD sufferers are 

200 percent more likely to be diagnosed with a disease within 5 

years of returning from deployment. Veterans with PTSD utilized 

non-mental health care services, such as primary care, ancillary 


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services, diagnostic tests and procedures, emergency services, and 

hospitalizations, 71 to 170 percent higher than those without 

PTSD. 

Research has also shown that traumatic brain injury, which is 

estimated to affect some 20 percent of Iraq and Afghanistan veterans, often in conjunction with PTSD, places sufferers at higher 

risk for lifelong medical problems such as seizures, decline in 

neurocognitive functioning, dementia, and chronic diseases. 

The high number of claims among recent veterans is due both to 

the health problems I described and also to better outreach and capacity at the VA and greater availability of information on the 

Internet and greater outreach by veterans service organizations. 

Since our book was written, a number of recommendations that 

we and others urged have been adopted, including that VA has expanded the Benefits Delivery at Discharge Program and Quick 

Start; increased the number of conditions that are presumptive in 

favor of the veteran; liberalized the PTSD ‘‘stressor’’ definition and 

increased some categories of benefits; provided 5 years of free 

health care instead of 2; and is in the process of restoring medical 

care to 500,000 moderate-income Priority 8 veterans. 

VA has also hired more medical and claims personnel and invested heavily in information technology (IT) upgrades to the 

claims process. All of these factors contribute to the rising cost estimates I will describe. 

Our model for projecting long-term budgetary cost is based entirely on government data. We based our projections for troop levels on estimates by the Congressional Budget Office and the Congressional Research Service. And we used rates of average disability compensation, Social Security Disability benefits, and medical costs on information from the Veterans Benefits Administration (VBA), the Veterans Health Administration, Social Security 

Administration, and government economic indicators. 

The projections cover the period for the 1.25 million servicemembers who have been discharged from Iraq and Afghanistan and 

become veterans from 2001 to the present, as well as estimates for 

military members who will become veterans by 2020. 

In our earlier work, we estimated that the long-term cost of providing medical care and disability compensation for these veterans 

would be between $400 billion and $700 billion, depending on the 

length of and intensity of the conflict and future deployment levels. 

We now expect the cost range to be between $589 billion and $934 

billion, depending on these factors. I believe there is a chart, which 

has been posted here, which shows our earlier estimates as well as 

our current estimates. 

About three-quarters of this increase is due to higher claims activity and higher medical utilization of Iraq and Afghanistan veterans. And about 18 percent is due to the higher number of troops 

deployed. Six percent is due to the difference in projecting through 

2020 instead of 2017. 

In terms of disability cost projections, in 2008, we had projected 

that between 366,000 and 398,000 returning Iraq and Afghanistan 

veterans would have filed disability claims by this point, by 2010. 

In fact, more than 513,000 veterans have already applied for VA 

disability compensation. We now estimate that the present value of 


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these claims over the next 40 years will be from $355 billion to 

$534 billion. 

In addition, veterans who can no longer work may apply for Social Security Disability benefits. We estimate that the present 

value of lifetime Social Security Disability benefits for these veterans will range from $33 billion to $52 billion. 

In terms of medical cost projections, in our earlier analysis, we 

had anticipated that 30 to 33 percent of returning veterans, which 

would be fewer than 400,000, would have been treated in the VA 

medical system by 2010. The actual number is running at more 

than 565,000 veterans, that number is from April, so it is probably 

approaching 600,000 veterans now, which is about 45 percent of 

discharged troops. In our earlier work, we had projected that the 

VA would not reach this level until 2016. 

We now estimate that the present value of medical care provided 

by the VA to veterans from Iraq and Afghanistan over the next 40 

years will be between $201 billion and $348 billion, depending on 

the duration and intensity of military operations. 

These estimates do not include a range of additional costs that 

will be paid by departments across government, including veterans’ 

home loan guarantees, veterans’ job training, concurrent receipt of 

pensions, higher costs to Medicare and TRICARE for Life by veterans who are not enrolled in the VA system, costs to State and 

local governments, or the GI Bill, which is an investment that will 

yield significant economic benefits but will also add budgetary 

costs. 

Taking these costs into account, the total budgetary costs associated with providing for America’s war veterans from Iraq and Afghanistan approaches $1 trillion. 

I also want to emphasize that the true cost goes beyond the 

budgetary costs. There are much larger social and economic burdens that are not paid by the Federal Government but nonetheless 

represent a real burden on society. These include the loss of productive capacity by young Americans who are killed or seriously 

wounded; lost output due to mental illness; the burden on caregivers who have to sacrifice paid employment in order to take care 

of a veteran; the cost of those, particularly among Reservists and 

Guards, who were self-employed and have lost their livelihood. For 

many veterans, there is simply a diminished quality of life, the 

costs of which is borne by individuals and families. 

Women troops have been especially hard-hit. They make up 11 

percent of the force. Divorce rates are three times higher for female 

than for male troops. And more than 30,000 single mothers have 

deployed to the war zone. 

The military has also employed several hundred thousand contractors, who have become indispensable to the war effort. These 

contractors have also suffered from high rates of casualties, injuries, and mental health problems. These impose both budgetary 

costs—through government subsidies to worker compensation and 

insurance companies—and social costs in all of the areas mentioned for troops. 

In our book, we attempted to quantify the monetary value of 

some of these costs, although some cannot be quantified. At that 

time, we estimated that these social costs would reach between 


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$295 billion and $400 billion in excess of the budgetary costs. 

Given the high number of casualties and the high incidence of mental illness, we expect that this cost will be even higher. 

Let me now turn to the issue of financial liability. The scale of 

our financial commitment to providing for veterans is enormous, 

and we have estimated that the cost of Iraq and Afghanistan will 

add at least another half-trillion dollars onto that debt. 

But, at present, the U.S. has no financial strategy for how it will 

pay this growing liability. The financial statements of the United 

States on the statement of net cost shows that providing for veterans is the fourth-largest cost to the U.S. Treasury. 

In terms of accrued long-term liability, the balance sheet of the United States lists $1.3 trillion in veterans’ compensation and burial benefits and a liability for $220 billion in veterans’ housing loan 

guarantees. Just to be clear, that is $1.3 trillion in deferred veterans’ compensation. This does not take into account, however, the 

accrued liability for providing medical care or veterans’ pensions. 

And we also believe it significantly understates the obligations for 

the current war. 

We now have no financial plan for meeting this obligation. There 

is no dedicated mechanism through which taxpayers who are not 

in military service contribute directly to caring for war veterans. 

Funding must come from general revenues, competing with a myriad of other demands. 

The consequence of ignoring this cost is threefold. First, it understates the true cost of going to war. 

Second, from an economic perspective, it is poor financial management. We should not be financing a 40-year-long pension and 

benefit obligation from annual budget revenues. We are essentially 

asking VA to fund mandatory benefits using discretionary appropriations. 

Third, it leads to the possibility that veterans’ needs will not be 

funded. The VA has the responsibility to determine the availability 

of VA care based on appropriations levels. But even with the best 

will in the world and with a strong management team, this may 

result in insufficient funding. VA ran short of funds in 2005 and 

2006. And, in January 2009, the U.S. Government Accountability 

Office found that VA’s assumptions about its costs of long-term 

care were unreliable because they assumed cost increases were 

lower than VA’s actual recent spending experience. 

VA is now facing the additional challenge of estimating demand 

for 2 years in advance appropriations. However, this is proving 

challenging because, using its current model, VA cannot determine 

precise operating needs 21⁄2 years in advance, yet it is being asked 

by appropriators and by the Office of Management and Budget to 

do this. 

We recommend a different funding model that would include a 

mandatory component. I would personally—I have long advocated 

mandatory funding for VA medical care, particularly in light of the 

long-term infrastructure needs of the VA medical system. 

Another way to accomplish creating a mandatory component 

would be to establish a Veterans Trust Fund that would be funded 

as obligations occur. Although we cannot estimate precisely the 

magnitude of long-term demands, it should be possible to develop 


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a framework for setting aside some funding at the time war money 

is appropriated. 

Secondly, in order to facilitate this, we need to improve the actuarial capacity of the VA. The Department should be directed to 

work with the Institute of Medicine to develop a better system of 

forecasting the amounts and types of resources needed to meet veterans’ needs in 30 years or more, when their needs are likely to 

peak. 

I will stop here. And thank you, again, very much for bringing 

attention to this important issue. 

[The prepared joint statement of Dr. Stiglitz and Ms. Bilmes appears on p. 40.] 

The CHAIRMAN. Thank you, Professor Bilmes. 

Mr. Violante. 

STATEMENT OF JOSEPH A. VIOLANTE 

Mr. VIOLANTE. Mr. Chairman and Members of the Committee, 

thank you for inviting me to testify today on behalf of Disabled 

American Veterans. With 1.2 million Members, all of whom were 

disabled during wartime, no organization understands the true 

costs of wars better than the DAV. 

Mr. Chairman, war leaves a legacy of pain and hardship, borne 

by the men and women who suffer the wounds and bear the scars, 

as well as families who suffer the loss of a loved one and family 

members who care for disabled veterans. The true cost of war also 

includes the cost of peace, because all who defend our Nation have 

earned the rights to the benefits. 

In order to cover all these costs today and in the future, there 

are a number of actions that Congress can take. 

First, Congress must ensure that all benefits for disabled veterans are paid in full, not offset against other Federal benefits, 

eroded by inflation, nor whittled down by budget gimmicks such as 

rounding down our cost of living adjustments. And it is time to 

fully eliminate the prohibition on concurrent receipt of disability 

compensation and military retirement pay. 

Second, we must fully compensate disabled veterans for their 

sacrifice and loss, which must include compensation for noneconomic loss and loss of quality of life, not just loss of earning capacity. Both the Institute of Medicine and the Congressionally authorized Veterans’ Disability Benefits Commission made this recommendation. 

Third, Congress must ensure that existing veterans’ benefits are 

paid accurately and timely to effectively fulfill their intended purpose. Unfortunately, everybody today recognizes the VA benefits 

claims-processing system is broken. VA must focus on the goal of 

getting claims done right the first time and not just, quote, ‘‘breaking the back of the backlog,’’ end quote. 

Mr. Chairman, in November, VBA will roll out its new IT system 

as a pilot program. At the same time, they are continuing to experiment with more than 50 pilots across the country. It is imperative 

that Congress provide strong oversight and leadership to ensure 

that each pilot is judged first and foremost on its ability to help the 

VA get claims done right the first time. 


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Fourth, we must fully support veterans’ families and survivors. 

We are grateful that Congress approved the ‘‘Caregivers and Veterans Omnibus Health Service Act of 2010,’’ but the law did not go 

far enough. Congress must extend these benefits to family caregivers of disabled vets from all conflicts and eras. Congress should 

also eliminate the offset for Survivor Benefit Plan and for those 

widows receiving Dependency and Indemnity Compensation (DIC). 

Fifth, we must ensure that veterans receive high-quality, comprehensive health care from a robust VA health care system. And 

that requires VA to have sufficient, timely, and predictable funding. 

While we remain grateful for the bipartisan support that made 

advanced appropriations a reality, we are concerned Congress and 

VA appear to be falling short of the promise of the law. With the 

new fiscal year beginning tomorrow and no Federal budget in sight, 

the fact that advanced appropriations for VA’s fiscal year 2011 

medical care budget is already in place demonstrates the importance and effectiveness of this new funding mechanism. However, 

Congress’s failure to approve the regular fiscal year 2011 VA appropriations before adjournment also means that there is no fiscal 

year 2012 advanced appropriations approved for next year. 

Furthermore, in a July 30th report to Congress, Secretary 

Shinseki stated that the level of funding contained in VA’s fiscal 

year 2011 advanced appropriations was no longer projected to be 

sufficient, yet he did not recommend any additional funding. Instead, he talked about reprogramming existing funding from lowerpriority areas, which is contrary to the purpose of advanced appropriations. 

When VA reports funding requirements have changed due to unforeseen circumstances, the Secretary must request supplemental 

funding and Congress must provide such funding to fully meet 

their obligation. 

Finally, we must ensure that our Nation never backs away from 

its obligations to veterans because of our government’s inability to 

keep its fiscal house in order. Any Nation that fails to meet its obligation to those who served, sacrificed, and suffered is a country already morally bankrupt. As such, any recommendations that seek 

to balance the budget on the backs of disabled veterans must be 

rejected. 

Mr. Chairman, the true cost of defending our Nation includes the 

full cost to compensate and care for all veterans as well as to support their family caregivers and survivors. Disabled American Veterans stands ready to work with this Committee and Congress to 

meet these sacred obligations to America’s veterans, especially disabled veterans. 

That concludes my testimony, and I would be happy to answer 

any questions. Thank you. 

[The prepared statement of Mr. Violante appears on p. 50.] 

The CHAIRMAN. Thank you, Mr. Violante. 

Mr. Mitchell, do you have any questions? 

Mr. Jones, you are welcome to participate. 

Mr. JONES. Mr. Chairman, I will be brief. 

I want to thank the professor and the doctor for the book, ‘‘The 

Three Trillion Dollar War.’’ I bought it 2 years ago. 


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I have Camp Lejeune down in my district—60,000 retired veterans, and the numbers are growing. I want to thank the Chairman for not only this hearing but to bring to the attention of this 

Congress that we cannot continue to take care of our veterans with 

the same process. And you have said this, and you have made it 

very clear. If we don’t look at alternatives, the DAV and all these 

other veterans service organizations are going to wonder, ‘‘Why 

were we cheated out of our benefits?’’ The shell game, Mr. Chairman, has to stop. That is why, again, this is so critical. 

And I hope that, after the elections, whatever happens in November, that this issue—and I am a Republican, and I am not on this 

Committee, but I want to make this pledge to you and to the veterans of this country. This needs to be one of the number-one priorities for the Congress to figure out what we are going to do, because the collapse is on the way. And I think that the Veterans 

Trust Fund is the way to start the debate as to what can we do 

to ensure that we keep our promise to those who have served this 

country and deserve every benefit that they have earned. 

And that is just a general statement. I don’t really have a question, but I feel frustrated when I sit here. I have seen it for years. 

I have seen it for years. I see those kids at Walter Reed with their 

legs blown off. I see the moms crying, the wives crying. The kids 

are 19, 20, 21 years old. And, as you said, it is 30 years from now 

that we really have to be careful. 

But, Mr. Chairman, please know that you have my commitment 

to join in whatever effort we move forward on. Because we are not 

being honest; we are cheating the veterans if we don’t do what is 

necessary today. 

I yield back. 

The CHAIRMAN. Again, I thank you for your leadership on the 

other side of the aisle. 

By the way, we can attribute Mr. Jones’—what shall I say—more 

expansive understanding to the fact that his father was a Democratic Congressman. He doesn’t like for us to know that, but thank 

you. 

Mr. Moran, again, thank you for your interest. Most people don’t 

realize that when Members attend another Committee hearing, it 

is very unusual in this Congress, and very much appreciated. 

Mr. MORAN OF VIRGINIA. Thank you, Chairman Filner. Thank 

you for your leadership. 

And I know that the folks in this audience know that Chairman 

Filner has taken on this responsibility not just as a professional 

duty but as a personal moral commitment. 

We have Mr. Miller entering the room, as well. 

And it is nice to see you, George. 

Speaking of Chairmen, Mr. Miller Chairs the Education and 

Labor Committee, which is very much involved in what we are 

talking about. That is one of the questions I want to ask. 

But the first one: Mr. Obey, myself, Mr. Murtha, I think Mr. 

Rangel, perhaps Chairman Filner, we voted for an amendment that 

went nowhere, but we did it for 2 or 3 years running—it was Mr. 

Obey’s idea—to have a surcharge to pay for the war. If we were 

going to pursue the Iraq War, let’s just figure out what the cost is 


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and pay for it, rather than making that decision to go to war but 

passing on the cost to our children and grandchildren to pay for it. 

It went down. I think there were more than 400 people who 

voted against the concept. But it doesn’t mean it wasn’t a legitimate issue to raise, and I think it would have been the responsible 

thing to do. 

So my first question of two would be, would you have been able 

to estimate what that kind of surcharge would have been when we 

were actually making the decision? Is that consistent with the 

thrust of your testimony, that that is how we should go about making the decision whether or not to go to the war in the future. 

Professor Stiglitz. 

Dr. STIGLITZ. Yes, I think it is an excellent idea for a number of 

reasons. 

First, I think it is very important to have transparency and accountability in government, that you ought to know what you are 

doing and what it costs, and citizens ought to know that, if you 

want to get something, you have to pay for it, you know, just like 

shopping, anything. 

Secondly, we can calculate it. That is the point that we have 

been making. You know, you can’t estimate it perfectly, but you 

can’t estimate Social Security perfectly. But you can get a fairly reliable estimate that would be the basis of a surcharge. And whether you express it as a percentage of the defense appropriations or 

as a tax, a separate tax, you know, you could express it in a number of different ways. It would be very easy, actually, to do that. 

And the third point is the point that Professor Bilmes made and 

the Congressman made, which is, by doing that, you would be setting aside money into a trust fund, and that is the only way that 

you can insulate this money against what I see as the increasing 

budget stringency that our country is going to be facing. And we 

should recognize that, for the next 20, 30 years, we are going to 

be facing very difficult budgetary problems. I mean, they are not 

going to go away. And there is no easy way—I mean, I have some 

views about how you could do it, but there is no easy way out of 

that. 

And the reality, then, is that, under the PAYGO current framework, supporting these obligations that we have undertaken to our 

veterans has to compete with every other expenditure. And there 

will be pressure. And the reference to the Debt Commission, the 

reference to former Senator Simpson’s testimony, is evidence of 

that kind of pressure that will be put on veterans’ expenditures. 

Mr. MORAN OF VIRGINIA. Well, thank you, Professor. 

You mentioned in your testimony, and Professor Bilmes has as 

well, the fragmented cost of war. Just one example, in the Defense 

Appropriations Committee, we put $900 million just for traumatic 

brain injury, and then in this Continuing Resolution, I don’t think 

there are two or three Members who are aware that we added another $300 million—it was a reprogramming of money for something else—bringing it up to $1.2 billion just for traumatic brain 

injury just for 1 year, fiscal year 2010. 

But the other question I wanted to ask—and then I will yield 

back the time. And I thank the Chairman. Senator Webb and others in both the House and Senate strongly supported, and was 


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passed, a GI Bill of Rights. The idea was to basically create a middle class again in the way that we did after World War II, by enabling returning veterans to get higher education and be able to 

lead to fuller, better employment prospects. Because, as you said, 

30 percent of our veterans returning home are unemployed. But 

this also extends to the family, the wives and spouses. 

Do we have an estimate of the cost of that? And I know that 

Chairman Miller would be very much interested, as well. What are 

we paying for that portion of higher education out of the same Federal budget? 

Professor Bilmes. 

Ms. BILMES. I don’t have, an estimate for that, but I think it is 

a good question. And I think it is, like all of these numbers, a number that could be calculated. 

One of our overall points throughout the process of working on 

these issues has been that there is actually very little attention to 

getting robust estimates in the veterans field. And when you compare the amount of effort, for example, that goes into studying the 

Social Security system compared with the amount of effort that 

goes into studying the long-term cost of veterans, whether it is the 

educational, the Transition Assistance Program, the research funding, the benefits, et cetera, it is a tiny fraction, not in scale with 

the, you know, actual, absolute size of the liability. 

But, unfortunately, I don’t have that particular number. 

Mr. MORAN OF VIRGINIA. No, but it would be interesting to calculate. 

Dr. STIGLITZ. Can I just make one further comment about the 

importance of providing the kind of benefit, the GI benefits? As we 

move to the All-Volunteer Army, we are recruiting particular socioeconomic groups into the Army and other military services. And 

these are often among the parts of our society that are less privileged. And, unless we do that, we will continue to have the problems of the 30 percent unemployment, which is a long-run problem 

for our society. 

And there has been reference made to high suicide rates, high 

problems of family. Those problems are all compounded when people can’t get a job. And when people don’t have the adequate education, in a modern economy it is very difficult to get the jobs. 

So I view this as part of our social obligation to those who fought 

for us which we are now not really fulfilling. 

Mr. MORAN OF VIRGINIA. Absolutely. And one cost that—a very 

substantial cost that we don’t factor in is the burden on local municipal human service programs. Because these folks, a large number go back into the community but still have mental health adjustment problems, domestic abuse problems and so on related to 

their combat experience. And it is a municipality’s responsibility to 

care for them, and we don’t calculate that cost, let alone add it to 

the full cost of the war. And I appreciate it. 

Chairman Filner, thank you so much for having this hearing and 

thank you for your commitment to this issue. 

The CHAIRMAN. Thank you, Jim. We appreciate your testimony 

today. 

This should not be radical, as I said in my remarks. This deferred liability is a common, accepted practice, and yet your testiVerDate Mar 15 2010 03:50 Jan 13, 2011 Jkt 061761 PO 00000 Frm 00020 Fmt 6633 Sfmt 6633 I:\WAYS\OUT\61761.XXX GPO1 PsN: 61761

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mony is mind boggling. The things that we have to take into account and that we can take into account, Professor Bilmes, we 

don’t. It is not rocket science as you are pointing out, that we do 

it. 

By the way, before I go further, I am not sure this hearing would 

have taken place without the incredible work of a former Congressman who is with us today, Tom Andrews from Maine. Tom, thank 

you for helping us do this and your persistence and understanding 

of the breadth of these issues. Thank you so much, Tom Andrews. 

Politicians and journalists like to get a headline out of this. You wrote the book, ‘‘The $3 Trillion War.’’ What would the title say if 

you were doing it now? Could I say $4 trillion? Could I say $5 trillion? Could I say $4 to $6 trillion? We Congressmen like a quick 

headline. I know you guys don’t, but help us out. 

Dr. STIGLITZ. When we originally did the book, the real numbers 

were $3 to $5 trillion. The reason we chose the title $3 trillion is 

not because we thought that was the most accurate number, but, 

at that time, if we had used one of the larger numbers, we would 

have lost credibility. 

The interesting thing is that after—as I said in my testimony, 

after we came out with the number $3 trillion, the CBO went and 

looked at it and the Joint Economic Committee, and they said we 

were basically right. 

There is an interesting point here, which is that we had a little 

bit of a scrap with the CBO on a few numbers, actually, on these 

numbers that are talking about—that we have been talking about, 

the veterans’ cost, the disability and medical costs. They said that 

we had overestimated those. We felt very confident that we had underestimated them. 

And I don’t want to crow. You shouldn’t take pride in this kind 

of thing. But the fact was that we had underestimated them, and 

they had vastly underestimated those costs. If you look at those 

numbers there, what you see is that the revised numbers are 25 

percent or more greater than our original numbers. So they are a 

substantial increase. 

I suppose if our original book had been called ‘‘The $3 to $5 Trillion War,’’ it would not have sold as well. The new book should be 

called ‘‘The $4 to $6 Trillion War and Increasing.’’ 

But I think what is clear—and we will be getting a full assemblage of numbers for a paper we will be presenting at the American 

Economic Association meetings in January. But what is clear from 

what we have already said is that the total cost is substantially 

higher than ‘‘The $3 Trillion war.’’ 

Ms. BILMES. I just want to say that I am very conservative and 

I had strongly favored when we wrote the book calling it ‘‘The $3 

Trillion War.’’ Because no matter which way you counted it up, if 

you looked at just the economic cost or just the budgetary cost, it 

always reached $3 trillion. So we didn’t want to add anything that 

could even conceivably be construed as double counting. 

I think what we know now is the long-term veterans’ costs are, 

as of now, beginning to approach the size of what we have already 

spent in actual combat operations, and that is the really startling 

thing. Because the tail of this war, the tail of all wars, is very, very 

long; and this tail in terms of cost is likely to be longer than others. 


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And we know that at least the minimum we can say is that the 

veterans’ costs will be 25 percent higher than we had expected. 

The CHAIRMAN. Every decision that we have thought about putting into legislation to help veterans of previous wars, whether it 

is the atomic veterans that I mentioned before, or the Agent Orange veterans, Persian Gulf War veterans illnesses, or PTSD, we 

cannot get money because of the PAYGO system for intelligent and 

thoughtful legislation. We have 250 Members on a bill to begin to 

adequately compensate Agent Orange victims. We are talking 

about 40 to 50 years ago. It scores at $20 billion so we can’t do it. 

This is a disgrace that we can’t even fund care for the more recent veterans because of the costs. Wherever we look, it is the same 

answer; it is the same barrier that we deal with. 

I don’t want to necessarily equate veterans’ benefits with other 

programs like Social Security or Medicare, which have been the 

programs that have threatened to bankrupt us, but as you look at 

the VA figures, there is also an incredible impact on our budget. 

Senator Simpson apparently already warned us that we may not 

have to do as much for veterans because of the impact. It looks to 

me that the deferred liability is rivaling some of that—is that a fair 

statement. 

Dr. STIGLITZ. First, let me just say the numbers are very large, 

as Professor Bilmes pointed out. The government’s own accounting 

talks about a $1.5 trillion gap, but that doesn’t really include the 

kinds of calculations that we have just done. So it is clearly vastly 

conservative. 

But I think I would make a very big distinction between Social 

Security and Medicare on the one hand and these benefits. Because, as you pointed out, Congressman, the right way to think 

about this is deferred compensation. This is really—they provided 

a service, and this is part of the contract. The contract when you 

go to fight in a war, you expect to get medical care and disability 

if you get injured. And to me it is a moral commitment. It is effectively a contractual commitment in a way that is really quite different from Medicare and Social Security. So, in my mind, putting 

these in the same basket, in the same framework is really the 

wrong way of thinking about it. They are all obligations. 

The CHAIRMAN. How about just the number. 

Dr. STIGLITZ. They are unfunded liabilities, and it is a very large 

number—it is a very large number that has been almost totally ignored. And what is so disturbing, of course, is—what we have 

talked about—these two relatively small wars, Afghanistan and 

Iraq, have increased that number by, in what we view as our moderate, realistic case, almost a trillion dollars, which to put into perspective, as Professor Bilmes pointed out, is essentially the amount 

we spent on operations. So that is a large amount that was not 

talked about when we went into this conflict. 

The CHAIRMAN. I have never argued with a Nobel Laureate before. But since I have a Ph.D., I can argue with you. 

Social Security to me is that contract. You pay into a system and 

we have a contract that you will be helped in your older years. 

Even with Medicare, you pay into a system, and we make a contract that we will not allow you to fall into poverty because of 

health care costs. 


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I know you are trying to make a distinction, but I think that 

what it does is that it shows the severity of the problem, which 

people are ignoring. That is all I am trying to get at. I don’t think 

we, as a Nation, want to know the true cost. I think that is the 

problem here. 

When I read those casualty figures every day or every week in 

the paper, the newspapers can talk about how many people have 

been admitted to the health care system—if we wanted to, we could 

have those figures. It is like looking at the homeless. Nobody wants 

to look at it. You know it is there; and if I had to think about it, 

it would boggle the mind. So we don’t want to know. And I think 

the bureaucracies who are involved in this really don’t want to 

know or want us to know. 

In 2005, the VA came to the Committee and said, we are a couple billion dollars short. I asked, why? Their response was, ‘‘Oh, we 

didn’t take into account there was a war going on.’’ These are the 

folks who we are relying on for accurate information but they forgot the war was going on. 

I just want to mention to my colleague, that this Veterans Trust 

Fund that I was mentioning that we are going to set that up the 

necessary funding. I tried an amendment on the last supplemental, 

and I am going to do it on every war bill that comes up. 

I just took as an arbitrary figure that the VA budget is about 

one-sixth of the Defense budget. So I said, let us do a surcharge— 

if I can use your term, Jim—of 15 percent on every war bill and 

put that money into the trust fund. All our colleagues on the 

Armed Services Committee said, well, we can’t do that. You are 

raising the cost of war too much. 

If I may quote my grandchildren on this, ‘‘duh,’’ that is the point, 

show what the real cost is. If it is 15 percent higher every year we 

are going to have to wrestle with how we define that. 

This trust fund is sort of becoming the budget for the VA. The 

fund would have even more money as these costs pile up over the 

years. We know a trust fund is not a lock box, but I think the concept we have to stress every time is that when you vote for war, 

vote for those who are going to suffer in the war. 

I don’t see the VA doing these kinds of calculations. They have 

a model for how much it is going to cost in the next fiscal year, 

but you would think they would be thinking about these deferred 

liabilities. It doesn’t sound like they are doing it. You recommend 

increasing their expertise in these fields. 

Ms. BILMES. Right, right. 

The CHAIRMAN. I think it is more than that, and I don’t think 

they want to think about it, myself. 

Ms. BILMES. Well, I think that the comparison to Social Security 

and Medicare doesn’t work in terms of scale because the Social Security is so much larger, the Medicare scale than the veteran’s 

scale. Where it does work is you are also facing a long-term deferred liability. And the quality of the actuarial function and the 

ability to think about these issues at Social Security and Medicare 

and the availability of information is just an order of magnitude 

higher. And what I see at the VA is a weakness. Because if we 

were going to go to a model with a more mandatory component, 


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you would need to develop that capacity to actually figure out on 

how to forecast. 

If I could just make one other comment—to Mr. Moran’s comment around how would we fund a trust fund would we need to 

have a surtax—there are a number of models for funding it, but I 

don’t see that it would necessarily have to be funded through a war 

tax, although that is one option. Right now, there are no mechanisms for designated war bonds, for example. So there is no method 

not just for individuals but for institutional investors who could be 

asked by their shareholders and by Congress to step up to the plate 

and finance portions of a Veterans Trust Fund, for example, 

through a low interest—some kind of subsidized war bond that 

could be used to endow a Veterans Trust Fund, and there are a 

number of other kind of options. So I would see, given the current 

environment and the economy, that in terms of thinking about this 

idea a surtax wouldn’t be the only option. 

Mr. MORAN OF VIRGINIA. If you would yield, Mr. Chairman, just 

a moment. 

Of course, the purpose of it was not just the budgetary mechanical process of paying for it but raising the issue so that when you 

make this decision are you also willing to pay for the results of the 

decision you are about to make. And so the surcharge being a discreet funding mechanism served that benefit of being—of forcing 

the decision makers to calculate that into their decision-making 

process. So thank you. 

The CHAIRMAN. Thank you, Jim. 

We thank you for your testimony. The book that you wrote 

opened a lot of eyes. It was a great title and it helps us in shorthand to make these points and you continue to add to it. 

I want your institutions to start thinking about giving tenure 

and promotions. You said you are going to be at the American Economic Association? Is that what it is called? If you write a paper 

for testimony, you should get extra credit because you are being 

peer reviewed right here, in my opinion. Thank you so much. You 

are really making a contribution to our understanding of all of 

these issues. 

We will proceed to Panel Two. 

We have with us on Panel Two—retired Major General John Batiste, retired Major General William Nash, and retired Colonel 

James McDonough. We thank you not only for your active-duty 

service but you thinking about these issues when you are retired 

and trying to help all of our citizens have a better quality of life. 

We thank all of you for being here. General Batiste, the floor is 

yours. 

STATEMENTS OF MAJOR GENERAL JOHN BATISTE, USA (RET.), 

ROCHESTER, NY; COLONEL JAMES D. MCDONOUGH, JR., USA 

(RET.), PRESIDENT AND CHIEF EXECUTIVE OFFICER, VETERANS’ OUTREACH CENTER OF ROCHESTER, NY; AND 

MAJOR GENERAL WILLIAM L. NASH, USA (RET.), WASHINGTON, DC (INDEPENDENT CONSULTANT) 

STATEMENT OF MAJOR GENERAL JOHN BATISTE, USA (RET.) 

General BATISTE. Thank you, sir. It is great to be here. 


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I am a 31-year veteran, combat veteran, first Gulf War, Bosnia, 

Kosovo, Iraqi Freedom, Chair of the New York State VA Commission, Board Member of the Veterans Outreach Center, Board Member of the great program called Warriors Salute. It goes on. I have 

a passion for veterans. 

The CHAIRMAN. You are overqualified. You are dismissed. 

General BATISTE. Let me be very brief. You have my comments 

in writing, but let me just capture the high points, what this is all 

about. 

We are draining our Treasury in blood and dollars with little to 

nothing to show for. We have never had a real comprehensive national strategy to deal with global Islamic extremism or whatever 

you want to call it. I would recommend everyone in this room read 

Bob Woodward’s book. It lays it out. 

Our interagency process is broken. The last panel was terrific, 

but the 800-pound gorilla in the room is that we don’t have an 

interagency that could develop a strategy to do anything. Let me 

expand on that a bit. 

It is a failure of both the Bush Administration and the Obama 

Administration. Most people that I talk with confuse the defense 

strategy with a comprehensive national strategy. Don’t fall into 

that trap. Of course, the Defense Department has a strategy. But 

the national strategy does not exist, no process to develop it, no 

trained planners in the 18 major departments and agencies to do 

it; and, as a consequence, there is no unity of effort, no teamwork, 

no base document that lays out the specified tasks to all 18 departments and agencies. Nobody is in charge, no process to balance the 

ends, ways, and means. And that is exactly what the last panel 

told you. 

Why are we discussing a Veterans Trust Fund 9 years into these 

wars? The reason is simple. There was never an interagency process to develop the strategy with the VA at the table to figure all 

of that out when it should have been figured out. We might very 

well have decided if we had done the strategy right that the ends, 

ways, and means were not in balance and, therefore, this was not 

a good idea. That at the end of the day is the bottom line. 

I would recommend that the Congress develop and do for the 

interagency process what the Goldwater-Nichols Act of 1986 did for 

the Department of Defense; and I offer that up to any Member who 

wants to, in my opinion, grab hold of the most important issue in 

our country today. And until we do that, we will never handle a 

Katrina right, we will never deal with an oil spill right, we will 

never deal with peak oil, we will never solve global Islamic extremism. We can’t plan our way out of literally anything. 

In conclusion, I will say again, as I have said many times, that 

how we treat our veterans defines our national character. In my 

view, based on my position—my observation within New York 

State and the country that we collectively get a failing grade. There 

is no synergy between Federal, State, county, and communitybased organizations and efforts that are ongoing. 

There are a million vets in New York State. Most of those are 

not being served. Their needs are absolutely not being met. Three 

hundred thousand Vietnam vets in New York State that are trying 

to deal with the 19 presumptive illnesses of Agent Orange. They 


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are going nowhere. There are 80 to 90,000 Iraqi and Afghanistan 

War vets in New York State. 

I could sit here for days and give you examples of how these 

young soldiers, men and women, are being let down by you and I. 

I won’t do that to you. 

But someone has stated that we are living in a sea of goodwill. 

I believe that is the case with all the people that I talk with. But 

there is—let me be very clear here. There is a huge difference between sending care packages from being fully committed to doing 

the right thing for veterans for as long as it takes. 

Sir, thank you. 

[The prepared statement of General Batiste appears on p. 53.] 

The CHAIRMAN. Thank you so much. Can you, by the way, define 

the Goldwater-Nichols Act? 

General BATISTE. The Goldwater-Nichols Act of 1986 took a dysfunctional Department of Defense, an Army, a Navy, a Marine 

Corps and an Air Force, all of these organizations working at odds 

against each other in a stovepipe organization and did so much to 

bring that team together, created the position of the Chairman of 

the Joint Chiefs, the Joint Staff, and today the services act like a 

team. There is unity of effort. 

I have served on the Joint Staff. Others in the room have as well. 

It works. 

The interagency process, on the other hand, needs this solution 

very quickly. And, again, it goes well beyond taking care of veterans. This is about doing the right thing for our country right 

now. The past Administration and the current Administration have 

not fixed it. It is a serious problem. And until we fix it, we are 

going to continue to meander. If you don’t know where you are 

going, any road will get you there. 

The CHAIRMAN. You just sped up my retirement from Congress 

for many years. Thank you, sir. 

General Nash. 

General NASH. Mr. Chairman, with your permission we should 

ask Colonel McDonough to speak first. 

The CHAIRMAN. Okay, Colonel McDonough. 

STATEMENT OF COLONEL JAMES D. MCDONOUGH, JR., USA 

(RET.) 

Colonel MCDONOUGH. Chairwoman Filner and Members of the 

Committee, I would like to thank you for the opportunity to appear 

before you today to discuss the true cost of war and its impact on 

veterans and their families, which is where I will spend my time. 

The truth about caring for veterans and their families in this 

country is that, for the vast majority, it is a luck of the draw proposition, determined largely by one’s geographic location and proximity to advocacy and resources that define success or failure as a 

veteran. Some will draw the card needed at precisely the right moment, and others will not. Some veterans will get help, and other 

veterans will not. The best we hope for as veterans to find an advocate who can help teach us what it means to become a veteran of 

our Armed Forces. I say this confidently after serving 26 years in 

the active Army, becoming a veteran and serving the past 3 years 

as Director of New York State’s Division of Veterans Affairs. 


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The true cost of war in some part can be tracked by our country’s 

willingness to consent to sending young men and women into battle. If willing to spend it all, citizens, through their elected representatives, provide their consent in return for the understanding 

that the Nation will be behind each and every warrior and their 

family as they head into battle. The Nation will provide for their 

every need if the circumstances demand, because we ask so much 

of each of them. This construct is fundamental to the American 

warrior, but I question whether it is shared by all in this country. 

The sea of goodwill referred to by General Batiste during this 

morning’s testimony before Congress is a phrase used by some in 

the Pentagon to describe and characterize how America views its 

support towards our veterans and their families, including me and 

mine. As the leader now of the Nation’s oldest nonprofit for veterans and their families, I question such claims that a galvanized 

effort is under way in this country behind its veterans and its families. 

From my perspective, our citizenry is indeed supportive of sending young Americans into battle. We have their consent to do so. 

But little to nothing is understood about their actual needs upon 

returning from battle and reintegration back into the very community from which they departed. 

One reason for is that our country lacks a coherent national 

strategy, such as General Batiste described, to not only go to war 

but to come home and care for those who fought these wars as well. 

And while I believe it is in our country’s best interest to foster that 

sea of goodwill around caring for veterans and their families, only 

ponds and lakes currently exist across this country unconnected by 

a coordinating tributary, linking river, or supporting stream. These 

separate and distinct efforts spring up daily but lack context, fit, 

and perspective, often leaving veterans and their families only to 

recognize and receive a fraction of their earned benefits or access 

to health care and services to support their reintegration. There is 

no sea in the sea of goodwill, only disjointed smaller bodies of 

water, which serve a minority of our veterans and their families 

and very poorly at that. 

So how do we improve upon that? Point one, start leveraging 

community-based private-sector providers to provide better care for 

veterans and their families. At the end of the day, what we want 

is barrier-free access to services and our families included to address the aftermath of war. 

On any given day in America, only a minority of returning veterans actually use VA services, leaving a majority of returning veterans and their families somewhere outside the VA’s portfolio of 

services and benefits. And, remember, these are benefits and services they have earned due to volunteer active service in the United 

States Armed Forces. 

So the first thing to reckon with in creating the conditions necessary for a sea of goodwill to exist in this country is that our system designed to care for veterans, the VA, the Department of Veterans Affairs, must be more inclusive to capture the majority 

versus the minority of veterans. To reach the majority of returning 

veterans not using their service, the VA must include communitybased providers as part of a more coherent delivery network, priVerDate Mar 15 2010 03:50 Jan 13, 2011 Jkt 061761 PO 00000 Frm 00027 Fmt 6633 Sfmt 6633 I:\WAYS\OUT\61761.XXX GPO1 PsN: 61761

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vate providers supported by the VA and working alongside public 

providers to deliver barrier-free and high-quality veterans’ services, 

benefits, and programs. 

The place to start is with our families, since that is where the 

VA is not charged with any responsibility outside its veterans’ centers. To think for a moment that you can somehow effectively treat 

the veteran absent his or her family where residual harm and damage lingers fails to understand one of the true costs of these wars, 

namely, that our families, spouses, and children have become casualties as well. So to understand the true cost of war, the system 

in place to care for veterans and their families must work to account for and include all of us who have served and our families. 

How this country supports a system of care for a minority of veterans at the expense of the majority is something we all need to 

understand in order to advocate for change. In our communitybased counseling center, Veterans Outreach Center in Rochester 

New York, we see on average 53 new veterans and family members 

every month; and that statistic is repeated in community-based 

clinics and counseling centers across this country outside of the VA. 

Our housing services, which consist of emergency, transitional, 

supportive, and independent living for homeless veterans, operates 

at capacity, 28 units every month. We have a waiting list just to 

get in. Folks can stay with us for up to 2 years. 

Twenty-five percent of our census today is compromised of veterans who have served in Afghanistan, Iraq, or both, which brings 

me to my second point. The true cost of these wars must include 

the sum cost of underwriting a troubled force. A 350-page report 

issued in July after a 15-month investigation into the Army’s rising 

suicide rate found that levels of illegal drug use and criminal activity had reached record highs, while the number of disciplinary actions and forced discharges were at record lows. The result the 

Army found is that drug and alcohol abuse is a significant health 

problem in the Army. 

Where the Army once rigidly enforced rules on drug use, it got 

sloppy in the rush to get soldiers ready for the battlefield. From 

2001 to 2009, only 70 percent of DUIs (driving under the influence) 

and 61 percent of positive drug tests were referred to the Army’s 

substance-abuse program, and drug testing became haphazard. In 

2009, 78,517 soldiers went untested for illegal drugs. Statistically, 

the Army estimated that 1,311 offenders probably escaped detection. ‘‘Where did they go,’’ said General Chiarelli, Vice Chief of 

Staff of the Army. 

We have kids that are going to have some behavioral health 

issues. The real hard part for to us determine, okay, I am willing 

to help this kid, but how long can I help him? These troubled kids 

have since separated and are now veterans and are back in every 

community in this country. As I stated a moment ago, they make 

up 25 percent of the homeless veterans we serve every day in upstate New York. 

Why, if we are the greatest country in the world, the one that 

prides itself on reminding others it cares for those that serve, do 

we continually pour good money down bad holes and experience the 

same substandard level of care we have come to almost expect as 

veterans? Has it become that bad that our expectation as veterans 


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is to be cared for poorly? Could a national strategy help? Certainly 

it can’t hurt, just as legislation to create a Veterans Trust Fund 

can’t either. 

An up-front investment to be made prior to going to war serves 

to remind everyone that the true cost of war is calculated differently, that human factors, families, children, spouses, veterans 

actually have real value and their care must be accounted for to 

receive our Nation’s true consent to wage war. If America paused 

for only a moment to count the true cost, it might just not like the 

price tag associated with their consent. As a veteran and now 

someone who cares for veterans and their families in a community 

setting, perhaps the cost of obtaining the Nation’s consent is the 

greatest cost to be calculated beforehand. 

Chairman Filner, I appreciate the opportunity to speak before 

you today. Thank you. This completes my statement. I will be 

happy to answer any questions you may have. 

[The prepared statement of Colonel McDonough appears on 

p. 54.] 

The CHAIRMAN. Thank you so much. 

General Nash. 

STATEMENT OF MAJOR GENERAL WILLIAM L. NASH, USA 

(RET.) 

General NASH. Thank you, Mr. Chairman. If it is okay with you, 

I would like to submit my statement for the record and just make 

a few comments here. 

The CHAIRMAN. That will be done. Thank you. 

General NASH. Sir, I begin with thanks, thanks to you and 

thanks to the Committee for your concern for veterans and their 

families. 

I also want to say that I could not be happier with our Secretary 

of Veterans Affairs. I think General Shinseki, who is an old friend, 

has taken on a very hard job and needs all of the help you and I 

can give him. And I would thank him for his service, and I would 

encourage us all to help him push those rocks up the hill. 

In the early 1980s, sir, I was a young commander in Germany 

and worked for a division commander. He used to distinguish between the love of soldiers and the care for soldiers. And he said 

that a lot of people like to pound the table and talk about how 

much they love soldiers, but some of those same professionals 

failed to understand what it took to care for soldiers, to equip 

them, to train them, to feed them, to pay them, to house them. 

The same battalion commander that would make eloquent 

speeches about love of soldiers didn’t understand how his personnel 

administration center worked and, therefore, the promotion system 

for the young soldiers was inefficient and inadequate to meet the 

aspirations of the individual soldier and needs of the Army for people to be promoted. And my commanding General would talk about 

the fact that to achieve care for soldiers you needed expertise and 

systems, you needed resources to make those systems operate, and 

you needed great energy to bring it all together. 

So as I look at what has been described this morning as a sea 

of goodwill, whether it be yellow ribbons or bumper stickers or 

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es, I hear a lot of love, but they don’t do the job of taking care of 

the veteran and his family. That, too, requires expertise, resources, 

and energy. 

The earlier panel talked about the contract that we have with 

those soldiers, sailors, airmen, and Marines. I would point out to 

you, sir, that that contract is an unlimited liability contract that 

the servicemember signs. It is cosigned by their spouses and their 

family members and their friends. We, as a Nation, having chosen 

to have an all-volunteer force, we must underwrite those contracts 

to full value. 

We have talked a lot this morning about our failure to anticipate 

requirements and to prudently prepare for those consequences. 

Others more knowledgeable, more articulate than I have talked 

about it to great detail. You, Mr. Chairman, have recognized the 

fatally flawed system of processing claims and appeals; and I would 

just say that the bottom line is the need for expertise, resources, 

and energy. 

As to resources, I think the conversation about a forced-savings 

program for veterans is sound. The Veterans Trust Fund is an idea 

that I think is desperately needed. 

But I think also we need to look at this issue with a broader perspective beyond the Veterans Administration. We have decided as 

a Nation to have that volunteer force, Active and Reserve, and I 

think we need to understand that, while their commitment is unlimited in scope, we, too, must examine the entire package of pay 

and benefits that we as citizens are willing to spend in order to recruit, train, and reward the small group of people, less than one 

percent of our population, that go in harm’s way. 

I think we need—as we are examining the true cost of the war, 

we need to have a better understanding of the true cost of the allvolunteer force. I, too, was privileged to serve over 30 years with 

the dedicated public servants. I have looked soldiers in the eye and 

given them the direct order to face battle and its horrible consequence. But I was able to do that because I knew that they were 

trained, equipped, and would be cared for and supported. We were 

individually and collectively very capable. We would leave no one 

behind. So must our Nation. We care for those who serve now and 

forever. 

Mr. Chairman, I look you in the eye and say that we must do 

even more to promote the necessary care through the development 

of expertise, the allocation of resources, and the great, great energy 

that is necessary to take care of those who serve us. 

I thank you very much; and, again, I appreciate your working on 

behalf of the veterans. 

[The prepared statement of General Nash appears on p. 57.] 

The CHAIRMAN. Thank you all so much. With your background 

and expertise, I think you have given us a framework to look at 

a lot of things that we observe all the time, but you have put it 

all into a framework that leads to a better understanding. 

As I listened to you and read your testimony, these come into 

conflict with the bureaucratic dynamic that sort of works—as individuals—with the 250,000 people that make up the VA. Most of 

them—almost everyone is committed to veterans. They want to do 

a good job. They work hard. 


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Yet the institution becomes something different. Many of our veterans think VA means ‘‘veterans adversary,’’ because they are constantly fighting with the VA. The turf wars that have made the 

kind of approach you are looking at, General Batiste, is very difficult. How do we break through that bureaucracy? 

You said some kind words about Secretary General Shinseki. I 

thought that he would be able to impose more change some stuff 

on the bureaucracy. However, it looks like it is working the other 

way, from my observations. In the Army when he says something, 

it gets carried out. In a bureaucracy, who knows? Besides the people who have to tell you it has been carried out. 

I will just give you one example of how I had asked General 

Shinseki this in his first meeting, his first appearance here on the 

Committee. I asked him about suicide coordinators that were supposed to be in place and I have been told there is a suicide coordinator at every hospital. I am only a private and you are a general, 

but let me tell you that you have to look beneath what you just 

heard or what you have been told. The janitor who has a 10-percent suicide coordinator job title by his name is probably at some 

hospital or there is a half-time person someone untrained. You 

have to go beyond what you hear. If that was his Army staff telling 

him, he could rely on it. But I don’t think he can rely on it with 

the bureaucracy here. 

How do you get through that to get to some of the issues you are 

talking about? 

General NASH. I know General Batiste will have some comments 

on this as well, but I would just start out the response is that 2 

years is a very short time when you are trying to overcome years 

and years of less than brilliant management. And the key to it, in 

my view, is not unlike the approach the services are taking with 

the emphasis on professional development of your workforce in parallel with your day-to-day working. 

We send off Army officers to school all the time. We take them 

out of the operating force, which is more and more difficult when 

you are fighting the wars we have been fighting for the last 9 

years. Even in World War II, we took people out of the force for 

purposes of education. In enduring times of peace, we did it even 

more so. 

So if you don’t set up a system to develop your workforce, you 

are never going to get better. You are going to keep fighting the 

same battles day in and day out and, as administrations change, 

all too many people turn over. And so the professional force has to 

be developed in such a manner that it provides the continuity. So 

when the Secretary of Veterans Affairs gives an order, there is a 

reasonable expectation it will be carried out uniformly throughout 

the force. 

Now, General Shinseki can tell you stories about having those 

problems when he was Chief of Staff of the Army. It wasn’t quite 

as uniform as we all might believe. But I think that is very important. 

And the number two thing is I do think we have to look at some 

of our personnel, civilian personnel regulations that allow a lack of 

expertise to succeed. 

The CHAIRMAN. General. 


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General BATISTE. I agree with General Nash. 

I also think that the VA is a very small cog in a huge bureaucracy, a bureaucracy that is not defined by teamwork and, as I discussed earlier, that it is without process. That bureaucracy, as 

huge as it is, can be reorganized. It will probably take something 

like a Goldwater-Nichols Act to do for that process interagency as 

it did for the Department of Defense back in 1986. 

Most in this room don’t even know what I am talking about, because that is so long ago. We all need to go back and read about 

that and see what happened and what it did. 

But that bureaucracy desperately needs process, it needs training, it needs trained planners and every single department to include the VA and State Department and the Department of the 

Treasury or whatever, fill in the blank. Responsibilities need to be 

defined. Somebody needs to be in charge. It is not the President 

today. 

We need organization. We need to be able to issue orders to the 

departments and agencies of our governments and have the expectation that they will do what they are told. And that is absolutely 

doable. It is possible. Plans developed, plans resourced, and then 

follow through to make sure people do what they are told to do. 

I think we are at a tipping point in our country, as I said earlier. 

If we don’t fix this, we will never be able to respond to a natural 

disaster. We have some real problems in front of us, and right now 

I would say that this government is disorganized, not focused. I, as 

a citizen, am looking for unity of effort, teamwork, and a commonality in what we are setting out to accomplish. 

The CHAIRMAN. Thank you, sir. 

Colonel MCDONOUGH. I am going to take a slightly different approach. While I agree with both General Nash and General Batiste, 

I think you have to start with the underlying principle at work 

here. The Department of Veterans Affairs, as one of our largest departments in Federal Government, exists to serve a minority of veterans and their families. The overwhelming majority are not being 

seen within the tent of the Department of Veterans Affair, especially when you add families to that. 

We are out in our communities pursuing whatever it is we are 

pursuing, gaining access to health care, counseling, benefits. We 

are doing all of that as a majority in this country out in a community setting. So when you look at the structure, I really think that 

what you need to look at is, is it performing where it needs to perform. 

What I mean by that is when the Department of Defense looked 

at aging infrastructure, it BRAC’d (Base Realignment and Closure) 

those type of things that were underserving and no longer needed. 

As the defense strategy changed, so, too, did where we base troops. 

If you go to some of our aging VA facilities around New York 

State, you are going to walk away with a conclusion that they are 

in the wrong spot serving a handful of veterans, whereas in communities where there are a good number of veterans, they are not. 

So where they are not, how do you take care of veterans and 

their families? And that is what I mean by leveraging community 

partners. Involve them in the process. 


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It is a big tent. The VA is one of those lakes I refer to in my 

testimony. It is not the sea itself. There are many players that go 

to work every day to care for veterans and their families. And 

when you look at the system as a system you understand that it 

is exists only to care for and service the minority of veterans that 

we are all talking about today. The overwhelming majority are outside the tent. We are out in communities pursuing our livelihood, 

through private physicians, through self-pay. 

There is a way to include that by making sure that the system 

is more comprehensive and looking at the architecture of the system and saying where it isn’t working anymore, where it is underserving there is probably a better way to do it and move those resources where they are needed. 

General NASH. Sir, if I could just add, that is a very important 

point. If you are ever asked the solution to the problem to care for 

veterans and their families, whether it should be a top-down or a 

bottom’s-up approach, the answer is yes. Because it has to be both 

of those methods used. 

The CHAIRMAN. Well, thank you all for your optimistic appraisal 

of the situation. I agree it is doable. It is just a massive situation, 

and have to confront it as a Nation. 

As I listened to you and some of the political streams that are 

going on in our country today I think it may be a reaction to focus, 

purpose, and unity, the lack of direction. People get angry and they 

don’t know what they are angry about, but they don’t see the system working for them. And I think you all have helped us understand that a little bit better. Hopefully, we can respond in my lifetime to your concerns. Thank you so much for helping us understand this better. 

Panel Three can come forward. 

Joining us on Panel Three is Paul Sullivan, the Executive Director for Veterans for Common Sense (VCS); Lorrie Knight-Major, 

mother of a soldier from Silver Spring, Maryland; Corey Gibson, a 

veteran from Terre Haute, Indiana; and retired Lieutenant Colonel 

Donna Van Derveer from Ashville, Alabama. 

We thank all of you for being here today. If you have written testimony, it will be made part of the record. 

You may have the floor, Mr. Sullivan. Thank you again for being 

here. 

STATEMENTS OF PAUL SULLIVAN, EXECUTIVE DIRECTOR, 

VETERANS FOR COMMON SENSE; LORRIE KNIGHT–MAJOR, 

SILVER SPRING, MD (MOTHER OF VETERAN); COREY GIBSON, TERRE HAUTE, IN (VETERAN); AND LIEUTENANT COLONEL DONNA R. VAN DERVEER, USA (RET.), ASHVILLE, AL 

(VETERAN) 

STATEMENT OF PAUL SULLIVAN 

Mr. SULLIVAN. Good morning. Veterans for Common Sense 

thanks Chairman Filner for inviting us to testify today about the 

true cost of war. 

Allow me to begin with a poignant quote by Jose Narosky, ‘‘In 

war, there are no unwounded soldiers.’’ 


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Mr. Chairman, we are here today because, in 2005, the VA faced 

a multibillion dollar budget shortfall because of the flood of Iraq 

and Afghanistan War veteran patients. Similarly, in 2007, DoD 

faced a national scandal at Walter Reed because it lacked planning 

and staff to handle battlefield casualties. 

Another very high and tragic price of our Nation’s failure to plan 

for our returning veterans can be seen in the skyrocketing suicide 

rate among our servicemembers and our veterans. Sadly, as you 

mentioned, new records are set each year. 

Our comments today about the true cost of war have three parts. 

First, we will talk about VA and DoD statistics; second, we will 

state our support for a new veteran benefit trust fund; and, third, 

we will urge Congress to give the current wars meaning for our 

servicemembers and veterans. 

First, here are the facts. Using the Freedom of Information Act, 

Veterans for Common Sense asked the military to tell us how 

many servicemembers have gone to the two wars; and the number 

is about 2.2 million. The Department of Veterans Affairs has treated 565,000 Iraq and Afghanistan War veteran patients at VA medical facilities. 

I ask you to look at the chart that we brought on the left over 

there, the first one, veteran patients treated by VA. As we can see, 

we loaded all of the data and it shows a sharp rise. And this information was provided to Professor Bilmes and Professor Stiglitz for 

their great work and ground-breaking effort to find out the cost. 

The one thing that is most surprising is that the numbers keep 

rising at the same rate, even though there are comments that the 

wars are deescalating and troops are coming back. Mr. Chairman, 

VA averages about 9,000 new patients each month. VCS estimates 

the count of VA patients today is about 619,000. By the end of 

2014, VCS estimates a total of one million new war veteran patients treated by VA. These counts of patients exclude veterans 

treated at military facilities and it excludes veterans treated by private care. 

On another subject, the VA has received 513,000 disability 

claims from Iraq and Afghanistan War veterans. Again, we have a 

chart over to my left, and it shows a very steep sharp rise in the 

number of claims from Iraq and Afghanistan veterans, and that 

rate of claims is higher than initially projected by Professor Bilmes 

and Stiglitz showing that their estimates were conservative. At the 

end of 2014, VCS estimates VA will receive about one million total 

claims from Iraq and Afghanistan War veterans. 

Switching to the Department of Defense, the military has reported 5,670 U.S. servicemember deaths in the Iraq and Afghanistan War zones. A total of 91,384 U.S. servicemembers were 

wounded or were medically evacuated due to injuries or illnesses. 

The grand total of U.S. battlefield casualties is more than 97,000. 

Here are two important facts. You were looking for headlines, 

Mr. Chairman. There are 100 new first-time veteran patients treated at VA for each battlefield death reported by the military. A second bullet point, there is one new VA patient every 5 minutes from 

these two wars. 

VCS is here today to endorse the proposal by Professor Linda 

Bilmes and Professor Joseph Stiglitz to create a veteran benefit 


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trust fund to make sure our veterans receive the health care and 

benefits they need and earned. 

In their book, ‘‘The $3 Trillion War: The True Cost of the Iraq 

Conflict,’’ the experts wrote, and I quote: ‘‘There are always pressures to cut unfunded entitlements. So when new military recruits 

are hired, the money required to fund future health care and disability benefits should be set aside, ‘lock-boxed,’ 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 larger 

amounts for future health care and disability costs as these will inevitably rise significantly during and after any conflict,’’ unquote. 

VCS agrees with the experts’ logical proposal. If we don’t prepare 

for our veterans, then our Nation may see more troubling news 

such as more suicides. According to testimony today by Professor 

Bilmes and Professor Stiglitz, the financial cost for health care and 

disability payments may be as high as $1 trillion. 

VA has made many impressive improvements in personnel, budgeting, and policies in the last 20 months, much of it thanks to the 

efforts of this Committee. VCS encourages Congress, VA, and DoD 

to learn lessons from past mistakes. VCS urges Congress to mandate national monitoring and planning for the return of our 

servicemembers. 

A national plan must also include fully funding all needed health 

care and benefits. We must honor and remember our fallen, and 

that is our last message. 

Archibald MacLeish, a World War I veteran and former head of 

the Library of Congress, wrote in a poem: ‘‘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.’’ 

VCS asks Congress to give meaning to our Nation’s fallen, 

wounded, injured, and ill who deployed to war. Our Nation must 

learn the painful lessons from prior wars and take care of our veterans who are protected and defended our Constitution, even when 

the American public does not support the war or when the war was 

started with misleading claims. 

We close with two powerful messages, Mr. Chairman. 

First, as of today, Veterans for Common Sense estimates our Nation currently has as many as 619,000 Iraq and Afghanistan War 

veteran patients, plus a similar number of disability claims. VA 

can reasonably expect one million claims in patients by the end of 

2014 if the trends continue. 

And, second, our Nation has no strategic plan to identify, monitor, treat, and compensate those veterans. We ask you, please, fix 

that today by introducing and passing legislation to create a veteran benefit trust fund. 

Thank you, Mr. Chairman. 

[The prepared statement of Mr. Sullivan appears on p. 58.] 

The CHAIRMAN. Thank you, Mr. Sullivan. 

Please, Ms. Knight-Major. 


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STATEMENT OF LORRIE KNIGHT–MAJOR 

Ms. KNIGHT-MAJOR. Good morning, Mr. Chairman and Members 

of the Committee. The following details a significant role that the 

nonprofit organizations in the communities have played in helping 

my injured soldier regain his independence. 

My name is Lorrie Knight-Major, and please correct the record. 

I am not a veteran. I am the mother of Ryan Major, Army Sergeant 

retired. 

On November 5, 2003, Ryan enlisted into the United States 

Army for a 3-year term. He was stop lossed. On November 10, 

2006, 5 days after his original discharge date, Ryan was critically 

wounded as a result of an improvised explosive device blast while 

on a mission with his unit in Ramadi. As a result of the blast, 

Ryan sustained multiple massive injury, including both legs were 

amputated above the knee, both arms were broken with multiple 

fractures, extensive peritoneum injuries, severe right pelvic fracture, traumatic brain injury, and post-traumatic stress disorder. 

Ryan reached Walter Reed within 4 days of the injury and underwent multiple surgeries over the course of 6 weeks. Ryan was 

then transferred to R. Adams Cowley Shock Trauma Center at the 

University of Maryland Medical Center, where he stayed for 1 

month. Then Ryan was transferred to the National Rehabilitation 

Hospital (NRH), where he spent the next 7 months. 

But getting Ryan into NRH wasn’t easy because he was an enlisted soldier. Before going to NRH, we were given four options of 

VA polytrauma hospitals in the U.S., but none were close to home. 

Ryan’s transfer to any of them would have required me to travel 

out of State and live for many months far from home without social 

support and away from my job while leaving my minor child at 

home. This was not an option for our family. 

Our veterans should have access to regional trauma hospitals 

and nationally recognized rehabilitation facilities that possess expertise on polytrauma that are located near their homes. Most families of severely injured soldiers travel across State lines and live 

in hospitals, motels, and hotels rooms to be near their injured soldiers for many months, placing additional burdens on an already 

emotionally fraught time period. 

Once it appeared very likely that Ryan would survive, I started 

to plan for his return home. Because of the wheelchair, major 

structural changes to our house were needed to accommodate him. 

Two separate architects examined our home and determined that 

we needed an elevator. Through the VA, there are three grants 

available for constructing an adapted home or modifying an existing home. To qualify for the maximum funding through these 

grants, veterans have to own the home. Up to half of the injured 

soldiers are single, and they return home to live with their parents, 

other family members or friends. Therefore, access to funding 

through the VA is limited to $14,000 for work done on someone 

else’s home where the veteran will live. 

This wasn’t available for us when Ryan came home in 2007. 

Fortunately, by word of mouth, I was informed about Rebuilding 

Together, a national nonprofit organization that provides home rehabilitation and modification services to homeowners in need. In 

2005, Rebuilding Together launched its Veterans Housing Program 


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to address the needs of soldiers returning from Iraq and Afghanistan. 

The work done to our home included an elevator, the conversion 

of our first-floor family room into Ryan’s bedroom with an accessible bathroom, a new deck addition for his egress, a new separate 

central air and heating system for his bedroom, and an in-ground 

generator for emergency purposes and escape. The value of these 

renovations is estimated at $150,000. Rebuilding Together made it 

possible for me to bring my soldier home. If we would have had access to the VA grant money, there still would have been a $100,000 

deficit. 

Rebuilding Together’s housing program has rehabilitated and 

modified the homes of 725 veterans and 25 veterans’ centers, with 

a market value exceeding $12 million. If these services had not 

been provided, all of these veterans would not have the quality of 

life they now enjoy, since the VA does not fully accommodate all 

of their needs through its grant programs. 

Ryan also received an IBOT wheelchair from another nonprofit 

organization, the Independence Fund. This chair can climb stairs 

and rises in the air, raising the seat height. Independence Fund 

has donated 20 IBOTs to wounded soldiers and veterans, totaling 

$500,000. Again, the VA did not have the ability to provide Ryan 

with this level of specialized equipment. 

Ryan also received a service dog named Theodore from Paws for 

Liberty. Theodore is a 3-year-old Belgian shepherd and has truly 

made the biggest impact on Ryan’s independence. Theodore helps 

Ryan with retrieving dropped items, helps him navigate crowded 

areas, and helps relieve and mitigate his PTSD symptoms. These 

dogs cost, on average, $15,000 to $20,000 to train—again, a resource not offered to Ryan by the VA. 

I have had to reach outside the system and rely on the nonprofit 

community for assistance throughout this ordeal. As Congressman 

Moran stated earlier, the costs have to be picked up. In my 4-year 

experience, it is being picked up by the nonprofits and families. We 

are the ones that are bearing this cost. This support should be provided by the government. 

It has been the nonprofits that have provided Ryan with the resources for him to live at home with his family, take charge of his 

own care, and allow him to feel safe and sleep at night. In light 

of this, there should be better collaboration between the Department of Defense, the VA, and nonprofit organizations. 

Navigating the complex maze of treatment options and benefits 

is a job in and of itself. As a result of caring for Ryan and the emotional toll it has taken on our family, I had to leave my job to provide the necessary level of medical care and advocacy that my son 

required. This led to significant financial hardship. Families should 

not have to sacrifice and bear the burden of advocacy and compromise their own financial stability and wellness to ensure that 

their soldiers receive the appropriate and necessary services from 

the government. 

I do recognize that progress has been made in the caring of our 

injured soldiers. We still have a ways to go. Here are the things 

that I would recommend to improve the lives of wounded warriors 

and veterans: increase the amount of the VA housing grant; estabVerDate Mar 15 2010 03:50 Jan 13, 2011 Jkt 061761 PO 00000 Frm 00037 Fmt 6633 Sfmt 6633 I:\WAYS\OUT\61761.XXX GPO1 PsN: 61761

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lish a competitive fund for national housing organizations to compete for housing dollars to better enable them to provide housing 

modifications for veterans; service dogs are made available by the 

VA to veterans with service-connected disabilities, as are done with 

guide dogs; increase the VA automobile grant; increasing the number of authorized electric wheelchairs based on a veteran’s changing needs; mandatory vocational rehabilitation assessments conducted before a veteran with service-connected disabilities separates from the military; and authorize a clothing allowance that is 

available for veterans to be available to servicemembers with similar injuries and conditions. 

As a mother, here are a few things that I would recommend that 

would have made my life easier if they were in place: health insurance allowance for myself and my minor son; non-medical attendant allowance that is provided by the DoD to caregivers of veterans 

who receive medical care greater than 50 miles from their residence. Since I live within the 50-mile radius, I didn’t qualify for the 

DoD benefit, but the VA could have filled the gap. 

As an observer with a window seat, here are my recommendations for the providers of care: allow private providers and facilities 

to fill in the gaps when a VA facility is not in the veterans’ community; improve communication between all of the providers, regardless if it is the VA, DoD, or the private sector; and, thirdly, require 

a pain team and infectious disease specialist as part of the multidisciplinary team approach for severely injured soldiers. 

I ask this Congress to not only honor this country’s solemn oath 

to care for our veterans, but I urge you to work towards the United 

States being proactive in making funding available for our wounded soldiers and veterans. If the United States can set aside funds 

for an unexpected oil spill, surely it can put aside monies at the 

time a war is authorized to take care of our military that continues 

to take care of us, preserving our freedom. 

We owe a tremendous debt to our veterans for their services and 

their families’ services and sacrifices. So I ask, if the nonprofit organizations had not provided assistance, would it have been acceptable to the government for my son to have been placed in a nursing 

home? Would it have been acceptable to the government for my son 

to have lived isolated in a basement because he didn’t have a 

means of accessing the main areas of the house? Would it have 

been acceptable for my son to require sleep medications or someone 

to be in his room nightly for him to sleep? Is this what the government considers to be the cost of the war? 

Again, thank you, Mr. Chairman, for the opportunity of sharing 

my personal experience. 

[The prepared statement of Ms. Knight-Major appears on p. 64.] 

The CHAIRMAN. Thank you so much. I know that it is not easy 

to talk about these things, but we appreciate you sharing that with 

us. 

Mr. Gibson. 

STATEMENT OF COREY GIBSON 

Mr. GIBSON. Good morning, and thank you, Mr. Chairman. My 

name is Corey Gibson, and I am a combat veteran from the Operation Iraqi Freedom campaign. I am here before you today as a colVerDate Mar 15 2010 03:50 Jan 13, 2011 Jkt 061761 PO 00000 Frm 00038 Fmt 6633 Sfmt 6633 I:\WAYS\OUT\61761.XXX GPO1 PsN: 61761

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lective voice for veterans nationwide. While this may be my individualized account, the issues and concerns within my time with 

you are pervasive. 

You all trained me how to fight, how not to turn in the face of 

an enemy, and how to watch out for the better interest of my 

brothers and sisters in arms. Regardless of my daily struggles with 

post-traumatic stress disorder, traumatic brain injury, and other 

diagnoses, don’t think that the training I received calls for me to 

stop fighting now. 

On September 23rd, Michelle Obama stated that veterans and 

spouses need support by local employers everywhere. I am sorry we 

can’t get Stephen Colbert here to help highlight problems with veterans’ health care and benefits. Could we send him into combat, 

where he will be forced to make the decision of kill or be killed in 

defense of his country, only to come back to a life of physical and 

mental disabilities so that we can have his input? He stated he 

likes to help people who don’t have any power but are needed by 

the American people, and I think that is exactly what many of us 

veterans feel that we are. Where is our celebrity? 

I was honorably discharged in October 2004 after being part of 

the initial surge into Iraq as a triage medic for the 555th Forward 

Surgical Team. I was exposed to things on a daily basis that will 

haunt my memories until my dying day. I am proud of the opportunity I had to defend my country, but only those who went before 

me, after me, and stood beside me know what that means. 

Truthfully, I should be a statistic, one of the many faceless veterans who are homeless or worse. I tried to integrate myself into 

a VA system, my local VA system, because I wanted to try and utilize my benefits, but also to help create a positive reintegration 

process at my local VA for those who were bound to follow me. 

I had voiced my complaints about back, neck, and shoulder 

issues that the Army did not investigate further. My complaints 

fell on deaf ears, as it took me 6 years to get an MRI and have 

the spinal issues that I have documented in my record. I took, at 

the beginning of this year, my own resources to fly to San Diego 

twice a month to get a specialist to start the process of a claim, 

because my own local VA ignored my complaints. 

I have had my personal information potentially leaked on a 

laptop that went missing from the VA and received merely an 

‘‘Oops’’ letter. I have been made aware, after an endoscopy procedure, that I may have to come back in for blood tests for hepatitis 

C or HIV because of improper equipment sterilization within the 

VA. 

If any of these things had happened in any other health care facility, I would be sitting here a wealthy man, and there would be 

many out of jobs due to negligence. But because we are veterans, 

we are subject to deal with the worst our Nation has to offer and 

are expected to be satisfied with that. Why? Why is it all too often 

minimized and eventually swept under the rug with no major 

changes? 

The rate of veterans committing suicide is astronomical. Statistics have shown that, last year, more than 125 veterans from the 

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flicts committed suicide every week. We have lost more soldiers 

here at home than in-country engaged in combat. 

Mental health services are paramount for our returning combatants. My interview, upon returning from Iraq, to decipher whether 

I needed mental health services or not was to be marched into a 

gym, separated from my family by a piece of glass, and asked if I 

wanted to see my family or do I feel that I need to talk to someone 

about my feelings at this time. 

Within the VA system, an individual veteran’s appeal for benefits 

can take up to 5 years. A reevaluation after a rating has already 

been established comes every 3. Why is it that it seems the system 

is more proactive in taking things away from veterans than reaching those in need? 

It is not just the people who serve, but it is the collateral damage 

destroying the lives of our loved ones who watch us struggle on a 

day-to-day basis and our inability to maintain relationships with 

those people because we do have unaddressed issues. 

My fiancee and I have discussed that, if we were to have a child 

before we got married, she would get more benefits toward her education than if she were just the spouse of a disabled veteran. Organizations such as Veterans of Modern Warfare, Vets 4 Vets, and 

the Coming Home Project are stepping up to fill the void of the 

VA’s shortcomings. Should they have to do this? 

On the tablet Lady Liberty holds, there is a sonnet, and that sonnet ends with, ‘‘Give me your tired, your poor, your huddled masses 

yearning to breathe free, the wretched refuse of your teeming 

shore. Send these, the homeless, tempest-tost to me. I lift my lamp 

beside the golden door.’’ Why is it that we veterans are outside that 

golden door, standing under overpasses begging for a few pieces of 

copper? 

I couldn’t be prouder to call myself a veteran of the United 

States military that joins me with a collective that is made up of 

some of the best our Nation has to offer. The ultimate fear for me 

and several of my veteran friends is that you have invited a veteran in to speak his compelling story and shine a light on the truth 

and it be dismissed. I am not here to simply complain, but I am 

here to point out the fallacies within the VA system. But, ultimately, it is up to you to take an action to fix this ongoing problem. 

I will end with this quick story. On my deployment, in the heat 

of battle, we took the most severely wounded as a life-saving measure. One of those was a Marine who came to us with his entire leg, 

from the hip down, looking like hamburger. I remember his words 

to me as he pleaded, ‘‘Doc, do whatever you have to do, tie a stick 

to it if you have to, but get me back in the fight because my guys 

need me.’’ How dare we offer this population anything less than 

our best. So I ask you to please do something. 

It is the unforeseen cost of the human toll war which beckons for 

a 21st-century veterans fund. This fund, if enacted, would mandate 

Congress to live up to its national obligation to acknowledge that 

caring for veterans is and must be a continuing cost of the national 

defense. 

[The prepared statement of Mr. Gibson appears on p. 68.] 

The CHAIRMAN. Thank you, sir. 

Colonel Van Derveer. 


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STATEMENT OF LIEUTENANT COLONEL DONNA R. VAN 

DERVEER, USA (RET.) 

Colonel VAN DERVEER. Thank you, Chairman, for allowing me to 

speak today. 

Good morning, ladies and gentlemen and distinguished Committee Members. My name is Lieutenant Colonel Donna R. Van 

Derveer, retired. I am originally from Washington, DC, but currently reside in Ashville, Alabama. 

I am honored to say I have served 29 years in the Army and 

Army Reserve as a military police officer and served my country 

with great pride and distinction. I served in Iraq as the anti-terrorism/force protection chief for Multinational Corps-Iraq from August 2004 through January 2005. During my tour, I faced numerous rocket attacks and barely escaped with my life after a small 

arms round came through my trailer. 

Upon returning from Iraq, I experienced increasing issues with 

sleep disturbance, nightmares, depression, memory loss, irritation, 

anger, and an inability to concentrate and multitask. I knew that 

I had a serious problem but feared that my security clearance and 

career would be impacted by seeking help. I did receive surgery on 

my right knee that I injured in Iraq. 

In 2006, I served as an action officer for J8, Protection Assistant 

Division, Joint Staff, Pentagon. During this tour, I eventually 

sought help through Defense Stress Management. Even with counseling, I was unable to manage my stress and give 100 percent to 

my position. I requested early release from my tour. 

After delay, denial of medical treatment, abusive counseling sessions, being relieved of duty, suspension of my security clearance, 

and a 4-day stay in Ward 54 at Walter Reed Army Medical Center 

as a civilian in non-duty status, I finally received help. On September 27, 2007, I was put on Medical Retention Processing 2 orders and attached to the Warrior Transition Brigade at Walter 

Reed. 

The 2 years, 4 months spent at Walter Reed was no less challenging than what I had already faced. The issue of improper diagnosis impacted my care. My psychiatrist placed an erroneous entry 

in my medical records, causing a delay of proper care for PTSD for 

over a year. This error impacted my Medical Evaluation Board/ 

Physical Evaluation Board, MEB/PEB, thereby reflecting PTSD as 

‘‘existed prior to service.’’ I was forced to prove my service and incident occurred in Iraq, since females are considered non-combatants 

even in a combat zone. 

The MEB/PEB process was excruciating for me. From my experience, I see the purpose of the DES pilot program is to expedite the 

process to save the Army money rather than provide for the soldier’s disability compensation and wellbeing. 

I received 50 percent disability from the Army for PTSD and 90 

percent from the VA for PTSD and various other conditions. The 

Army determined that I overcame presumption of fitness for PTSD 

and nothing else, even though, weeks earlier, the PEB found that 

I should receive 80 percent disability and it was forwarded for processing. 

As a veteran receiving care through the VA, I have not seen a 

psychiatrist since I retired. I see a psychologist once a month 


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versus seeing a caregiver at Walter Reed once or twice a week. In 

my eyes, this is minimal care. I was told that this is due to staffing. I was given the option to travel 65 miles one way for additional behavioral health care. This is unrealistic for me, as well as 

other veterans. 

The lack of behavioral health care should be of great concern. 

Those veterans placed on the Temporary Disability Retirement List 

are required re-evaluations. My initial re-eval was to be in July 

2010. On 7 September 2010, I was informed that Fort Benning was 

backlogged due to the psychiatrist leaving, that my re-eval would 

be delayed for another 8 months. Putting veterans’ lives on hold 

and extending the transition process is unfair and unjust treatment. 

In summary, the transition process lacks concern for the soldier 

veteran from the individual unit through the MEB/PEB process to 

the care provided by the VA. Behavioral health care, proper diagnosis, and need for more providers are significant issues for the 

Army as well as the VA. 

The establishment of a Veterans Trust Fund to ensure these 

issues are not experienced by future generations of warriors due to 

fiscal constraints is imperative and should be a national priority. 

Thank you very much, Chairman. 

[The prepared statement of Colonel Van Derveer appears on p. 

70.] 

The CHAIRMAN. Thank you. 

Thank you all for being so eloquent. I can only say that for putting real lives in front of us as a consequence of the decisions that 

are made or not made, I can only say to you as Chairman of this 

Committee, and speaking for our Committee, that your stories will 

help us make the system better. We are recommitted to do that by 

listening to you. I thank you for being here today. 

Ladies and gentlemen, I thank you all for being here. I hope we 

have all learned and, I hope, committed to action in the future. 

Thank you so much, and this hearing is adjourned. 

[Whereupon, at 12:22 p.m., the Committee was adjourned.] 


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A P P E N D I X 

Prepared Statement of Hon. Bob Filner, 

Chairman, Full Committee on Veterans’ Affairs 

Good morning. The Committee on Veterans’ Affairs will now come to order. 

Before we get started, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks. Hearing no objection, so 

ordered. 

Why is it that so many of the men and women who have returned from military 

service in Iraq and Afghanistan are finding it difficult to get the care that they 

need? 

Is it because we failed to understand that the cost of serving our military veterans 

is a fundamental cost of war? Is it because when we sent these men and women 

into harm’s way, we failed to account for and provide the resources necessary for 

their care should they be injured or wounded? 

Every vote that Congress has taken for the wars in Iraq and Afghanistan has 

failed to take into account the actual cost of these wars by ignoring what will be 

required to meet the needs of our men and women in uniform who have been sent 

into harm’s way. 

This failure means that soldiers who are sent to war on behalf of their nation 

today do not know if their nation will be there for them tomorrow. The Congress 

that sends them into harm’s way assumes no responsibility for the long-term consequences of their deployment. Each war authorization and appropriation kicks the 

proverbial can down the road. 

Whether or not the needs of soldiers injured or wounded in Iraq or Afghanistan 

will be met is totally dependent on the budget politics of a future Congress which 

includes two sets of rules—one for going to war and one for providing for our veterans who fight in that war. 

The fight to meet the needs of soldiers suffering from the effects of Agent Orange, 

for example, requires that offsets for the necessary funding are found in other parts 

of the budget. It is known around here as ‘‘pay-go.’’ The Department of Defense has 

no such requirement. In other words, our current system of appropriating funds in 

Congress is designed to make it much easier to vote to send our soldiers into harm’s 

way than it is to care for these soldiers when they come home. 

This is morally wrong and an abdication of our fundamental responsibility as 

Members of Congress. It is past time for Congress to recognize that standing by our 

men and women in uniform and meeting their needs is a fundamental cost of war. 

Congress should, therefore, account for these needs and take responsibility for 

meeting them at the time that we send these young people into combat. 

In short, every Congressional appropriation for war should include money for a 

Veterans’ Trust Fund that will assure that the projected needs of our wounded and 

injured soldiers are fully met at the time that they are needed. 

This is not a radical idea. Businesses are required to account for the differed liability of their company every year. Ask any business accountant who has had to 

report to the IRS. Our Federal government has no such requirement when it comes 

to the deferred liability of meeting the needs of our men and women in uniform— 

even though meeting these needs is a moral obligation of our nation and a fundamental cost of war. Does this make any sense fiscally or ethically? I think not. 

If, in years past, Congress had taken into account the deferred fiscal liability— 

and moral obligation—of meeting the future needs of soldiers injured or wounded 

in the conflicts that they were sent would we have been able to prevent hundreds 

of thousands of wounded warriors from the burden of an overwhelmed veterans’ 

service delivery system? 

And, would veterans and their advocates on Capitol Hill have to fight as hard as 

they do every year for benefits that should be readily available as a matter of 

course? Would they have to worry as much as they do today that these benefits will 

become targets in the debate over reducing the federal budget deficit? Would it not 


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be less likely that the Co-Chairman of the National Commission on Fiscal Responsibility, Allen Simpson, would tell the Associated Press: 

‘‘The irony is that veterans who saved this country are now, in a way, not 

helping us to save the country in this fiscal mess.’’ 

Today’s hearing will examine these and related questions. We will begin by focusing on what war actually costs when we take meeting the needs of our soldiers into 

account. To do this we are pleased and honored to have with us Nobel Laureate Joseph Stiglitz of Columbia University and Linda Bilmes of Harvard, the authors of 

The Three Trillion Dollar War. 

Their groundbreaking book brought a healthy but sobering dose of reality into 

public debates about the wars in Iraq and Afghanistan and the long-term consequences of our decision to go to war. 

We are also pleased to have distinguished military leaders, veterans of the wars 

in Iraq and Afghanistan, prominent veterans’ advocates and families of veterans 

here today to help us to put this question into the sharp relief of the day-to-day 

reality of those who have served their nation in uniform. 

It is time for an open and honest discussion about the moral obligation of our nation to our nation’s veterans. It is time to reflect on the need to reform a process 

that systematically denies the connection between fighting a war and meeting the 

needs of those who we send into harm’s way. Our veterans deserve better. 

f 

Prepared Joint Statement of Linda J. Bilmes, Daniel Patrick 

Moynihan Senior Lecturer in Public Policy, John F. Kennedy 

School of Government, Harvard University, Cambridge, MA, and 

Joseph E. Stiglitz, Ph.D., University Professor, Columbia 

University, New York, NY (Nobel Laureate) 

Chairman Filner, Congressman Buyer, and Members of the House Veterans Committee: 

Thank you for convening this hearing today and for inviting us to testify on the 

true costs of war. 

There is no such thing as a ‘‘war for free.’’ The history of warfare is a tragic cycle 

of people fighting, killing, wounding, exhausting armies and depleting treasuries followed by burying, taking care of the wounded, reconstructing, repaying war debts, 

and recruiting fresh troops. The repercussions of war, and the costs of war, persist 

for decades after the last shot is fired. 

Despite this well-worn path, the inevitable costs, the economic consequences and 

the long-term welfare of the troops are seldom mentioned at the start of a conflict. 

Even when they are mentioned, the costs and risks are systematically understated. 

The result is that the burden of financing the war, the social cost of lives lost, quality of life impaired, families damaged and the expense of caring for veterans are 

typically not provided for in the run-up to conflict. 

All wars, whether long or short, have continuing costs associated with the care 

of those who have fought in them. It is a sobering thought that the peak year for 

paying out disability claims to World War I veterans did not occur until 1969—more 

than 50 years after the armistice. The peak for paying out World War II benefits 

was in the 1980s—and we have not yet reached the peak cost for Vietnam veterans. 

Even the Gulf War of 1991, which lasted just six weeks, costs more than $4 billion 

a year in disability compensation alone. 

It is obvious now that the wars in Iraq and Afghanistan have been far more costly 

(in terms of both blood and treasure) than its advocates suggested at the outset. 

Even with more realistic estimates, we might have come to the same decision about 

going to war. But the absence of reliable estimates meant there was no opportunity 

for a meaningful debate. It has also prevented us from planning ahead for future 

costs. 

The United States has already spent more than a trillion dollars in Iraq and Afghanistan for incremental war costs; in other words, costs that are in addition to 

regular military salaries, training and support activities, weapons procurement and 

so on. There are other substantial incremental war-related expenditures across government for items including military medicine, military recruiting, contractors’ life 

insurance, Social Security disability benefits and paying interest on money borrowed 

to finance the war. 

But these figures do not include the long-term budgetary costs of veterans care, 

or any estimate of the economic and social costs of the wars. 


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[i] Joseph E. Stiglitz and Linda J. Bilmes. The Three Trillion Dollar War: The True Cost of 

the Iraq Conflict, WW Norton, 2008. 

It may be hard to believe, but we still do not know the true cost of the Iraq war, 

much less the current war in Afghanistan. The U.S. Government budget is based 

on cash, rather than accrual accounting. Government financial accounts track 

inflows and outflows of funds within a fiscal year, ignoring the long-term costs of 

depreciating equipment, purchasing complex weapons systems and caring for disabled veterans. Basic information about outlays—what has actually been spent—is 

not readily available. The accounting systems at the Pentagon are notoriously poor 

at tracking expenditures; the Department has failed its annual financial audit for 

the past decade. The Congressional Budget Office, the Congressional Research Service, the General Accounting Office, the Iraq Study Group and the Department’s own 

auditors and Inspector General, have all found numerous discrepancies in the Pentagon’s figures. Expenditures that relate directly or indirectly to the war are fragmented among many different departmental budgets and programs, making it laborious to piece together a complete picture. Additional war funds are appropriated 

little by little, through supplementary budgets, making it all the more difficult to 

tally up the total costs. 

The most detailed analysis of war costs has been conducted by the Congressional 

Research Service (CRS). The CRS has noted that none of the known factors in the 

increasing war costs, including the operating tempo of the war, the size of the force, 

and the use of equipment, training, weapons upgrades and so forth, ‘‘appear to be 

enough to explain the size of and continuation of increases in cost.’’ We believe this 

discrepancy relates to the way the war has been fought, with excessive reliance on 

expensive contractors and funding for core defense activities getting mixed in with 

war funding due to poor budgeting and accounting. 

The U.S. Government also makes no attempt to capture the economic costs (including those associated with deaths or quality of life impairment of those injured), 

much less any tracking of how the economy might have fared in the absence of any 

conflict. 

These full costs are not transparent anywhere in the system. Throughout the nine 

years of conflict in Iraq and Afghanistan, the Congressional Budget Office (CBO) 

has continued to use accounting frameworks that focus at best on the budgetary 

costs of war for 10 years, even as the long-term accrued costs of the wars and their 

impact on the economy have grown more apparent. The only hint of the full costs 

of providing for military veterans is in the U.S. Treasury’s financial statements for 

2009, in the little-read ‘‘statement of net costs’’ which uses accrual methods. According to this document, the U.S. liability for burial and disability benefits for military 

veterans exceeds $1.3 trillion dollars. (Even this figure—although large—does not 

reflect the full liability, because it excludes medical care and other benefits). There 

is no provision anywhere in the budget for how this liability will be paid. 

Consequently, the estimate of budgetary costs that is presented to the public and 

the press is a partial snapshot, based on faulty accounting and incomplete data. 

Our work, which is based entirely on government data, was intended to fill this 

void. 

Two years ago we published The Three Trillion Dollar War: The True Cost of the 

Iraq Conflict, in which we estimated that the total cost to the United States—including military expenditures through 2017, and lifetime health care and disability 

costs for returning troops, as well as economic impacts to the United States—would 

be $3 trillion [i

]. This price tag dwarfed previous estimates, but subsequent investigations by both the Congressional Budget Office and the Joint Economic Committee of Congress found our estimate to be broadly correct. To ensure the credibility of our analysis, we deliberately used conservative assumptions. As we will explain today, the empirical data that has come to light since the publication of The 

Three Trillion Dollar War demonstrates that our cost projections were excessively 

conservative, and that the war has had far-reaching economic consequences. In particular, the costs of diagnosing, treating and paying disability benefits for veterans 

of the Iraq and Afghanistan conflicts are proving to be much higher than our earlier 

estimates. 

This morning we will focus on three issues. 

First, we will discuss some of the costs that the war has imposed on the U.S. 

economy. 

Second, we will provide an updated estimate for the single biggest long-term 

budgetary cost of the current war, which is the cost of providing medical care, disability compensation and other benefits to veterans of the Iraq and Afghanistan conflicts. 


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Third, we will argue that such costs are inevitable and can be estimated to some 

extent in advance; therefore, the United States should make provisions for its war 

veterans at the time we appropriate money for going to war. We will recommend 

steps that can be taken to address this unfunded financial liability. 

I. The Cost of War and Its Impact on the U.S. economy 

The United States went to war without a clear understanding of the costs to the 

budget or to the economy. Today we have a better view of both the benefits and the 

costs. 

The benefits of war center on the value of additional security obtained by the war. 

This is a subject on which reasonable people may disagree, since it requires assumptions (typically unverifiable) about what would have happened in the absence of the 

conflict. But even in this area, basic analytic principles can be of help, especially 

as we confront the challenge of the global war on terrorism, a security threat that 

is markedly different from earlier wars such as World War I and II, where our main 

objective was the defeat of a particular government. The wars in Iraq and Afghanistan are different. For instance, securing a particular piece of territory—ensuring 

that it cannot be used, for instance, for training of terrorists—may have little value, 

since training and terrorist activity can easily shift. We have to have a global perspective. We have seen this as Al Qaeda has shifted from Afghanistan, to Iraq, to 

Pakistan, and to Yemen. Secondly, victory in this war, like all such insurgencies, 

entails winning hearts and minds—killing innocent victims, even if only as collateral damage, is a sure way to lose this battle. The supply of insurgents can increase 

even as we succeed in killing thousands of the enemy. (Economists say that the supply of insurgents and more broadly the strength of the opposition are endogenous.) 

Thirdly, mistakes made at one point can have long lasting consequences, some more 

so than others. 

Economists and physicists refer to this under the name hysteresis; historians by 

the term path dependence. We cannot go back to the world as it was, or as it would 

have been, if we had conducted the war in Afghanistan differently, and had not become embroiled in the war in Iraq. But the consequences of some actions are more 

irreversible than others, and it is in those areas that we have to be particularly 

careful not to make mistakes. 

Estimating the cost of the war is more straightforward. There is no doubt that 

wars use up resources. The question is how to estimate the full magnitude of those 

resources used and assign values to them. 

The taxonomy of costs centers on (i) resources spent to date; (ii) resources expected to be spent in the future; (iii) budgetary costs to the government; and (iv) 

costs borne by the rest of the economy. These latter costs are very real, even if the 

government does not pay them, and are referred to as the economic as opposed to 

the budgetary costs of the conflict. In terms of the economic costs, there are microeconomic costs—costs borne by particular individual people or firms—and macroeconomic costs—impacts on the total economy over and above the sum of the micro 

costs. 

What makes this analysis challenging is that government accounting systems do 

not document most items in a way that would enable an easy assessment of the resources directly used, or the full budgetary impact. Accurate accounting is important 

because it provides information on the use of resources that is essential for good 

governance. Transparency—clear, accurate financial information that is made available in a useable and timely format—is an essential part of democratic governance 

and accountability. 

The way we account for our troops matters. For example, from the sole perspective of military accounting, the cost of a soldier’s life is valued at $500,000, 

($400,000 in life insurance and $100,000 in ‘‘death gratuity’’ payment). This number 

does not reflect either the true budgetary cost to government or the economic cost 

to society. It does not include, for instance, the cost to the military of recruiting and 

training a new troop to replace the one who is lost, and the impact on morale and 

mental health on the rest of the unit, which may result in higher medical costs. It 

also does not reflect the economic loss of a young person. By contrast, when civilian 

agencies such as the EPA and FDA are evaluating a proposed regulation—when 

they compare the cost of imposing a regulation to the potential lives saved—they 

estimate the value of a life at between $6 million and $8 million. 

Once a government embarks on a war, it has a myriad of decisions to make. Not 

the least of these is the decision about when to exit. An accurate assessment of the 

full costs of war—including, for instance, the full incremental cost of a surge of, say, 

30,000 troops for one year—is an essential ingredient in making good decisions. The 

budgeting and accounting systems should be able to accurately track what has been 


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spent as well as to anticipate the order of magnitude of future costs. For example, 

if 50,000 troops have already been wounded, it is feasible to estimate the approximate minimum future liability that the government will incur to provide these veterans with medical care and disability compensation (if a business incurs a liability 

to pay for injuries to some of its employees, it is required to make a provision for 

this liability). For an ongoing war, an accurate accounting of costs incurred is important information in assessing likely costs going forward. Any business would want 

this kind of information as it made decisions; any publicly owned business would 

be required to keep its books in ways that investors could see the future consequences; and good business practice requires that the firm set aside money today 

for future obligations, like retirement benefits, accrued today. We should expect no 

less of government. 

It is important to realize why such information is so important. It is partly a matter of accountability—how are our citizens to evaluate and judge a particular course 

of action if they do not know the costs? But bad accounting leads to bad decisions. 

If we do not take into account future disability and health costs, there is a temptation to scrimp on current expenditures, without regard to future costs. Good accounting frameworks would show that such a course was penny wise but pound foolish. Some actions entail cost shifting—say from government to others. If VA hospitals are underfunded, some of our veterans who served their country so well— 

those who can afford it—may pay some of their own medical costs. The total societal 

costs have not disappeared, even if budgetary costs are reduced. This is one of the 

reasons that one needs an assessment of the overall economic costs. 

The overall economic costs are typically much larger than the budgetary costs. 

However, there are instances where this is not the case. An example is where payments from the government to the private sector exceed the value of the resources 

procured—i.e., in war profiteering, which has been widely documented during the 

Iraq war. The sheer size of the U.S. military operations in Iraq and Afghanistan, 

(the biggest wartime mobilization since the all-volunteer force was created in 1973) 

placed a strain on the enlisted force, which led to an unprecedented reliance on paid 

private contractors. This resulted in some cases, in payment of exorbitant sums for 

simple tasks such as painting walls and repairing trucks and gross over-payments 

to contractors such as Halliburton and Blackwater. There have also been numerous 

cases of outright fraud where the U.S. Government has been found to have paid contractors for services that were never provided at all. Though such problems arise 

in all government procurement, there are normally safeguards in place that limit 

its scale. During the Iraq War, many of these safeguards were suspended or relaxed. 

The best-run government organizations use cost accounting to estimate the direct 

and indirect costs of their activities. They also use accrual-based accounting to try 

to take future costs into account. The focus on current-year cash budgeting leads 

to costly mistakes. For example, the decisions not to buy more protective armor for 

troops or not to purchase mine-resistant vehicles certainly saved money on a cash 

basis. But these decisions led, predictably, to much higher death and injury rates. 

So too, the decision not to fund the Veterans Department adequately in 2005, 2006 

and 2007 reduced current budgetary expenditures but at the expense of increasing 

the long-run (budgetary and economic) costs of providing care to returning veterans. 

These and similar decisions were shaped by an accounting system that does not provide for the full long-term budgetary costs of current policies and by a budgetary 

system that does not estimate costs to the economy. 

In addition to the known costs of conducting current and future military operations and caring for war veterans (which we discuss below) the most sobering costs 

of the conflict are in the category of ‘‘might have beens’’—what economists call opportunity costs. Specifically, in the absence of the Iraq invasion: would we still be 

mired in Afghanistan? Would oil prices have risen so rapidly? Would the federal 

debt be so high? Would the economic crisis have been so severe? 

Arguably the answer to all four of these questions is ‘‘no.’’ 

The first question concerns the ‘‘security opportunity costs’’ of the war. The Iraq 

invasion diverted our attention from Afghanistan, a war that is now entering its 

tenth year and which threatens to destabilize nuclear-armed Pakistan. By most accounts, the effort is encountering serious challenges, and even General Petraeus 

sees little prospect of an early exit. While ‘‘success’’ in Afghanistan might always 

have been elusive, we would probably have asserted control over the Taliban, and 

suffered less expense and loss of life, if we had maintained our initial momentum 

and not been sidetracked in Iraq. Between 2003 and 2006, we spent five times as 

much money in Iraq as in Afghanistan. It is likely we would have done far better 

if we had devoted those resources to Afghanistan, before the Taliban had re-established control. 


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The second cost is the higher price of oil, which has had a devastating effect on the economy. When we went to war in Iraq, the price of oil was under $25 a barrel, 

and future markets expected it to remain around that level. With the war, prices 

started to soar, by 2008 reaching $140 a barrel. The war and its impact on the Middle East, the largest supplier of oil in the world, clearly had something to do with 

the price rise. We believe it was one of the major contributing factors—not only was 

Iraqi production interrupted, but the instability it brought to the Middle East dampened investment in this vital region from what it otherwise would have been. In our 

conservative $3 trillion estimate, we attributed only $5-$10 of the increase to the 

war. But, given our thirst for imported oil, even that small amount has a big impact—it translates into a much higher import bill for the United States. We now 

believe that a more realistic estimate of the impact of the war on the oil price over 

a decade is at least $10–15 per barrel. That translates into a $250 billion increase 

in the cost of war. 

Third, the war added substantially to the federal debt. It is the first time in 

America’s history where a government cut taxes as it went to war, even in the face 

of continued government deficits. The U.S. debt rose from $6.5 trillion to $10 trillion 

between 2003 and 2008, before the financial crisis. At least one-fourth of that debt 

is directly attributable to the wars. Of course, this doesn’t include unfunded future 

liabilities, for instance the more than half trillion dollars in future health care costs 

and disability payments for returning troops. 

The increased indebtedness meant that the U.S. had far less room for maneuver 

in dealing with the global financial crisis. Worries about the debt and deficit constrained the size of the stimulus. 

But the crisis itself was, in part, due to the war, and while, as we will explain 

below, the estimates that we provided in our book were overly conservative overall, 

e.g. in estimating future health care and disability costs, the most serious underestimate involved the macroeconomic consequences of the war. The increase in oil prices 

reduced domestic aggregate demand—money spent buying oil abroad was money not 

available for spending at home. The war spending itself provided less stimulus to 

the economy than other forms of spending—giving money to foreign contractors 

working in Iraq neither stimulated the economy in the short term (compared to investments in education, infrastructure, or technology) nor did Iraq spending provide 

a basis for long term growth. Loose monetary policy and lax regulations kept the 

economy going—through a housing bubble, whose breaking brought on the global financial crisis. We mentioned earlier that the deficits, to which the war contributed, 

reduced our room for maneuver. But even today, three years into the crisis, as we 

struggle to deal with the aftermath—with more than one out of six Americans who 

would like a full time job unable to get one, with one quarter of Americans with 

mortgages owing more than the value of their house—it is increasingly clear that 

the size of the national debt—of which more than $1 trillion, or more than 7 percent, is attributable to the war—imposes important constraints on our response. The 

result is that the recession will be longer, output lower, unemployment higher, deficits larger, than they otherwise would have been. 

Counterfactuals—what might have happened if we had not gone to war—are always difficult, and especially so with complex phenomena like global financial crises 

with many contributing factors. What we do know is that one of the true costs of 

war is its contribution to a worse economic recession, higher unemployment and 

larger deficits than might have otherwise occurred. 

I want to emphasize that there is a marked difference between deficit spending 

to finance investments—in infrastructure, technology, education—and to finance a 

war such as those in Iraq and Afghanistan. Borrowing in the former case may make 

sense, especially when the economy has significant unemployment and interest 

rates are low. Such expenditures improve the long-term debt, lower the long-term 

debt to GDP ratio, and enhance growth—in short, they improve the country’s balance sheet. That is not the case for debt-financed war expenditures, which worsen 

the country’s balance sheet. 

The large disparity between budgetary and the full economic costs of war means 

there is a need for a comprehensive reckoning of the cost to the economy as a whole. 

The fact that we have been able to construct estimates of both underlines the fact 

that this exercise can be done once there is a will to do it. There are many skilled 

economists and plenty of data in various branches of government. Going forward, 

it is important that major decisions in the military arena, especially when they are 

decisions of choice, are subject to the same sort of rigorous analysis, both budgetary 

and economic. No estimate and no accounting system will be perfect. But the discipline that comes from applying these techniques routinely should increase the 

quality of debate and enable us as a country and a government to make more informed decisions in the future. 


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[ii] Anne Leland and Mari-Jana Oboroceanu, ‘‘American War and Military Operations Casualties: Lists and Statistics,’’ February 26, 2010. [iii]Karen Seal et al., 2009, ‘‘Trends and Risk Factors for Mental Health Diagnoses Among Iraq 

and Afghanistan Veterans Using Department of Veterans Affairs Health Care, 2002–2008,’’ 

American Journal of Public Health, 99(9): 1651–1658. (See also Karen Seal et al., 2007.) 

II. Updated estimates of long-term budgetary costs for returning Iraq and 

Afghanistan veterans 

Over the past nine years more than 2.1 million Americans have served more than 

three million tours of duty. More than 1.25 million veterans from these conflicts 

have returned home. The most significant long-term budgetary cost of war is providing medical care to those who have served, and paying disability compensation, 

pensions and other benefits to eligible veterans. As of this month, 5700 U.S. servicemen and women have died and over 90,000 have been wounded in action or injured 

seriously enough to require medical evacuation. A much larger number—nearly 

600,000—have already been treated in veterans’ medical facilities for issues ranging 

from brain injuries to hearing loss. The number returning home with serious mental 

problems has increased as troops were obliged to do repeated tours of duty, with 

shorter spans to recuperate. The medical community reports an ‘‘epidemic’’ of posttraumatic stress disorder (PTSD). 

The evidence from previous wars shows that the cost of caring for war veterans 

continues typically rises for several decades and peaks in 30–40 years or more after 

a conflict. The costs rise over time as veterans age and their medical needs grow. 

For example, the annual disability payment to veterans aged 34 and under is $6633. 

This rises to $8641 for veterans aged 35–54 and to $12,237 for those aged 55–74. 

(In addition, the older veterans who are retired may now receive concurrent receipt 

of benefits from the Defense budget. Those veterans who are not enrolled in the VA 

system are likely to be requiring significant costs from the Medicare system). 

However, for several reasons the long-term costs of the Iraq and Afghanistan conflicts can be expected to be even higher than in previous conflicts. This is due to 

(a) higher survival rates; (b) higher incidence of PTSD and other mental health ailments; (c) a higher percentage of veterans claiming for benefits, especially those associated with mental health conditions; and (d) more generous medical benefits, 

more presumptive conditions, and higher benefits in some categories. 

Let me briefly address each one of these factors. 

First, the survival rate for severely injured troops has increased, relative to previous wars, as a result of improvements in battlefield medicine and other advances 

in health care. In Iraq, the ratio of deaths to wounded-in-action was 1:7.3; compared 

with 1:2.6 in Vietnam, 1:2.8 in Korea, and 1:1.6 in World War II [ii]. This means that 

a large number of seriously wounded troops, some of whom have severe disabilities, 

will require lifetime care. The wars have also had a high level of non-hostile injuries; our research shows that such injuries were more than 50 percent higher than 

during peacetime. 

Second is the issue of mental health diagnosis and PTSD. There has been a considerable amount of medical research on this subject, including a number of recent 

studies on Iraq and Afghanistan veterans. The studies conducted at the University 

of California, San Francisco Medical School (UCSF) and elsewhere control for variables such as demographic factors, smoking, BMI, alcohol use, depression, and other 

factors, so they are an important way for us to understand what is attributable 

purely to war exposure. 

There are three key findings in this literature. 

First, the incidence of PTSD is closely correlated to the number of exposures to 

firefights that a soldier experiences. That means that almost certainly, the long deployments, multiple deployments, and the lack of a clear ‘‘front line’’ for many of 

those serving has contributed to the extremely high levels of PTSD and other mental illness. There are now close to 900,000 troops who have served two or more tours 

of duty. 

Second, PTSD is widespread, and has increased by 4–7 times since the invasion 

of Iraq. The team at UCSF medical school, led by Dr. Karen Seal, studied all returning veterans who had been treated by the VA from 2002 through 2008 [iii]. Her 

team found that 37 percent of returning troops received a mental health diagnosis. 

Almost one in five of the troops were diagnosed with PTSD, with others diagnosed 

with depression. The majority of troops had concurrent diagnosis with other problems. Younger, lower-rank troops with the highest combat exposure were at the 

highest risk for PTSD. 

Third, there is strong correlation demonstrated between PTSD and long-term 

physical health problems. This includes heart disease, rheumatoid arthritis, heart 


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[iv]Daniel Bertenthal, Beth Cohen, Charles Marmar, Li Ren and Karen Seal, 2009, ‘‘Association of cardiovascular risk factors with mental health diagnoses in Iraq and Afghanistan war 

veterans using VA health care,’’ JAMA 302 (5):489–492.; and Boscarino JA, 2008, ‘‘A prospective 

study of PTSD and early-age heart disease mortality among Vietnam veterans: implications for 

surveillance and prevention,’’ Psychosomatic Medicine, July, 70(6):668–7; Boscarino, JA, CW 

Forsberg and J Goldberg, 2010, ‘‘A twin study of the association between PTSD symptoms and 

rheumatoid arthritis,’’ Psychosomatic Medicine, June 72(5):481–6. (In the latter, a study of twin 

pairs showed that the highest PTSD sufferers were 3.8 times likely to have rheumatoid arthritis 

compared with the lowest sufferers). (Spitzer has also shown increased incidence of angina, 

heart failure, bronchitis, asthma, liver and peripheral arterial diseases among PTSD sufferers). [v] Judith Andersen, et al., 2010, ‘‘Association Between Posttraumatic Stress Disorder and Primary Care Provider-Diagnosed Disease Among Iraq and Afghanistan Veterans,’’ Psychosomatic 

Medicine 72. [vi]See Hoge, C.W. et al., ‘‘Mental disorders among U.S. military personnel in the 1990s: Association with high levels of health care utilization and early military attrition,’’ American Journal 

of Psychiatry, 159(9):1576–1583; see also work from the Veterans Health Research Institute. 

failure, bronchitis, asthma, liver and peripheral arterial diseases [iv]. One recent 

study (Judith Andersen et al., 2010) [v] found that PTSD sufferers are 200 percent 

more likely to be diagnosed with a disease within 5 years of returning from deployment than the control group. Another new study (Beth Cohen, 2010) found that that 

veterans with PTSD utilized non-mental health care services such as primary care, 

ancillary services, diagnostic tests and procedures, emergency services and hospitalizations 71–170 percent higher than those without PTSD. In addition, recent 

studies have shown that traumatic brain injury, which is estimated to affect some 

20 percent of Iraq and Afghanistan veterans (often in conjunction with PTSD) places 

sufferers at higher risk for lifelong medical problems, such as seizures, decline in 

neurocognitive functioning, dementia and chronic diseases [vi]. 

Regarding the other reasons for higher costs: 

Compared to previous conflicts, a higher percentage of Iraq-Afghanistan veterans 

are claiming for benefits, especially those associated with mental health conditions. 

In large part, this is due to the outreach efforts that VA has undertaken, as well 

as the introduction of the post-deployment screen for mental health symptoms, and 

successful efforts by VA and many veterans groups and local organizations to make 

returning servicemembers more aware of what they have earned and how to apply 

for it. It is also likely that the Internet has made it easier to obtain information 

and to file disability applications. 

In addition, since our book was written, a number of recommendations that we 

and others urged have been adopted. VA has expanded the Benefits Delivery at Discharge (BDD) program and Quick Start, increased the number of conditions that are 

presumptive in favor of the veteran, liberalized the PTSD stressor definition, increased some categories of benefits and outreach, provided five years of free health 

care instead of two, and is in the process of restoring medical care to 500,000 moderate income ‘‘Category 8’’ veterans. 

VA has also hired more medical and claims personnel, invested heavily in IT upgrades to the claims processing system, and is preparing to do much more. 

All of these factors contribute to the rising cost estimates we will describe. 

Our model for projecting long-term budgetary costs is based entirely on government data. We based our projections for troop levels on estimates by the CBO and 

CRS, and we used rates of average disability compensation, social security disability 

benefits and medical costs on information from the VBA, VHA, Social Security Administration and government economic indicators. 

In our earlier work, we estimated that the long-term cost of providing medical 

care and paying disability compensation for veterans of the Iraq and Afghanistan 

wars would be between $400 billion and $700 billion, depending on the length of 

the conflict and future deployment levels. This estimate was based on assumptions 

derived from historical patterns of medical claims and disability claims experienced 

in previous wars. Since then we have updated our analysis to reflect the actual data 

for veterans returning from Iraq and Afghanistan and it is clear that the costs will 

be much higher. 

Revised Disability Cost Projections 

In 2008 we had projected that between 366,000 and 398,000 returning Iraq and 

Afghanistan veterans would have filed disability benefit claims by this point (given 

1.2 million returned troops, which we had correctly projected). In fact, more than 

513,000 veterans have already applied for VA disability compensation. In our projections, the VA would not have received this many claims until 2013 at the very earliest. We had also underestimated the complexity of these claims, the number of disabling conditions being demonstrated, and the likely increases in disability ratings 


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[vii] As of June 2010, 2.15 million U.S. troops had served in the GWOT in Iraq and Afghanistan and there were 1.25 million veterans who were discharged. The number who had filed 

claims for compensation in connection with their service disabilities was 513,000 (Veterans for 

Common Sense, from DoD, previous number of 483,000 from Veterans Benefits Administration 

Office of Performance Analysis and Integrity, 11/18/09). The number of GWOT veterans who had 

been treated at VA Hospitals and medical facilities was 565,000 (Veterans Health Administration). 

over time for veterans who have been diagnosed with PTSD. We now estimate that 

the present value of these claims, over the next 40 years, will be from $355 billion 

to $534 depending on the duration and intensity of U.S. military deployment to the 

region. 

In addition, veterans who can no longer work may apply for Social Security disability benefits. We estimate that the present value of the lifetime benefits for these 

veterans will range from $33 to $52 billion. 

Revised Medical Cost Projections 

In our earlier analysis, we had estimated that 30–33 percent (which would be 

fewer than 400,000) of returning veterans would be treated in the VA health system 

by 2010. The actual number is running at more than 565,000 veterans, which is 

about 45 percent of discharged troops [vii]. In our earlier work, we projected that the 

VA would not reach this level until 2016. 

We had also underestimated the long-term costs of treating and caring for these 

veterans. We had projected that at worst 20 percent of veterans would be diagnosed 

with mental health issues, whereas we now know that 30–40 percent of returning 

veterans are receiving these diagnoses. This increases both immediate and longterm costs, given the relationship between mental illness and other conditions. We 

also did not account for the cost to VA of adding personnel and increasing the mental health infrastructure. 

Accordingly, we can project how disability claims, and medical costs of the Iraq 

and Afghanistan veterans are likely to continue to increase with age. In this respect, 

they are likely to follow the pattern of Vietnam veterans, where it is estimated that 

30 percent suffered from PTSD. For example, the disability compensation paid to 

Vietnam veterans is 60 percent higher than the amount paid to veterans who served 

in peacetime. 

We now estimate that the present value of medical care provided by the VA to 

veterans from Iraq and Afghanistan over the next 40 years will be between $201 

billion and $348 billion, depending on the duration and intensity of military operations in the region. 

Table 1: Estimated PV of Iraq and Afghanistan Veterans Disability and 

Medical Costs 

(US$ Billions) Moderate-Realistic Best Case 

Medical 348 201 

Disability (VA) 534 355 

Disability (SSA) 52 33 

Total Cost $ billion 934 589 

Original Estimate (2/08) 

Medical 284.8 121.1 

Disability 388.5 276.6 

Social Security 43.7 23.8 

Total Cost $ billion 717 422 


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[viii]Statement by Rear Adm. Christine Hunter, Deputy Director of TRICARE, that Pentagon 

spending has increased from $19 billion in 2001 to projected $50.7 billion in 2011. (USA Today 

4/25/10). 

Other Budgetary Costs 

These estimates do not include a range of additional costs that will be paid by 

departments across government, including veterans’ home loan guarantees, veterans’ job training, concurrent receipt of pensions, and higher costs to Medicare and 

TRICARE for Life for veterans who are not enrolled in the VA system. For example, 

Pentagon spending on health care for active-duty military has increased by 167 percent since 2001 [viii]. It also does not include costs paid by state and local governments, or billions of dollars in VA capital investments, such as the construction of 

mental health clinics and construction of new hospitals, that will serve all veterans 

but are primarily targeted toward those returning from Iraq and Afghanistan. 

One of our core recommendations in the book was that Iraq and Afghanistan veterans should be able to receive full education benefits, on a par with those provided 

to World War II veterans in the GI Bill. Congress and the Administration finally 

enacted a new GI bill in 2008. This is an investment that will yield significant economic benefits. However it will also add to the budgetary cost of the war. 

Taking these costs into account, the total budgetary costs associated with providing for America’s war veterans from Iraq and Afghanistan approaches $1 trillion. 

Economic Costs of Veterans 

Earlier, we explained how the true cost of war goes beyond the budgetary costs; 

there are much larger social and economic costs. While this is true for the country, 

it is especially true for our veterans and their families. 

The military has faced its biggest challenge since conscription ended in 1973. In 

many respects, the ‘‘All-Volunteer Force’’ has come under enormous strain. Suicide 

among veterans is at record levels. Women troops (who make up 11 percent of the 

force) have been especially hard-hit: divorce rates are three times higher for female 

than for male troops, and more than 30,000 single mothers have deployed to the 

war zone. These social costs are far-reaching. They include the loss of productive 

capacity of young Americans who have been killed or seriously wounded in Iraq and 

Afghanistan, lost productivity due to mental illness, the burden on caregivers who 

frequently have to sacrifice paid employment in order to take care of a veteran with 

a disability, as well as increases in divorce, domestic violence, substance abuse, and 

other social problems. Additionally, a substantial number of those who were deployed, particularly among Reservists and Guards, were self-employed and have lost 

their livelihood as a result of deployment. For many veterans there is simply a diminished quality of life, the costs of which are borne by the individuals and families. 

The military has also been forced to employ a shadow workforce of several hundred thousand contractors, who have proven to be indispensable to the war effort. 

These contractors have also suffered from high rates of casualties, injuries and mental health problems. These impose both budgetary costs (through subsidies to worker compensation and insurance companies) and social costs in all the areas mentioned for troops. 

These substantial ‘‘social’’ costs are not captured in the Federal Government budget but nevertheless represent a real burden on society. In a number of countries, 

this is actually recognized with quality of life impairment lump sum payments. In 

our book, we attempted to determine the monetary value of some of these costs, although many cannot be quantified. At that time we estimated that the social costs 

would reach between $295 and $400 billion, in excess of the budgetary costs. Given 

the high number of casualties in the war and the high incidence of illnesses, especially mental illness, it is certain that the true cost will be even higher. 

III. Funding War Veterans 

The scale of our financial commitment to providing for veterans is huge; both in 

terms of the payments we make today—mostly for previous wars—and in the future. 

We have predicted that the long-term cost of caring for the veterans of Iraq and Afghanistan will be at least $500 billion, and quite possibly much higher. But at 

present, the U.S. has no provision for how it will pay for this growing long-term liability. 

The size of the current outgoings for veterans can be seen most clearly in the financial statements of the United States on the Statement of Net Cost, which lists 

the gross cost of U.S. expenditures minus revenues. It shows that the net cost of 


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[ix] ‘‘Financial United States Government Notes to the Financial Statements for the Years 

Ended September 30, 2008, and September 30, 2007,’’ Notes to the Financial Statements, Page 

73. [x]GAO–09–664T. 

providing for veterans is the fourth largest cost to the U.S. Treasury. For example, 

for the year ending September, 2008, the net costs were Defense: $740 billion; HHS: 

$713 billion; Social Security Administration: $663 billion; Veterans: $430 billion; Interest on the Debt: $241 billion; with all other costs far below. In other words, the 

cost of providing for veterans equaled 12 percent of the cost of running the country. 

In terms of accrued long-term liability, the Balance Sheet of the United States lists $1.3 trillion in veterans’ compensation and burial benefits, and a liability for 

$220 billion in veterans housing loan guarantees. But this does not take into account the accrued liability for providing medical care, or for veterans pensions, or 

for many of the other benefits we intend to provide. 

Yet, while there are extensive debates and hundreds of studies on how to fund 

our obligations for Social Security and Medicare, there is little attention being paid 

to how best to fund veterans’ care. In addition, both Social Security and Medicare 

are financed in part by taxes on non-recipients. But there is no dedicated mechanism through which taxpayers who are not in military service contribute directly 

to caring for war veterans. Funding must come from general revenues, competing 

with the myriad of other demands. 

The consequence of essentially ignoring the cost of caring for veterans is threefold. 

First, it understates the true cost of going to war. We know that every war will 

have a long ‘‘tail’’ of costs, including the significant cost of providing for those who 

fight in the war, and their families and survivors. However, in the appropriations 

process, we do not make any provision for this inevitable cost. This disguises and 

hides the true costs. 

Second, from an economic perspective, it is poor financial management. We should 

not be financing a 40-year long pension and benefit obligation from annual budget 

revenues. Third, it inevitably leads to the possibility that veterans’ needs will not be funded 

adequately. There are always pressures to cut unfunded entitlements. But veterans’ 

benefits are different from Social Security and Medicare. They are more akin to ‘‘deferred compensation.’’ They are payments for services rendered. They are part of the 

implicit contract between our country and those that serve our country by fighting 

for and defending it. The VA has the responsibility to determine the availability of 

VA care based on appropriations levels. The financial statements explain that: ‘‘In 

addition to health care benefits for civilian and military retirees and their dependents, the VA also provides medical care to veterans on an ‘as available’ basis, subject to the limits of annual appropriations. . . . VA’s Secretary makes an annual enrollment decision that defines the veterans, by priority, who will be treated for that 

fiscal year subject to change based on funds appropriated, estimated collections, 

usage, the severity index of enrolled veterans, and changes in cost.’’ [ix] 

VA does not have the capacity to fully estimate its long-term obligations, and even 

with the best will in the world, this may result in insufficient funding. It is well 

known that VA ran short of funds in 2005 and 2006 due to budget planning that 

was based on 2001 numbers, before the conflict began. As recently as January 2009, 

GAO found that VA’s assumptions of the cost of long-term care were ‘‘unreliable’’ 

because the assumed cost increases were lower than VA’s recent actual spending experience [x]. VA is now facing the challenge of estimating demand for two years for 

the advance appropriations. However, even this is proving very challenging since, 

using its current model, VA cannot determine its precise operating needs two-anda-half years in advance; yet it is being asked by OMB and the appropriators to do 

this. This places an impossible burden on the top VA officials. 

Recommendations 

We recommend a different funding model that would include the following: 

1. Establish a Veterans Trust Fund that would be funded as obligations occur. 

Although we cannot estimate precisely the magnitude of long-term demands, 

it should be possible to develop a framework for setting aside some funding 

at the time war money is appropriated. 

2. Improve the actuarial capacity of the VA. The VA should be directed to work 

with the Institute of Medicine to develop a better system of forecasting the 

amounts and types of resources needed to meet veteran’s needs in 30 years 

or more, when their needs are likely to peak. This should also include forecasting the regional impact and the infrastructure needs of the VA. 


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[xi]For more information on the ongoing costs of war: Visit http:// 

www.ThreeTrillionDollarWar.org. 

3. The cost of any conflict that persists beyond one year should be funded by 

current taxpayers, through war surtaxes, war bond issues, or other means. 

Conclusions 

It is commonplace today for government to undertake extensive cost-benefit analyses of individual projects and regulations, to assess and, where possible, to quantify 

the benefits and costs. Our analysis of true war costs follows in this tradition. While 

expenditures on the military represent the single largest item for many countries, 

it has largely been immune from this kind of scrutiny. Even if such an analysis does 

not change the decision to go to war, it can alter how the war is fought—and how 

we plan for the inevitable future costs of the war. 

We hope that the kind of analysis that we conducted for the Iraq and Afghanistan 

wars will become routine. While the kind of economic calculus that we have conducted can only capture a fraction of the broader costs of war, we believe that even 

a greater awareness of these immense economic costs may have a salutary effect. 

In particular, we hope that our work will contribute to a new way of thinking about 

long-term veterans costs, a way of thinking that would require us to budget for the 

lifetime needs of war veterans at the same time that we appropriate funds for the 

wars they will fight. 

At the very least, we believe that democratic processes require an informed citizenry—and an informed citizenry must have a sense of the true costs that are likely 

to be encountered before it embarks on war. [xi

f 

] 

Prepared Statement of Joseph A. Violante, National 

Legislative Director, Disabled American Veterans 

Mr. Chairman and Members of the Committee: 

Thank you for inviting me to testify today on behalf of the Disabled American 

Veterans (DAV) about the continuing cost of war. With 1.2 million members, all of 

whom were disabled while serving during times of war, no organization understands 

the true costs of war better than the DAV. Our core mission is to build better lives 

for America’s disabled veterans and their families and survivors, which we do 

through our service, transportation, volunteer, advocacy and charitable programs. 

For example, last year DAV National Service Officers provided claims representation to nearly a quarter of a million veterans and their families, helping them obtain 

almost $4.5 billion in new and retroactive benefits. Our fleet of DAV vans, driven 

by almost 9,000 volunteers, transported more than 645,000 veterans to VA health 

care facilities across the country, traveling over 24 million miles in the process. 

Overall, DAV volunteers donated more than 2.2 million hours to serve hospitalized 

veterans, saving the federal government more than $40 million in 2009 alone. We 

understand that everyone who serves during wartime is forever changed by that experience, and a grateful Nation must always stand up for those who stood up for 

us. 

Today there are about 23 million veterans, almost 17 million of whom served during periods of war and conflict. More than eight million veterans are enrolled in the 

VA health care system, and more than 3.1 million receive disability compensation 

for service-connected disabilities. To meet these needs, the Department of Veterans 

Affairs (VA) employs over 300,000 people with a budget now topping $125 billion 

annually. These numbers provide a baseline for the cost to care for veterans and 

any calculation of the true cost of war must fully fund programs and services for 

veterans, not just today, but far into the future. Since there are witnesses here 

today who will provide specific estimates and projections of the monetary requirements, my testimony will focus instead on the moral and practical obligations we 

have to the men and women who served in uniform. 

Mr. Chairman, the true cost of war is not sufficiently measured by the dollar cost 

alone, but must include the human costs. War leaves a legacy of pain and hardship 

borne by the men and women who suffer the wounds and bear the scars—both visible and invisible—of having served their Nation. War also profoundly affects the 

families who suffer heartbreak and agony of losing a loved one, as well as the family 

members who bear the burden of caring for disabled veterans for a lifetime. They 

too have earned the thanks of a grateful Nation. 


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The true cost of war must also include the cost of peace because all who defended 

our Nation and have wounds or disabilities as a result of their service—regardless 

of when or where they served—have earned benefits that must be paid for. For 

these men and women, the price they paid in service will continue for years and 

decades to come. 

Our Nation must fully and faithfully meet all obligations to veterans, especially 

disabled veterans, and my testimony will highlight some of the most important obligations that Congress can and must meet in the coming years. 

First, we must ensure that all benefits earned by disabled veterans are paid in 

full; Congress must not allow veterans benefits to be offset against other Federal 

benefits, nor eroded by inflation, nor whittled down by budget gimmicks, such as 

the practice of ‘‘rounding down’’ cost-of-living adjustments (COLAs) for disability 

compensation payments. Every benefit payment must have an appropriate mechanism to account for inflation or other rising costs so that its value is not reduced 

over time. After two years with zero increase in disability compensation, we would 

urge Congress to consider whether the Social Security COLA is the most appropriate index. Since disability compensation is intended to compensate for the average loss of earnings, we believe that there are more accurate and appropriate indexes or other methods to set rates, such as those that determine wage increases 

for Federal workers or the military. 

Congress must also ensure that disability compensation is paid in full to all service-connected disabled veterans, including those who retire after a career in the 

military, by fully eliminating the prohibition on concurrent receipt of disability compensation and military retirement pay. It is simply unfair that a disabled veteran 

who chooses to complete a career in the military will have his or her retirement pay 

offset by disability compensation, whereas those who leave the military to work in 

any other public or private sector job can receive their full retirement benefits and 

their full disability compensation. 

Second, we must fully compensate disabled veterans for their sacrifice and loss, 

which must include compensation for non-economic loss and loss of quality of life, 

not just loss of earnings capacity. In its final report released in 2007, the Veterans 

Disability Benefits Commission, which was authorized by Congress in Public Law 

108–136, recommended that, ‘‘ . . . VA disability compensation should recompense veterans not only for average impairments of earning capacity, but also for their inability to participate in usual life activities and for the impact of their disabilities on 

quality of life.’’ The Institute of Medicine made the same recommendation in 2007, 

and such a system has been successfully implemented in other countries with comprehensive veterans benefits, including Canada and Australia. The true price paid 

by disabled veterans includes a loss in the quality of their lives, and we urge Congress to begin instituting a system that fairly compensates for this continuing cost 

of war. 

Third, Congress must ensure that existing veterans’ benefits are paid accurately 

and on time in order to effectively fulfill their intended purpose. The ability of disabled veterans to care for themselves and their families often depends on the timely 

delivery of these benefits. But long waits and incorrect decisions by VA end up causing many disabled veterans and their families to suffer severe financial hardships; 

and these protracted delays can lead to further deprivation, bankruptcies, and even 

homelessness. 

The reality today is that too many veterans continue to wait too long for their 

claims to be resolved, and the results are too often wrong. The problem, put simply, 

is that the VA benefits claims processing system is broken and must be reformed. 

Although recent increases in staffing and funding were necessary to keep pace 

with a growing workload, it will take fundamental change to reform the claims processing system. VA needs to undergo a major cultural shift so that rather than focusing on production and cycle times, they concentrate on improving accuracy and quality. Instead of defining success as the elimination of the backlog, VA must realize 

that for veterans, success is having their claims done right the first time. 

Mr. Chairman, the Veterans Benefits Administration (VBA) today is at a critical 

juncture in reforming its claims process. In November, VBA will roll out their new 

Veterans Benefits Management System (VBMS) as a pilot program at the Providence Regional Office (RO). At the same time, they are continuing to experiment 

with process improvements with more than 50 pilots ongoing at ROs across the 

country. Over the next six months, it is imperative that Congress provide strong 

oversight and leadership to help guide VBA towards real and lasting reform. The 

VBMS must receive the full funding required over the next several years, and it 

must be developed so that quality control is built-in at every stage of production. 

Congress must aggressively oversee VBA’s myriad of ongoing pilots and initiatives 

to ensure that ‘‘best practices’’ are adopted and integrated into a cohesive new 


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claims process. Each pilot or initiative must be judged first and foremost by its ability to help VA get claims done right the first time. 

Fourth, we must fully support all families who have lost loved ones in service or 

who are caring for loved ones disabled in service. The true cost of war must include 

generous support for the widows and children of those who make the ultimate sacrifice in defense of our Nation. While nothing can restore their families, VA must 

ensure that survivor benefits are sufficient. One way Congress can help is by eliminating the offset of Survivor Benefit Plan (SBP) payments against Dependency and 

Indemnification Compensation (DIC) benefits to help these widows and their families. 

To assist family caregivers of disabled veterans, Congress approved the ‘‘Caregivers and Veterans Omnibus Health Services Act of 2010’’ (Public Law 111–163) 

earlier this year. This historic law authorizes comprehensive benefits and services 

for family caregivers of severely wounded and disabled veterans, and we thank this 

Committee for its role in moving that legislation. Unfortunately, due to budgetary 

concerns, the law provided direct financial support to a limited set of caregivers: 

those caring for veterans with the most severe disabilities and only for caregivers 

of veterans from the most recent conflicts. The true cost of war includes the cost 

of supporting caregivers of all severely disabled veterans from all wars and eras, 

and we call on Congress to continue expanding this benefit until all such needs are 

met. 

Fifth, we must ensure that disabled veterans receive high quality, comprehensive 

health care from a robust VA health care system; and that requires VA to have sufficient, timely and predictable funding. Congress made historic progress in health 

care funding reform last year with enactment of Public Law 111–81, the ‘‘Veterans 

Health Care Budget Reform and Transparency Act,’’ which authorizes Congress to 

provide one-year advance appropriations for VA health care programs. The law also 

requires VA to meet a number of financial and budgetary reporting requirements 

to assure the transparency necessary for Congress to make the new funding system 

work. 

While DAV and our allies in the Partnership for Health Care Budget Reform remain grateful for the broad, bipartisan support that made advance appropriations 

a reality, we are concerned that less than one year later Congress and VA appear 

to be falling short of the promise of the law. With the new fiscal year beginning 

tomorrow—and no Federal budget in sight—the fact that we have advance appropriations for VA’s fiscal year (FY) 2011 medical care budget already in place demonstrates the importance and effectiveness of this new funding mechanism. However 

Congress’ failure to approve the regular FY 2011 VA appropriations before adjournment also means that there is no FY 2012 advance appropriation approved for next 

year. Moreover, the likelihood of a long-term continuing resolution makes it unclear 

when or whether Congress will approve the FY 2012 advance appropriation at all. 

Furthermore, in a July 30 report required by Public Law 111–81, VA Secretary 

Shinseki stated that as a result of increased reliance on the VA health care system, 

as well as newly authorized caregiver programs, the level of funding contained in 

VA’s FY 2011 advance appropriation was no longer projected to be sufficient. Yet, 

the Secretary did not request any additional funding, instead indicating that VA 

could reprogram existing funding from other ‘‘lower-priority areas,’’ which is exactly 

why the report was required in the first place: to identify supplemental needs that 

manifest subsequent to the approval of advance appropriations. 

Congress must ensure that the advance appropriations process, which was supported by virtually every member of the House and Senate on both sides of the aisle, 

is fully and faithfully implemented to assure sufficient, timely and predictable funding for VA health care. When VA reports that funding requirements have changed 

due to unforeseen circumstances, VA must request supplemental funding and Congress must provide such funding to fully meet their obligations to the veterans who 

rely on VA health care. The true cost of war includes the provision of comprehensive 

medical care to veterans, especially those disabled by their service, and that requires a fully-funded VA health care system. 

Finally, we must ensure that our Nation never backs away from its sacred obligation, as Lincoln put it so eloquently, ‘‘. . . to care for him who shall have borne the 

battle, and for his widow and his orphan . . .,’’ because of our government’s inability 

to keep its fiscal house in order. While the Federal Government faces serious financial and budgetary challenges that must be addressed, any Nation that fails to meet 

its obligations to those who served, sacrificed and suffered is a country already morally bankrupt. As such, any recommendations that seek to balance the budget on 

the backs of disabled veterans, whether they come from the President’s National 

Commission on Fiscal Responsibility and Reform, or from the Office of Management 

and Budget, or from any other source, must be rejected. 


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For example, there are those who would restrict access to VA health care to only 

the most severely disabled veterans or those requiring specialized care, as a way 

to reduce the price of VA health care and thus reduce the budget deficit. However, 

moving veterans out of VA care will force many of them to utilize Medicare, Medicaid or other public options that actually cost the Federal Government more per 

capita than the same care provided through VA. Moreover, efforts to shrink the size 

of the VA health care system or reduce it to so-called ‘‘core functions’’ threaten both 

the quality of care and the viability of the system itself. The true cost of war includes the cost of medical care to treat the wounds and disabilities of those who 

served. 

Mr. Chairman, the true cost of defending our Nation, whether at war or in peace, 

includes the full cost to compensate and care for veterans, as well as to support 

their family caregivers and survivors. The Disabled American Veterans stands ready 

to work with this Committee and others in Congress to meet the sacred obligations 

to America’s veterans, especially disabled veterans. That concludes my testimony 

and I will be happy to answer any questions the Committee may have. 

f 

Prepared Statement of Major General 

John Batiste, USA (Ret.), Rochester, NY 

As we observed the anniversary of September 11th, we all experienced very mixed 

emotions. On the one hand, we remember those whose lives were taken in the cowardly attacks on the World Trade Center, the Pentagon, and a field in Pennsylvania. 

As Americans, we continue to grieve with their families and loved ones. We are resolute and angry. We are incredibly proud of our troops and are grateful for their 

unimaginable sacrifices and selfless service. On the other hand, most of us do not 

feel any safer. The notion that the war in Iraq is over is disingenuous. There is no 

functional Iraqi government, the police force is corrupt and ineffective, the army is 

weak and focused on police missions, and the forces of sectarian violence are alive 

and well. The only thing that has changed in Iraq is the mission, but rest assured 

that our troops can and will transition back to combat at a moment’s notice. We 

wonder where it is all going in Afghanistan and how the mission fits within a greater strategy. We have lost confidence in our elected leaders. 

Our Veterans answered the call to serve, but America is letting them down. Americans were never mobilized in support of our troops in Iraq and Afghanistan. Some 

speak about a ‘‘Sea of Goodwill’’ of American support, but the truth is that there 

is no unity of effort or synergy between Federal, State, local, and community efforts 

in support of Veterans and their families. From the perspective of the Veterans Administration (VA), this is a huge opportunity lost. As the chair of the New York 

State Veterans Affairs Commission, I can tell you that there is an enormous gap 

between resources and the needs of Veterans in these wars. The VA system is seemingly overwhelmed and work to synchronize Federal, State, local, and community 

efforts is in need of serious attention. The cost of today’s wars is staggering. We 

have spent over a trillion dollars and that number will multiply as the cost to care 

for our wounded is tallied over the decades to come. Over 5,500 Americans have 

given their last full measure in Iraq or Afghanistan and over 50,000 have been 

wounded. The number of Veterans suffering from traumatic brain injury and post 

traumatic stress disorder is in the hundreds of thousands. Far too much in support 

of our Veterans is simply not getting done. As I have said many times before, how 

we treat our Veterans defines our national character. How does it feel to receive a 

failing grade. 

There is a void between the VA Central Office, the range of VA medical centers 

and regional State offices, and local Veteran service organizations. Federal and 

State Governments are not aligned to serve Veterans and their families. I believe 

that the VA Central Office should lead by promoting community participation and 

involvement in its outreach efforts and developing competitive grant-based opportunities for community service providers specializing in Veteran services. As it has 

been suggested, it will take a ‘‘Sea of Goodwill’’ with Federal, State, local, and community efforts working in unison. The VA desperately needs community participation as an extension of its programs. To make this happen, leadership is needed to 

mobilize communities in support of VA objectives. 

From the State perspective, the New York State Division of Veterans Affairs is 

underfunded during a period of time when Veteran support requirements are exploding. The State is short the required county Veteran counselors and existing 

counselors lack training and certification. Some counties are doing a great job supporting their Veterans, but most are not. A major portion of the challenge is inforVerDate Mar 15 2010 03:50 Jan 13, 2011 Jkt 061761 PO 00000 Frm 00057 Fmt 6604 Sfmt 6621 I:\WAYS\OUT\61761.XXX GPO1 PsN: 61761

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mation sharing. A web-based portal for all of New York State would go a long ways 

towards informing our Veterans and reducing costs such as unused services, unsupported Veterans whose problems multiply in expense and complexity, and Veterans 

and their families who do not know about job, education, and career opportunities. 

Connecting all Federal, State, local, and private sector resources should be a top priority. 

In his address to the Nation on August 31st, 2010, President Obama rightly recognized that ‘‘. . . one of the lessons of our effort in Iraq is that American influence 

around the world is not a function of military force alone. We must use all elements 

of our power—including our diplomacy, our economic strength, and the power of 

America’s example—to secure our interests and stand by our allies.’’ Sadly, the 

president is not walking the talk. Our government’s decision-making process is not 

capable of developing a comprehensive national strategy to synchronize the elements of national power that the president described. The truth is that our government’s interagency process is not capable of developing such a strategy. No one is 

in charge, there is no strategic planning process, and our government’s 18 departments and agencies, to include the VA, are not unified with a common purpose. 

There is no teamwork with a bias for action. We do not have a government-wide 

strategy to deal with global terrorism or Islamic extremism, whatever we decide to 

call it. Without such a strategy, how can we put the sacrifice in Iraq and Afghanistan into context? How do Iraq and Afghanistan fit into the global context? How do 

we define success? How do we organize to better support our returning Veterans 

and their families? 

Many people I talk with confuse our defense strategy with a national strategy. 

Rest assured that our Department of Defense has a great planning process and routinely develops defense strategies and operational plans. The problem is that there 

is no overarching government-wide national strategy with all departments and 

agencies engaged, resourced, and committed to achieving a common goal. In Iraq 

and Afghanistan, the Department of Defense is carrying the lion’s share of the load 

without the benefit of the entire team. This is a huge failure of both the Bush and 

Obama administrations. If you don’t know where you are going, any road will get 

you there. Along the way, the military industrial complex, incompetent and corrupt 

elected representatives, and zealous officials in and out of uniform have taken us 

in the wrong direction. At the end of the day, our Veterans and their families suffer 

for this failure. 

I believe the root cause for our disconnected ventures in Iraq and Afghanistan, 

and our failure to properly care for our Veterans returning from war, is that America went to war in 2001 without a national strategy to deal with global terrorism 

with clearly defined ends, ways, and means. Indeed, such a strategy does not exist 

today. The president and elected representatives in Congress are expected and empowered to fix this. My recommendation is that Congress enact legislation to force 

upon our government’s interagency process what the Goldwater Nichols Act did for 

the Department of Defense in 1986. Congress can force the interagency process to 

organize for success with clearly defined authorities, responsibilities, and a strategic 

planning process with trained planners in every department and agency. We expect 

and deserve a government that is capable of developing and executing serious strategic plans with a focus on teamwork and unity of effort. Short of this, we will continue to spin our wheels in responding to natural disasters, leaking oil wells, peak 

oil, controlling the integrity of our borders, properly attending to the needs of our 

Veterans and their families, and global terrorism. America can do better. 

Why are Americans indifferent today that we are a Nation at war? Why are we 

less safe today than we were on September 11th, 2001? Why are we failing our Veterans and their families? Why are we introducing legislation to create a Veterans 

Trust Fund nearly nine years after commitment of troops into these wars? Part of 

the answer is that our government’s interagency process is broken. Part of the answer is that our Federal Government lacks the process and trained planners to develop a real national strategy. 

Thank God that America is resilient, but let’s not confuse resiliency with purpose. 

f 

Prepared Statement of Colonel James D. McDonough, Jr., 

USA (Ret.), President and Chief Executive Officer, Veterans’ 

Outreach Center of Rochester, NY 

Chairman Filner and Members of the Committee, I would like to thank you for 

the opportunity to appear before you today to discuss the true cost of war and its 

impact on veterans and their families. The truth about caring for veterans and their 


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[i]Sea of Goodwill. Matching the Donor to the Need, (A White Paper) Major John W. 

Copeland and Colonel David W. Sutherland, Office of the Chairman of the Joint Chiefs of Staff, 

Warrior and Family Support. 

families in this country is that for the vast majority, it’s a ‘‘luck of the draw’’ proposition, determined largely by one’s geographic location and proximity to advocacy 

and resources that defines success or failure as a veteran—some will draw the 

‘‘card’’ needed at precisely the right time and place; others will not. Some veterans 

will get help, other veterans will not. The best we hope for is to find an advocate 

who can help teach us what it means to become a veteran of our armed forces. I 

say this confidently after serving twenty-six years in the active Army, becoming a 

veteran and serving the past three years as Director of New York State’s Division 

of Veterans’ Affairs. 

The ‘‘true cost of war’’ in some part can be tracked by our country’s willingness 

to consent to sending young men and women into battle—if willing to ‘‘spend it all,’’ 

citizens, through their elected representatives, provide their consent in return for 

the understanding that the Nation will be behind each and every warrior and their 

family as they head into battle. The Nation will provide for their every need if the 

circumstances demand because we ask so much of each of them. This construct is 

fundamental to the American warrior, but is it shared by all in this country? 

The ‘‘Sea of Goodwill’’ [i] referred to by Major General Batiste during this morning’s testimony before Congress is a phrase used by some in the Pentagon to describe and characterize how America views its support toward our veterans and 

their families, including me and mine. Whether or not that phrase aptly captures 

the sentiment of America nine years into war in Afghanistan or seven years into 

war in Iraq, is largely a point I dare say many Americans have not paused to think 

of, let alone determined, given the state of national rhetoric underway regarding our 

fragile economy, health care reform measures and educational standing in this 

world. 

As the leader of the nation’s oldest non-profit for veterans and their families, I 

question such claims that a galvanizing effort is underway in this country behind 

its veterans and their families. From my perspective, our citizenry is indeed supportive of sending young Americans into battle—we have their consent to do so, but 

little to nothing is understood about their actual needs upon returning from battle 

and reintegration back into the very community from which they departed. One reason for this is that our country lacks a coherent national strategy to not only go 

to war, but to come home and care for those who fought these wars as well. And 

like all wars, they’re easier to start than end, as we’re seeing daily in Afghanistan, 

Iraq and back in America in every state where our veterans and their families return to get on with their lives. 

And while I believe that it’s in our country’s best interests to foster a ‘‘Sea of 

Goodwill’’ around caring for veterans and their families, only ‘‘ponds’’ and ‘‘lakes’’ 

currently exist in pockets across this country, unconnected by coordinating tributary, linking river or supporting stream. These separate and distinct efforts spring 

up daily but lack context, fit and perspective; often leaving veterans and their families only to receive a fraction of their earned benefits, access to health care and services to support their reintegration. There is no ‘‘Sea’’ in the ‘‘Sea of Goodwill,’’ only 

disjointed smaller bodies of water which serve a minority of our veterans and their 

families, and very poorly at that. So how do we improve upon that? 

We should start by leveraging community-based, private sector providers to better 

care for veterans and their families. At the end of the day, we want barrier-free access to services and our families included to address the aftermath of war. 

On any given day in America, only about 36 percent of returning veterans actually use VA services, leaving 64 percent of returning veterans—and their families— 

somewhere outside the VA’s portfolio of services and benefits, and remember, these 

are benefits and services they’ve earned due to volunteer active service in the 

United States Armed Forces. So the first thing to reckon with in creating the conditions necessary for a ‘‘Sea of Goodwill’’ to exist across this country is that our system designed to care for veterans—the United States Department of Veterans Affairs (the ‘‘VA’’)—must be more inclusive to capture a majority vs. minority of veterans. 

To reach the 64 percent of returning veterans not using their services the VA 

must include community-based providers as part of a more coherent delivery network; private providers, supported by the VA and working alongside public providers, to deliver barrier-free and high quality veterans services, benefits and programs. The place to start is with our families since that’s where the VA is not 

charged with any responsibility, outside its Veteran Centers. To think for a moment 

that you can somehow effectively ‘‘treat’’ the veteran absent his/her family, where 


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[ii]McClatchy Newspapers, ‘‘As wars wind down, U.S. Army faces it problems,’’ Greensboro, 

NC News & Record, Sunday, September 19, 2010. 

residual damage and harm lingers, fails to understand one of the ‘‘true costs . . . 

of these wars,’’ namely that our families—spouses and children—have become casualties as well. Like other veteran families, my own is now different because of my 

service to my country, which is a dynamic unlike any other dynamic associated with 

fighting our Nation’s previous wars. So to understand the ‘‘true cost of war,’’ the system in place to care for veterans and their families must work to account for and 

include all of us who have served, and our families. How this country supports a 

system of care for a minority of veterans—at the expense of the majority—is something we all need to understand in order to advocate for change. 

Vietnam was largely a young, single male experience. Afghanistan and Iraq is 

similar age-wise (young), but not exclusively the domain of single males anymore, 

for today women comprise between 15 and 17 percent of the active armed forces. 

Add to this demographic the fact that many servicemembers are now married and 

with families of their own. So much that my Army talked of ‘‘recruiting’’ an individual soldier, but ‘‘reenlisting’’ a family, out of recognition that soldiers would serve 

again, despite the hardship endured, as long as they knew their family would be 

taken care—and they would be. But what happens when that family becomes the 

family of a veteran? Is the sense of caring the same? Unequivocally, I can tell you 

that the feeling of caring is not. When servicemembers and their families separate 

from service one of the first things experienced is a sense of isolation from their 

community. I see it nearly every day as families visit us at Veterans Outreach Center in downtown Rochester (New York). 

New York State remains the fifth most populous state in the country when it 

comes to its veteran population (and their families). Nearly one million veterans call 

New York State home. Almost 90,000 New Yorkers have served in Afghanistan, Iraq 

or both since September 11, 2001. If you accept that 36 percent of all returning veterans are actually using VA services and these rates are actually emblematic of 

broader VA usage rates, in New York State there are roughly 640,000 veterans accessing health care, benefits and services outside the system designed to support 

their needs. Add to this figure their families and you understand that most veterans 

are being cared for in a community setting. In our community-based counseling center at Veterans Outreach Center we see on average 53 new veterans and family 

members every month. Our housing services (emergency, transitional, supportive 

and independent) for homeless veterans operate at capacity (28 ‘‘units’’) every 

month; we have a waiting list just to get in and you can ‘‘stay’’ with us for up to 

two years if need be. 25 percent of our census is comprised of veterans who have 

served in Afghanistan, Iraq or both, which brings me to my second major point: 

The ‘‘true cost of these wars’’ must include the ‘‘sunk cost’’ of underwriting a troubled force 

A 350-page report issued in July after a 15-month investigation into the Army’s 

rising suicide rate found that levels of illegal drug use and criminal activity have 

reached record highs, while the number of disciplinary actions and forced discharges 

were at record lows. The result, the Army found, is that ‘‘drug and alcohol abuse 

is a significant health problem in the Army.’’ [ii] Where the Army once rigidly enforced rules on drug use, it got sloppy in the rush to get soldiers ready for the battlefield. From 2001 to 2009, only 70 percent of DUIs and 61 percent of positive drug 

tests were referred to the Army’s substance abuse program, and drug testing became haphazard. In 2009, 78,517 soldiers went untested for illegal drugs. Statistically, the Army estimated that 1,311 offenders probably escaped detection. Where 

did they go? Said General Peter W. Chiarelli, Vice Chief of Staff of the Army, ‘‘we’ve 

got kids that are going to have some behavioral health issues. The real hard part 

for us to determine, ‘OK, I am willing to help this kid, but how long can I help 

him?’’ 

These troubled ‘‘kids’’ have since separated and are now veterans and are back 

in every community in this country. As I stated a moment ago, they make up 25 

percent of the homeless veterans we serve every day in upstate New York. How 

much of the ‘‘Sea of Goodwill’’ even understands this fact? We do because we see 

it every day; another ‘‘lake’’ amongst other ‘‘lakes,’’ but certainly not within any ‘‘Sea 

of Goodwill’’ that America buys into when it provides Congress its consent to go to 

war. Lastly, I encourage Congress to stop spending scarce resources on brick & mortar 

VA facilities which continue to under-serve our veterans and their families. Like its 

sister department, the Department of Defense, the Department of Veterans Affairs 

maintains an aging infrastructure, some of which exists in locations no longer conducive to serving veterans. A BRAC-like process is needed to reform where 


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and how the VA and its community partners deliver health care and services to veterans and their families. Geography plays a significant role in proximity to services in our state (like most others) and when you get there after your 

1.5 hour drive from Victor to Batavia, New York, what do you see when you walk 

toward the lobby of the Batavia VA Medical Center? You’re greeted by a sign that 

reads ‘‘No Emergency Services,’’ limited primary care capacity and only a small 

handful of actual services. Veterans and their families enter a lobby that is wellworn, devoid of younger veterans, and certainly absent of women veterans. 

If this is part of the ‘‘Sea of Goodwill’’ the Pentagon likes to speak of, where actually is the ‘‘Goodwill?’’ Why, if we are the greatest country in the world—the one 

that prides itself on reminding others it ‘‘cares for those who served,’’—do we continually pour good money down bad holes and experience the same sub-standard level 

of care we’ve come to almost expect as veterans? Has it become that bad, that our 

expectation as veterans is to be cared for poorly? Could a national strategy help? 

It certainly can’t hurt, just as legislation to create a Veterans Trust Fund can’t either. An up-front investment to be made prior to going to war serves to remind everyone that the true cost of war is calculated differently; that human factors—families, children, spouses, veterans—actually have real value and that their care must 

be accounted for to receive our nation’s true consent to wage war. If America paused 

for only a moment to count the true cost it just might not like the price tag associated with their consent. As a veteran, and now someone who cares for veterans and 

their families in a community setting, perhaps the cost of obtaining the Nation’s 

consent is the greatest cost to be calculated beforehand. 

Chairman Filner and Members of the Committee, I appreciate the opportunity to 

speak before you today. Thank you. This completes my statement. I am happy to 

answer any questions the Committee may have. 

f 

Prepared Statement of Major General William L. Nash, 

USA (Ret.), Washington, DC (Independent Consultant) 

Thank you, Mr. Chairman. And thank you and the Committee on Veterans’ Affairs for your work on behalf of the members of our Armed Forces and their families. Your work is crucial and I believe this hearing is most important. I would also 

like to thank Secretary of Veterans Affairs, Eric K. Shinseki for his wisdom, initiative and hard work on behalf of veterans and their families. General Shinseki is an 

old friend, and I could not be happier for the Nation in having him lead the Department of Veterans Affairs. 

When I was a fairly young commander in Germany in the early 80s, I worked for 

a commanding general who drew a clear distinction between ‘‘love of soldiers’’ and 

‘‘care for soldiers.’’ He used to say that everyone ‘‘loved’’ soldiers, but fewer knew 

how to take care of them. By that he meant, that not every commander had the 

necessary understanding of how the various Army systems worked in order to ensure that soldiers were equipped, trained, fed, compensated, and housed. Those efforts required expertise and resources and great energy to accomplish successfully. 

It was a lesson all commanders need to learn early in their careers. 

The same is true at the national level when talking about veterans. Yellow ribbons and bumper stickers are nice; so are standing ovations at ball games and 4th 

of July speeches. But they don’t do the job of taking care of veterans and their families. For that you need expertise and resources and great energy. 

One important aspect of this endeavor is the need to anticipate requirements. As 

we have seen for many years and again this morning, the preparation for the wars 

in Afghanistan and Iraq were inadequate. Basically, we as a Nation failed to understand the consequences of our actions abroad or at home. Hence, we failed to prudently prepare for those consequences. 

Our soldiers, sailors, airmen and Marines sign an unlimited liability contract 

when they join the armed forces. The co-signers are their families. And we as a Nation, having chosen to have an all-volunteer force, must underwrite these contracts 

to full value. 

Thus I am troubled as to the current state of preparedness to care for our veterans and their families. While significant progress has been made in many areas, 

there is much more to be done by both the executive and legislative branches of our 

government. We know that more than 450,000 veterans from Afghanistan and Iraq 

have submitted disability claims. More are coming; many more are to be expected. 

This is a long-term, life-time challenge. 

Mr. Chairman, you have recognized that there are ‘‘more than one million claims 

and appeals jammed in a fatally-flawed system.’’ As you have stated, the benefits 


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claims processing system must be reformed. We must increase our capacity to handle the volume of applications as well improve the accuracy of initial claims decision. Drastic improvements are needed in the current appellate process. We must 

recognize and do something about the direct relationship between the shortages of 

behavioral health specialists and substance abuse counselors and the high suicide 

rates of veterans as well as the other ramifications of the dramatic numbers of post 

traumatic stress experienced by personnel returning from Afghanistan and Iraq. 

In other words, Mr. Chairman we need more expertise, more resources and even 

more energy. As to resources, I would add that a forced savings program—a Veterans’ Trust Fund—seems to me to be a sound and prudent initiative to help meet 

long-term needs. 

It is the long-term that requires our attention. Care for our veterans and their 

families requires a broad perspective that goes well beyond the responsibilities of 

the Department of Veteran Affairs. Our citizens have determined that the Nation 

will be defended by volunteers, active and reserve, who serve because they have chosen to serve. And as I said before, that commitment is unlimited in scope. So as 

we look at veteran issues, we must examine the entire package of pay and benefits 

that we citizens are willing to spend in order to recruit, retain and reward the small 

group of soldiers, sailors, airmen and Marines that go in harms’ way to defend our 

Nation. We have not done enough. 

I was privileged to serve for over thirty years with those dedicated public servants. I was also responsible at times to give the direct order to face battle and its 

horrible consequences. I never hesitated to look them in the eye as I gave those orders because I knew we were individually and collectively capable and dedicated. 

But I also knew that we were committed to caring for our dead and wounded—no 

soldier left behind. So must our Nation—we care for those who serve—now and forever. Thus, Mr. Chairman, I look you in the eye and ask you and the Committee 

and the Congress to give to our veterans the very best expertise, resources and energy possible. 

Thank you. 

f 

Prepared Statement of Paul Sullivan, 

Executive Director, Veterans for Common Sense 

Veterans for Common Sense (VCS) thanks Committee Chairman Filner, Ranking 

Member Buyer, and Members of the House Veterans’ Affairs Committee for inviting 

us to testify about ‘‘The True Cost of War,’’ and the consequences of the Iraq and 

Afghanistan conflicts. We are honored to be in the company of experts, advocates, 

and fellow veterans to discuss this important long-term issue. 

VCS begins by presenting the Committee with the most salient official government statistics about the human and social costs of the current conflicts. Our top 

priority for this hearing is to inform Congress, the press, and the American public 

about the human cost of the Iraq and Afghanistan wars because everyone in our 

country is impacted by high taxes, spending, and lost opportunity costs caused by 

war. 

As of March 2010, government statistics show 565,000 new veteran patients were 

treated at Department of Veterans Affairs (VA) hospitals and clinics since 2001. As 

of today, based on an average of 9,000 new patients each month, VCS estimates the 

current count of VA patients is approximately 619,000. 

The significant post-deployment statistics about our veterans must be contrasted 

with events during 2002, when the Administration had no casualty estimate, no 

plan to monitor or estimate fatal or non-fatal casualties, no plan for caring for nonfatal casualties, and no dedicated long-term funding for non-fatal casualties. 

The consequences of the war are high, especially for non-fatal casualties. There 

is a general lack of awareness about the hundreds of thousands of post-deployment 

casualties. And there appears to be a lack of urgency to adequately and promptly 

meet our veterans’ growing needs. Therefore, VCS urges Congress to pass a new law 

mandating that the Administration must estimate, monitor, plan, and fund health 

care and disability benefits for our casualties before starting or entering into a war. 

VCS broadly defines casualty. This includes battlefield deaths, and caring for our 

grieving families. Casualty includes our servicemembers who become wounded, injured, or ill on the battlefield as well as during training. This includes post-war 

medical conditions among our veterans not immediately apparent while in the military, such as toxic exposures, traumatic brain injury, and mental health conditions. 


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Part One: Official Statistics 

Government statistics paint a disturbing picture of enormous human suffering 

among our servicemembers and veterans. VCS obtained the following facts from the 

Department of Defense (DoD) and VA using the Freedom of Information Act (FOIA). 

According to DoD: 

• At the end of August 2010, a total of 5,670 U.S. servicemembers died in the 

Iraq War and Afghanistan War combat zones. 

• At the end of August 2010, a total of 91,384 U.S. servicemembers in the two 

war zones were wounded or were medically evacuated due to injuries or illnesses that could not be treated in the war zones. 

• The grand total of U.S. battlefield casualties is more than 97,000. 

According to VA: 

• As of March 2010, VA treated and diagnosed 565,000 new, first-time Iraq War 

and Afghanistan War veteran patients. Again, based on VA data trends, VCS 

conservatively estimates VA has treated 619,000 patients as of today. 

• VA’s count excludes veterans who sought private care, retired veterans 

treated by the military, and student veterans treated at campus clinics. VA’s 

count also excludes treatment for wounded, injured, or ill civilian contractors. 

• As of June 2010, VA received 513,000 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 100 new, 

first-time veteran patients for each battlefield death reported by DoD. 

• At the current rate of approximately 9,000 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 2014. 

Missing Facts: 

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 and analyzed immediately by the Administration, Congress, academics, and advocates. 

• 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 (health care, disability, etc.) since returning home? In another example, is VA able to accurately and consistently 

provide the expenditures for all of these VA programs? VCS remains alarmed 

VA is incapable and unwilling to answer these two easy questions. 

• DoD and VA must prepare an official accounting of the financial costs for 

medical care, disability benefits, education benefits, life insurance, home loan 

guaranty, and all other DoD and VA benefits for servicemembers, veterans, 

and families. For the past several years, VCS has requested this information 

from VA using the Freedom of Information Act. VA has not provided any cost 

data. Starting in 2001, VA employees urged VA leaders to begin tracking warrelated benefit use and costs, and nearly all requests were refused. 

• 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 this Committee documented tens of thousands of improper discharges, often for veterans at high 

risk of readjustment challenges due to TBI and 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. 

• VA should monitor negative post-deployment outcomes, such as homelessness, 

suicides, divorce, and crime, as well as state, local, and private 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 reVerDate Mar 15 2010 03:50 Jan 13, 2011 Jkt 061761 PO 00000 Frm 00063 Fmt 6604 Sfmt 6621 I:\WAYS\OUT\61761.XXX GPO1 PsN: 61761

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search 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 crosscountry 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. • VCS provides additional examples of the cost of war at the end of our statement. The important statistics were summarized by reporters in the article, 

‘‘The Numbers,’’ published last weekend by the Fayetteville Observer. 

Part Two: Need for Trust Fund and National Plan 

VCS believes we 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 health care and benefits they 

earned. 

As a non-profit advocacy organization, VCS uses the Freedom of Information Act 

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 Three Trillion Dollar War: The True Cost of the Iraq Conflict (2008). In 

their ground-breaking work on the subject of the cost of war, Bilmes and Stiglitz 

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 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 

nine years of war in Afghanistan, and 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 war veteran, VA 

was given additional resources to meet the tidal wave of new, first-time Iraq and 

Afghanistan war veteran patients flooding into VA. 

VCS remains a strong supporter of VA, and VA has made many improvements 

in personnel, budgeting, and policies in the past 20 months. VCS wants VA to live 

up to the high standard set by President Abraham Lincoln: ‘‘To care for him who 

shall have borne the battle and for his widow and his orphan.’’ VCS encourages Congress, VA, and DoD to learn lessons from past mistakes. VCS urges Congress to 

mandate national monitoring and planning for the return of our servicemembers. A 

national plan must also include fully funding all needed health care and benefits 

for our veterans. 

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 


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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. 

Gulf War combat veterans formed VCS in 2002. After our return from Iraq in 

1991, we veterans learned President George H. W. Bush led our nation to war based 

on false pretenses. There was no formal declaration of war by Congress, only an ‘‘authorization for the use of force.’’ There was no threat to our Constitution or the safety of our Nation, as this first invasion of Iraq was a war of choice. 

The most painful lesson for Gulf War veterans has been the continuing lack of 

a national plan to care for our returning veterans, starting in 1991. The brutal irony 

today is the fact the Agent Orange Act of 1991 was enacted by Congress shortly 

after the Gulf War began, nearly 25 years after the Vietnam War began. On October 

30, 2010, VA is set to finally begin, in earnest, providing additional health care and 

disability benefits to seriously ill Vietnam War veterans due to exposure to Agent 

Orange. 

We tried to learn a lesson from 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 street-to-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 that the White House never answered our letter. President George W. Bush started his war of choice based on false pretenses. He ignored 

the wise and experienced counsel of the only group of living Americans who had 

ever fought in Iraq. 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. 

Earlier, on October 12, 2002, our VCS Executive Director, Charles Sheehan Miles, 

published an editorial criticizing the Congressional Budget Office (CBO) for failing 

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 naı ̈ve and unrealistic when you consider the kind of war we are preparing to enter—an openended 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. 

At the end of the day, robust monitoring, planning, implementation, and oversight 

are best for our returning veterans. 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 


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today, the elderly veterans of tomorrow may enjoy better health and quality of 

life. 

Conclusion 

Why does Veterans for Common Sense care about the U.S. casualties from the 

Iraq and Afghanistan wars? Our founders are Gulf War veterans, and many Iraq 

War and Afghanistan War veterans are members. When we returned home, we encountered a DoD and VA medical system unable and unwilling to listen to our concerns about toxic exposures in Iraq and Kuwait in 1991. Based on our experience, 

in late 2002, we saw the handwriting on the wall: misleading information to start 

another war of choice. There were other disturbing signs: CBO, the White House, 

VA, and DoD had no post-deployment plan. As Gulf War combat veterans and advocates, we could see that in 2002 the George W. Bush Administration was going to 

repeat the miscalculation the George H. W. Bush Administration made in 1990 by 

failing to estimate or prepare for the true long-term costs of war. This unique hearing presents us with a rare opportunity to begin a dialog and plan for our long-term 

casualties. 

The statistics describing the damage to our Gulf War veterans are stunning in 

depth and scope. 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. 

Here are the two messages VCS sends to Congress, VA, DoD, and fellow Americans. First, as of today, VCS estimates our nation currently has as many as 619,000 

Iraq and Afghanistan war veteran patients, plus a similar number of claims. VA can 

reasonably expect another half million new veteran patients from the two wars by 

the end of 2014, for a total of one million current war veteran patients and claims. 

This estimate is supported by the fact 44 percent of current Iraq and Afghanistan 

war veterans were already treated at VA. Based on 2.2 million servicemembers deployed to the two war zones, that also equals one million patients. Second, our nation has no strategic plan to identify, monitor, treat, and compensate those veterans. 

In order to resolve this current problem, Veterans for Common Sense urges Congress to demand transparency from DoD and VA. Furthermore, VCS urges Congress 

to establish a Trust Fund, as proposed by Linda Bilmes and Joseph Stiglitz, so our 

Nation never again faces billion-dollar budget shortfalls at VA and national scandals 

such as Walter Reed. 

Again, we thank Chairman Filner and Ranking Member Buyer for your interest 

in this important issue. As a Gulf War veteran, I remain impressed with your advocacy for our veterans. We want our service to our Nation to have meaning. However, 

I remain deeply disappointed how, after 20 years of warfare in Iraq and neighboring 

countries, our Administration can’t tell us, with accuracy, the full human and financial costs of the conflict. Even more troubling is the lack of monitoring, planning, 

and funding to provide care and benefits for we who have defended our Constitution. Please fix this now. 

* * * 

News Articles Cited by VCS: 

The wars in Iraq and Afghanistan have taken a toll on soldiers that isn’t readily 

visible. In a five-part series published on September 26, 2010, in The Fayetteville 

Observer and on www.fayobserver.com, reporters Greg Barnes, Jennifer Calhoun 

and John Ramsey examine the mental health challenges facing Fort Bragg and how 

they will impact the military and civilian communities. 

‘‘The Numbers’’—A look at some of the research into the mental health of soldiers and their families. 

A. 38 percent of Army soldiers and 31 percent of Marines report symptoms of 

psychological problems. The figure rises to 49 percent for members of the 

National Guard. Source: Department of Defense Task Force on Mental 

Health, June 2007. 

B. Lengthy U.S. Army deployments increase the occurrence of depression, anxiety, sleep disorders and other mental health diagnoses for soldiers’ wives 

left at home. Among women whose husbands were deployed during the study 

period, 36.6 percent had at least one mental health diagnosis. Source: Jan. 


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2010 study by RTI International, the University of North Carolina at Chapel 

Hill and the Uniformed Services University of the Health Sciences. 

C. The overall rate of child abuse and neglect was more than 40 percent higher 

while a soldier-parent was deployed for a combat tour than when he or she 

was home. Source: Study in 2007 by RTI International and the University 

of North Carolina at Chapel Hill’s School of Public Health. The study was 

funded by the U.S. Army Medical Research and Materiel Command. 

D. The overall rate of child abuse and neglect was more than 40 percent higher 

while a soldier-parent was deployed for a combat tour than when he or she 

was home. Source: Study in 2009 led by Dr. Eric M. Flake of the Madigan 

Army Medical Center, Tacoma, Wash. 

E. Children of U.S. military troops sought outpatient mental health care 2 million times last year, double the number at the start of the Iraq war. The 

number of military children who were hospitalized for mental health reasons 

also skyrocketed, from 35,000 to 55,000 during that time. Source: 2009 analysis of internal Pentagon documents by The Associated Press. 

F. Researchers found that 37 percent of Iraq and Afghanistan war veterans 

who used the veterans health system for the first time between April 1, 

2002, and April 1, 2008, received a mental health diagnoses. Of those, 22 

percent were diagnosed with PTSD, 17 percent with depression and 7 percent with alcohol abuse. One-third of the people with mental health diagnoses had three or more problems, the study found. The study says fewer 

than 10 percent of the veterans diagnosed with PTSD received the appropriate level of care at VA facilities. Source: 2010 study by the San Francisco 

VA Medical Center and University of California-San Francisco. 

G. Stigma remains a critical barrier to accessing needed psychological care. 

Analysis revealed that 20 percent to 50 percent of active duty servicemembers and Reservists reported psychosocial problems, relationship problems, depression and symptoms of stress reactions, but fewer than 40 percent sought help for their problems. Source: Report of the Department of Defense Task Force on Mental Health, June 2007. 

H. ‘‘The Task Force was not able to find any evidence of a well-coordinated or 

well-disseminated approach to providing behavioral health care to servicemembers and their families... Another concern identified by the Task Force 

involves the care provided to servicemembers as they transition from the 

Military Health System to the VA system.’’ Source: Report by the American 

Psychological Association Presidential Task Force on Military Deployment 

Services for Youth, Families and Servicemember, 2007. 

* * * 

‘‘Veterans With PTSD Suffer More Physical Ailments Than Their Peers; 

Female vets with disorder plagued by more medical illnesses than male 

counterparts, study shows.’’ 

Published on September 24, 2010, by HealthDay News /Businessweek 

U.S. soldiers with post-traumatic stress syndrome (PTSD) returning from the 

wars in Iraq and Afghanistan suffer more physical ailments than those with no 

mental health issues, and this effect is stronger in women than men, a new study 

shows. 

The findings suggest that veterans with PTSD need closer integration of their 

physical and mental health care, said Dr. Susan Frayne, of the VA Palo Alto Health 

Care System and Stanford University. The study appears online in the Journal of 

General Internal Medicine. 

The researchers analyzed data from more than 90,000 U.S. veterans who used VA 

services and found that women with PTSD had a median of seven physical ailments, 

compared with a median of 4.5 among those with no mental health issues. Lower 

spine disorders, headache and leg-related joint disorders were the most common 

physical complaints. 

Among men, those with PTSD had a median of five physical ailments, compared 

with a median of four for those with no mental health concerns. Lower spine disorders, leg-related joint disorders, and hearing problems were the most common 

physical conditions. 

‘‘Health delivery systems serving our veterans with post-traumatic stress disorder 

should align clinical services with their medical care needs, especially for common 

diagnoses like painful musculoskeletal conditions,’’ Frayne said in a journal news 

release. ‘‘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 reVerDate Mar 15 2010 03:50 Jan 13, 2011 Jkt 061761 PO 00000 Frm 00067 Fmt 6604 Sfmt 6621 I:\WAYS\OUT\61761.XXX GPO1 PsN: 61761

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cently 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,’’ she 

concluded. 

f 

Prepared Statement of Lorrie Knight-Major, 

Silver Spring, MD (Mother of Veteran) 

Good morning Chairman Bob Filner, Ranking Member Steve Buyer, and Members 

of the Committee. Thank you for the opportunity to share my personal experience 

with the Military and the Department of Veterans Affairs. The following details my 

family’s experiences with Ryan’s journey and the significant role that the nonprofit 

communities played in helping my injured soldier regain his independence. 

My name is Lorrie Knight-Major. I am the mother of Sergeant Ryan Christian 

Major. On November 5, 2003, Ryan enlisted in the U.S. Army for a three year term, 

which was later extended for an additional five months. On November 10, 2006 at 

0300, five days after his original discharge date and two months prior to his redeployment from Iraq to the U.S., Ryan was critically wounded as a result of an improvised explosive device (IED) blast while on a mission with his unit on a foot patrol in Ramadi. The device was hidden under ground. As a result of the blast, Ryan 

sustained multiple massive injuries including: 

• Both legs were amputated above the knee; • Both arms were broken with multiple fractures; • Extensive peritoneum injuries; • Severe right pelvic fracture; and • Traumatic Brain Injury and post traumatic stress disorder 

As I recall the events following the blast as a mother and a caregiver, I am reminded of the pledge that soldiers take when they enlist, the Soldier’s Creed. I ask 

that each one of you listen closely and reflect on America’s solemn oath to providing 

the necessary resources to our military. 

A Soldier’s Creed 

I am an American Soldier. I am a Warrior and a member of a team. 

I serve the people of the United States, and live the Army Values. 

I will always place the mission first. I will never accept defeat. 

I will never quit. I will never leave a fallen comrade. 

I am disciplined, physically and mentally tough, trained and proficient in my 

warrior tasks and drills. 

I always maintain my arms, my equipment and myself. 

I am an expert and I am a professional. 

I stand ready to deploy, engage, and destroy, the enemies of the United States 

of America in close combat. 

I am a guardian of freedom and the American way of life. 

I am an American Soldier. 

I met Ryan at his bedside in the intensive care unit in Landstuhl, Germany, three 

days after I had received the news. He was barely hanging on. I was frightened beyond description. But as bad as Ryan looked, I knew in my heart, he was a fighter. 

As a child, he had challenged every line I had drawn in the sand. Now I was certain 

that his determination would save his life. Although he lay there helpless, I believed 

that if given a fighting chance and the best possible medical care available, Ryan 

would persevere. 

Within 24 hours of our arrival in Landstuhl, doctors had stabilized Ryan for 

transport to Walter Reed Army Medical Center. Ryan underwent multiple surgeries 

while at Walter Reed. On January 3, 2007, Ryan was moved by ambulance to the 

R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center (Shock Trauma). Shock Trauma is world renown for managing difficult traumas 

and complicated infections and is the only freestanding hospital center in the world 

dedicated to trauma. 

Within hours of Ryan’s admission to Shock Trauma, the Pain Team was on board 

employing its unique holistic approach to treatment. The team used a host of tools 

including narcotics, Reiki therapy, massage therapy and, later, acupuncture. For the 

first time in three weeks, Ryan was able to sleep through the night peacefully, as 

the staff turned him every two hours. 

On January 31, 2007, Ryan was transferred to National Rehabilitation Hospital 

(NRH) where he spent the next seven months. But getting Ryan into NRH wasn’t 

easy because he was an enlisted soldier. It took multiple meetings with military 


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staff, but ultimately they granted permission. I convinced them that NRH had a 

proven track record and that Ryan’s family and friends could routinely visit—support I felt would be critical to his successful recovery. 

Before going to NRH, we were given four options of VA polytrauma hospitals in 

the U.S., but none were close to home. Ryan’s transfer to any of them would have 

required me to travel out of state and live for many months far from home, without 

social support and away from my job, while leaving my minor child at home. Our 

veterans should have access to Regional Trauma Hospitals and nationally recognized rehabilitation facilities that possess expertise on polytrauma that are located 

near their homes. Our family was very fortunate to live in the national capital region, home of two of the finest medical facilities, R Adams Cowley Shock Trauma 

Center at the University of Maryland Medical Center and National Rehabilitation 

Hospital. Most families I have met or talked to don’t live in close proximity to hospitals such as these in their home towns. Most families of severely injured soldiers 

travel across state lines and live in hospital and hotel rooms to be near their injured 

soldiers for many months placing additional burdens on an already emotionally 

fraught time period. 

For the first two months after Ryan’s injuries, we were not certain if he would 

survive. He was in a coma fighting for his life. He battled serious infections and 

underwent surgeries daily. Once we crossed those bridges and it appeared very likely that he would survive, I started to plan for his return home. 

Because of the wheelchair, I knew that major structural changes to our house 

were needed to accommodate him. Two separate architects examined our home and 

determined that a stair lift wasn’t feasible. They both said that we needed an elevator. I didn’t know how I would accomplish the huge task of making our home wheelchair accessible. 

Through the VA, there are three grants available for constructing an adapted 

home or modifying an existing home to meet veterans with service connected disabilities’ adaptive needs: the Specially Adapted Housing Grant, The Special Home 

Adaptation Grant and the Home Improvements and Structural Alterations Grant 

(HISA), which require separate applications to the Veterans Health and Benefits 

Administrations. HISA does not require a service connected disability. To access the 

maximum funding through these grants, veterans have to own the homes where the 

modifications will be done. Up to half of the injured soldiers are single and they return home to live with their parents, other family members, or friends. Therefore, 

access to funding through the VA is limited to fourteen thousand dollars 

($14,000.00) for work done on someone else’s home where the veteran will live. 

In 2007, when I was looking for available housing resources, the grant provided fifty thousand dollars ($50,000). Now the grant provides sixty thousand dollars 

($60,000). For the modifications that our home required, it wasn’t enough money. 

The grant would have only paid for the elevator to be installed which would have 

carried him from the garage into the first floor of the house. But the bedrooms were 

located on the second floor. 

Fortunately, by word of mouth, I was informed about Rebuilding Together, a national non-profit organization that provides home rehabilitation and modification 

services to homeowners in need. In 2005, Rebuilding Together launched its Veterans 

Housing Program to address the needs of soldiers returning from Iraq and Afghanistan. This program has been expanded to help veterans of all wars, and is now 

sponsored by Sears Holdings Corporation. 

Rebuilding Together’s Veterans Housing Program to date has rehabilitated and 

modified the homes of 725 veterans and 25 veterans’ centers. Their overall mission 

is homeownership preservation for those in need, and their 200 affiliates nationwide 

rehab 10,000 houses a year, at no cost to the homeowner, thanks to the work of 

thousands of skilled and unskilled volunteers and the support of national and local 

sponsors. 

Rebuilding Together immediately committed to the project upon receipt of my application. An evaluation of our house was performed. Their staff and architect met 

with Ryan’s medical team at NRH to thoroughly assess Ryan’s needs. 

The renovations were completed within four months. The work that was done by 

Rebuilding Together included: an elevator, the conversion of our first floor family 

room into Ryan’s bedroom with an accessible bathroom, a new deck addition for his 

egress, a new separate central air and heating system for his bedroom, and an inground generator for emergency purposes and escape. The value of these renovations is estimated at $150,000 which, thanks to Rebuilding Together, didn’t cost our 

family anything. This project was not just about installing an elevator or renovating 

the bathroom or adding a new deck. It was a life changing experience. Without the 

modifications, Ryan would have been confined to the basement—apart from his family or dependent on his brothers and friends to carry him up and down the stairs. 


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The elevator and handicap accessibility renovations gave Ryan the freedom and the 

independence to move around his home and insured that he was an integral part 

of our home and our family. 

If these services had not been provided by Rebuilding Together, over 725 veterans 

and their family members would not have the quality of life they now enjoy since 

VA does not fully accommodate all of their needs through its grant programs. Sometimes that is because the veteran is unaware of the benefit, ineligible, or it’s simply 

not enough as in our case. Ryan’s dream to come home could not have been fulfilled 

without the generosity of many other members in our community. 

In 2008, Ryan received an IBOT wheelchair from the Independence Fund. This 

chair can climb stairs and rises in the air raising the seat height. Ryan’s IBOT gives 

him the ability to reach upper kitchen cabinets in our home and allows him to visit 

friends where climbing stairs is necessary to enter their home. Independence Fund 

is a small nonprofit that was established in 2004. Independence Fund has donated 

twenty IBOTs to wounded soldiers and veterans totaling $500,000. Again, the VA 

did not have the ability to provide Ryan with this level of specialized equipment. 

In August 2009, Ryan received Theodore from Paws for Liberty. Theodore is a 

three year old Belgian Shepherd and has truly made the biggest impact on Ryan’s 

independence. Theodore helps Ryan with retrieving dropped items, helps him navigate crowded areas, and helps relieve and mitigate his PTSD symptoms. Once Theodore came home with Ryan, Ryan no longer required someone at his bedside so that 

he could sleep. Paws for Liberty is a five year old organization based out of Lake 

Worth, Florida. They have donated four service dogs to veterans and six service dogs 

to individuals with disabilities. These dogs cost on average of $15,000–$20,000 to 

train. Again, a resource not offered to Ryan by the VA. 

I am reminded of the ancient African proverb, ‘‘It takes a village to raise a child’’ 

because, ‘‘It takes a community to bring a soldier home’’. Thanks to all of the support that we have received, Ryan is embracing his challenges, and is moving forward with his life. He has completed both the New York Marathon and the Boston 

Marathon on a hand crank bicycle, skied in Aspen, Colorado, kayaked on the Colorado River, and is driving his own car. He began attending college this semester 

pursuing a degree in Business Administration with the assistance of Sentinels of 

Freedom, a nonprofit organization. 

I have had to reach outside the system and rely on the nonprofit community for 

assistance throughout this ordeal. This support should have been provided by the 

government. It is because of the nonprofits that have provided Ryan with the resources for him to live at home with his family, take charge of his own care, and 

allow him to feel safe and sleep at night. In light of this, there should be better 

collaboration between the Department of Defense, VA and nonprofit organizations. 

Unlike many other soldiers transitioning out of the military, Ryan’s transition 

into the VA system went smoothly. I credit this success to Ryan’s Federal Recovery 

Coordinator. She laid the groundwork in planning Ryan’s transition into the VA a 

year in advance by beginning the communication between Walter Reed and the Baltimore VA. Ryan’s medical board process with the VA was a simple process. All of 

the VA staff that dealt with Ryan’s medical board and disability rating provided 

outstanding services. I could not have asked for a more straightforward process. 

However, in hindsight, now that Ryan is enrolled in college, I wish that a vocational 

rehabilitation assessment was mandatory as part of his disability evaluation process 

before he separated from the Army. This would have provided vital information on 

his aptitude and functioning and would have informed his college course choices. He 

has still not had a VA Vocational Rehabilitation and Employment assessment. 

The one item that I feel has been overlooked in the VA Disability Rating is the 

disability’s impact on a veteran’s quality of life. And based on its impact, a corresponding dollar value should be assigned and paid to the veteran as part of the 

monthly disability compensation as a special monthly compensation. 

From the moment that Ryan was injured, his clothes required alterations due to 

surgeries, arm and hand splints, bilateral lower extremity amputations and the use 

of medical creams and ointment frequently soiled and ruined clothes. The clothing 

allowance available to veterans is not permitted under the law to active duty 

servicemembers with the same injuries or conditions. This benefit should be treated 

equally with the other benefits available to active duty wounded warriors, such as 

the auto and housing allowances. 

Our journey has been fraught with various obstacles that serve as barriers to access to quality care. Navigating the complex maze of treatment options and benefits 

is a job in and of itself. But, we remain determined that Ryan receives the quality 

care that he was promised when he enlisted to serve in the United States Army 

should he become injured. Advocating for this quality medical care and the coordination of services has been my mission. But this level of care and advocacy comes at 


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a price. The cost has been my family’s financial security. As a result of caring for 

my Ryan, and the emotional toll it has taken on our family, I had to leave my job 

to provide the necessary level of medical care and advocacy that my son required. 

This led to a significant financial hardship for our family because of my living on 

credit cards and a home equity line of credit, which have all been exhausted. When 

I gave up my job, I also gave up my health insurance that covered me and my minor 

child, shifting that additional monthly expenditure to my out of pocket expenses. 

Families should not have to sacrifice and bear the burden of advocacy, and compromise their own financial stability and wellness to ensure that their soldiers’ receive the appropriate and necessary services from the government. 

I recognize that progress has been made in the caring of our injured soldiers. We 

still have a ways to go. 

Recommendations in Moving Forward 

Here are the things that I would recommend to improve the lives of wounded warriors and veterans: 

1. Increase the amount of VA Housing Grants and the establishment of a competitive fund for national housing organizations to compete for housing dollars to better enable them to provide housing modifications for veterans. 

2. VA Service Dogs are made available to veterans with service connected disabilities to include challenges with mobility and mental health issues as are 

done with Guide Dogs. 

3. Increase in the VA Automobile Grant. 

4. Increase in the number of authorized electric wheelchairs based on changing 

needs and a program for veterans to return wheelchairs that no longer meet 

their needs. 

5. Vocational Rehabilitation Assessments are made mandatory during the Disability Evaluation System process before a veteran with service connected 

disabilities separates from the military. 

6. Authorize a clothing allowance that is available for veterans to be available 

to servicemembers with similar injuries and conditions. 

As a mother, here are the things that I would recommend that would have made 

my life easier if they were in place: 

1. Health insurance allowance for my minor son and me; and 

2. Non-medical attendant allowance that is provided by DoD to caregivers of 

veterans that receive medical care greater than fifty miles from their residence. Since I lived within the fifty mile radius, I didn’t qualify for the DoD 

benefit, but VA could have filled the gap. 

As an observer with a window seat, here are my recommendations for the providers of care: 

1. Improved communication between all of the providers regardless if VA, DoD 

or private; 

2. Better collaboration between all of the medical policy leaders, both in the 

government and civilian population. Allow private providers and facilities to 

fill in the gaps when a VA facility is not in the veteran’s community. Additionally, the sharing of best practices between all medical providers would 

improve the medical care provided to both the military and civilian populations; and 

3. Require a multidisciplinary medical team approach in providing care in military and VA hospitals to include the Pain Team and Infectious Disease specialty. 

Ryan loved being in the Army until the day he separated on May 20, 2010. He 

loves the military. He never quit. He never once complained about getting hurt. The 

men in his Unit never quit. The medical teams that saved him in theater never quit. 

I ask this Congress to not only honor this country’s solemn oath to care for our veterans, but I urge you to work towards the United States being proactive in making 

funding available for our wounded soldiers and veterans. If the United States can 

set aside funds for an unexpected oil spill, surely America can put aside monies at 

the time a war is authorized, to take care of our military that continues to take care 

of us preserving our freedoms. We owe a tremendous debt to our veterans for their 

services and sacrifices. It is our social, moral, and ethical responsibility to provide 

them with the appropriate resources, and the tools and support that are necessary 

for them to live longer, fuller, and healthier lives. 


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Now that the Caregiver Bill has been signed by the President, I would like to 

know how it would address the concerns that I have shared on the record. Will the 

VA pay retroactive compensation to caregivers of OEF/OIF veterans? If so, will 

there be a lump sum payment to these caregivers? 

If the nonprofit organizations had not provided assistance, would it have been acceptable to the government for my son to have been placed in a nursing home? 

Would it have been acceptable to the government for my son to have lived isolated 

in a basement because he didn’t have a means to be transported to the main areas 

of the house? Would it have been acceptable for my son to require sleep medications 

or someone in his room nightly for him to sleep? Is this what the government considers to be the cost of the war? 

Ryan couldn’t be here today because he is attending classes. Therefore, I included 

a picture of him and his service dog, Theodore. 

Again, thank you Mr. Chairman for the opportunity to share my personal experience in accessing care and resources within the Department of Defense and the Department of Veterans Affairs. 

(Courtesy of b free daily) 

f 

Prepared Statement of Corey Gibson, Terre Haute, IN (Veteran) 

Good Morning. My name is Corey Gibson and I am a combat veteran from the 

Operation Iraqi Freedom Campaign. 

I am here before you today as a collective voice for veterans nationwide. Where 

this may be my individualized account, the issues and concerns within my time with 

you are pervasive. You all trained me how to fight, how not to turn in the face of 

an enemy, and how to watch out for the better interest of my brothers and sisters 

in arms. 

Regardless of my daily struggles with PTSD, TBI, and other diagnosis, don’t think 

that the training I received calls for me to stop fighting now. 

On September 23rd, Michelle Obama stated that veterans and spouses need support by local employers everywhere. I am sorry we can’t get Stephen Colbert here 

to help highlight problems with veteran’s health care and benefits. Could we send 

him into combat where he will be forced to make the decision of kill or be killed 

in defense of his country only to come back to a life of physical and mental disabilities so that we can have his input? A constant struggle affecting him daily for the 

rest of his life where life is never as he has known it before? He stated he likes 

to help people who don’t have any power but are needed by the American people 

and I think that is exactly what many of us veterans feel that we are. Where is 

our celebrity? 


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I was honorably discharged in October 2004 after being part of the initial surge 

into Iraq as a triage medic for the 555th Forward Surgical Team. I was exposed to 

things on a daily basis that will haunt my memories until my dying day. I am proud 

of the opportunity I had to defend my country but only those who went before me, 

after me, and stood beside me could possibly understand what that means. 

Truthfully, I should be a statistic, one of the many faceless veterans who are 

homeless or worse. I tried to integrate myself into the VA system because I wanted 

to try to utilize my benefits, but also to try to help create a positive re-integration 

process at my local VA for those who were bound to follow me. I had voiced complaints about back, neck, and shoulder issues that the Army did not investigate further. My complaints fell on deaf ears as it took me 6 years to get the MRI and have 

the spinal issues that I have documented in my records. 

I have had my personal information potentially leaked on a laptop that went 

missing from the VA and received an ‘‘OOPS’’ letter from the VA. I have been made 

aware after an endoscopy procedure that I may have to come back in for blood tests 

for Hepatitis C or HIV because of improper equipment sterilization within the VA. 

If any of these things happened in ANY other health care facility, I would be sitting 

here a wealthy man and there would be many out of jobs due to negligence. 

The rate of veterans committing suicide is astronomical. Statistics have shown 

that last year more than 125 veterans from the OIF/OEF conflicts committed suicide 

every week. We have lost more soldiers here at home than in country engaged in 

combat. Mental health services are paramount for our returning combatants. My 

interview upon returning from Iraq to decipher whether I needed mental health 

services or not was to be marched into a gym separated from my family by a piece 

of glass and asked if I wanted to see my family or do I feel I need to talk to someone 

about my feelings at this time. 

Within the VA system, an individual veteran’s appeal for benefits can take up to 

5 years. A re-evaluation after a rating has already been established comes every 3 

years. Why is it that it seems the system is more proactive in taking things away 

from veterans than reaching those in need? It’s not just the people who serve but 

it is the collateral damage destroying the lives of our loved ones who watch us 

struggle on a day-to-day basis and our inability to maintain relationships with those 

people because we have unaddressed issues. 

My fiance ́ and I have discussed that if we had a child before we got married she 

would get more benefits toward her education than if she were JUST a spouse of 

a disabled veteran. Organizations such as Veterans of Modern Warfare, Vets 4 Vets, 

and The Coming Home Project are stepping up to fill the void of the VA shortcomings. Should they have to do this? On the tablet that Lady Liberty holds there 

is a sonnet and that sonnet ends with: 

‘‘Give me your tired, your poor, 

Your huddled masses yearning to breathe free, 

The wretched refuse of your teeming shore. 

Send these, the homeless, tempest-tost to me, 

I lift my lamp beside the golden door!’’ 

Why is that we veterans are outside that golden door standing under overpasses 

begging for a few pieces of copper. 

I couldn’t be prouder to call myself a veteran of the United States Military that 

joins me with a collective that’s made up of some of the best our Nation has to offer. 

The ultimate fear for me and several of my veteran friends is that you have invited 

a veteran in to speak his compelling story and shine a light on the truth and it be 

dismissed. I am not here to simply complain but I am here to point out fallacies 

that are within the VA system, but it is ultimately up to you to take an action to 

fix this ongoing problem. 

I will end with this quick story. On my deployment in the heat of battle we took 

the most severely wounded as a life saving measure. One of those was a Marine 

who came to us with his entire leg from the hip down looking like hamburger. I 

remember his words to me as he pleaded ‘‘Doc, do whatever you have to do, tie a 

stick to it if you have to, but get me back into the fight because my guys need me.’’ 

How dare we offer this population anything less than our best? So I ask you to 

please do something. 

f 


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Prepared Statement of Lieutenant Colonel Donna R. 

Van Derveer, USA (Ret.), Ashville, AL, (Veteran) 

Good morning Ladies and Gentlemen and Distinguished Committee Members. My 

name is LTC Donna R. Van Derveer, (Ret.), and I am originally from Washington, 

DC, but currently reside in Ashville, AL. 

I am honored to say I’ve served 29 years in the Army and Army Reserve as a 

Military Police Officer, and served my country with great pride and distinction. I 

served in Iraq as the Antiterrorism/Force Protection Chief for Multi-National 

Corps—Iraq from August 2004 through January 2005. During my tour, I faced numerous rocket attacks and barely escaped with my life after a small arms round 

came through my trailer. 

Upon returning from Iraq, I experienced increasing issues with sleep disturbance, 

nightmares, depression, memory loss, irritation, anger, and an inability to concentrate and multi-task. I knew that I had a serious problem, but feared that my 

security clearance and career would be impacted, by seeking help. I did receive surgery on my right knee that I injured in Iraq. 

In 2006, I served as an Action Officer for J8–PAD, Joint Staff, Pentagon. During 

this tour, I eventually sought help through DSM. Even with counseling, I was unable to manage my stress and give 100 percent to my position. I requested Early 

Release from my tour. 

After delay and denial of medical treatment, abusive counseling sessions, being 

relieved of duty, suspension of my security clearance and a four-day stay in Ward 

54 at WRAMC as a civilian in non-duty status, I finally received help. On September 27, 2007, I was put on MRP2 orders and attached to the Warrior Transition 

Brigade at Walter Reed. 

The 2 years and 4 months spent at Walter Reed was no less challenging than 

what I had already faced. The issue of improper diagnosis impacted my care. My 

psychiatrist placed an erroneous entry in my medical records, causing a delay of 

proper care for PTSD for over a year. This error impacted my Medical Evaluation 

Board/Physical Evaluation Board (MEB/PEB), thereby reflecting PTSD as ‘‘Existed 

Prior to Service.’’ I was forced to prove my service and incident that occurred in 

Iraq, since females are considered Non-Combatants even in a combat zone. 

The MEB/PEB process was excruciating for me. From my experience, I see the 

purpose of the DES Pilot Program is to expedite the process to save the Army 

money rather than provide for the soldiers disability compensation and wellbeing. 

I received 50 percent disability from the Army for PTSD and 90 percent from the 

VA for PTSD and various other conditions. The Army determined that I overcame 

Presumption of Fitness for PTSD and nothing else, even though weeks earlier the 

PEB found that I should receive 80-percent disability, and was forwarded for processing. 

As a veteran, receiving care through the VA, I have not seen a psychiatrist since 

I retired. I see a psychologist once a month versus seeing a caregiver at Walter Reed 

once or twice a week. In my eyes, this is minimal care. I was told that this is due 

to staffing. I was given the option to travel 65 miles one-way for additional behavioral health care. This is unrealistic for me as well as other veterans. 

The lack of behavioral health care should be of great concern. Those vets placed 

on the Temporary Disability Retirement List are required Re-evaluations. My initial 

re-eval was to be in July 2010. On September 7, 2010, I was informed that Fort 

Benning was backlogged due to the psychiatrist leaving, that my re-eval would be 

delayed for another 8 months. Putting veterans lives on hold and extending the 

transition process is unfair and unjust treatment. 

In summary, the transition process lacks concern for the soldier/veteran from the 

individual unit through the MEB/PEB process to the care provided by the VA. Behavioral health care, proper diagnosis and need for more providers are significant 

issues for the Army, as well as the VA. The establishment of a Veterans Trust Fund 

to ensure these issues are not experienced by future generations of warriors due to 

fiscal constraints is imperative and should be a national priority. 

f 

Statement of Swords to Plowshares 

Thank you Chairman Filner, Congressman Buyer, and the members of the House 

Veterans Affairs Committee for the opportunity to submit testimony on this important topic; The True Cost of War: The U.S. Conflicts in Iraq and Afghanistan. 

Founded in 1974, Swords to Plowshares is a community-based not-for-profit organization that provides counseling and case management, employment and training, 

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cisco Bay Area. We promote and protect the rights of veterans through advocacy, 

public education, and partnerships with local, state and national entities. 

The purpose of this testimony is to address the true and enduring costs of war 

as we see it from our perspective as community-based providers. 

The cost of war goes well beyond bullets and boots. The true cost of caring for our veterans must be considered prior to their return from war or 

separation from active duty. The federal government externalizes the cost 

of war to local and state entities, the community-based continuum of care, 

non-profit agencies, and to the veterans and their families. We write to extend our strong support for the Veteran Benefit Trust Fund which will 

guarantee funding for our aging veterans, our recently returned veterans 

and our future veterans. 

At Swords to Plowshares we have 35 years experience in picking up the pieces 

and pulling our Vietnam-era clients out of poverty, and chronic homelessness. We 

address mental health need and substance abuse stemming from their military service. We hope that we have learned lessons and may be proactive, prevent future 

homelessness and suffering by ensuring that this generation of combat veterans are 

afforded the honor, care and support they need for successful outcomes. 

Swords to Plowshares and similar agencies across the country cover operational 

costs through a mosaic of federal, state, local and private dollars. We are the recipients of federal funding in order to deliver care in the community. However, we are 

chronically underfunded and must again and again demonstrate the dire need for 

care ‘‘on the ground’’ in order to operate programs. Quite frankly, we and many 

other VSOs are at capacity, our staff is working miracles with limited resources to 

ensure that the veterans in our community receive the care they need. Federal resources are insufficient. The true cost of war must be subsidized by individual donors, foundations, and localities. At the same time, state and local coffers are 

shrinking while we on the ground respond to the flood of new veterans returning 

from war and an aging population of veterans. 

We are extremely appreciative of the support we receive through Department of 

Veterans Affairs and our partnership with the VA and their case managers, social 

workers and medical professionals in our community. We hope to ensure that the 

cost of this care is not reactive, but planned for well in advance so that each and 

every veteran have the access to health care, housing, employment opportunities 

and benefits they have earned in service. 

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