U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2250 Mail: Stop SSOP, Washington, DC 20402–0001

98–295PDF 2005

STATUS OF DEPARTMENT OF VETERANS AFFAIRS

POST-TRAUMATIC STRESS DISORDER PROGRAMS

HEARING

BEFORE THE

SUBCOMMITTEE ON HEALTH

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

HOUSE OF REPRESENTATIVES

ONE HUNDRED EIGHTH CONGRESS

SECOND SESSION

MARCH 11, 2004

Printed for the use of the Committee on Veterans’ Affairs

Serial No. 108–31

(
COMMITTEE ON VETERANS’ AFFAIRS 

CHRISTOPHER H. SMITH, New Jersey, Chairman 

MICHAEL BILIRAKIS, Florida 

TERRY EVERETT, Alabama 

STEVE BUYER, Indiana 

JACK QUINN, New York 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

ROB SIMMONS, Connecticut 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

JEB BRADLEY, New Hampshire 

BOB BEAUPREZ, Colorado 

GINNY BROWN-WAITE, Florida 

RICK RENZI, Arizona 

TIM MURPHY, Pennsylvania 

LANE EVANS, Illinois 

BOB FILNER, California 

LUIS V. GUTIERREZ, Illinois 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

CIRO D. RODRIGUEZ, Texas 

MICHAEL H. MICHAUD, Maine 

DARLENE HOOLEY, Oregon 

SILVESTRE REYES, Texas 

TED STRICKLAND, Ohio 

SHELLEY BERKLEY, Nevada 

TOM UDALL, New Mexico 

SUSAN A. DAVIS, California 

TIM RYAN, Ohio

PATRICK E. RYAN, Chief Counsel and Staff Director 

SUBCOMMITTEE ON HEALTH 

ROB SIMMONS, Connecticut, Chairman 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

JEB BRADLEY, New Hampshire 

BOB BEAUPREZ, Colorado 

GINNY BROWN-WAITE, Florida 

RICK RENZI, Arizona 

CLIFF STEARNS, Florida 

TIM MURPHY, Pennsylvania 

CIRO D. RODRIGUEZ, Texas 

BOB FILNER, California 

VIC SNYDER, Arkansas 

TED STRICKLAND, Ohio 

SHELLEY BERKLEY, Nevada 

TIM RYAN, Ohio 

LUIS V. GUTIERREZ, Illinois 

CORRINE BROWN, Florida 

DARLENE HOOLEY, Oregon

(II) 
(III)

C O N T E N T S 

March 11, 2004

Page

Status of Department of Veterans Affairs Post-Traumatic Stress Disorder 

Programs ............................................................................................................... 1

OPENING STATEMENTS 

Chairman Simmons ................................................................................................. 1

Prepared statement of Chairman Simmons ................................................... 47

Hon. Lane Evans, ranking democratic member, full committtee ........................ 2

Prepared statement of Congressman Evans .................................................. 52

Hon. Ted Strickland ................................................................................................ 3

Hon. Tim Murphy .................................................................................................... 17

Hon. Rick Renzi ....................................................................................................... 19

Hon. John Boozman ................................................................................................. 21

Hon. Luis V. Gutierrez, prepared statement of ..................................................... 50

WITNESSES 

Brown, Lt. Col. Kenneth N., Chaplain, U.S. Army ............................................... 31

Prepared statement of Colonel Brown ............................................................ 102

Hodges, Lt. Charles E., Chaplain Corps, U.S. Naval Reserve, Parris Island, 

SC .......................................................................................................................... 32

Prepared statement of Chaplain Hodges ........................................................ 109

Horvath, Thomas, M.D., Chief of Staff, Michael E. DeBakey Veterans’ Affairs 

Medical Center, Houston, TX .............................................................................. 5

Prepared statement of Dr. Horvath ................................................................ 67

Jumper, Comdr. Mark A., Staff Chaplain, U.S. Coast Guard Academy ............. 34

Prepared statement of Commander Jumper .................................................. 118

Keane, Terence, Director, National Center for Post-Traumatic Stress Disorder, VA Boston Health Care System ............................................................... 7

Prepared statement of Dr. Keane ................................................................... 73

Kudler, Harold, M.D., Co-Chair, Under Secretary for Health’s Special Committee on PTSD, Durham VA Medical Center ................................................... 8

Prepared statement of Dr. Kudler .................................................................. 78

Mikol, Chaplain Robert W., Clinical Chaplain, Lyons Campus of the VA 

New Jersey Health Care System ........................................................................ 36

Prepared statement of Chaplain Mikol .......................................................... 124

Roswell, Robert H., M.D., Under Secretary for Health, Department of Veterans Affairs; accompanied by: Alfonso R. Batres, Chief Officer, Readjustment Counseling Service, Department of Veterans Affairs; and Laurent 

S. Lehmann, M.D., Chief Consultant, Mental Health Strategic Health Care 

Group, Department of Veterans Affairs ............................................................. 24

Prepared statement of Dr. Roswell ................................................................. 95

Salois, Father Philip G., VISN 1 Chaplain Program Manager, VA Boston 

Health Care System ............................................................................................. 37

Prepared statement of Father Salois .............................................................. 132

Satel, Sally, M.D., Resident Scholar, The American Enterprise Institute .......... 10

Prepared statement of Dr. Satel ..................................................................... 88
Page

IV

MATERIAL SUBMITTED FOR THE RECORD 

Correspondence: 

Letter from Congressman Evans to Dr. Roswell, dated January 15, 2004 . 54

Response letter from Dr. Roswell to Congressman Evans, dated March 

10, 2004 .......................................................................................................... 57

Statements: 

Matthew J. Friedman, M.D., Ph.D., Executive Director, National Center 

for PTSD ........................................................................................................ 136

Ronald J. Zaczek, former Marine .................................................................... 140

AMVETS ........................................................................................................... 142

Veterans of Foreign Wars ................................................................................ 153

Written committee questions and their responses: 

Chairman Simmons to Department of Veterans Affairs ............................... 158

Congressman Evans to Department of Veterans Affairs .............................. 169
(1)

STATUS OF DEPARTMENT OF VETERANS AFFAIRS POST-TRAUMATIC STRESS DISORDER 

PROGRAMS 

THURSDAY, MARCH 11, 2004

U.S. HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON HEALTH, 

COMMITTEE ON VETERANS’ AFFAIRS, 

Washington, DC 

The subcommittee met, pursuant to notice, at 9:35 a.m., in room 

334, Cannon House Office Building, Hon. Rob Simmons (chairman 

of the subcommittee) presiding. 

Present: Representatives Simmons, Strickland, Boozman, Renzi, 

and Murphy. 

Ex officio present: Representative Evans. 

OPENING STATEMENT OF CHAIRMAN SIMMONS 

Mr. SIMMONS. The subcommittee will come to order. 

This morning the Subcommittee on Health of the Veterans’ Affairs Committee will conduct an oversight hearing on the status of 

post-traumatic stress syndrome programs in the care of veterans of 

combat and hardship deployments. 

The subcommittee will be exercising its routine oversight duties 

on this important issue, and we look forward to having three panels of very distinguished physicians, chaplains, and experts on this 

subject. I have a full statement that I would like to submit into the 

record, and for the sake of timeliness, I will summarize. 

In September of 1864, Union General William Tecumseh Sherman made the comment ‘‘War is Hell.’’ Speaking as a Vietnam veteran, he was absolutely correct. And it’s interesting to note that 

when the Civil War was over—and it was the most divisive and 

bloodiest war in our history—in a number of locations volunteer 

soldier homes were created, or in the case of Rocky Hill, Connecticut, the Nation’s first state home for veterans was created, to 

care for what was called the ‘‘war-weary.’’ The war-weary. 

There are different names, I guess, for what some call battle fatigue, combat fatigue, war weariness. We call it post-traumatic 

stress syndrome in today’s language. And as a Vietnam veteran, it 

has an interesting history. Because when I returned back from two 

tours in Vietnam and began my work as a Senate staffer back in 

1979 and 1980, a very senior senator who actually was a veteran 

of World War II, and of Korea, referred to the concern of Vietnam 

veterans as the concerns of cry-babies. Cry-babies. They lost the 

war and now they’re just a bunch of cry-babies. 
2

In a movie featuring General Patton, titled ‘‘Patton,’’ there’s a famous incident where he slapped a soldier for being a coward. But 

chances are, that same soldier was suffering from war weariness, 

battle fatigue, post-traumatic stress syndrome. 

So it’s a serious issue. It’s a serious topic. And even though the 

names or the labels change over time, I would argue that the condition is the same. And when our men and women in uniform serve 

us in the field of battle, and when they return, we often seem to 

be so very good when it comes to dealing with physical injuries or 

injuries involving the limbs, the face, the jaw. But when it comes 

to the mental injuries and wounds that all soldiers are exposed to 

in a battle environment, we seem to do less well, except I would 

say that over the last 20 years, there has been a tremendous 

amount of focus on this specific issue, which I think is a very positive thing. 

I note that Time Magazine this January named the person of the 

year as the American soldier, and I think that recognition is extremely appropriate. But I will also note that of the 130,000 or so 

soldiers returning back from service in Iraq and Afghanistan on the 

largest rotation since World War II, that many of these soldiers 

will be receiving their DT214 and they will be coming American 

veterans. And the challenge for us today and in the future is to be 

sure that we are prepared to care for them, whatever wounds they 

may carry from their service, whether they be physical or mental. 

And so the purpose of today’s hearing is a serious purpose, and 

we all take it seriously, and I look forward very much to hearing 

the testimony of our witnesses. And now I would like to recognize 

Mr. Strickland, who is sitting in as Ranking Member on behalf of 

our Ciro Rodriguez, who is still engaged in a tough battle down in 

Texas. And I also would like to recognize that Lane Evans, the 

Ranking Member of the full committee, is here, and I will defer to 

my Democrat colleagues to decide who wishes to speak next. 

[The prepared statement of Chairman Simmons appears on p. 

47.] 

OPENING STATEMENT OF HON. LANE EVANS, RANKING 

DEMOCRATIC MEMBER, FULL COMMITTTEE 

Mr. EVANS. Thank you, Mr. Chairman. We soon will have thousands of young men and women returning from Iraq and Afghanistan. Unfortunately, past experience indicates that many of them 

will suffer from PTSD. PTSD has been well documented among veterans from wars dating back to ancient times. In a recent study, 

the VA found that 10 percent of veterans from the Persian Gulf 

War had the disorder. The rate more than doubled if they experienced combat. 

As a Vietnam-era veteran, I have a long-standing concern about 

PTSD. Adequate information and science hold the key to helping 

veterans. As a freshman, I introduced legislation to require the VA 

to carry out a study of the prevalence of PTSD among Vietnam veterans. 

I still am working to push the VA to obtain this information and 

demonstrate that it is providing the services veterans need to combat this condition. I recently wrote a letter to the VA about its current efforts on behalf of our newest veterans with PTSD. Mr. 
3

Chairman, I would like for the record to reflect my letter and the 

VA’s response be included in the hearing record. 

I want to thank you for your sensitivity on this issue. You have 

been a standout, I think, on all of our Vietnam veterans’ issues. 

You’re known largely for your accomplishments working with this 

committee and I’m very happy to continue to work with you. I do 

have to go before the Appropriations Committee here, and I’m already late, and I think that’s probably where Chris is. So we’ll 

head over, and we’ll try to get back. 

[The prepared statement of Congressman Evans appears on p. 

52.] 

Mr. SIMMONS. I thank the gentleman for his kind remarks. I 

thank him for his leadership and his bipartisanship, and I encourage him to go over to the Appropriations Committee and get the 

big bucks. (Laughter.) 

Mr. EVANS. Thank you, Mr. Chairman. 

Mr. SIMMONS. The chair orders that the letter and the statement 

will be inserted into the record, and I recognize my colleague, Mr. 

Strickland. 

Mr. STRICKLAND. Thank you, Mr. Chairman. And good luck, Mr. 

Evans. (Laughter.) 

OPENING STATEMENT OF HON. TED STRICKLAND 

Mr. STRICKLAND. I want to thank you, Mr. Chairman, for calling 

this hearing on the status of the Department of Veterans Affairs 

post-traumatic stress disorder and other mental health programs. 

There are few topics, perhaps no topics within the VA health 

care system more timely or more significant to our servicemen and 

women who are returning from Iraq and Afghanistan. 

Meeting the needs of men and women who have been injured in 

service to our Nation is both VA’s responsibility and its privilege. 

It is my view that the VA has thus far embraced the challenge of 

smoothing the transition between military service and civilian life 

for the most seriously physically wounded of our returning soldiers. 

Things are not perfect, particularly for reservists and National 

Guardsmen, but the VA should be commended I believe for the efforts it has made to date. I hope that meeting the mental health 

care needs of the thousands of young men and women whose 

wounds will not be so visible will not be a different story. 

It is fair to say that mental health services have not fared well 

in VA’s transition away from hospital-focused care. Psychiatric bed 

care is certainly perhaps not the gold standard of care for the seriously mentally ill veterans, but in many cases, I believe it should 

be. VA’s beds do serve as a means of keeping some semblance of 

mental health services intact through this health care system. 

Since 1994, VA has closed thousands of psychiatric beds, dropping its census from 14,125 to 2,803. It has eliminated 43 percent 

of the employees once committed to psychiatric care. Many of the 

facilities targeted for closure or mission conversion under the Capital Assessment Realignment for Enhanced Services are primarily 

psychiatric facilities. 

Even the VA acknowledges that it has fallen short of the mark 

in meeting Congress’s requirement to meet the capacity of its programs for substance abuse disorders. But since neither beds nor 
4

employees are used for a measure of compliance with the congressional requirement, it has been difficult to monitor how VA is reprogramming mental health resources. It does not appear that VA 

is using them to develop alternative mental health programs in the 

community. Only about half of the newly established communitybased outpatient clinics offer mental health services. 

The mental health intensive care management health teams 

which hold a great promise—they’ve been slow to be established. 

The General Accounting Office and VA’s Inspector General are also 

skeptical of VA’s claim that it is complying with the law in this regard. 

Mr. Chairman, this is important when we begin to discuss VA’s 

programs for post-traumatic stress disorder, which is an important 

specialty within VA’s continuum of mental health care. VA has 

some of the preeminent experts on PTSD, but its resources are limited, and some say they’re stretched beyond capacity with the current workload. Sadly, the rates of suicide among service members 

in Operation Iraqi Freedom might lead us to believe that this has 

been and is a particularly stressful military engagement. 

I am pleased that we will hear from the frontline providers, our 

chaplains, in our final panel. It is unfortunate that the military 

does not appear to have identified a systematic means of readily 

sharing information with the VA about service members who will 

be discharged. As the chaplains will attest, immediate intervention 

is critical for allowing these men and women to successful process 

traumatic events before those events lead to chronic problems. 

Already more than 11,000 veterans from Operation Enduring 

Freedom and Iraqi Freedom have used VA’s services. About 13 to 

15 percent of those veterans are in fact seeking care for mental 

health disorders, including PTSD. It is clear that the VA must be 

able to provide outreach, outreach and ready access to high quality, 

specialized PTSD treatment and other mental health services in 

order to successfully intervene. 

And I would just like to close my remarks by saying before coming to the Congress, I worked in a maximum security prison in 

Ohio, and I worked in that prison with many Vietnam veterans 

who I am convinced are spending their lives in prison because they 

were not provided with timely and appropriate mental health interventions following their return to this country. And we must not 

let that happen to those who are fighting for us this day. 

Thank you, Mr. Chairman. 

Mr. SIMMONS. I thank the gentleman for his statement, in particular for his insight as somebody who has worked with the prison 

population. I see that I’m joined by three of my colleagues, and I 

would like to extend to each of them the opportunity for an opening 

statement if they would like to make it. Mr. Murphy? Renzi? 

Boozman? Boy, aren’t they great. They’re terrific. 

We will now call the first panel to the table. We have Dr. Thomas Horvath, who is Chief of Staff of the Michael E. DeBakey Veterans’ Affairs Medical Center in Houston, TX. We have Terence 

Keane, who has got his Ph.D. and is director of the National Center for Post-Traumatic Stress Disorder at the VA Boston Health 

Care System. We have Harold Kudler, a doctor, who is the co-chair 

of the Under Secretary for Health’s Special Committee on PTSD in 
5

the Durham, Virginia Medical Center, and Dr. Sally Satel—I hope 

I pronounced that correctly—Resident Scholar at the American Enterprise Institute. 

I will advise the panel that we have three panels today, and I 

know that our membership probably wants to engage in some questions. And so we are going to keep a tight five-minute clock. And 

I would also suggest that if you have a length statement which we 

have as a matter of the record, you are free to consider summarizing that if that works for you. 

And now I would like to begin with the testimony. Should we 

begin with you, Dr. Horvath? And if you could turn on your microphone by just pushing the button. 

STATEMENTS OF THOMAS HORVATH, M.D., CHIEF OF STAFF, 

MICHAEL E. DeBAKEY VETERANS’ AFFAIRS MEDICAL CENTER, HOUSTON, TX; TERENCE KEANE, DIRECTOR, NATIONAL 

CENTER FOR POST-TRAUMATIC STRESS DISORDER, VA BOSTON HEALTH CARE SYSTEM; HAROLD KUDLER, M.D., COCHAIR, UNDER SECRETARY FOR HEALTH’S SPECIAL COMMITTEE ON PTSD, DURHAM VA MEDICAL CENTER; AND 

SALLY SATEL, M.D., RESIDENT SCHOLAR, THE AMERICAN 

ENTERPRISE INSTITUTE 

STATEMENT OF THOMAS HORVATH 

Dr. HORVATH. My name is Thomas Horvath. Thank you, sir. I’m 

a neuropsychiatrist and am currently the chief of staff of one of the 

largest medical-surgical psychiatric facilities of the VA. I’m a professor at Baylor at Houston. I’m also the son and grandson of combat veterans who carried their painful war memories and symptoms throughout their productive lives. Thus for me, combat stress 

is a family experience, not a textbook abstraction. 

My Army Reserve career taught me the doctrine of combat stress 

control, but the Hungarian Revolution of ’56 gave me the whiff of 

mortal danger. Having seen the ravages of war in Hungary, having 

seen the delayed effects of World War II in Australian patients, I 

expected to learn a lot when I came to study at Stanford 30 years 

ago. But at the Palo Alto VA, we had no instruction whatsoever in 

military medicine, post-deployment psychiatry, or the problems of 

Vietnam veterans. What we learned, we learned from veterans. We 

came to understand the reality of the trauma and the symptoms. 

That painful condition, which also affects hundreds of thousands 

of veterans of all wars, only received formal recognition in 1979– 1980, first by the APA, then by the VA. To this day, some people 

confuse a set of political and cultural attitudes, the post-Vietnam 

syndrome, with a clinically coherent, statistically valid diagnostic 

entity, Code 309.81, 308.3 of DSMIV, which is triggered by a range 

of catastrophic stressors, including combat, ambush, carnage and 

rape. Yet to this day, many people regard this PTSD as a weakness, a yellow streak, and not the red badge of courage. This despite CT scan findings of the shrinking of a part of the brain involved in emotion and memory, which correlates with combat intensity scores. This despite persistent biochemical changes which 

eventually lead to higher rates of cardiovascular disease and of 
6

mortality in general, shown in World War II veterans, POWs and 

Holocaust survivors. 

PTSD is a persistent biological condition that maims the body as 

well as the mind. It correlates with combat intensity. But unit cohesion and warm homecoming support partly protects from it. Regrettably, the VA 30 years ago did not provide these. However, 

we’ve come a long way. Twenty-five years ago we had PTSD services, no vet centers, no homeless programs. We did, however, have 

a set of substance abuse services that we no longer have. Still, the 

growth of PTSD programs has been gratifying, but not quite 

enough for the demand. 

These demands will now increase, especially by the many reservists who on their return from overseas are judged RPGs while nation building, will be eligible for the VA. But PTSD is only one of 

the consequences of stress: Suicide, unexplained physical illness, 

depression, even the precipitation of psychoses and addictive disorders or others. 

So we must provide specific PTSD services, like our excellent vet 

centers and trauma teams. We must also provide a wide range of 

mental health programs appropriate for the age, sex, ethnicity of 

today’s military, and we just continue to honor our commitment to 

the older veteran. Yet here the news is not good enough. Our committee, the Seriously Mentally Ill, chartered by Congress, has repeatedly observed that VHA is not in substantial compliance with 

the provisions of Public Law 104–262 and Public Law 107–135, inasmuch as it failed to maintain the full required capacity for special services for the mentally ill. Over the past seven years, VA inadvertently took 25 percent of inflation adjusted dollars and 23 

percent of its staff for mental health services to support primary 

care and general medical/surgical services. This was not a single 

executive decision, but the unintended consequence of hundreds of 

well-meaning actions. Better access, better primary care and better 

preventive medicine—are laudable goals, and we’ve proudly 

achieved them. But this did not have to come at the expense of the 

mentally ill. 

The wide variation among the networks from minus 20 percent 

to plus 35 percent shows that this could have been done better. Excessive decentralization and persistent stigma about mental illness 

contributed to this problem. The stigma in the VA is probably no 

worse than in the rest of health care, and it is being turned around 

by leaders like Mr. Principi, whose 15 years of support for the mentally ill veteran has earned him the highest award of the APA Assembly. The presence of Dr. Roswell and the support received from 

him and his three deputies, also express their commitment and 

their lack of bias. 

But why do we have problems despite this stellar top leadership? 

Look. The VA is a huge oil tanker that responds very slowly to 

steering. The mentally ill were never a popular constituency. We 

made efforts in the 1980s to reverse this, but in the 1990s, we oversteered towards the inclusion of a large number of non-service-connected veterans who flock to us to get their expensive medications. 

We have become a safety valve of sorts for the problems of Medicare and drifted away from our core constituents who experienced 

the lasting wounds of war. 
7

It is time to drag the wheel back, Mr. Chairman. 

[The prepared statement of Dr. Horvath appears on p. 67.] 

Mr. SIMMONS. I thank you for that testimony. I would ask that 

the other three panelists also make their statements, and then 

we’ll get into questions. 

Next, Dr. Keane. 

STATEMENT OF TERENCE KEANE 

Mr. KEANE. Thank you, Mr. Chairman. My name is Terry Keane. 

I’m Chief of Psychology at VA Boston Health Care System. I’m also 

Director of the National Center for Post-Traumatic Stress Disorder, 

a center that was established by Congress to address the needs of 

Vietnam veterans with PTSD and veterans of all eras, in particular 

assigned the responsibilities for research and for education and 

training. 

I’ve been involved in the work of PTSD for more than 25 years, 

having been chief at the Sonny Montgomery VA Medical Center for 

five years before moving to Boston. As well, I’ve had oversight responsibility for the National Vietnam Veterans Readjustment 

Study, an epidemiological study that was commissioned, mandated 

by Congress and conducted by VA through a contract to understand the prevalence of war zone-related stress conditions and 

other related kinds of psychiatric problems. 

I’m here today to make a number of points for your consideration. First, I want to assure you that the VA is unquestionably the 

international leader in treatment, education and research on war 

zone-related PTSD and related psychiatric conditions. Yet the quality, the quantity and the access of care for veterans with PTSD is 

quite variable across the country, even varying by networks. 

Specialty programs across VA are struggling to meet the demand 

for PTSD services from veterans of earlier eras. Individualized 

care, the rock bed of psychiatric interventions, individualized care 

has frequently been replaced by group interventions that do not 

have an evidence base in the area of PTSD. VA as well loses three 

to five of these hard-earned specialty PTSD programs each year. 

Reestablishing these programs in geographic locations will be costly, and the loss of corporate knowledge when programs close is 

great. 

With the existing demand for services high and the possibility for 

increased demand from new veterans, there is a need for creativity 

in the development and the delivery of effective interventions. New 

resources, redirected resources or greater use of resources saved by 

reengineering inpatient to outpatient should be seriously considered and reconsidered. PTSD treatment programs for women veterans exist to some extent in the vet center program, which has 

done a particularly good job in this arena, less so in VA medical 

centers nationwide. 

The needs for treating combat stress in women, but as well, war 

zone stress, sexual harassment and sexual assault, are an increasing component of the needs for care in VA. Recent studies highlight 

these findings. 

But now to the issue of incoming veterans. VA is presented with 

a unique opportunity now to take the national lead in the development and the evaluation of the effectiveness of early psychological 
8

and psychopharmacological interventions for promoting resiliency 

and preventing adverse outcomes, a broad array of adverse outcomes following exposure to military trauma. 

Consideration for sponsoring centers for early intervention for 

trauma is one way to assert international leadership in this arena. 

The use of telecommunications, especially the World Wide Web, for 

surveillance, for treatment and evaluation of these early interventions will be one efficient way of managing these complex emotional and behavioral problems. They may prove to be indispensable for the seamless transition implemented between VA and 

DOD. 

As well, we need support for developing innovative rehabilitative 

methods for war-injured veterans through our MIRECCs, through 

medical research and academic affiliations, and the National Center for PTSD will continue with possibly increased support to provide to top clinicians, to top academics, a place where they can scientifically study respectably the problems of exposure to war. 

I’d like to say that I believe that it’s critical for us to be filling 

vacancies in these PTSD specialty programs. I think establishing 

centers of excellence for early intervention in trauma is a timely 

recommendation for you to consider. The prevention of the chronic 

course of PTSD should be foremost in our minds as we proceed to 

try to take care of this next generation of veterans, particularly 

those people who are at high risk for developing psychological problems, those who have suffered or sustained serious war injuries, 

and those who have experienced extreme distress as a result of 

their exposures. 

Thank you very much for the opportunity to speak with you 

today. 

[The prepared statement of Dr. Keane appears on p. 73.] 

Mr. SIMMONS. Thank you, Doctor, and apologies for the buzzer. 

I hope that—you probably thought it was somebody’s alarm clock 

or something like that. But in any event, those will go on throughout the day. 

Dr. Kudler, welcome. 

STATEMENT OF HAROLD KUDLER 

Dr. KUDLER. Thank you, Mr. Chairman. I appreciate this second 

opportunity to testify before the subcommittee. My name is Harold 

Kudler, and my remarks reflect 20 years as a VA psychiatrist, my 

service as co-chair of the Under Secretary for Health’s Special 

Committee on PTSD, and my role in developing the new joint VA/

DOD Clinical Practice Guidelines for the Treatment of Traumatic 

Stress. 

On the day after my October 16 testimony to this committee, 

partly based on committee members’ comments, I decided to take 

a cab up to Walter Reed, and I took a tour. As an expert in PTSD, 

I sincerely hoped that the patients there would not need my help. 

But when I asked the nurses how could I be of help to them, they 

said, could you find a way to get them to stop firing that cannon 

at 4 o’clock every afternoon? Because it takes us half an hour to 

get the guys back into bed. 

Mr. SIMMONS. I can associate with that. 
9

Dr. KUDLER. Yeah. Well, I thought you might. And the fact is 

that the Army’s deployment health program has found that three 

months after admission to Walter Reed, 40 percent of the casualties treated there develop symptoms consistent with PTSD. Now 

that’s including all med/surg casualties. It’s not just mental health 

casualties. It’s 40 percent. 

The Department of Defense and VA have a unique opportunity 

to intervene now while the majority of new combatants are still in 

uniform to address the complications of traumatic stress. And it’s 

not just PTSD. It includes major depression, substance abuse, job 

loss, family dissolution, homelessness, violence towards self and 

others, and as mentioned, incarceration. 

There’s also military sexual trauma and suicide. We need to create a progressive system of engagement and care. We need to focus 

on prevention and integration. For a relatively small investment 

we could significantly improve health outcomes. For instance, VA 

has a point of contact at every VA medical center for new combat 

veterans. But these people are not trained to recognize traumatic 

stress, especially acute traumatic stress. It would be relatively easy 

to teach them to spot a problem and triage it, not make them specialists, but spot a problem and triage it. 

During demobilization, returning soldiers complete the post-deployment evaluation screen, but the results are not yet available to 

VA planners or clinicians. This must change. As one Army doctor 

just back from Afghanistan told me, returning soldiers don’t have 

the emotional bandwidth to explore psychological issues during the 

demobilization process. It’s not practical. An intervention then 

would be seen as an obstacle to coming home and would be resented and lead to further stigmatization. It would be better to intervene after soldiers had a chance to sleep in their own beds and 

spend time with their families, and then they’d be more likely to 

recognize readjustment problems when they do exist and perhaps 

to talk about them. 

Mental health professionals would be best at talking with them 

because they have special skill in developing rapport and recognizing early signs of distress. A confidential interview could be 

made with individuals or small functional groups, and the emphasis would be on normalizing responses, not on pathologizing them. 

A pamphlet summarizing the information—because people never 

listen or remember much of what happens in interviews like this—

would be handed out, and a separate pamphlet would be mailed to 

the family identifying resources and reviewing again the core information. 

The co-chairs of the PTSD and SMI Committees recently met 

with the Under Secretary to recommend a partnership with DOD 

to provide this intervention because it would serve as a force multiplier in DOD and improve health outcomes in VA. 

VA could extend its counseling services by training peer counselors drawn from military unit associations. These are veterans 

who are already on site and part of the unit culture. It wouldn’t 

be hard to bring them and their spouses into helping new combat 

veterans and their spouses. 

VA cannot meet the needs of new combat veterans and still treat 

its current patients. Only half of all VA medical centers actually 
10

have PTSD teams, and even at those sites, many positions have 

been drawn off to other programs or lost to attrition. 

The Special Committee calls for a fully operational PTSD team 

at every medical center and an additional family therapist at every 

vet center. We suggested VA prioritize sites adjacent to military 

bases and locations where guard and reserve units are based as a 

first step. 

We recommend implementation of the Director’s Performance 

Measure for PTSD. We recommend that the Clinical Practice 

Guideline be aggressively rolled out, and that a PTSD coordinator 

be identified within each VISN to ensure that every site has a plan 

backed by sufficient resources. 

Further, I’d like to recommend the development of note-generating software to support the Clinical Practice Guideline. People 

will not use it unless it makes their life easier, and this kind of 

information technology is easily within our grasp. 

The Special Committee has pressed for a National Steering Committee on PTSD Education, but given the situation we’re in right 

now, I’d like to roll that idea into a joint DOD/VA Council on Post 

Deployment Mental Health. This joint council would hammer out 

the remaining details and be responsible for documenting successes, problems, lessons learned and opportunities for the future. 

Given that we have, for 2 years, had a standing group working 

on the Clinical Practice Guideline, VA and DOD, and that most of 

the DOD staff involved have been to the Gulf and back, we have 

a real jumpstart on a group that trusts each other, knows each 

other and understands the general backbone for PTSD services in 

VA and DOD. 

It’s time to act on behalf of those who have borne our latest battles and to prepare for future operations. Mr. Chairman, this concludes my remarks, and I’ll be happy to respond to any questions. 

[The prepared statement of Dr. Kudler appears on p. 78.] 

Mr. SIMMONS. Thank you very much. Dr. Satel? Did I pronounce 

your name correctly? 

Dr. SATEL. Yes, that’s right. 

Mr. SIMMONS. Thank you. 

STATEMENT OF SALLY SATEL 

Dr. SATEL. Thank you, Mr. Chairman and members of the committee. I’m also a psychiatrist, and actually, I did work at a VA for 

five-and-a-half years, Westhaven, CT, and I certainly know that 

post-traumatic stress disorder is a real and painful condition and 

that undoubtedly it will affect some men and women returning 

from Iraq. Clearly, a humane and grateful country needs to care for 

them. 

One question that’s arisen, though, is how many might there be? 

And we’ve been hearing in the news over the past few weeks that 

roughly, perhaps one-third of returnees from Vietnam suffered 

from PTSD, and based on that, we can roughly expect the same 

count this time. And I want to address the first part of my comments to the debatability of that assertion. 

There are several reasons why I think those data are questionable, but perhaps the most compelling piece of evidence was just 

released two days ago by the VA Health Administration. This re-
11

port here called ‘‘Operation Iraqi Freedom: Analysis of VA Health 

Care Utilization,’’ this report found that of the 107,540 soldiers 

who have returned from Iraq, 436 have so far been diagnosed with 

PTSD. That’s 0.4 percent of veterans. 

Now according to the adherence of what’s called the National 

Vietnam Veterans Readjustment Study, which I’ll call the NVVRS, 

that’s where the 30 percent number came from, that would mean 

that there would need to somehow be a seventy-fold increase in 

PTSD cases between now and 10 to 20 years from now. Because, 

remember, the NVVRS examined veterans who had been back from 

the war a minimum of one decade. So somehow we’re going to get, 

according to some folks I’ve heard speak about this, from 0.4 percent to 30 percent. I think that is a highly unrealistic and misleading forecast. 

But supposedly such an amplification of pathology already took 

place once before with Vietnam veterans. Now consider during the 

years of most intense fighting in Vietnam, Army psychiatrists calculated that between 12 and 15 soldiers per thousand were psychiatric casualties, between 12 and 15 per thousand. That’s essentially less than 2 percent. And moreover, the vast majority of those 

men did not see combat. They were called to psychiatric attention 

for behavioral problems and substance abuse. So, in other words, 

the bulk of the 12 to 15 per thousand psych casualties during Vietnam were not even in combat. Thus, if the NVVRS number is correct, that 30 in 100 veterans after the war developed PTSD, that 

is a vast multiplication of the number of psych casualties during 

the war, which is to say 1 to 2 out of 100, and most of them did 

not even see combat. 

How do we begin to explain that kind of explosion in cases in 

PTSD? Well, one explanation that’s offered is the concept of delayed PTSD. And I just want to state that this is the psychiatric 

equivalent of an urban legend. It has very little support in the epidemiologic literature. Certainly people delay seeking care, and that 

can be mistaken for delayed PTSD, but that doesn’t mean that the 

symptoms appear out of the blue months and years later. In fact, 

most studies, in fact all of the studies that have actually looked at 

symptom formation, find that in the vast majority of cases, they develop within a week after a traumatic syndrome, and the tendency 

of PTSD is to go away over time, certainly not to emerge after the 

fact. 

Another aspect of the NVVRS, and I think this is a very compelling explanation for why, again, they found such a high rate, again, 

30 percent of veterans with PTSD 10 to 20 years after, is because 

there was a very low cutoff for making the diagnosis. Nowadays 

when clinicians make a diagnosis of PTSD, there has to be a degree 

of impairment in the person’s daily functioning or extreme psychic 

pain. Symptoms of nightmares, painful memories, trouble concentrating, while distressing—I’m not minimizing them—that’s not 

enough for a diagnosis of a mental illness. And in fact, a number 

of psychologists and psychiatrists have begun to question the rigor 

with which diagnoses of other conditions, not just PTSD, are being 

made. 

In short, I think the NVVRS results are very shaky and not a 

good guidepost. So what is a good guidepost to what we should be 
12

doing? Well, I agree with a lot of what Dr. Kudler said. We’ve 

learned a lot of lessons from treating Vietnam veterans. One is a 

very practical focus group or individual treatment should be focused on solving practical problems and rehabilitation, putting 

trauma experience in perspective. It is not healthy or helpful to entail repeated rehashing of terrifying or demoralizing stories. These 

often interfere with coping and agitate the patient further. 

Long inpatient treatment should be reserved for those who cannot function. The VA used to have, and I think some VAs still do, 

specialized inpatient VA treatment units. They’ve been very problematic, often promote regression rather than facilitate readjustment, and in fact the Westhaven VA no longer has them. 

I see the red sign, so I’ll just finish up by saying——

Mr. SIMMONS. It’s all part of our training here. 

Dr. SATEL. Okay. Also beware of the disability trap. I would hate 

to see therapists pushing patients too quickly towards obtaining 

service-connection disability for PTSD. And the reason is because 

once a patient gets permanent disability, the motivation to ever 

hold a job declines, and the patient assumes, often incorrectly, that 

he can’t work, that he is not employable, and his confidence in any 

kind of skills he might have once had erode, and his confidence in 

himself atrophy. Work is often the best therapy. And I know the 

VA is developing supported employment, which is very important. 

I suppose I’ll stop, since it’s red, but we can continue this later, 

I hope. Thank you. 

[The prepared statement of Dr. Satel appears on p. 88.] 

Mr. SIMMONS. Thank you very much. And we do have your written testimony, and I notice my colleagues whipping through it as 

you speak. 

Dr. SATEL. And I have this report, extra copies of it. 

Mr. SIMMONS. Yes. I’d like to address two questions to the panel. 

The first, I will go to Dr. Horvath’s statement, page 2, where he 

says: ‘‘PTSD is not a little old ‘adjustment disorder’ which is ‘all in 

the veteran’s head.’ It is not a hyped-up myth. It is a persistent, 

dangerous biological condition that maims the body as well as the 

mind, the brain as well as social relationships.’’

I’d like to focus on the words ‘‘persistent, dangerous biological 

condition,’’ because I think that is important for us to understand, 

and it’s important for our veterans to understand that as I understand the issue, your exposure to combat, combat conditions, or just 

the stress of service can actually change the physical chemical nature of your brain, which then leads to the symptoms that we identify as post-traumatic stress disorder. 

So it’s not a fiction or a myth; it’s an actual physical condition. 

Is that generally the view of the panel? 

Dr. HORVATH. Well, it certainly is my view, and it’s clear in the 

literature, and some of the work was done actually at the 

Westhaven VA, replicated at several other places. And it’s actually 

supported by animal work. The hippocampus is the part of the 

brain that shows atrophy, and this correlates with objectively obtained, careful details of combat and other trauma exposure; the 

higher that exposure, the more—the greater is the degree of atrophy, which is an anatomical change. 
13

This is also seen in monkeys who are traumatized, psychologically traumatized. It is seen in children who underwent child 

abuse. We probably know the mechanism, which is high cortisol 

levels, which are these spurts of a stress hormone. Some of the best 

work in this area, again, was done at the National Center for 

PTSD at the Westhaven VA. Currently that unit is also working 

on looking at resilience, because not everybody gets it. And it does 

appear that some people are fortunate enough to have a 

neuropeptide Y, another chemical which counteracts the effect of 

this other hormone called norephenephrine. If you wish, in subsequent questions I’m more than willing to provide a literature review on this. National Center has done this. 

I think it’s really important to understand, and I have shown 

this to Mr. Harvey when he was in the Senate staff some time ago, 

showing that in fact the severe stress which is then continued to 

be re-lived, this doesn’t go away. It’s like King Amfortas’ wound in 

Parsifal. It’s the persistent wound. It is when every time you duck 

for cover when you hear the gunshot, there is a startle reaction in 

your body. If you could stop that, if you could ameliorate it, if you 

could intervene early as indeed Harold suggests, that would be one 

way. The fact is that we didn’t. We ignored these guys. I know. I 

was there. We ignored them. And therefore we have a responsibility for them. 

To call them to task, to call them compensation seeking after 30 

years of neglect, is a cheap shot. 

Mr. SIMMONS. I thank you for that response, and I would ask 

that that document be placed in the record. My second question 

goes to the testimony of Dr. Satel. As I understand the problems 

of the Vietnam veteran, lack of unit cohesion, lack of a welcome 

home if you will, were contributing factors to those numbers. And 

it seems to me that in some respects, those conditions don’t exist 

today. Certainly the country is much more united in their support 

for veterans, although there is division on the policy of the war. I 

have attended a number of welcome home ceremonies in my state, 

and I understand they’re taking place elsewhere. 

What effect will those changes have on the overall numbers, in 

your opinion? And anyone else can answer the question as well. 

Dr. SATEL. That’s a very good point, and one would predict, and 

certainly follow the numbers to see if the prediction holds up, but 

one would predict that just as you say, factors like unit cohesion 

and good training and good morale, appreciation of sacrifice from 

the public and good training are very important protective factors. 

So that may make a very big difference. 

Mr. SIMMONS. I appreciate that. Dr. Kudler? 

Dr. KUDLER. Yes, Mr. Simmons, one would predict that. However, we couldn’t have done a better job of welcoming home people 

than we did with the Gulf War, and having been working in the 

Westhaven VA in 1980, I can tell you—now that was a different 

story—but the Gulf War, we did everything right I think in terms 

of welcoming people home. When those people came home, they 

often gratuitously said, we don’t have that Vietnam stuff, so don’t 

worry about us. 

Now if we look at the numbers from the Gulf War, we have an 

outstanding study just published last year in the American Journal 
14

of Epidemiology, 30,000 Gulf War veterans, 15,000 Gulf War era 

but not deployed, 15,000 Gulf War and deployed to the Gulf, found, 

if you look across everybody who went to the Gulf, 10 percent incidence of post-traumatic stress disorder using a very well validated 

PTSD tool. If you look at people who were in heavy combat in the 

Gulf, not just everybody who went there, but those who were in 

combat, it doubles to 20 percent. It’s not just about politics. It’s not 

just about what happened in Vietnam. When you put people in 

combat—and this is the lesson of World War II where one out of 

five combat casualties was psychiatric—if you put people in combat, some people are going to have problems, and we have to be 

able to deal with them. 

Mr. KEANE. Mr. Chairman, may I respond as well please? 

Mr. SIMMONS. Yes. 

Mr. KEANE. I do appreciate the information that’s been put forth 

here this morning, and I want to go back to your opening remarks 

which indicate the historical precedence of recognition of post-traumatic stress disorder. And it is indeed the case that World War II 

veterans received remarkably positive and warm welcomes back 

from the country. Yet we had a proliferation of psychiatric facilities 

that were necessary to take care of people who had psychiatric 

problems, not termed PTSD at the time, but yet there were thousands of men and some women who required treatment for what 

we would consider today to be PTSD. 

I would like to take my comments further into another arena, 

which I think is relevant here. In a March 6th New York Times op 

ed, Dr. Satel suggested that the National Vietnam Veterans Readjustment Study did not explore military records. And I want to assure this committee that indeed we vetted through thousands of 

military records looking for evidence and information about exposure to war. Unfortunately, those records were remarkably inadequate to the task. And so to repudiate that study without regard 

to the hard work and tremendous effort on the part of VA to document military stress exposure is simply unacceptable. And it seems 

to me as well, that among the most impressive findings of the 

NVVRS was the association of PTSD with several very powerful indicators of social dysfunction among people who were having difficulty earning a living, people who were having difficulty with 

their marriages, people who were having difficulty managing their 

children, and people who were having difficulty with alcohol and 

drug abuse as well. All of these things fell in collections of findings. 

So the idea that there was no functional impairment, as she stated earlier today, is simply an incorrect appraisal of the evidence. 

Thank you. 

Mr. SIMMONS. I thank you for those remarks. I can remember 

when I mustered out, my goal was to get the hell out of town and 

get home, which is one of the reasons why this committee and this 

subcommittee have focused on the demobilization process. And the 

1109th, which just returned, which is a Connecticut unit, actually 

spent five days at Fort Drum demobilizing before they would be released home, and I think that’s an important change. And I thank 

the panel for their remarks. 

Mr. Strickland? 
15

Mr. STRICKLAND. Thank you. And I want to thank the panel for 

an interesting and stimulating set of presentations. I would like to 

return to the urban myth of delayed PTSD, because—and I find 

myself agreeing with much of what the good Dr. Satel says and disagreeing with much of what she says, so. (Laughter.) 

So I’m a flip-flopper, okay. I’ll admit it. Is it possible that a returning soldier can suck it in, so to speak, deny problems and so 

on, and then at a later time in that individual’s experience, perhaps there’s some triggering mechanism, there’s some other traumatic events that may occur in the individual’s life that causes or 

allows these behavioral symptoms to surface when they may have 

been masked or hidden in the past? 

Dr. SATEL. That’s true. What you typically find with supposed delayed onset when you look at the patient more carefully is that 

they have had perhaps sub-threshold symptoms all along, right? 

And then some kind of intercurrent stress might tip them over. 

That’s definitely true. 

But I should say again, I’m not here to argue that there’s not 

going to be PTSD. What I’m actually more concerned about is that 

when we have a person who’s suffering, and sometimes you don’t 

need a full-fledged diagnosis still to need some help and benefit 

from it, that we don’t take that and turn it—that the help itself 

doesn’t become iatrogenic, doesn’t turn it into a more chronic problem. 

Mr. STRICKLAND. Do you agree with the criteria that’s presented 

in the DSMIV regarding the diagnosis of this disorder? 

Dr. SATEL. I do, but I actually think they changed—you’re a psychologist by training. Isn’t that right? 

Mr. STRICKLAND. Yes. 

Dr. SATEL. In 1994 the DSM changed criterion 1. Now, I think 

it’s too easy to qualify for PTSD. In other words, you could hear 

about—as you know now, you could hear about something horrible 

happening to someone else and still qualify. I think that trivializes 

the kinds of horrible trauma that people in combat or rape victims 

suffer. But, yes, I basically agree with it. And I think PTSD is legitimate. As I say, it’s a fear reaction that essentially hasn’t extinguished. 

Mr. STRICKLAND. When did we first acknowledged PTSD as a distinct disorder? 

Dr. SATEL. Well, it was ratified, so to speak, by the American 

Psychiatric Association in 1980. I’ve heard people say that, you 

know, it used to be called shell shock and battle fatigue and trauma neurosis. That’s not quite true. Shell shock is a much more 

acute situation that happens in the course of battle. And the typical treatment for that, as you probably know, is to treat people as 

close to the front as possible, as quickly and with the expectation 

that they return, and most people actually do. The folks who tend 

to have the most trouble, who don’t reconstitute with that kind of 

care, typically have preexisting problems with substance abuse or 

depression or anxiety. 

Mr. STRICKLAND. I see Dr. Kudler shaking his head, so I’d like 

to know—— Dr. SATEL. I can provide you all the references. I’m sure we’ll 

have dueling references. 
16

Mr. STRICKLAND. Dr. Kudler, why were you shaking your head? 

Dr. KUDLER. Because the lesson of World War II is that given 

enough stress, anybody can break. 

Dr. SATEL. Shell shock. 

Dr. KUDLER. No, no, it wasn’t just shell shock, although they 

didn’t call it PTSD thereafter. Dr. Satel is absolutely right that 

acute stress, and we have this in the treatment guidelines, is different than chronic. On the other hand, we’ve found through good 

recent literature that if you have these early signs you are at higher risk. And therefore, the logical thing to do is to try to intervene. 

And that’s what we’re arguing for. 

Mr. STRICKLAND. Okay, Dr. Horvath. I’m sorry. 

Dr. HORVATH. If I may go back to World War II again. 

Mr. STRICKLAND. Sure. 

Dr. HORVATH. It seems to be a safer topic. (Laughter.) 

And look at a study that had nothing to do with traumatic stress, 

namely the so-called Grant Study of Normal Human Development 

that was done at Harvard and looked at Harvard undergraduates 

entering 1938, 1939, 1940. And then incidentally, they also went to 

war. These were the days when Harvard people still went to war. 

But that wasn’t the purpose of the study. The purpose of the study 

was to see what happens to these wealthy, influential good Americans, 50, you know, 20, 50 years later. 

Somebody went back, George Valiant and his group went back, 

published in the American Journal of Psychiatry, which I will submit for you, and looked at it and found that you could actually rate 

their combat intensity; that you could actually rate in the transcripts of interviews done in 1947, 1952, et cetera, you could glean 

symptoms which we now know to be PTSD. 

These people didn’t seek care. And you could identify a constellation of symptoms that was subthreshold or threshold PTSD. These 

were not treatment-seeking people. These were scions of wealthy 

America of the good war. And guess what? The interesting, the 

truly interesting finding is that they did have early morbidity and 

mortality; that even without the diagnosis of PTSD, combat kills 

and combat can kill 30, 40 years later by increasing I suspect—and 

I’m now speculating—that is the persistence of the stress, of the 

unrecognized stress. 

So we’re taking it away from the social pathology and the culture 

wars of the 1960s, go back to basic combat. And basic combat has 

effect on the system that we in the VA must include in our planning. And it seems that we are determined to send our kids to war, 

and therefore we have a responsibility to plan not for the next 2 

years, not for the next PCT alone, but for the 30, 40 years that our 

kids will be coming back to this VA. 

Mr. STRICKLAND. Mr. Chairman, my time is up. I would just like 

to say one more thing to Dr. Kudler, and I won’t take time to have 

you respond, but I think you’ve presented some good ideas, suggestions. In the absence of obtaining a post-deployment health assessment from DOD, I think we should think about what VA can do 

immediately to identify these acute cases. 

But I want to thank you all for a stimulating presentation. I 

found it very interesting. Thank you. Thank you, Mr. Chairman. 
17

Mr. SIMMONS. I thank the gentleman. The next question goes to 

Mr. Smith, or was it Mr. Renzi who was here first? Excuse me, Mr. 

Murphy. And I will apologize to the panel. I will give the gavel to 

Mr. Murphy, if he’s willing, and I hope to come back after another 

meeting. Mr. Murphy. 

OPENING STATEMENT OF HON. TIM MURPHY 

Mr. MURPHY (presiding). Thank you, Mr. Chairman. We’ll keep 

the seat warm for you. 

I really appreciate the testimony that all of you are giving here. 

I’m a psychologist myself, and my field has often times been in 

dealing with children, adolescents and families who have themselves faced trauma on multiple levels, abuse and other trauma. 

And much of the training that I received was from people in the 

military who are also passing on information and lessons learned 

from veterans. And there are a couple of things that I want to help 

myself and the panelists understand in this as well. As I look at 

the whole sequence of what appears to happen during combat, 

there are several steps that I understand research tells us are critically important. One is what happens on the battlefield itself with 

the commanding officer, the unit cohesion, the exposure, the length 

of exposure, and several other elements there, as well as if someone does experience some acute trauma, the shell shock concept, 

the idea of three hots and a cot nearby the battlefield and return, 

and what occurs at a field hospital, what occurs if they were evacuated to another site, what occurs when they’re at a continental 

United States site, and then what occurs with long-term care. All 

those things are important. 

But throughout that—and it’s brought up, particularly Dr. Satel, 

has been this continuing threat of expectations, expectancy for improvement of symptoms, as well as the expectation for occurrence 

of symptoms. Now I find it particularly interesting, Dr. Satel, your 

testimony when you talk about the actual incidents that occurred 

by that one study of reports of PTSD from Vietnam veterans, and 

yet there could not have possibly have been that many veterans 

who actually were in combat. Am I correct in that? So if it’s 31 percent, 31 percent of Vietnam veterans were not in combat? 

Dr. SATEL. Thirty-one percent with PTSD and 15 percent in combat units, even though people not in combat units sometimes did 

get in dangerous situations. 

Mr. MURPHY. In your assessment, that might be that some of 

them may also be—there’s different thresholds of what people could 

pick up. So, based upon again their expectations, their exposure, 

what happened to them earlier in life. 

I want to ask about another issue, too, and that has to do with, 

let’s remember the era of the 1960s and 1970s and the society they 

were returning to. Yes, part of that was the greeting that people 

received when they came home, but also it was the world that we 

lived in back here in the States was having its own struggles and 

traumas on many levels. We had throughout the 1960s presidential 

assassinations, the assassination of Martin Luther King, demonstrations, drug use, et cetera. 

And I’m wondering if the kind of things that were occurring too 

with regard to when people return home and their own makeup, 
18

drug use, their social lives, et cetera, I’m wondering what influence 

those may have had, as well, to exacerbate or provoke symptoms 

in our veterans. 

Dr. SATEL. That’s a good question. Actually, in terms of the drug 

use, there’s a very well-known study from Washington University 

in St. Louis looking at the veterans in Vietnam who had a heroin 

problem, and the majority of them, as you know, stopped when 

they came back. And the people who continued to have problems, 

that minority who did have problems stateside, were those who actually had drug addiction problems even before they were deployed. 

But in terms, as you say, of, you know, potential hostility, of an 

unwelcome milieu, can exacerbate distress, certainly. And I suppose for some people it might be that stressor that pushes them 

over the edge. I don’t know if you read, Robert J. Lifton’s letter to 

the editor today about that op ed that I had written, but he talked 

about the demoralization and the bitterness and the anger and the 

resentment of some of the soldiers, and I don’t doubt that. But that 

constellation of human reactions is not necessarily pathology, is not 

necessarily mental illness. It’s a reaction. 

Mr. MURPHY. That’s a very important point. And that is the ways 

that we react under stress—part of my curiosity here, and it seems 

like you’re saying it—sometimes we’re too quick to diagnose something as mental illness when it would actually be within the bandwidth of what human beings face under stress. 

Dr. SATEL. I agree 100 percent. 

Mr. MURPHY. And, therefore, if the expectation is, well, these 

symptoms you’re experiencing we’re going to label as PTSD or some 

other adjustment disorder, some other major disorder, when part 

of the comments might be, and I know this is part of what we do 

as treatment is say this is not necessarily a long-term chronic problem you have, but you are having a normal human reaction, and 

sometimes normal human reactions need treatment. Is that fair? 

Dr. SATEL. You know, sir, this is awful. I can’t hear you very 

well. I’m so sorry. 

Mr. MURPHY. I’m sorry, too. I don’t know what to do about the 

speakers. 

Dr. SATEL. No, the acoustics are strange. 

Mr. MURPHY. Well, perhaps somebody else could respond to that, 

too. Dr. Kudler, you’re nodding at that? 

Dr. KUDLER. I’ll take you back to the American Civil War for a 

moment. There were two very famous doctors working out of Turner’s Lane Military Hospital in Philadelphia, a fellow named 

DeCosta, one of the most famous diagnosticians in medicine and 

one of the first American cardiologists, and his very good friend, 

Dr. Weir-Michell, a neurologist. And the two of them looked at 

combat veterans of the American Civil War in the Union army. 

One said this is a cardiological disorder, the guy who was a cardiologist. And the guy who was a neurologist said it was a neurological disorder. 

This is what always happens. These are arbitrary constructions 

in an attempt to define a real human process. But I think you’re 

right on the point, though. It is a real human process, and there 

are interventions that need to be done. And so we’ve got work to 

do. 
19

Dr. SATEL. Okay. Now I know what you’re saying. Sometimes 

there are interventions. That’s true. And the ones you suggested I 

think are very, very sensible. But sometimes there are not, and 

that’s all I’m saying, is that not everyone who is distressed necessarily needs mental health care. And if the person wants it, 

that’s fine. If they’re so dysfunctional, yes, they need it and I would 

advocate strongly that they have it. But some people use the chaplains. Some people use all kinds of support systems. Some people 

really do need formal professional care, and that’s fine too. But not 

every distressed person needs a psychologist or a psychiatrist. 

Mr. MURPHY. Thank you. Mr. Renzi. 

OPENING STATEMENT OF HON. RICK RENZI 

Mr. RENZI. Thank you, my friend. I want to than you all for your 

testimony. Very interesting. Dr. Keane, I felt like you really 

touched on a real niche when you talked about women in combat. 

I had the honor of representing Lori Piestewa, the first Native 

American woman killed in combat. I’m being pressured right now 

to open up classified information as it relates to what her days 

were, the last few days that she went through. And that group that 

wants that information is the group who is opposed to women in 

combat. So I want to ask with your expertise, sir, is there more of 

a resilience in women or less a resilience? Or what do you see? And 

can you just expand on—you know, you can see where I’m going 

with my questioning here. Please. 

Mr. KEANE. Well, I don’t know whether or not there are excellent 

empirical studies to substantiate the direction that you’re taking it, 

whether women are more or less vulnerable to the stressors of combat. It’s an important question for us to consider. 

Many of the people who have examined the stress that women 

have been in in the military have examined it across multiple different kinds of experiences. You may know that already it’s fairly 

well documented that the rate of physical abuse and sexual abuse 

among women who enter the military is elevated compared to the 

general population, and we also know that these are things that 

are placing people at increased risk, as we’ve been talking about 

this morning, for when a stressor occurs for psychiatric problems 

to ensue. 

That, however, should not be a screen-in or screen-out variable. 

It’s something that’s important for us to understand. Many people 

are utilizing the military in ways that will help them get a leg up 

and a step out of bad situations and give them opportunities to acquire knowledge, education and thrive in their lives. The discussion 

about whether women are more vulnerable is a very complicated 

one. It’s not one that I’m prepared to give you an answer to today, 

but I think it’s worthy of discussion. 

Mr. RENZI. Thank you. For the women in the audience, I saw a 

study also that says that women eventually will surpass men as it 

relates to their times in the marathon, so that the Olympic marathon someday will be won by a woman, because of their ability for 

endurance. Dr. Horvath, did you want to expand? 

Mr. HORVATH. Less a science and more of a personal anecdote, 

my daughter is a naval aviator, now flying for the Coast Guard 

who went through SAR training. Many of her friends, also naval 
20

aviators, went through the full horror show. They survived it as 

well as the men. I think whenever you compare men and women, 

you’ll find a tremendous overlap, and there are women whom I 

would trust in combat far more than I would trust some men. On 

the other hand, we are working very hard, in fact there is new information coming on, I alluded earlier to these resilience factors, 

these biological resilience factors in addition to the psychosocial resilience or vulnerability factors. And I can assure you that the National Center for PTSD is doing great work in places like Fort 

Bragg looking at the rangers. I hope they’ll do some studies with 

Naval aviators in their particular training so that we do and we 

will find the kind of answer that you seek, which frankly right now 

is not available. 

But to talk about the weak sex who can’t fly jets, can’t go to combat, can’t survive SAR training, disrespects a whole group of people, to one of whom I’m related. 

Mr. RENZI. Yeah, I agree. And particularly—I agree. Dr. Satel, 

thank you. You did a great job, I thought, on touching on the aspect of work and the healing effect that it has. This committee is 

really pushing it in areas as it relates to transitioning our guys and 

gals out of the military and quickly helping them with training, 

with using their Montgomery GI bill for education. We’re focused 

a lot on entrepreneurship. 

One of the criticisms that I got on my bill last session was that 

to use your Montgomery GI bill for entrepreneurship courses to be 

able to use it to buy computers to set up your own business, that 

we weren’t going to be able to reach to those troops that had the 

post-traumatic syndrome disorder. Do you believe a greater disadvantage—do those people who suffer even slightly in this area 

have the inability to take on added stress as it relates to entrepreneurship? 

Dr. SATEL. It’s case-by-case, certainly. But I would think for—

well, I have to tell you, I do think we make that diagnosis too liberally, so that people who might have—a particular individual who 

might have the PTSD label might be someone who is capable of 

doing a lot, and what’s keeping him kind of mired in this dysfunctional state and being demoralized is the fact that he doesn’t feel 

purposeful or doesn’t see an opportunity for the future. So I could 

see that capacity to take advantage of these programs as being 

very therapeutic. 

Mr. RENZI. Yeah. Thank you. Let me finish with Dr. Kudler. And 

thank you for your testimony. Excellent expertise. You talked about 

your visit to Walter Reed. You talked about the cannon shot that 

you heard. Is there—can we help you with the pressure on DOD 

to get a letter out that all hospitals nationwide should eliminate 

any kind of aggravating procedures, not just cannon shots, but 

maybe war movies? Are there other observations you have in that 

field? 

Dr. KUDLER. It’s not that simple. One of the other things that 

went on there is that these fellows won’t walk off the paved paths 

on the grounds because they’re afraid of land mines. They just can’t 

walk on the grass. We can’t pave the whole place. 

What we need to do is to create the interventions that get at the 

common denominator, which is that they’re very stressed. They 
21

don’t want to talk about being stressed, because it’s bad for morale. 

It’s bad for their buddies. It’s bad for the mission. It’s bad for their 

careers. We have to create interventions that are safe, that allow 

them to see that if they talk about it and work on it they’re actually—it’s good for the mission, it’s good for their buddies, and it’s 

good, well, hopefully for their careers. We’ll see. We have to work 

on that level. 

Mr. RENZI. Excellent testimony from all of you. Thank you. Mr. 

Chairman. 

Mr. MURPHY. Thank you, Mr. Renzi. Mr. Boozman. 

Mr. BOOZMAN. Yes, I also have really enjoyed the testimony. As 

a panel, then, do you agree that we’ve got a problem with—do we 

have a good diagnosis as far as, you know, when we make the diagnosis, is there any conformity at all amongst the professions as to 

what it is? And if so, or if not, do we agree, are we overidentifying 

or underidentifying? 

Mr. KEANE. Actually, I think that there is great consensus about 

this condition, and I’ll give you a few pieces of information about 

that. There is a lot of suggestion that PTSD was a Western construction, that it really applied to Europeans and North Americans. 

And in the last five years, there have been remarkable epidemiological studies completed in countries as far away as Southeast 

Asia, Africa and the Middle East. Very different cultures, very different religious backgrounds, very different ways of representing a 

wide variety of emotional states. PTSD was found across all of 

these countries, and it was found with the same kinds of relationships that we have found here in America. 

There seems to be, as I think Dr. Horvath introduced in his remarks, a biological drive to many of the symptoms that we’re seeing in PTSD. So I think there is a great deal of consistency. 

Now to the point that Dr. Satel raises, are we letting the threshold down too low? That’s always a point of departure and always 

a point of a discussion in any mental health disorder. The real 

question is, what’s the relationship of the diagnosis to disability? 

And that’s where measures of disability and dysfunction must be 

used in conjunction with the diagnosis in order for us to understand how complicated a situation one person presents with. 

So, you never do make a decision simply on the basis of a diagnosis. It’s about a much greater array of information. 

Mr. BOOZMAN. Once we label, to we unlabel? I mean, is this 

a——

Mr. KEANE. Yes. We have terms for it. 

Mr. BOOZMAN. Is this a condition that once a person has this diagnosis that they’re, you know, like a learning disability, they have 

a learning disability forever? 

Mr. KEANE. Well, we have terms for PTSD, for example, in remission, which means that it’s not present at the time that you’re 

examining somebody, but it was present previously. It’s my experience that people with PTSD actually do have a phasic course. In 

other words, there are times when they are better and there are 

times when they are worse. 

The difficulty for us, of course, is where you have problems in 

where you take that cross-sectional inspection. If you take it at the 

anniversary date of a major military encounter, it’s likely you’re 
22

going to have extreme symptomatology—nightmares, flashbacks, 

lots of anxiety and stress. If, however, you take it while someone 

is on vacation, it’s a different story. 

The other thing that I’d like to point out, too, is that people who 

develop PTSD often retain a sensitivity to other kinds of life 

stressors, so that if there’s another major loss in their lives, if a 

child dies, for example, a case that I’ve had very recently, nightmares of Vietnam returned in this patient. So these stressors contribute to the whole being. We are a single person. There is this 

sensitivity that remains for people with PTSD. People are affected 

for their lives. Whether or not they’re disabled for their lives is a 

separate question. 

Mr. BOOZMAN. Dr. Horvath? 

Dr. HORVATH. May I make two points? 

Mr. BOOZMAN. Sure. 

Dr. HORVATH. First of all, diagnostic accuracy and stability in the 

United States stank to high heaven 30 years ago. I came from Australia. I was astonished at the loose diagnostic practices we had 30 

years ago. Since then we had more than 25 years of hard-nosed empirical science imposed on us. We do know how to make the diagnosis. We have inter rater reliability. It is far better than it used 

to be. The construct for PTSD is as strong as any medical diagnosis. It is as strong as any medical diagnosis. Are there some people who lie about it? Yes. Are there some doctors who don’t read 

the textbook, don’t read the criteria? Yes. But on the whole, I’m actually very proud of the VA where we actually do know and we 

have gone through studies showing good inter rater reliability. 

Mr. BOOZMAN. And I’m not arguing. Don’t misunderstand. I’m 

not arguing that there’s not. I know that, again, you know, you say 

learning disability, some of these things, it’s so broad that it’s difficult to quantify. Is there a disease process—you know, we’ve had 

many periods of times of peace, okay. Is there a disease process 

that’s not labeled with this label but has a similar construct just 

from being in the service and in a—or for whatever reason, for 

servicemen and women, do we see the same sort of symptoms and 

call it something else? 

Dr. HORVATH. Yes sir. In fact, in my military training, on combat 

stress. Combat stress is not a diagnosis. It is very carefully kept 

away from this whole diagnostic notion. Our motto in AMEDD is 

to ‘‘preserve the fighting strength.’’ In those days we made no diagnosis. We do return people to duty, and our first priority is the well 

being of the unit and the well being of the mission. It’s a missionoriented approach, and in fact we de-pathologize and de-mythologize the very same stress conditions that under civilian conditions 

we may very well call an acute stress condition. But it’s a very conscious decision. And in fact we are often quite successful. However, 

these people still live that experience, and it is very possible, and 

their biology continues underground, and when they return to civilian life and they manifest certain symptoms, they’re not faking it. 

They’re not exaggerating it, they’re just stating it how it is, and we 

can make the diagnosis with very good inter rated reliability. 

Mr. BOOZMAN. Mr. Chairman, can I just ask one thing? And they 

don’t even have to respond to it. But the other thing I was interested in Chairman Simmons, he talked about the difference in, you 
23

know, right now the troops are supported when they’re going away 

and coming back, and, you know, the difference. Again, maybe you 

could give me some information about if there’s a difference in the 

guard troops versus the other draftees versus, you know, nondraftees, professional, those kind of things. Thank you. 

Mr. MURPHY. Thank you. We’re going to give each member here 

one minute for a follow-up question if you want. Mr. Strickland? 

Mr. STRICKLAND. Yes. There’s been discussion here of women. 

And in this regard, my understanding is that the VA currently has 

authority to provide military sexual trauma counseling and treatment, and that that authority is due to expire in December. Now 

the chairman of the subcommittee, Mr. Rodriguez, has introduced 

legislation to permanently extend that authority. And I would like 

just, you know, a quick opinion from each of you if you think that 

that authority should be extended. 

Dr. HORVATH. It should be extended. 

Mr. KEANE. Data from the National Center for PTSD in a report 

indicate that prevalence rates of sexual assault and related PTSD 

are extraordinary among women in the National Guard. I would 

suggest that we continue this program. 

Dr. KUDLER. And that there’s a high incidence of military sexual 

trauma in people coming back from the Gulf now. I want to include, though, that we shouldn’t be too narrow in our view of this 

because women are 20 times more likely than men to have sexual 

trauma during their military service. There are 20 times more men 

in the VA system than there are women. It comes out to equal 

numbers. And we’re talking about tens, and actually more than 

hundreds of thousands of people, men and women. We have to 

make sure the services are built in for men as well as for women. 

Mr. STRICKLAND. Thank you for that response. I was wondering 

that myself, and I appreciate that. 

Dr. SATEL. That’s interesting because we know that actually 

male rape creates a higher rate of PTSD than even female. But I 

certainly defer to my colleagues about their judgment on whether 

this should be continued. They’re on the front lines of the VA system, so I would say yes. 

Mr. STRICKLAND. Mr. Chairman, given the response, I would 

hope that all of us on this committee would consider signing on to 

that legislation and doing whatever we can to see that it’s enacted. 

Thank you all very much. 

Mr. MURPHY. I have one question too. I’d like Dr. Horvath, for 

you to respond to Dr. Satel’s concerns about the incentives of paying veterans to be sick with PTSD and paying them more to be 

sicker. Is there anything wrong with this model of disability compensation? Does it clash, as suggested by Dr. Satel, with the goals 

of rehabilitation and expectations of improvement? 

Dr. HORVATH. Any compensation system has that difficulty built 

in, and it would be naive to deny it. You would have to know that 

the VA goes a long way towards working towards rehabilitation despite the fact that somebody has benefits. And in fact, we will give 

you a, if you don’t mind, sir, a review from Dr. Rosenheck from 

Westhaven, Yale who studies this issue at some length, and that 

in fact you will find no significant difference between compensated 

and uncompensated groups in getting back to work. 
24

If you look at the level of clinical disability and then you factor 

in those who have compensation and those who do not, compensation alone isn’t an obstacle to rehabilitation. On the other hand, opportunity for rehabilitation is a very important issue, and I’m delighted that recent legislative changes plus changes that I hope Dr. 

Roswell will speak to improve the VA’s capacity for supported employment, and I on this one topic—on this one topic—I agree with 

Dr. Satel that work is excellent therapy. 

Mr. MURPHY. Thank you very much. Mr. Renzi, do you have a 

follow-up? Mr. Boozman? 

We appreciate the testimony. This panel has been very illuminating. Thank you so much. 

While they’re stepping away to get the next panel ready, I’ll introduce them. We have the Honorable Robert H. Roswell, M.D., 

Under Secretary for Health, Department of Veterans Affairs. We’re 

also joined by Alfonso Batres, the Chief Officer, Readjustment 

Counseling Services, Department of Veterans Affairs. And also Dr. 

Laurent Lehmann, Chief Consultant, Mental Health Strategic 

Health Care Group, Department of Veterans Affairs. 

Dr. Roswell, I believe you’re opening up with a statement from 

the VA. 

Dr. ROSWELL. Thank you, Mr. Murphy. 

Mr. MURPHY. We’ll have the usual five minutes for you. 

STATEMENT OF ROBERT H. ROSWELL, M.D., UNDER SECRETARY FOR HEALTH, DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY: ALFONSO R. BATRES, CHIEF OFFICER, READJUSTMENT COUNSELING SERVICE, DEPARTMENT 

OF VETERANS AFFAIRS; AND LAURENT S. LEHMANN, M.D., 

CHIEF CONSULTANT, MENTAL HEALTH STRATEGIC HEALTH 

CARE GROUP, DEPARTMENT OF VETERANS AFFAIRS 

Dr. ROSWELL. Thank you very much. It’s a pleasure to be here 

before the committee today to talk about a subject I feel very personally and strongly about. And in so doing, I feel compelled to deviate from the statement I intended to make. 

I’ll be the first to admit that I’m not a psychiatrist. But I can tell 

you this. The Hippocratic Oath that I took said I would comfort the 

suffering, not to question whether they have sufficient combat 

stress exposure to cause suffering. We have to understand that 

these men and women in uniform who are in Iraq right now are 

being subjected to circumstances that almost certainly will cause 

suffering. And I submit to you and this committee that it’s inappropriate to argue about the causality of that symptom but to recognize that there is suffering and do everything we can to reach out 

and comfort those who will return with suffering. 

Let me point out the experience we had following the Gulf War 

of some 12 years ago. Men and women came back and they had 

suffering, sometimes weeks, sometimes months, sometimes years 

after that conflict of only 12 years ago. And some of that suffering 

took the form of unexplained physical illnesses. And we as a government and we in the Department of Veterans Affairs and this 

Congress spent too much time arguing about what might have 

caused those physical ailments instead of reaching out and pro-
25

viding the care that the men and women who provided the freedom 

we enjoy in this country earned for us. 

So I’m not a psychiatrist, but I took a Hippocratic Oath, and as 

Under Secretary for Health, I am committed to do everything I possibly can to reach out to those who have served and comfort their 

suffering. 

I’m sorry for that outburst, Mr. Chairman. 

Mr. MURPHY. Understood. 

Dr. ROSWELL. The information we have received from DOD has 

been unprecedented. Let me point out that there have been 107,000 

troops who have returned from Operation Enduring Freedom and 

Iraqi Freedom, but the diagnosis of PTSD is not in less than one 

half a percent of those who have received care from the VA. Some 

15,000 of the 107,000 have received care from the VA. And of those 

we have already seen approximately 4 percent have been diagnosed 

with PTSD, using the very DSMIV criteria you spoke of. 

For returning service members who are experiencing emotional 

and behavioral problems, VA has mental health programs including the Readjustment Counseling Program specifically developed to 

assess and address their problems. VA provides care through general mental health clinics, through PTSD specialists in general 

mental health programs and through specialized PTSD programs. 

Last month VA and DOD released a clinical practice guideline 

for the management of stress associated with trauma, both in the 

combat theater and post-deployment. The guideline pools DOD and 

VA expertise to help build a joint assessment and treatment infrastructure between the two systems in order to coordinate primary 

care and mental health care for the purposes of managing, and if 

possible, preventing acute and chronic PTSD. I have provided a 

copy of the guideline for the committee. 

We have also deployed a screening instrument in the form of a 

clinical reminder system triggered by the veteran’s separation date 

from returning Iraqi Freedom or Enduring Freedom veterans who 

come to VA for health care. This assessment tool will prompt the 

provider, any provider, including all primary care providers, with 

specific screening requirements to assure that the veterans are 

evaluated for medical and psychological conditions that may be related to recent combat deployment. 

The Veterans Health Initiative is a program designed to increase 

recognition of the connection between military service and certain 

health effects, better document veterans’ military and exposure histories, improve patient care and establish a database for further 

study. The education component of VHI prepares VA health care 

providers to better serve their patients. The VHI program includes 

a module on PTSD and another module on caring for war wounded 

that’s just recently been released. These modules are available to 

all VA clinicians. They’re also available on a compact disk that can 

be viewed from any computer. 

Last year Congress mandated additional funding for mental 

health programs in fiscal years 2004 through 2006, and I’m pleased 

to tell you that $25 million in additional funding will be allocated 

this year to enhance mental health programs for treating patients 

suffering with PTSD and related disorders regardless of the diagnosis. In fact, from 2002 to 2004, VA funding for treatment of seri-
26

ous mentally ill veterans increased from $2.2 billion to $2.5 billion, 

an increase of over 9 percent. PTSD funding went from $138 million to $178 million, a 25 percent increase, and substance abuse 

funding went from $425 million to $491 million, a 15 percent increase. 

On February 3rd of this year I approved funding to hire an additional 50 employees for our Readjustment Counseling Service for 

the specific purpose of providing outreach to veterans of Operation 

Enduring Freedom and Operation Iraqi Freedom as well as veterans of the global war on terrorism. Our hope is to hire people 

who have actually served in these conflicts so that they can reach 

out to their peer group and identify the services and treatment 

available through the VA. 

Early this summer we’re planning a conference for readjustment 

counseling staff, primary care and mental health staff to improve 

skills in assessing and managing problems of returning Iraqi Freedom and Enduring Freedom veterans. This conference is being 

planned in collaboration with the Under Secretary’s Committee on 

PTSD and the National Center for PTSD to focus our efforts on 

treating this important disorder. 

Also later this year we’re planning a national conference to commemorate the 25th anniversary of the Readjustment Counseling 

Program and to bring experts from all fields together to assess this 

important topic. 

Numerous other steps in coordination with DOD have assured 

that we’ll have a seamless transition for those who have been deployed. We’ve used a variety of mechanisms to reach out to them. 

But let me summarize by saying that service members separating from military service and seeking health care through VA 

today will benefit from VA’s decade-long experience treating Vietnam and Gulf War veterans. We’re working hard to inform and encourage returning service members to seek available VA services. 

We have undertaken significant educational efforts and provide 

clinical tools to our staff to make sure that all veterans who have 

a need for care and who may be suffering now or in the future have 

access to the care they need. 

Mr. Chairman, I’ll be happy and so will my colleagues to answer 

any questions you may have. Thank you. 

[The prepared statement of Dr. Roswell appears on p. 95.] 

Mr. MURPHY. I’m grateful. Thank you very much, Doctor. I’m told 

your colleagues don’t have any statements at this point, so I will 

go to Mr. Strickland. 

Mr. STRICKLAND. Dr. Roswell, thank you for your outburst. I for 

one appreciate it. It gives me confidence that—I mean, I didn’t 

need the confidence because I know you well enough to know that 

you are committed. But it’s good to occasionally see some real 

human feeling coming from someone in your position, and I really 

appreciate it. 

I had a question about family support for returning veterans as 

they readjust and so on, but that question kind of triggered another concern that I have that really involves active duty folks 

right now. A young friend of mine who is a recent West Point graduate and currently serving in Iraq e-mails me occasionally—frequently as a matter of fact. His most recent e-mail indicated that 
27

a significant number of the men under his authority have experienced family breakup and divorce since they have been deployed. 

And I’m unaware of what resources may be available to an active 

duty soldier in those kind of circumstances that may not only be 

dealing with the stress and the trauma of war and conflict but also 

at the same time dealing with, you know, the most traumatizing 

perhaps personal experience. I don’t know if you can speak to that 

or not, because I know that’s—— Dr. ROSWELL. It’s an important issue. I actually just retired myself from 30 years of military service, most of it in the reserves. 

The Department of Defense has put a tremendous emphasis on 

family support programs to try to address and minimize the very 

factors you’ve talked about. It concerns me as a clinician not only 

while service members are deployed and the disruption that causes 

in the nuclear family unit, but quite frankly, we see it in veterans 

after they’ve redeployed as well. 

The sad truth is, combat changes many people who are exposed 

to that, and the weeks, months, sometimes years of separation between a service member and their family result in irreparable 

changes in personality. And what we’ve seen in virtually every previous conflict is that redeploying soldiers over time find that the readjustment is very difficult, and there are subsequent divorces or 

breakups, which necessitates a need for intervention. 

That’s why our Readjustment Counseling Service plays such an 

important role, and I’d like to ask Dr. Batres to just briefly address 

how we reach out not only to service members but support their 

families. 

Dr. BATRES. Thank you. One of the concerns we’ve had with this 

particular cohort has been the high percentage of National Guard 

and reserve folks that I think present an even larger challenge in 

terms of providing a spectrum of services for families, especially as 

they’re disbursed over a great area and may not be close to a military base. Because certainly DOD has a vast array of family services available to them while they’re on post. 

What we’ve done is we’re providing outreach to these families 

wherever we can in communities to sponsor affairs and get 

togethers where we can provide them education, not only that DOD 

has and VA, but their entire communities, and bring them together 

in a peer-to-peer fashion to embellish support systems within their 

community and to keep track of them. 

They have many questions, and not only questions about concerns about the safety of their loved ones, he or she—and by the 

way, we have to keep in mind that the combat veteran now typically can be a she, not just a he—and what kinds of support systems we have for those families in terms of education and to answer their questions not only in terms of, again, concern, but concerns with their children and concerns with jobs and security an 

those kinds of situations. 

One group that Dr. Roswell has authorized us to provide services 

to are those families of veterans who are killed while on active 

duty. And in the last year we’ve initiated a bereavement program 

which we run out of the Readjustment Counseling Service where 

we are providing bereavement service and support to those family 

members of those killed while on active duty. And right now we’ve 
28

run about 45 different families. We’re getting a lot of referrals from 

the DOD casualty officers, our VBA casualty system and then selfreferrals from families. And I think that’s another service that VA 

is providing that I think kind of addresses issues that are I think 

our country is in great need of. 

Mr. STRICKLAND. Thank you, sir. I see my time is running out 

here. Dr. Roswell, I would like to ask you, will the VA be seeking 

or supporting the authority to extend the sexual trauma program 

that is due to expire in December? 

Dr. ROSWELL. Absolutely. 

Mr. STRICKLAND. Thank you so much for that. One additional 

question—I see the yellow light is on, so I don’t have much time. 

Dr. Batres, in your judgment, do the vet centers have enough resources to meet the demand that you’re now experiencing with returning troops? 

Dr. BATRES. Yes sir. I have approximately 940 positions to serve 

my program nationwide. We process about 130,000 unique veterans 

every year, and we provide about a million visits each year. My 

budget has remained fixed and costs other than for cost of living 

adjustments for the last ten years which represents my tenure at 

the vet center. During this time we’ve extended eligibility to all 

veterans who have served in a combat zone. 

Over those ten years, we’ve utilized optimal efficiency strategies. 

In other words, we’re doing a lot more with less over the years. I 

represent a group of folks that are highly motivated. Most of them 

are combat veterans. Eighty percent are veterans in my program. 

We understand and empathize with the folks that we serve, much 

like Dr. Roswell just demonstrated. We have that commitment to 

our clients. 

If there is a recommendation to increase family services at vet 

centers is accepted, we will need a new cadre of employees to address that need. The increased number of National Guard and reserve units in OEF/OIF presents increasing challenges, and we 

hope to get resources to address these issues in the future. And, 

of course, I want to again commend Dr. Roswell for allowing us 

those 50 FTEE to go out and promote this outreach effort. It’s 

unique. Given where we are, I think it represents his statement 

that this is a very important cohort that we want to outreach to 

and provide services to. 

Mr. STRICKLAND. Thank you very much for that answer, and I 

think that gives us on this committee information that we need, 

and so I really appreciate that response. Thank you so much. 

Thank you, Mr. Chairman. 

Mr. RENZI (presiding). I thank the gentleman. I’ve got a couple 

of questions I want to ask. The previous panel I thought did a wonderful job of setting the stage of where we are right now, where 

we’ve come from, mistakes of the past, certainly trying to peer into 

the future as to the research that’s provided. 

And, Dr. Roswell, you know that I’m not a real advocate of some 

of the budget tightening discussions and wrestling matches that 

we’re going through right now. There has been I think honest criticism as it relates to cutting the budget in the area of the mental 

health. And could you help me understand a little bit if we are 

looking at tightening our belt within the VA and some of the pro-
29

posed budget cuts in mental health research, what effect that 

might have on our discussions today with this unique situation? Go 

ahead. 

Dr. ROSWELL. Well, there’s no question that we’re in an austere 

budget climate. I think the issue, though, is looking at demand, 

doing everything we can to identify potential need and meeting 

that need. 

We do have an increase in money going into mental health care. 

I alluded to that in my testimony, on the order of 15 to, in some 

cases, 25 percent increases in money committed to mental health 

services with a single exception, the range of services across the recent capacity report showed an increase in funding. We are moving 

to new accounting or measuring or tracking methods, a monthly 

program cost report that will allow us to better track the expenditure of funds to be sure that they’re going to serve the needs of 

mental health. 

But mental health, like all of medicine, is an emerging field, and 

the way we approach mental health, the newer treatment modalities, more effective medications, new interdisciplinary interventions. And as highlighted by the President’s New Freedom Commission, a model focused on recovery, not stabilization or institutional 

care, but recovery and reintegration into the community and reintegration into a productive livelihood is a model that in many 

cases is actually less resource intensive with regard to the traditional measures of capacity, those being inpatient beds and dollars. 

So I’m much more focused on making sure that the outreach 

identifies the entire universe of potential need, that we then meet 

that need timely and comprehensively, and that we track outcomes 

to make sure that reintegration and recovery are paramount in our 

efforts. 

Mr. RENZI. I just want to agree with you that given what I’ve 

learned today, and as you’ve stated accurately, that it is an emerging medicine and is an area where we really need to focus our dollars on research that we be sure to be careful with our tightening 

in this area. 

Are you, Dr. Roswell, involved at all with DOD as it relates to 

the suicide studies that are going on over at the Pentagon? Are you 

working collaboration efforts? 

Dr. ROSWELL. We are. I’ve had some lengthy discussions with my 

counterpart, Dr. Bill Winkenwerder, at DOD, and we are trying to 

understand the combat stressors and the situations that may have 

resulted in the increase in suicide. I would point out in fairness to 

DOD that there has been a concerted effort over the past number 

of years, some eight, ten years, to reduce suicide rates in military 

service members both during peacetime and during deployment. 

And those efforts, in fairness, have had a measurable and sustained success in reducing suicide rates in the military. This recent 

distressing increase in suicide rate is cause for concern and it is 

being looked at very carefully and we are working with DOD. 

Mr. RENZI. I appreciate the answer. And let me finish up, anyone 

on the panel. Our next panel is going to be a group of chaplains, 

and I just wanted to give you an opportunity before they come on 

to expand on the role that they’re playing at the VA or your 

thoughts at all on how the spiritual aspect of healing really is, in 
30

my opinion, probably as paramount as being able to address the 

chemical imbalances, the medication portion. 

Dr. ROSWELL. Well, speaking personally, I believe that care must 

be holistic; that spiritual care is a critical part of the care we provide. I believe that chaplains, particularly with the clinical pastoral 

education program that we emphasize so strongly in VA, can be in 

fact very effective and play a tremendously valuable role in the 

care of our patients. But I would certainly defer to Dr. Lehmann 

for any comments he might wish to make. 

Dr. LEHMANN. Thank you. We very much value the services of 

chaplains in the mental health arena, because they really can 

reach out and help people in ways other than other types of mental 

health clinicians. And very many of our chaplains actually do have 

mental health training. We have the services of chaplains are in 

fact cited in the Clinical Practice Guideline. And in addition, we 

have consulted and worked with chaplains in the training programs that we’re developing for our clinicians. 

So, yes, they absolutely are part of our range of service providers. 

Mr. RENZI. I hope I’m not stealing anybody’s thunder here, but 

I just want to do a little commercial. Apparently the VA chaplains 

just put out under your auspices, Dr. Roswell, and your leadership, 

this new CD. Did you want to comment on it all? The spirituality 

of inspiring hope and healing? 

Dr. ROSWELL. It’s a wonderful video. I would encourage you to 

look at it. It really I think very dramatically demonstrates the potential role that spiritual care plays in the service we provide to 

the Nation’s veterans. 

Mr. RENZI. Let me thank you all. I appreciate very much your 

time and your testimony, and thank you for the service. 

We’ll go ahead and welcome our next panel, Panel Number 3. As 

they approach, I’ll go ahead and introduce you. Lieutenant Colonel 

Kenneth Brown, Chaplain, U.S. Army; Lieutenant Charles Hodges, 

Chaplain Corps, U.S. Naval Reserve; Commander Mark Jumper, 

U.S. Coast Guard Academy; Chaplain Robert Mikol, Clinical Chaplain, VA New Jersey Health Care System; and Father Philip Salois, 

who is a Chaplain Program Manager with the Boston Health Care 

System. 

We welcome all of you today and thank you for providing us with 

your expertise that you’re about to lend to us. We’ll give you some 

time to get settled in. Chaplain Brown, I think we’ll start with you 

if you’re ready. Recognized for five minutes. The lights control the 

room. 

Chaplain Brown? Go ahead, sir. 
31

STATEMENTS OF LT. COL. KENNETH N. BROWN, CHAPLAIN, 

U.S. ARMY; LT. CHARLES E. HODGES, CHAPLAIN CORPS, U.S. 

NAVAL RESERVE, PARRIS ISLAND, SC; COMDR. MARK A. 

JUMPER, STAFF CHAPLAIN, U.S. COAST GUARD ACADEMY; 

CHAPLAIN ROBERT W. MIKOL, CLINICAL CHAPLAIN, LYONS 

CAMPUS OF THE VA NEW JERSEY HEALTH CARE SYSTEM; 

AND FATHER PHILIP G. SALOIS, VISN 1 CHAPLAIN PROGRAM 

MANAGER, VA BOSTON HEALTH CARE SYSTEM 

STATEMENT OF LT. COL. KENNETH N. BROWN 

Lt. COL. BROWN. It’s a real privilege for me to appear here today. 

Thank you very much. I served as the Division Chaplain in the 

101st Airborne Division (Air Assault) during combat operations in 

Afghanistan and Iraq, and I saw first hand some of the effects of 

PTSD on our fighting force. 

But the beginning of this story has its roots prior to the entry 

of soldiers into the combat arena. Pastoral ministry provided our 

soldiers and families by U.S. Army Chaplains began pre-combat, 

and chaplains of the 101st Airborne Division trained in accordance 

with the core principle of U.S. Army Chaplains Corps as the centerpiece of their preparation for combat. And those core principles are: 

Nurture the living, care for the wounded, and honor the dead. 

This framework provided the foundation for the 46 chaplains 

that went into combat in Iraq. Chaplains provided comprehensive 

pastoral care across the full spectrum of operations throughout 

each phase and pushed forward with their assault units in combat 

operations just as they had trained, providing nurture, care and 

honor in the face of enemy fire, traumatic wounds, battlefield 

chaos, death and fear. 

The Army chaplain’s unique positioning at the battalion level enabled chaplains to go forward with infantry and other maneuver 

units to provide first line care in helping soldiers deal with immediate trauma-producing events. Chaplains were trained to accomplish on-scene defusing which occurred within a few hours of the 

critical causation event. 

The Critical Incident Stress Management framework that the 

chaplains of the 101st trained to standard on proved to be an important tool in decreasing PTSD complications and certainly I 

think lessened the effects of chronic PTSD. 

A vital part of the chaplains’ success directly correlates to their 

well-developed spiritual preparedness and their certainty of their 

calling to provide this ministry to soldiers. The chaplains theologically integrated combat into their sense of call and as a part of 

their calling to the military chaplaincy and their responsibility and 

privilege as a soldier-minister. They brought the presence of God 

into the most horrific situations, reviving hope in the face of unspeakable horrors, sights, sounds and smells. 

The intangibles became reality in the presence of such courage 

and fortitude. They did this during enemy body recovery and burial 

and here too were critical in keeping the fighting strength of force 

emotionally, mentally and spiritually healthy. They did this during 

the unearthing of mass grave sites, providing care and comfort 

given to the mass grave site teams. They did this during mass casualty incidents where there were many wounded and dead. 
32

They did this through their close pastoral relationship with their 

soldiers before combat and built on those relationships during the 

hardships of deployment and hostilities. They were unique go-to 

persons for soldiers who were experiencing PTSD or other problematic dysfunctions. They continued to provide suicide intervention, 

family and marital issues counsel, personal problem intervention, 

screenings of homeward bound soldiers and PTSD follow-up of 

some of the chronic occurrences or flareups. 

Army chaplains remain a constant force of good on the battlefield. They bring a dynamic healing, comfort and care to soldiers 

and leaders that I think no one else does, through dozens of difficult memorial services, post-wound ministry, funerals, family 

care, grief processing assistance and sustained pastoral care that 

continues today at home station. 

The chaplains of the 101st were prepared, and they gave themselves in such a way that many soldiers benefitted tremendously 

because their chaplain was there. The chaplain is a shepherd. That 

is an irreducible. The shepherd takes care of the sheep, those that 

are well, and those that are wounded. The healing continues. No 

soldier or family member is left to struggle with PTSD alone. 

I think it is imperative that the lessons learned about PTSD during this conflict are correctly understood, templated and applied so 

as to improve on early intervention techniques and prevention of 

chronic PTSD. The best hope for accomplishing this objective in my 

opinion is exemplified in the first line defender in this battle—the 

well-trained, uniquely called and fully prepared battalion chaplain. 

And I’d like to close with this statement. It’s a statement that 

could have been made by an American commander in any of our 

wars. It was made by Fleet Admiral Chester M. Nimitz who wrote 

about the combat ministry in World War II, and I quote: ‘‘My own 

esteem for the chaplains is not so much based upon deeds of valor 

as it is of appreciation for their routine accomplishments. No one 

will ever know how many young men were diverted from acts of depression by a heart-to-heart talk with the padre. By his patient, 

sympathetic labors with men day in and day out and through many 

a night, every chaplain I know contributed immeasurably to the 

moral courage of our fighting men. None of that appears in statistics. It is for that toil in the cause of God and country that I honor 

the chaplains most.’’

Thank you very much for allowing me to have a say. Pro Deo Et 

Patria. 

[The prepared statement of Colonel Brown appears on p. 102.] 

Mr. RENZI. Thank you, Chaplain Brown. I want to thank you too. 

I was just informed of the fact that you were with our troops, the 

101st from Kuwait all the way into the bunkers of Baghdad and 

you fought shoulder-to-shoulder with them and in other ways. So, 

sir, thank you very much for the service. 

Lt. COL. BROWN. Yes, sir. Thank you. 

Mr. RENZI. Chaplain Hodges. 

STATEMENT OF LT. CHARLES E. HODGES 

Lt. HODGES. Mr. Renzi and Mr. Strickland, thank you, sir, for 

this opportunity to speak. On Friday 11 April 2003, Headquarters 

and Service Company, a second assault amphibian battalion, estab-
33

lished a position just north of the Baghdad city limits. Our convoy 

was a mix of various large trucks, Humvees, and amphibious assault vehicles, also known as tracks. At sunset the crew chief of a 

nearby track came over and asked me to speak to one of the Marines on his track. On the way into the city, they had witnessed 

the tragic aftermath of a hit-and-run accident in which several children were critically injured. 

When our convoy entered the city, we encountered something 

similar to rush hour. And complicating the situation were mobs of 

cheering people standing in the streets greeting us. We frequently 

had to stop as the convoy worked its way through congestion, and 

at one of these stops, an impatient local motorist zoomed around 

one of our tracks and hit a crowd of people. The two Marines in 

the open hatches on top of the track saw the accident, and when 

the Iraqis came to the track, the commander instructed his crew 

to render assistance in any way that they could. While they were 

not required to do so, since they were not responsible for the injuries, they wanted to do as much as they could as long as the situation permitted. 

The Marine in charge of security was the first out the back 

hatch, and he quickly directed about half a dozen other Marines to 

set up a quick defensive perimeter to keep people away from the 

vehicle. A Navy corpsman was the last one to come out. The corpsman later reported to me that three children were brought to him. 

One child had flesh which had been ripped off the back of his legs 

from his knees to his waist, exposing bone and connective tissue. 

Since there was nothing that the corpsman could do, he turned his 

attention to another boy. The second boy had multiple compound 

fractures in his legs and showed symptoms of internal injuries and 

bleeding. Again, there was little the corpsman could do for that 

child. The third child also had sustained serious injuries, but just 

as the corpsman was rendering aid to that child, the word came 

that the convoy was again on the move and that the Marines and 

the corpsman needed to get on board. All they could do was leave 

gauze and compression bandages for the children. 

As the security Marine ordered everyone back into the track, he 

felt like he was in a dream. Time didn’t flow naturally. Some of 

this may also have been due to the fact that his attention was 

drawn in several different directions at once as he maintained security and supervised the situation. As that security Marine closed 

the hatch behind him, one terrified father lunged at him with outstretched arms and screamed in English, ‘‘Do not leave.’’ Unfortunately, the track had to move or risk the security of the entire convoy. 

It was growing dark when I reached the track and met the Marine. He was extremely agitated and had been crying. I asked him 

to tell me what had happened, and with a shaky voice he told me 

a fractured and confused story. When he finished, I sorted through 

the story with him. I then asked him to first focus on what had 

happened, then his thoughts as it happened, his reactions to the 

incident and how he was feeling in that moment as we talked. It 

turned out that the stress of the incident caused him to twist his 

perceptions and blend his memories. One of his buddies had come 

over to us just as the Marine got to the part in his story about the 
34

children, and his buddy told him that what the Marine thought he 

had seen had not actually happened. The corpsman also later confirmed this. It helped that this buddy had walked up and joined the 

conversation, because with his input, we helped that distressed 

Marine work through the anguish and guilt as we reviewed what 

happened. 

As the night grew darker around us and as we felt some security 

within our defensive perimeter, we had given that stressed Marine 

a safe environment in which to work through his anguish, and we 

believe that that can help mitigate and sometimes prevent later 

stress problems after deployment. 

Well, the next morning I went over to the track to check on the 

Marine. He appeared to be feeling fine. I asked him how he slept 

and he seemed amazed that he had experienced the best night’s 

sleep since the beginning of the war. I continued to check on him 

over the next few days and look for him on several other occasions 

before we came back to the United States. And he said he would 

never forget what happened that day, but he did not think that the 

event would haunt him as it did that evening in Baghdad. The last 

I talked to this Marine before being assigned to Parris Island, he 

was still doing fine. 

Thank you. 

[The prepared statement of Chaplain Hodges appears on p. 109.] 

Mr. RENZI. Sir, your words are compelling. I’m grateful. Chaplain 

Jumper. 

STATEMENT OF COMDR. MARK A. JUMPER 

Comdr. JUMPER. I have served as Project Officer of the Warrior 

Transition Program for the U.S. Marine Corps. On behalf of Navy 

chaplains, thank you for the opportunity to provide our ministry to 

the personnel and families of the armed forces. We consider this access to our people’s lives, sharing their deployments and dangers, 

and satisfactions, in the name of God, to be a high privilege, to be 

exercised with utmost care, respect and diligence. 

Our Navy Chaplain Corps has been providing this ministry since 

the Continental Congress first authorized Naval chaplains in 1775 

228 years ago. We pray that we may continue this precious heritage faithfully invoking the presence and the power of God as an incomparable resource among our people for many years to come. 

In recent years, several of the helping professions -- chaplain, 

medical, mental health and social work—have come to understand 

much better those dynamics experienced by our veterans who experience combat. Several scholars such as Jonathan Shay have 

helped us recover the truth that such dynamics have always applied to warriors. Various rituals of cleansing, talking, absolving, 

restoring and renewing have been helpful traditions among warriors of many times and places from Greek Hoplites to Roman Legionnaires to Medieval knights, to Native American braves, and 

now to modern American veterans. 

Chaplains since the Vietnam war have been involved in several 

responses to the issues faced by warriors who find that their very 

souls have been seared and changed by their experience of combat 

and trauma. CREDO, of which I was a CREDO director, was 

founded in 1971 as a retreat ministry offered to active duty vet-
35

erans returning from Vietnam. Interdisciplinary sprint teams have 

intervened in several crisis situations. Chaplains have also been involved in critical incident stress management programs, including 

debriefs of personnel. 

We active duty chaplains recognize that our presence is most valuable near the front lines, offering the ministry of presence that 

you have just heard about. For those displaying symptoms of distress, we work with our professional colleagues to offer some spiritual first aid and comfort and a gentle guiding hand through those 

doors leading to more specialized and intensive help and hope for 

tomorrow. And for all those who have faced trauma, we offer a new 

ministry that we believe can make a positive difference for their future health. The Warrior Transition Program provided by chaplains 

at the invitation of the commandant of the U.S. Marine Corps following Operations Enduring Freedom and Iraqi Freedom offers 

what we believe to be a somewhat modest but very valuable program for those on the road back to their normal lives in society. 

We help those veterans look at the changes that have happened 

in their own hearts and souls as a result of their experience. We 

model for them the value of a debriefing experience as an experience of normative maintenance rather than the repair of something 

broken. We train them to recognize, renounce and recover from 

those attitudes and actions whose toxicity causes the long-term destruction of one’s own character, including berserking, violations of 

what’s right, and dehumanization of the enemy. 

And we encourage our warriors to seek intentionally an integrated balance in life of positive physical, mental and spiritual 

practices. To date our surveys of those who went through the warrior transition program, and the commandant required all Marines 

in theater to go through the program before going home, have 

shown approval and appreciation of our efforts consistently. Well 

over 90 percent of Marines who went through the program would 

recommend the program to another Marine. We have so far some 

positive anecdotal evidence, observations of our warriors back home 

following our program that they’re doing well. Again, our program 

is modest. We may not work wonders in our 60 to 90-minute program, though God may. But we can accomplish some valuable 

things to help our veterans. It’s our moral obligation to do so. We 

do this from a powerful perspective of divine belief and spiritual reality that we wish to make available to every veteran. We are 

trained to make such an offer in such a way as to completely respect each veteran’s own belief. Many we believe will find this offer 

beneficial. 

For any program seeking to deal with trauma, it is essential to 

include the spiritual component that chaplains best offer, working 

with other professionals as cooperative colleagues for the sake of 

our veterans. Such is our hope, such is our prayer, and such is our 

plan with God’s help. 

Thank you from the heart for this opportunity to share our story. 

And may God bless you in your mission supporting veterans, and 

may God bless America and those who serve her together, one nation under God. 

[The prepared statement of Commander Jumper appears on p. 

118.] 
36

Mr. RENZI. Chaplain, your words express unique insight. Thank 

you. Chaplain Mikol. 

STATEMENT OF ROBERT W. MIKOL 

Chaplain MIKOL. Mr. Chairman and members of the subcommittee, I thank you for this privilege of appearing before you 

this morning. I’m not a military chaplain. I’m a VA chaplain. I’m 

a full time VA chaplain in mental health in the Medical Center, 

Lyons, NJ. 

We are proud of our program of post-traumatic stress rehabilitation with our combat vets, and I’m proud to be part of a team that 

I believe and I know to be the best of the best. 

I pondered over the days before coming here of how I would 

present chaplaincy to post-traumatic stress combat veterans as 

they attempt to reintegrate into society. The men and women 

whom I have had the opportunity and privilege of sharing time and 

counsel were mostly from the combat era of Vietnam. I have had 

the opportunity and privilege of meeting a few combat veterans 

from Desert Storm and Bosnia, and I find it a privilege to work 

with them and to be with them and to share their lives. 

So I’d like to talk a little bit about chaplaincy and psychiatry and 

addiction and PTSD. Over my 15-year experience as a unit chaplain, I find that it’s multidimensional. It is very personal and private, and it’s sacred to the veteran. The brokenness and pain that 

they carry with them each day as they struggle to be, in quotes, 

‘‘normal.’’ It impacts their spouse and their children, their parents 

and their significant others 24/7. It affects communities in which 

they live. It affects extended families and friends, neighbors, coworkers and their churches. It presents challenges to government, 

social and religious, medical psychiatric resources, personnel at all 

levels. 

PTSD is the direct result of a person experiencing extreme trauma beyond the capability and the capacity to absorb it and to cope 

with it. When a combat vet comes to a chaplain seeking help, they 

come with the same mixed emotions and feelings that they have 

when they enter the VA system. There are issues that I will share 

with you briefly that have to be understood and that have to be addressed directly. 

When they come to a chaplain, they look at the chaplain, from 

what I understand from them, in role and in identity. They look 

at the chaplain and they see a healer, different from a physician 

or a psychiatrist or a psychologist. They see a healer of the spirit 

and the soul. The come to a chaplain as a confessor, as an adviser, 

as an intercessor, as a shepherd, as a guide, as a teacher, as a 

friend, but most of all as an absolver. 

They see in the chaplain in his or her identity a fallible human 

being who has baggage of their own. They also see the chaplain as 

normal and honest and living in confidentiality. They see a chaplain as a listener, and they see a chaplain and hope a chaplain is 

authentic. When a veteran presents themselves to me either by referral or consult or by direct intervention, I usually follow a modality that I found to work. 

The first thing we will do is we will review the pre-military belief 

systems, their practices and values. Then we will assess the pain 
37

and brokenness of their lives and we will learn from the veteran 

what he hopes for himself and dreams about. And then we will 

begin to reform and restore that which we have lost to the degree 

that we can. 

All of this is built upon the foundation of faith, of belief, of trust 

and of the undying hope that they can recover and eventually come 

home. 

Thank you very much. 

[The prepared statement of Chaplain Mikol appears on p. 124.] 

Mr. RENZI. Thank you very much. Father Salois, my mom was 

an Irish Catholic from Massachusetts, so I’ve got a lot of guilt and 

probably need to see you after this session. (Laughter.) 

Father SALOIS. I’ll hang my shingle right after the hearing. 

Mr. RENZI. Please go ahead. 

STATEMENT OF FATHER PHILIP G. SALOIS 

Father SALOIS. Thank you, Mr. Chairman and committee members, for the opportunity to be here to address all of you on a very 

important subject very near and dear to my heart—the psycho-spiritual effects on men and women who have participated in and witnessed first hand the horrors of war on the battlefield. First of all, 

let me preface my remarks by giving you all a small picture of 

what qualifies me to speak to the subject. At the age of 20 I was 

drafted into the U.S. Army and served as a combat infantryman 

from 1969 to 1970. As a result of leading a rescue mission on 

March 1, 1970, I was awarded a silver star. I also served 12 years 

in the U.S. Army Reserves as a chaplain to hospital units. My last 

assignment was with the 883rd Medical Company (Combat Stress 

Control). In addition, I have worked the last 15 years as a chaplain 

at the VA Boston Healthcare System, with a special focus on PTSD 

and spiritual healing. 

Having gone through an extensive journey of healing myself, and 

the journey is by far not over, I can speak as a witness to the fact 

that when one has been exposed to war up close and personal, that 

person is forever changed, scarred and spiritually wounded. Even 

with the best of foreknowledge and training available, there’s absolutely nothing that can prepare a young man or woman for the horrors that war will embed in one’s mind, heart and soul. 

That being said, it is important to learn from lessons from the 

past, particularly the war in Vietnam and the devastating effects 

it has had on thousands of men and women. We share the experiences and the wisdom we have gained for our young men and 

women returning from Iraq and Afghanistan. The February 15 

issue of the New York Times Magazine featured a lengthy article 

entitled ‘‘The Permanent Scars of Iraq’’ by Sara Corbett. It relates 

the story of a few returning soldiers from the 101st Airborne Division who were wounded both physically and psychologically. Reading this article transported me back some 30-plus years as something that could have been written in the 1970s, only the characters and geography have changed. Sleepless nights. Nightmares. 

Flashbacks. Self-medicating with alcohol and drugs. Not communicating with the spouse. Thousand yard star, and the saga rages 

on. The psychosocial-spiritual effects of war are universal, and I 

learned that when I met war veterans from all over the world at 
38

the First International Conference of Psyco-Social Consequences of 

War in Dubrovnik, Croatia in April 1998. There is a common denominator among persons who have engaged in hostile fire in time 

of war, and that common denominator is the deep-seated wounds 

that appear at every human level. The memory is forever branded 

into the fabric of one’s life. 

How do we meet the challenge of reaching out to our brother and 

sister veterans who have been to hell and come back to talk about 

it? It is often said in the circle of ministers I associate with that 

religion is for those who are afraid of hell, and spirituality is for 

those who have been there and don’t want to return. 

Veterans’ Affairs chaplains are certified and clinically trained to 

serve the spiritual needs of the returning veterans from Iraq and 

Afghanistan. It is of paramount importance that VA chaplains play 

an integral role on the mental health interdisciplinary teams in our 

medical facilities. They continue to provide excellent one-on-one 

spiritual and pastoral counseling to our veteran patients. They also 

facilitate spirituality groups for those suffering from PTSD and 

substance abuse. In fact, there are several 12-step models that 

have been drafted with a special focus on PTSD modeled after the 

12 steps of AA. 

In 1989 I founded the National Conference of Viet Nam Veteran 

Ministers, an organization comprised of people like myself who 

served in Vietnam as enlisted men and women and later answered 

the call to ordained ministry. WE also invited Vietnam chaplains 

to join. The purpose was to share our own trauma stories with one 

another on the level of faith and spirituality so that we could receive affirmation and healing of our own souls. It truly was and 

still is a clinic for wounded PTSD-ridden ministers. As an outgrowth of this organization, which is better referred to as a community, we began to explore ways of sharing our stories with combat 

veterans. 

Combat veterans, by the very nature of their exposure to battle— that is, killing and witnessing death -- develop a poisonous world 

view causing a wounded ‘‘Imago Dei.’’ This phrase, ‘‘Imago Dei,’’ or 

Image of God, refers to the belief that all persons are created in 

God’s image. That wounded ‘‘Imago Dei’’ is characterized by secretkeeping, loss of voice and self-enforced separation. Secret-keeping. 

How can I ever talk about what I witnessed and participated in on 

the battlefield to my spouse, my children, my friends? As a result, 

this causes us to lose our voice. If we are keeping secrets, then we 

stop communicating, which then forces the third factor, self-enforced separation, isolation, or more commonly referred to as ‘‘bunkering in.’’ Our combat veterans experience deep guilt, which 

comes in many forms: guilt from killing or maiming civilians, children who may be booby-trapped, or enemies disguised as friendlies. 

It could be guilt over a mistake which caused the mutilation or 

death of a comrade. It could be guilt over being a survivor when 

buddies are killed, and the list goes on. 

One way that the National Conference of Viet Nam Veteran Ministers found to be helpful was to develop a Spiritual Healing Weekend Retreat Program for combat veterans and their spouses or significant others. In the past seven years we have offered 15 of these 

retreats throughout the country, and although it’s a mere drop in 
39

the bucket, veterans and their families have been greatly comforted 

and assisted spiritually in these retreats. Many couples have come 

back to these retreats and brought other couples with them. We 

felt it was important to try to get the veteran to bring their spouse 

or significant other to these retreats because our goal was to help 

heal the family and not just the veteran—to reopen those doors of 

communication, the lack of which can destroy a relationship. 

The main point I want to make here before this committee is the 

importance of making the combat veteran, particularly those who 

are now coming home from overseas deployment, begin the process 

of telling this story to someone who can encourage them and guide 

them in a healing, loving and accepting manner. They may feel 

they are damaged goods. The role of the chaplain is to help them 

recognize that their experience offers them a unique perspective on 

the meaning of life and that their suffering is not meaningless but 

can be redemptive. The chaplain can help the veteran learn what 

it means to be a wounded healer, which the veteran in his or her 

woundedness can help heal another wounded veteran. This is the 

gift of life one person gives to another. 

The theory of the sacred story which we teach them is the use 

of their personal story as a vehicle of hearing. The development of 

one’s unique story through the eyes of faith and ultimately the redemptive value of their sacred story can move them from a state 

of being scared, recognizing that they are scarred, and ultimately 

see themselves as sacred. It’s a far greater task for the minister to 

guide the veteran in this direction than simply moving letters 

around in a wordplay to get the point across. 

We tell our veterans that there is no one else on earth like them. 

Just as there are not two fingerprints the same, neither is their 

story. It is the gift of love when they can speak the story with all 

the trauma, pain, suffering, tears and emotions and share that 

story with another human being who is hurting. 

Over the years, I cannot count how many Vietnam veterans and 

veterans of World War II and Korea I have counseled, but the end 

result of war and its impact on our psyche is the same. I, along 

with my colleagues, welcome the opportunity to reach out to returning soldiers, Marines, sailors and airmen and women t begin 

that healing process so it does not begin to fester and grow like a 

cancer that eats away at the core of their being. If we knew back 

in the 1970s and 1980s what we know today, how many lives could 

have been saved? How many marriages could have been saved? 

Who knows? 

Thank you for the opportunity to address this esteemed body. 

Mr. RENZI. Father, I’m grateful. Very full and complete testimony. 

We’ll move to some questioning now and I’ll begin with my colleague, Mr. Strickland. 

Mr. STRICKLAND. I want to thank each of you, and I want to 

thank you, Father, for distinguishing between spirituality and religiosity. As someone who is a former member of the clergy myself, 

I am quite frankly sometimes skeptical and perhaps more cynical 

than I should be of religious leaders and religious spokespersons. 

But I can tell you that listening to you today, you are the kind of 
40

people that I would want to sit with, talk with, go to if I had a 

problem that was troublesome to me. 

I’ve been very impressed by your statements. You obviously are 

people of great maturity, insight and tolerance. And the question 

I have is, where do you go? You deal with human suffering and 

pain and trauma. Where do you go for your nurturance and assistance as you deal with your own needs? 

Father SALOIS. I can address that very simply. That’s the reason 

why I started the National Conference of Viet Nam Veteran Ministers, because I had no one to go to. So I had to find other people 

like myself who had been in war and begin to talk about it, because 

my religious community told me, Phil, this has been 13 years ago. 

Get over it. So they weren’t listening to me, and I couldn’t dump 

on my patients, so I needed to find a group of people, and I did, 

and that’s how I founded this organization. We have 50 members 

throughout the country, and they’re all Vietnam War veterans. 

Some of them are women, and we come together every year and we 

support each other, and that’s how we do it. I don’t know about the 

others. 

Chaplain MIKOL. I would like to address that question. The clinical team is very helpful to the chaplain. There are many times 

that I find myself presented with a problem, an issue that makes 

it quite difficult to address. Rather than use cliches or what the 

veterans call pious platitudes, I go to the team, and they give me 

a different dimension, a different spin that I bring back, theologize 

and share with the veteran. 

Personally, I find Vietnam—well, I find all veterans to be very 

helpful to the chaplain. I guess we could see that or understand 

that as a reward for what little we do for them. But when we talk 

to each other on the heart level and we speak from our souls, it 

is not difficult to find someone that you can go to and be honest 

with and candid with and find support. 

I believe in ministry that the veterans look for support. They 

want someone to stand in their sacred place with them. It is a 

privilege and an honor to do that. And they, therefore, I would assume, look for the opportunity to do that with us as well. 

Comdr. JUMPER. I’ve been part of a CREDO retreat and recovery 

ministry, which is extremely intensive. And I have seen CREDO 

chaplains crash and burn. When I came to CREDO in Groton, Connecticut, I instituted a system of pastoral care for our chaplains in 

CREDO, and each of us saw a therapist once a month. 

I also go to my fellow chaplains—I went to a couple last night— to be updated on my own progress. I also go to the Military Chaplains Association, which I have found -- which is chartered by Congress and which I have found to be an extremely valuable mentoring experience. I’m looking forward to going to a reunion of my 

ship this coming June, and I expect that at this reunion—it will 

be our first reunion -- and we will be sharing about the profound 

experiences that occurred to us during Operation Desert Storm. 

And finally, I go to my wife, who is more supportive than any 

man deserves, and I thank God for my wife, Ginger. 

Lt. HODGES. The Geneva conventions do not permit chaplains to 

carry weapons in the field, and so we have to have a bodyguard 

with us. In the Navy we call that person a religious program spe-
41

cialist. And down in Parris Island, there is an RP who was also 

over in Iraq, and he’s been through some things himself, and what 

he and I do is sometimes we just get together and talk. 

The RP I had with me in Afghanistan has recently crossed from 

the RP rate over into crypto, and he was passing through Parris 

Island on his way down to his new school in Florida. And he and 

I got together for lunch and we talked about things, and thinking 

back to the things that happened to us in Afghanistan was again, 

it was like detox. It was really great to talk about these things, 

and, hey, do you remember when? And what about this, that and 

other. And we chuckled and laughed. 

There’s another chaplain down in Parris Island that I run with 

on a daily basis, and he and I just talk. We talk as we run. And 

we go by this one place at Parris Island where they do bayonet 

training, and there’s this mannequin tied up, and it’s olive drab, 

olive drab green. And the first time I ran back there, I did a double 

take because it looked a lot like a body I saw lying on the ground 

in Amazaria, and the chaplain says, you all right? What’s wrong? 

And I tell him the story, and he just quietly ran beside me while 

I told him what was going on. 

And then when we came back from Iraq, I was at Camp Lejeune 

at the time, division chaplain ensured that we had somebody there 

for the chaplains to talk to. It was strongly recommended that we 

attend this little meeting, and all the chaplains that had been 

there talked about our experiences. We had a mental health professional there to recognize that there were problems, tell us what we 

could do if we had problems, and to remind us that we were not 

invulnerable to stress, mental health issues, and we had a responsibility to take care of ourselves as much as we had to take care 

of other people. 

Lt. COL. BROWN. I think my experience pretty much mirrors 

what’s already been said. I think I would add that during Iraq as 

the division chaplain, you have a little more difficulty doing some 

of the things because of the construct and the way that it’s developed. We had what we specifically trained to have a buddy system 

where we took care of one another. I was fortunate to have a good 

friend in the division, a surgeon who really became my confidante, 

and I could talk with him about a lot of things that I needed to 

get out of my system and talk. And I’ve been around long enough, 

not that that makes me wise, but I’ve been around long enough 

that I know when I need to go and talk with someone about things 

that may be going on in my life. 

We had a fine system. And then we have a system back in place 

at home station where chaplains go through redeployment cycling, 

and then we have our mental health community also interrelated 

in that, and we had a great relationship with our division surgeon 

in that department, and we coalesced with them and really had 

some fine coordination there for helping us in those areas. 

Mr. STRICKLAND. The good chairman has given me an extra few 

moments here just to say something to you. I want to honor you 

for your service. I sense something about each of you that I think 

is important. Listening to you, I’m reminded of one of my constituents who is in Iraq right now, hopefully going to be coming home 

next month. His name is Chris Shafer. Father, being a Catholic, I 
42

think you’ll take special pride in this young man. He sends me CDs 

of Gregorian chants. And every e-mail I get from him, he describes 

what he’s doing and the trauma of war. But in every e-mail he also 

talks about the other part of his life and how he tries to comfort 

his men, those who are going through divorce, those who are missing their children and the like. 

So there’s a lot of spirituality within and throughout the military, which I think for me as the representative of this young man, 

I tell people he is the best this country can produce. He’s patriotic 

and loyal and smart, committed and dedicated, but he is especially 

caring. And he’s caring not just for the men that he’s responsible 

for leading, but in nearly every e-mail, he expresses to me how 

much he cares for the Iraqi people and for the children. And I am 

just incredibly proud of him today and your words reminded me of 

him. Thank you so much. 

Mr. SIMMONS. Mr. Boozman? 

Mr. BOOZMAN. I just want to make a quick comment. I’m sorry 

I had to—I was here and left and came back. But I really want to 

thank you, Mr. Chairman, and the ranking member for holding 

this hearing, and the staff. I’ve been to many, many meetings, and 

again, the testimony today has been excellent and very helpful. 

I grew up in a time—I graduated from high school in about 1968 

at the height of things going on in Vietnam, went on to college. 

And about the time I got done with college, then the draft had 

ended. My brother is four years older, and so as a result, I was 

good friends with his friends, you know, my friends, and so I had 

so many, you know, just really good friends that went off to war 

and saw in many cases the effect that that had on them. And now 

I think really the thing that has kept them going in many cases, 

the thing that kept so many going during the conflict and then 

after and coming back has been their faith. 

And so I really do appreciate, you know, as was said earlier, all 

that you all do, your faithfulness and, you know, you really do in 

providing the counseling that you do and things, you really do 

change lives. So thank you very much. 

Mr. SIMMONS. Mr. Renzi? 

Mr. RENZI. Thank you, Mr. Chairman. I want to share an interesting statistic. Chaplain Jumper, you talked a little bit about history. Our good staff here was able to find out that when Abraham 

Lincoln established the legislation for the first national home for 

disabled volunteer soldiers, chaplains were paid $1,500 a year and 

enough forage for one horse. (Laughter.) 

So you all have come a long way. 

Mr. SIMMONS. It’s about the same. 

Comdr. JUMPER. The first naval chaplains were allowed a share 

of the prize money. 

Mr. RENZI. Of the prize. (Laughter.) 

Always for the prize. I had an opportunity to go down to Guantanamo Bay, and when I was there, I was accompanied by a Muslim 

chaplain who later was brought up on espionage charges, and since 

then I believe those charges have been decreased. And I had an interesting conversation with him about an area that I have been 

studying for many years and the chairman and I have also talked 

about, Whahabism, the extreme fundamentalism evolving in Mus-
43

lim practice. And the idea that the Whahabists who engage in holy 

jihad believe that killing innocent people because they are polytheists—whether you be Christian, Jew, whatever your religion— even a moderate Muslim is viewed as a heretic, and that taking 

our lives, taking the lives of our children is an absolution to them. 

And I thought how interesting in listening to your comments when 

you talk about absolution, when you talk about forgiveness, letting 

go, that it’s the opposite of what we’re fighting against in the war 

on terrorism. 

And I’d just like to ask if anyone has encountered, particularly 

in the field, the idea of the relationship of having to fight back 

against an individual who believes that they’re in a holy war or 

how God comes into play in that. Any thoughts on Wahabism? 

[No response.] 

Mr. RENZI. Okay. We’ll pass on that one. (Laughter.) 

Lt. COL. BROWN. I’ll make a stab. 

Mr. RENZI. Thank you, Colonel. 

Lt. COL. BROWN. We encountered, in Phase 4 operations, 

sustainment and security—stability and security operations, we 

began to go out and talk with the local Imams, and part of our 

work involved in that. And as a result of that, we encountered 

some of the Wahabie methods and some of the persons that were 

involved in that, not in a personal way but through the more stable, more middle-of-the-road Islamic Imams who talked about the 

Wahabists to us. So just strictly from that standpoint. But they did 

cause us some difficulty. 

Mr. RENZI. Thank you. Colonel, you hit on the whole nexus of my 

point that I’ve been making with my colleagues, and that is that 

we will be involved in the war on terror until we are able to help 

move Saudi Arabia and some of the Nations who have Wahabism 

as their national religion to become more moderate, to becoming 

open to the ways of the spiritualism that we talk about, whether 

it be among diverse different religions. But if they don’t moderate 

their faith in Saudi Arabia where they’re constantly teaching it in 

the schools, in the universities, in the mosques, we will be dealing 

with terrorism for generations to come. 

Let me finish up by asking, there was good testimony today from 

our good doctors on statistics, and we saw a little bit of wrestling 

there. As first kind of responders in the field when it comes to seeing probably first hand, even before the soldiers approach you, I’m 

sure you can observe it in the field, and we talked about early 

intervention. Dr. Kudler talked about it, Dr. Keane. What do you 

see, what do you think, just off the cuff, is your statistical analysis 

of -- how many soldiers do you feel in the field, what are you observations on what statistics might be per thousand, per hundred? Another question? Another balloon? 

Lt. HODGES. I’ll try to do the math real quick in my head, and 

I know that in Afghanistan we had—I had about 1,500 Marines in 

my care throughout our entire battalion landing team. And the bad 

guys attacked us on 10 January and we had a brief firefight, and 

the next day when I was going along the defensive perimeter, fighting hole to fighting hole, everyone that was on that side of the airport that was attacked reacted in some way. Every one of them. 

Some of them were like laughing it off. 
44

Man, I survived it. I’m a big guy now. I got my combat action 

ribbon. I’m a badass. But then there were a couple that were truly 

terrified. And one Marine was talking to me, and he was genuinely 

scared to the very core of his soul because the word going around 

was they were going to do it again the next night. Somehow or 

other, I don’t know why they thought they could be doing these 

kind of things, but the word going around was, they’re going to do 

it again tonight. They never came back. Not while we were there. 

But that one Marine was genuinely scared. 

The math, I think that, you know, just quick math in my head, 

I think that—I think the math is fairly accurate based on my personal experiences. After we went through An Nasiriyah we saw a 

lot of death and destruction and broken bodies. And of all the Marines in my care, I’d say the math is probably—— Mr. RENZI. That math being close to 20 percent, as Dr. Kudler 

spoke about with the combat? I don’t want to misquote Dr. Kudler, 

but when we talk about people who have been in combat, who have 

been in the severe—point of the spear, 20 percent, Dr. Kudler? 

Lt. HODGES. Twenty percent were what, please, sir? 

Mr. RENZI. Twenty percent having to come back and deal with 

not just lower incidences of PTSD but having to deal with clinical 

incidences of it. 

Lt. HODGES. Oh, I can’t speak to that. I don’t know. 

Mr. RENZI. Okay. But that’s the number, the math? 

Lt. HODGES. Okay. I thought you were speaking about the 1 percent or something like that. 

Mr. RENZI. Well, that was the contradiction was that it was half 

a percent or was it 20 percent. 

Lt. HODGES. When I was out there, I think the 1 percent that 

I saw right then and there. Now, coming back to the United States, 

I can’t speak to that. I don’t know. 

Mr. RENZI. Okay. Let me finish. No more questioning, but I just 

want to make a statement that I believe we’re all in this society 

beginning to move to an understanding of a balanced approach, 

whether it be science or medicine, and God. The idea of the separation of theories and that we can’t blend and take advantage of a 

holistic approach, I think that’s falling away in ignorance. So thank 

you all very much for today. I’m grateful. 

Mr. SIMMONS. If there are no more questions, I would like to give 

a special thanks to Commander Jumper for coming down from Connecticut, East Lime, within my district. It’s great to have you here. 

How’s the family? He’s got seven children. You know, that’s—wow, 

that’s a lot of voters. (Laughter.) 

If I can do anything for you, let me know. (Laughter.) 

But on a more serious note, I’d also like to thank all of the panelists, and I’d like to thank all of the people who testified here this 

morning. And in particular I’d like to thank my colleagues for their 

very sensitive and perceptive approach to this very difficult problem. 

I remember from my own Army experience that, you know, if you 

got a Dear John of you complained too much, they’d say take it to 

the chaplain. Stop whining, stop complaining. Take it to the chaplain. But the fact of the matter is, I came back from my wartime 

experiences with a deeper Christian faith, which has been with me 
45

ever since. And a sense that the chaplains really helped me and 

helped so many of my comrades. And it’s true that perhaps in dealing with issues such as post-traumatic stress disorder, we need the 

medical professionals. They do a great job. But as Mr. Renzi pointed out, they can’t necessarily do it alone. And I just want to thank 

this panel for their work to assist our men and women in uniform 

dealing with the most difficult experiences that we can ever deal 

with, which are the experiences of war. And war is hell. And thank 

you for helping us see that there is a vision of heaven, too. 

With that, I conclude the hearing. 

[Whereupon, at 2:10 p.m., the subcommittee was adjourned.] 

47

A P P E N D I X 
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174

Æ