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82–896 2014

MAKING A DIFFERENCE: SHATTERING BARRIERS 

TO EFFECTIVE MENTAL HEALTH CARE FOR 

VETERANS 

FIELD HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

FIRST SESSION 

TUESDAY, SEPTEMBER 17, 2013 

FIELD HEARING HELD IN ANDERSON TOWNSHIP, 

OHIO 

Serial No. 113–36 

Printed for the use of the Committee on Veterans’ Affairs 

( 

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ii 

COMMITTEE ON VETERANS’ AFFAIRS 

JEFF MILLER, Florida, Chairman 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

DAVID P. ROE, Tennessee 

BILL FLORES, Texas 

JEFF DENHAM, California 

JON RUNYAN, New Jersey 

DAN BENISHEK, Michigan 

TIM HUELSKAMP, Kansas 

MARK E. AMODEI, Nevada 

MIKE COFFMAN, Colorado 

BRAD R. WENSTRUP, Ohio 

PAUL COOK, California 

JACKIE WALORSKI, Indiana 

MICHAEL H. MICHAUD, Maine, Ranking 

Minority Member 

CORRINE BROWN, Florida 

MARK TAKANO, California 

JULIA BROWNLEY, California 

DINA TITUS, Nevada 

ANN KIRKPATRICK, Arizona 

RAUL RUIZ, California 

GLORIA NEGRETE MCLEOD, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

TIMOTHY J. WALZ, Minnesota 

HELEN W. TOLAR, Staff Director and Chief Counsel 

SUBCOMMITTEE ON HEALTH 

DAN BENISHEK, Michigan, Chairman 

DAVE P. ROE, Tennessee 

JEFF DENHAM, California 

TIM HUELSKAMP, Kansas 

JACKIE WALORSKI, Indiana 

BRAD R. WENSTRUP, Ohio 

VACANCY 

JULIA BROWNLEY, California, Ranking 

Minority Member 

CORRINE BROWN, Florida 

RAUL RUIZ, California 

GLORIA NEGRETE MCLEOD, California 

ANN M. KUSTER, New Hampshire 

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

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

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

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

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

is further refined. 

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C O N T E N T S 

September 17, 2013 

Page 

Making A Difference: Shattering Barriers To Effective Mental Health Care 

For Veterans ......................................................................................................... 1 

OPENING STATEMENTS 

Hon. Dan Benishek, Chairman, Subcommittee on Health ................................... 1 

Prepared Statement of Hon. Benishek ........................................................... 33 

Hon. Brad R. Wenstrup, Subcommittee on Health ............................................... 3 

Prepared Statement of Hon. Wenstrup .......................................................... 34 

WITNESSES 

Howard Berry, Father, Joshua Berry (deceased) .................................................. 5 

Prepared Statement of Mr. Berry ................................................................... 35 

Nate Pelletier, Executive Director, Joseph House, Inc. ........................................ 6 

Prepared Statement of Mr. Pelletier ............................................................... 38 

Rodger Young, Clermont County Veteran Service Commission .......................... 10 

Prepared Statement of Mr. Young .................................................................. 40 

Paul Worley, Adams County Veterans Service Commission ................................ 12 

Prepared Statement of Mr. Worley ................................................................. 42 

Kristi D. Powell, Scioto County Veterans Service Commission ........................... 14 

Prepared Statement of Ms. Powell .................................................................. 42 

Linda D. Smith, FACHE, Medical Center Director, Cincinnati VA Medical 

Center, Veterans Health Administration, U.S. Department of Veterans Affairs ....................................................................................................................... 22

Prepared Statement of Ms. Smith .......................................................................... 46 

Accompanied by: 

Kathleen M. Chard, Ph.D., Director, Cognitive Processing Therapy Implementation, Director, Trauma Recovery Center, Cincinnati VA 

Medical Center, Veterans Health Administration, U.S. Department 

of Veterans Affairs 

Emma Bunag-Boehm, MSN, APRN, BC, Primary Care Provider, OEF/ 

OIF/OND Clinic, Clinician, Persian Gulf Registry, Cincinnati VA 

Medical Center, Veterans Health Administration, U.S. Department 

of Veterans Affairs 

Chadwick Watiker, MSW, LISW-S, BCD, Cincinnati Vet Center Team 

Lead, Readjustment Counseling Service, U.S. Department of Veterans Affairs 

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(1) 

MAKING A DIFFERENCE: SHATTERING BARRIERS TO EFFECTIVE MENTAL HEALTH 

CARE FOR VETERANS 

Tuesday, September 17, 2013 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON VETERANS’ AFFAIRS, 

SUBCOMMITTEE ON HEALTH, 

Washington, D.C. 

The Subcommittee met, pursuant to notice, at 10:00 a.m., at 

7850 Five Mile Road, Anderson Township, Ohio, Hon. Dan 

Benishek [Chairman of the Subcommittee] presiding. 

Present: Representatives Benishek and Wenstrup. 

Also Present: Representative Massie. 

OPENING STATEMENT OF CHAIRMAN DAN BENISHEK 

Mr. BENISHEK. Please remain standing for the Pledge of Allegiance, led by Commander Rick Simpson. 

[Pledge of Allegiance.] 

Mr. BENISHEK. Good morning. Thank you all for joining us this 

morning. It is a pleasure for us to be here in beautiful Cincinnati 

with all of you. 

To start, I would like to ask unanimous consent for our friend 

and colleague from Kentucky, Congressman Thomas Massie, to sit 

at the dais and participate in today’s proceedings. 

Without objection, so ordered. 

I am honored to serve as the Chairman of the House Veterans’ 

Affairs Committee, Subcommittee on Health, and to be joined on 

the Subcommittee by your Congressman and my friend, Dr. Brad 

Wenstrup. As – 

[Audio Disturbance.] 

Mr. BENISHEK.—lieutenant colonel. In the spring of 2005, he was 

deployed to Iraq for a year, and while there he served his fellow 

soldiers, sailors, airmen and Marines, as well as prisoners and civilians, in the Abu Ghraib prison as Chief of Surgery and Deputy 

Commander of Clinical Services. For his brave and loyal service 

there, he earned numerous awards and accolades, including the 

Bronze Star. Brad is a doctor of podiatric medicine and former 

small-town business owner. 

Needless to say, the immense wealth of knowledge, experience 

and insight that Brad brings to the Subcommittee is very invaluable. I am extremely grateful to work side by side with him and 

with his leadership on behalf of our Nation’s veterans and their 

families. 

So when Brad asked me to come to Cincinnati, his hometown, to 

address an issue of such importance to us all, the provision for 

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high-quality and effective mental health care to veterans in need, 

I was happy to take the opportunity. 

Yesterday, Brad and I paid a visit to the Cincinnati Department 

of Veteran Affairs Medical Center. While there, we had an in-depth 

discussion with medical center leaders and toured the facility. Having worked myself as a surgeon in the Iron Mountain VA Medical 

Center, I most enjoyed the meeting with some of our hard-working 

Ohioans who strive day in and day out to provide the best possible 

care and services to the veterans in this community. 

I would like to take a moment to thank each of those health care 

providers, administrative personnel and support staff for their 

dedication to our servicemembers, veterans and their families. It is 

clear that there are some very special things going on here in Cincinnati for our heroes, and you have much to be proud of here in 

Ohio. 

However, where the health care and services provided for our 

veterans is concerned, exercising our responsibility for oversight 

and policy in Congress is paramount. This past February, the VA 

issued a sobering report which showed that for the last 12 years 

there have been 18 to 22 suicide deaths among our veterans every 

single day. 

Ladies and gentlemen, we have lost far too many of our veterans 

on the battlefield of mental illness. We have to do better, and we 

have to do it now. Key to that effort is breaking down barriers to 

care that veterans in the midst of struggle often face when attempting to access the care they need to successfully transition 

home and maintain happy, healthy and productive lives. No veteran should be reluctant to ask for help because they are ashamed 

or embarrassed; and no veteran who takes the brave step of seeking care should be told they have to wait for an appointment that 

is weeks or months away, or travel long distances from their home 

and family to receive the services that they need. 

Today, we will discuss the actions we must take to reduce the 

stigma and improve the accessibility and availability of mental 

health care for veterans here in Ohio and across the VA health 

care system. We will also discuss the increasingly vital role that 

faith-based and community groups play in helping our veterans 

and what we need to do to increase and improve meaningful partnerships between the VA and these community resources, who are 

often the first and most trusted point of contact for veterans and 

families in need. 

Finally, we will also discuss the critical part that family members and other loved ones play in the healing of our heroes and the 

need to increase family awareness, involvement, and the integration of mental health services, particularly for those veterans most 

in need of support. 

I look forward to hearing from the local Ohioans, many of them 

veterans, who will testify today. I thank you for being here and for 

your devotion to improving the lives of Ohio’s veterans. With the 

help of communities like Cincinnati and discussions like the one we 

were having here this morning, I am hopeful that we will shatter 

the mistaken perceptions that mental health care is not available, 

not appropriate, or not effective, and there will come a day when 

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3 

no veteran is discouraged from reaching out and seeking care, and 

no family suffers alone. 

With that, I now recognize your Congressman and my colleague 

and friend, Dr. Brad Wenstrup, for his opening statement. 

[THE PREPARED STATEMENT OF HON. BENISHEK APPEARS IN THE

APPENDIX]

OPENING STATEMENT OF HON. BRAD R. WENSTRUP 

Mr. WENSTRUP. Thank you, Mr. Chairman. 

If you would, everyone, I would like for us to bow our heads and 

let us take a moment to remember those who lost their lives in yesterday’s tragic Washington Navy Yard attack. Their service and 

sacrifice will forever be remembered by their families and loved 

ones. 

[Moment of silence.] 

Mr. WENSTRUP. Good morning, everyone, and welcome to the 

House Committee on Veterans’ Affairs, Health Subcommittee field 

hearing entitled, ‘‘Making a Difference: Shattering Barriers to Effective Mental Health Care for Veterans.’’ I want to formally and 

officially welcome you to Cincinnati. 

As you have seen in the past few days, this district is a district 

that I am privileged and proud to represent. I want to thank you 

for the leadership you have shown on the issue of veterans’ mental 

health care and for hosting this field hearing today. I am also 

grateful that Representative Thomas Massie, a strong supporter of 

our military and our Nation’s veterans, has taken time out of his 

busy schedule to be here with us as well. Congressman Massie, 

thank you. 

To the witnesses on our panels, to each person in the audience, 

and especially to every veteran present today, thank you for joining 

us. It is important for us all to be engaged in this issue if we are 

going to truly improve the care that our veterans receive. 

A field hearing is an opportunity to bring Congress to Cincinnati, 

and I am pleased that the Subcommittee on Health will hear directly from the veterans, the family members of veterans, the service officers, and the community providers of this region, who will 

provide a valuable perspective on the common barriers to mental 

health care that our veterans face. 

Veterans of Southern and Southwest Ohio are a diverse group. 

They were raised on farms, urban high-rises, and in suburban 

neighborhoods. But they share a common bond. They made the voluntary commitment to serve our Nation. Only 1 percent of Americans have served in uniform. Their accomplishments have been 

amazing and truly unmatched by the rest of the world. 

As a veteran of the war in Iraq and a member of the Army Reserve, I have witnessed the heroism of my fellow veterans and have 

deep respect for them. We can never repay them for their sacrifice, 

but we can honor it by ensuring that they and their families receive the care that they deserve. 

In Ohio, we have a robust system of veteran service commissions 

that serve our veterans with zeal and dedication. I am grateful to 

have representatives from commissions in three different counties 

present to testify here today. 

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4 

There is a growing recognition that we must develop better treatment for the invisible wounds that veterans bring home, including 

depression, post-traumatic stress disorder, substance abuse, and 

traumatic brain injury. These wounds effect veterans of all our past 

wars, but the veterans of Operations Enduring Freedom and Iraqi 

Freedom face unique mental health challenges. Because of technology and advances in that, more soldiers are surviving physical 

combat injuries, but they present disproportionate neurological and 

psychological wounds. 

Studies suggest that 1-in-5 veterans of the wars of Iraq and Afghanistan have PTSD. A decade of war with frequent and extended 

deployments have made it more critical than ever before to create 

a quality mental health care system for our veterans. 

There are many challenges in our current system that do not 

allow veterans to get the care they need. Sometimes veterans are 

simply unable to access care. They have difficulties in scheduling 

timely appointments, or the office is simply too far away. Other 

times, veterans are unwilling to ask for or accept help. They feel 

ashamed of their mental injuries. Each veteran has unique struggles and needs, and we need a mental health care system that is 

able to provide effective individualized care. 

But today, we will discuss how the Department of Veterans Affairs can better improve its approach to and delivery of mental 

health care. Truly effective care, however, will extend beyond the 

VA. It will require the involvement of veterans’ families and their 

communities, including veteran service organizations, community 

health care providers, and faith organizations. Each of us has a 

role to play in improving veterans’ access to mental health care. 

Again, I want to thank each and every one of you for being here 

today for this important discussion. 

Mr. Chairman? 

[THE PREPARED STATEMENT OF HON. BRAD R. WENSTRUP APPEARS

IN THE APPENDIX]

Mr. BENISHEK. Thank you, sir. 

We will start with our first panel who are already seated today 

at the tables. 

Doctor, would you please introduce the panelists? 

Mr. WENSTRUP. Yes. On our first panel joining us today is Mr. 

Howard Berry, the father of Army Staff Sergeant Joshua Berry. 

Josh served in Afghanistan and was stationed at Fort Hood during 

the shooting on November 5, 2009. Josh suffered from PTSD and 

ultimately took his own life on February 13, 2013. Howard is here 

to tell his son’s story, as well as his own. 

Barriers to effective mental health care exist not only for our 

servicemembers, but for their loved ones as well. I sincerely appreciate Mr. Berry’s willingness to share his experiences as a way to 

improve outcomes for veterans and their families. 

Also with us today is Mr. Nate Pelletier, Executive Director of 

the Joseph House here in Cincinnati. Mr. Pelletier is an Army veteran of Operation Iraqi Freedom. 

Mr. Rodger Young, veteran service officer at Claremont County 

Veterans Service Commission. He is an Air Force Master Sergeant 

with 20 years of service. 

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Paul Worley, Army veteran who has agreed to represent the 

Adams County Veterans Service Commission here today. He has 

served three tours in the global war on terror. 

Ms. Kristi Powell, veteran service officer at the Scioto County 

Veterans Service Commission, Air Force veteran. 

Thanks to each of you for your service to our Nation and for the 

work you do every day to help your fellow veterans. I look forward 

to your input on this important issue. 

On the second panel, I will be pleased to welcome Ms. Linda 

Smith, the Director of Cincinnati VA Medical Center, here to testify on behalf of the VA. She is accompanied by Dr. Kathleen 

Chard, Director of Trauma Recovery Center at the Cincinnati VA 

Medical Center, Professor of Clinical Psychiatry at the University 

of Cincinnati; and also accompanied by Ms. Emma Bunag-Boehm, 

primary care provider for the OIF/OEF/OND Clinic and the Persian 

Gulf Registry clinician at the Cincinnati VA Medical Center; and 

also by Mr. Chadwick Watiker, an Air Force veteran, Cincinnati 

Vet Center Team Leader. I want to thank you all for being here 

today. 

Mr. BENISHEK. Thank you, Doctor. 

Once again, thank you all for being here. 

Mr. Berry, I think we will begin with you. Please proceed with 

your testimony. 

We are trying to keep it around 5 minutes each, so I appreciate 

your consideration there. 

Please begin. 

STATEMENT OF HOWARD BERRY, FATHER OF JOSHUA BERRY 

(DECEASED); NATE PELLETIER, EXECUTIVE DIRECTOR, JOSEPH HOUSE, INC.; RODGER YOUNG, CLERMONT COUNTY 

VETERANS SERVICE COMMISSION; PAUL WORLEY, ADAMS 

COUNTY VETERANS SERVICE COMMISSION; KRISTI D. POWELL, SCIOTO COUNTY VETERANS SERVICE COMMISSION 

STATEMENT OF HOWARD BERRY 

Mr. BERRY. Good morning. My name is Howard Berry. I am the 

father of the late Staff Sergeant Joshua Berry. My son was injured 

both physically and mentally during the shooting at Fort Hood in 

2009. I am not an expert on the diagnosis and treatment of PTSD, 

but I am an expert on the pain and suffering of the surviving family members of soldiers who turn to suicide as a final solution to 

their problems. 

Please read what I submitted for the record. Some of the observations and possible solutions to consider are not just my thoughts. 

I solicited input from family, friends, soldiers who served with my 

son, veterans and caregivers. All have contributed to what I hope 

you will read. 

The reason I am humbly asking you to read what I wrote is simple. I am skeptical due to the fact that I have already written the 

President twice, all 100 senators, and all Members of the House of 

Representatives. To date, I have received eight responses. That is 

less than 2 percent. 

I had the opportunity to attend some of the trial at Fort Hood 

several weeks ago. I was fortunate to stay with my son’s former 

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commanding officer and his family. I learned that Josh’s captain 

sustained a traumatic brain injury during a subsequent deployment to Afghanistan. He also suffers from PTSD. He described 

what it is like to live with PTSD to members of Senator Cornyn’s 

staff during a meeting I scheduled while in Texas. 

He said, ‘‘I have a wonderful wife and three children. I retired 

from the Army after 21 years of service. I have a good job and a 

house and two cars. I am living the American Dream. I have PTSD. 

I don’t know where, when, or how long an episode will last when 

it starts. When it does, I cannot see the wife, kids, career, job, 

home. All I feel is pain, guilt, and shame. I should have died in Afghanistan. I have no worth. I should take my life. The PTSD I have 

is mild compared to what Staff Sergeant Berry had. His was severe.’’ 

Stigmas encountered by soldiers with PTSD start in the military, 

continue through treatment at the WTUs, the VA, and into society. 

Current perceptions are that PTSD-affected soldiers are different 

or messed up. We need to keep them at arm’s length. We need to 

watch them. 

I recently spoke with a director from a local company. I asked 

him if he had one job to fill and two equally qualified applicants, 

one a veteran with a Purple Heart, which one would he hire? He 

replied, ‘‘The veteran.’’ I then asked him to consider the same scenario, only the veteran has PTSD. He did not respond. 

I understand that he has a responsibility to look out for the company’s interest, that he must look out for the welfare and the safety of all the people employed there. That is his job. The society we 

live in has to change. PTSD-affected soldiers deserve better treatment, like all of us. 

The suicide rate is still rising among our veterans. I hope my 

coming here today to speak to you is not a waste of our time. I 

hope this is the beginning of better days for veterans with PTSD. 

After all, we are all responsible. 

Please read what I submitted. 

Thank you; God bless. 

[THE PREPARED STATEMENT OF HOWARD BERRY APPEARS IN THE

APPENDIX]

Mr. BENISHEK. Thank you very much, Mr. Berry. I truly appreciate your testimony. I am so sorry for the loss of your son. Thank 

you for telling some of us his story. 

Mr. Pelletier, please go ahead. 

STATEMENT OF NATE PELLETIER 

Mr. PELLETIER. Thank you, Mr. Chairman, and thank you, Mr. 

Berry, for being here. I would first like to say that on behalf of all 

veterans, this is why we continue to serve our population, so that 

your son is remembered and so others do not follow in his footsteps. 

I would first like to say that in my testimony, I am very, very 

proud of our VA Medical Center that we have here in Cincinnati 

and the work that has been done. I personally received best-inclass care here as a disabled veteran. As a veteran leader here in 

the community, I have a vested interest in ensuring that our FedVACREP180 with DISTILLER

7 

eral and community resources enable our warriors that are in transition to soon be veterans and that our current veterans successfully reintegrate into our communities. 

I have recently conducted research that studied the impact of 

transitioning veterans and drafted a proposal to assist not only the 

VHA, which is the main effort post-transition, but the Departments 

of Defense, Labor, HUD, Human Resources, and all supporting 

agencies within our community to make sure that we improve and 

implement a sustainable transition system for our veterans or before they become veterans. 

As the executive director of a local agency supporting veterans’ 

needs, I am in the fight every day. I have witnessed what can happen if those who have served our country fall into what I call the 

‘‘distrust gaps’’ of an inefficient transition and support network 

within the veteran community. I lived that on the very first day of 

the Joseph House on April 1st. One of my War on Terror clients 

overdosed on heroin and nearly died in his room. Thankfully, his 

roommate, who was also there for addiction reasons, was EMT-certified and saved his life that day. That day, I knew it was real. 

Over the next three years, roughly 300,000 new veterans are 

going to return to our communities, and we want to make sure that 

we utilize their talents in every way that we can. To this end, I 

want to show the interconnected ways that draw attention to this 

Committee on the VHA side. We need to address the scope of expansion of our local VHAs, and also address the administrative 

leadership’s ability to support community partnerships. 

During the transition of new veterans into the community, the 

VHA currently feels the burden to fill gaps in the process due to 

the absence of a seamless transitioning system. I define this as 

‘‘scope creep.’’ The DoD, VA, all parts of the VA, including benefits 

and health, the Department of Labor, as well as other agencies and 

community organizations have acknowledged that the transition 

process is inefficient and that the responsibilities of each organization are unclear. 

With this in mind, some examples of VHA scope creep include, 

but are not limited to employment assistance, which can be handled in our community, as well as education assistance, benefits assessment, family supportive services, and some maybe unrelated 

medical tasks that can be handled through the partnerships in our 

communities. 

As we attempt to define these responsibilities, I feel it is necessary to look at the process in the three different categories: the 

processes that the VHA can fund and own responsibility to execute; 

processes that the VHA funds and outsources to the community 

partners to execute; and finally, processes that the VHA outsources 

to the community partners who are either VA or privately funded 

and can own the responsibility to execute on their own. 

In addition to addressing the systems and process responsibility 

to reduce scope creep, I think it is important for the VA administrative leadership to empower and leverage VHA and community 

partnerships. 

In an attempt to fully assess the effectiveness of the VHA in our 

community and scope creep, we really need to say what are the primary responsibilities of our local VAMCs. In my mind, the purpose 

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of the VHA is very focused and clear: support the medical needs 

of veterans who qualify for medical services post military service. 

Any services in addition to these primary responsibilities should be 

assessed according to those three categories that I previously mentioned. 

The first step to effectively optimize the veteran support administration is to take an active role in partnering and oftentimes leading the convening of mobilized community efforts in our community. We are doing this right now in Cincinnati. We need more involvement from the VHA. 

We can assess two areas of concern nationally and locally, particularly locally here as it concerns us, one being employment and 

chemical dependency, that we are seeing real difficulty among our 

returning veterans. In my mind, employment is a critical node in 

the process. If you look at all the different nodes to ensure the ecosystem is best for our veterans, sustaining income and having a job 

that not only provides that income but a sense of purpose is vital 

to their successful reintegration. 

Often, what I have talked from the sources at the Joint Chiefs 

of Staff Office for Warrior and Family Support, that it is not just 

PTSD. Not having that stability to be able to provide for yourself 

and your family can also trigger symptoms of depression, self-esteem, a sense of purpose, other things that may not be directly related to combat-related issues. 

Too frequently, these breakdowns lead to the use of unhealthy 

coping mechanisms, which then leads to things such as substance 

abuse. This is what I call the downward spiral of the veteran’s reintegration or lack of reintegration back into our communities. 

To really access the importance of employment again, the Joint 

Chiefs of Staff Office for Warrior and Family Support said they are 

accountable for $960 million in unemployment compensation to veterans without the ability to fix the problem because in the transition to the community, those veterans are no longer a part of the 

Department of Defense. 

I feel that we see that the first access the VHA has, that veterans have, is to our local VHA, and they feel the burden to meet 

some of these gaps. I think this is an example of scope creep within 

the VHA due to the inefficiencies related to who owns what in the 

transitional process. 

Besides veteran employment efforts, I think the VA administration can optimize the partnerships with the community agencies to 

provide clinical treatment for our veterans. This is a very specific 

topic here. As the director here of the Joseph House, my clients are 

prime examples of the system breakdown within the ecosystem of 

support. I have currently identified that 12 out of 27 of my clients 

are not only suffering from chemical addiction, but also from a cooccurring disorder related to mental health, most of them from 

PTSD. 

Recently, we just reassessed those numbers, and it is 78 percent 

of my current clients from yesterday suffering from co-occurring 

disorders related to chemical addiction and mental health. Subsequently, those are broken down to family support, employment, and 

all those other things that they need to be able to successfully reintegrate. 

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I would also like to mention that although the VA administration 

has provided exceptional support through their VHA Community 

Outreach Division to fund and evaluate current programs like the 

Joseph House, VA has been reluctant to partner in the communitybased veteran mobilization efforts or the community action team effort here in Cincinnati. We can really do better by having participation in there, not just to figure out what they can do to support 

us, but what we can do to relieve the burden of their scope creep. 

Local agencies such as the Joseph House, Talbert House, Volunteers of America in the region provide services and treatment for 

veterans that are suffering from chemical dependency. The majority of these programs are actually funded by VA Grant Per Diem 

programs. Although the VA provides a series of measures to validate funding each year, they also operate their own internal substance clinic within the hospital. Again, a very action item where 

we can look at what can the VA do internally, and what can we 

do externally to serve our veterans. We are already funded to do 

it in our communities. 

Also we have seen, although it is not true everywhere, but that 

the private agencies or funded agencies in the VA and the community require certifications of their clinical counselors. We are not 

often seeing the same at the VA hospital, where it is not part of 

the hierarchy to actually have an LICDC or a CDCA certification 

to be a clinical counselor. Just a couple of examples of things we 

can look at. 

And then also related back to chemical dependency locally here, 

we are seeing an increasing rise in the use of opiates in our community versus alcohol. This is an alarming effect, and we have 

power within our community agencies to really partner to do that 

very well, to relieve the burden on our local VAs. 

Just in summary, I would like to reiterate the opportunities to 

optimize VHA scope creep and the VA administrative leadership 

for the community are not a reflection of the dedicated staff and 

those that are leading them, but an opportunity to optimize our 

processes. 

If I could, in closing, just give you an example of how I experienced the stress of a veteran who recently was discharged from our 

local VA. In 2011, I received a call from a soldier on a Wednesday, 

a weekday night. I believe it was a Wednesday at 10:30 p.m. Actually, the call came from the local VA hospital, to see if I could 

house a War on Terror veteran for the night. He was no longer able 

to stay in the hospital because his time was up. 

At around 11:30 he arrived at the house, at my house, and for 

the next two hours he tearfully told me his story. Like many soldiers, he signed up to serve his country and suffered severe trauma 

related to combat that came home with him post deployment. If I 

recall correctly, his father had also recently passed away, and his 

mother was suffering from chemical dependency as well. 

Despite the breakdown of his support, he soldiered on and secured a meaningful job, but was later laid off like so many other 

Americans. Without stable housing or employment, he found solace 

on the streets and had built a relationship with local law enforcement to allow him to just spend a few nights on the street while 

he reached out for help during the day. And unfortunately, like 

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10 

many homeless citizens in distress, he turned to alcohol and other 

drugs as his coping mechanism. 

While he fortunately found his way to the VA where he completed their chemical dependency program, he did not have the 

support network to sustain his sobriety post treatment, and my 

home became his last resort that night. 

This story, like so many others, is simply unacceptable. We must 

think strategically, we must act operationally, and continue to 

identify opportunities to improve the system while always keeping 

the end-state in mind, ensuring our veterans thrive and are productive members of our society. One veteran left behind is one too 

many. 

[THE PREPARED STATEMENT OF NATE PELLETIER APPEARS IN THE

APPENDIX]

Mr. BENISHEK. Thank you, Mr. Pelletier. 

Mr. Young, you are up. 

STATEMENT OF RODGER YOUNG 

Mr. YOUNG. Good morning. My name is Rodger Young. I am a 

Veteran Service Officer for the Clermont County Veterans Service 

Commission. Veteran Service Officers assist veterans in obtaining 

their VA benefits. This can include enrolling into health care, applying for compensation or pension, education benefits, burial benefits—can you hear me now? 

Mr. BENISHEK. Pull the microphone closer. 

Mr. YOUNG. Can you hear me now? How is that? 

Good morning. My name is Rodger Young. I am a Veteran Service Officer for the Clermont County Veterans Service Commission. 

Veteran Service Officers assist veterans in obtaining their VA benefits. This can include enrolling into health care, applying for compensation or pension, education benefits, burial benefits, VA home 

loans, and financial assistance programs. We are also charged with 

aiding veterans with their appeals and dealing with the overpayments and billing issues at the VA. We are pretty much the proverbial one-stop-shopping for VA benefits. 

Our office was invited here today for this Committee to provide 

feedback on the services the Veterans Healthcare Administration 

provides and also comment on the programs and stigmata associated with the PTSD programs. 

To start off, I would like to give some positive feedback first. I 

have noticed—I have been with the Veterans Service Commission 

for five years, and within the last couple of years, the VA has 

transitioned into nursing teams. The nursing teams have been very 

well organized, and it opened up the communications between the 

veterans and their doctors. 

Along with that, they also opened up the MyHealthyVet Web 

site, which is a great way again to open up communication channels between the veterans and their doctors, and also for them to 

download some of their medical information. 

Coupled with that, VBA, the Veteran Benefit Administration, 

also has their own Web site, and the E-Benefits Web site also is 

a major hub for VA benefits and downloading of VA correspondence. 

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I want to personally commend the staff, especially at the CBOC 

Clermont County. They always have great service, great nursing 

teams, very cooperative and friendly with the VSOs, and they treat 

every veteran with the utmost care and respect. 

The quick reference flipbooks are also a great way of passing on 

information concerning health care, and I have seen the Ohio Department of Veterans Services is also tagged on to that. 

The areas I feel that we need to improve on over at the VA as 

far as health care goes, non-VA health care—fee basis is what it 

used to be called—it is not as easy as it sounds. Many veterans are 

confused about the program and when VA will actually pay for the 

emergency or care and transportation. VHA needs to be clear on 

what VA will pay and the requirements before the health care is 

covered. Again, the handout makes it sound easy. There should 

also be a claim form to send in to VHA along with the hospital 

bills. 

The processing time is another big concern. It takes so long for 

the veteran to even receive an answer if the VA is going to cover 

their bills or not. And by this time, the bills are handed over to collections, and the veteran, of course, their credit is going to go bad 

and everything else. 

VHA also needs, I feel, a call center for billing specific non-VA 

care alone. Normally, you are going to get an answering machine 

when you call, and very rarely will we get a call back on that. 

Another problem that they are having down there, especially at 

the medical center, is average wait time for surgeries, anywhere 

from six months to a year. I feel personally if the VA does not have 

the facilities available for surgeries, they should fee base it out 

somewhere, to one of the local hospitals. 

Still getting complaints about the professionalism down there at 

the VA Medical Center. I know there are a lot of great folks down 

there, but there are a lot of angry folks down there also, which concerns me. A lot of the angry folks we have identified. As one veteran put it to me, some of those folks down there at the medical 

center need to go to Happy College. 

[Laughter.] 

Mr. YOUNG. I get little to no complaints over at the Georgetown 

facilities or the Clermont CBOC. 

Another problem that we have, disability questionnaires. I know 

we are looking for a way to expedite some of these claims. That is 

the key. That is probably the best idea I have heard since I have 

been a service officer, is to bring in these DBQs, which the doctors 

can fill out there at the CBOCs and at the VA medical centers. 

Matter of fact, the central office there in Washington, Tom Moe— 

I’m sorry, Tom Murphy; I misspoke there. Tom Murphy actually 

told us that they are supposed to be doing that. The CBOCs, we 

have no problem with this, with the medical centers. 

We are having an issue with filling out the DBQs, and these disability questionnaires, once filled out—take a diabetes claim, for instance. You have a Vietnam vet in-country. These disability questionnaires will clearly identify that he has a diagnosis of diabetes, 

what he is doing for the diabetes, medication. That is a 20 percent 

rating. That is easy. Versus a claim that is going to take eight 

months to a year-and-a-half just to identify the same things. 

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Also, another thing that we run into, if doctors refer veterans to 

file a claim, especially to our office, please ensure the diagnosis and 

notes are annotated in CAPRI or in their systems. It makes 

everybody’s life much easier. I get a lot of veterans coming into the 

office, and I will file a claim for PTSD, no problem there, especially 

if a psychiatrist sends a veteran over there. But please, if you send 

a veteran over there under the impression he has PTSD, please annotate that he has PTSD. There are times when we get claims 

back. The claim was denied because there was no diagnosis. 

Veterans endure many adjustments when returning home from 

deployment to include indoctrination back into family life, adjusting back into their home station and their rules, and trying to process what has happened while deployed. In general, many veterans 

are reluctant to seek help for mental issues due to the stigmata associated with PTSD. Employment is a big issue to include separation from the military if they self-identify. Also, they may run into 

problems with their family, and also with current gun laws. Many 

veterans will not self-identify as having PTSD or won’t seek help 

because of these things. 

Feedback from the CBOC staff indicate cognitive therapy is 

working on many veterans, and I will vouch for that. It does work. 

Success stories, to be honest, though, I don’t have any. PTSD, folks, 

you can get treated for that, but it does not go away. 

Many veterans who seek help for PTSD receive some relief 

through medications to tone down the symptoms, but I have never 

seen a veteran completely cured of it. Realize in past wars, veterans would endure one to two deployments in the warzone. Contemporaneously, it is not uncommon to see five to eight deployments nowadays. 

PTSD programs have prevented many suicides, but I think we 

still have a long road ahead of us in treating PTSD. In my opinion, 

we need to fix the stigmatas associated with PTSD so more veterans will seek help, and then we need to rehabilitate them to 

function in today’s society outside the military. 

Veterans, they feel disconnected when they come home. They are 

totally disconnected from the civilian society. They are programmed 

for military. 

Our office appreciates the invitation today to outline some of the 

hurdles VA faces and the vast improvements it has made to ensure 

the veterans are taken care of. Partnerships within VHA, VBA, and 

the VSO offices will solidify a smooth transition for the returning 

veterans and their families. Standardization, consistency and communication within these agencies is the key element to minimize 

the confusion within the veteran communities. 

[THE PREPARED STATEMENT OF RODGER YOUNG APPEARS IN THE

APPENDIX]

Mr. BENISHEK. Thank you very much, Mr. Young. 

Mr. Worley, could you begin, please? 

STATEMENT OF PAUL WORLEY 

Mr. WORLEY. Good morning, Mr. Chairman, Members of the 

Committee. It is an honor to testify before you today. Thank you 

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for allowing me the opportunity to speak this morning about mental health care for veterans. 

My name is Paul Worley, and I am an Army veteran. I served 

as an infantry rifle platoon leader and scout platoon leader in the 

2nd Battalion, 502nd Infantry Regiment, 101st Airborne Division 

in Iraq in 2005 to 2006. In 2008, I went to Afghanistan and served 

as an operations officer for Regional Command South in Kandahar. 

In 2010, I went back to Iraq as a company commander and saw the 

drawdown and was there for Operation New Dawn. 

At times and places few will ever know, we fought for each other 

against an unseen enemy. I was honored to serve my country and 

privileged to lead the best soldiers in the world. Today, I am equally proud to represent my fellow veterans and to talk about the 

issues we face in regards to mental health. 

When it comes to mental health care for veterans, the major 

issues are access and availability. The VA is the largest integrated 

health care system in the country. There are going to be issues, as 

there are in every health care system, but that does not mean that 

the system is broken. 

In Adams County, Ohio, our veterans are faced with the issue of 

getting reliable transportation to their mental health appointments. The nearest clinics are located in Portsmouth and Chillicothe, which are at least a 45-minute drive for the majority of our 

veterans. For those who receive services in Cincinnati and Columbus, the task of getting to their appointments is even more 

daunting. 

Our local veteran service commission and our local veteran service organizations, including our VFW Post 8327 and our Disabled 

Veteran Chapter 71, currently provide transportation, but it is not 

enough to meet the demands of our veterans and their families. I 

believe it is essential that we provide more mobile veteran centers 

to provide access to our rural residents. 

Another access issue we face in southern Ohio is Internet availability. Our Internet infrastructure in Adams County is extremely 

limited due to the terrain and the financial challenges of our local 

population. Many veterans do not have ready access to fill out 

forms online or to obtain the information they need about mental 

health services. As more and more information is shared online, it 

is critical that we provide our veteran population with this essential basic modern need. 

I believe that the military as a whole has made positive progress 

to reduce the stigma of post-traumatic stress disorder within its 

ranks over the past 10 years. However, I believe that there is still 

a great amount of work to do to reduce the stigma of PTSD among 

the American people. Young veterans seeking civilian jobs are extremely reluctant to seek help because of the risk of an employer 

not hiring them. All veterans deal with the stigma that seeking 

help for mental health is a sign of weakness. More education is 

needed to make sure that the American public comprehends the 

issues associated with PTSD. 

It is very encouraging that the VA has recently hired an additional 1,300 mental health care workers that will potentially alleviate some of the availability issues. I believe that the VA employees 

and leadership want nothing but the very best care and benefits for 

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14 

our veterans. However, we need to continue to improve the mental 

health care system. We need to be prepared to pay for veteran 

health care services as readily as we were to fund the wars that 

caused these issues. The price tag may be great, but that truth 

does not take away the Nation’s duty to care for its veterans. 

The country sent us to war. Now is the time to make sure that 

this country is delivering on the solemn promise made to our veterans for their voluntary service. No one gets left behind. Thank 

you. 

[Applause.] 

[THE PREPARED STATEMENT OF PAUL WORLEY APPEARS IN THE APPENDIX]

Mr. BENISHEK. Thank you, Mr. Worley. 

Ms. Powell, please begin. 

STATEMENT OF KRISTI D. POWELL 

Ms. POWELL. Good morning. Thank you for this opportunity. 

My name is Kristi Powell. I work with Scioto County Veterans 

Service Office. It is through my job there that I get the opportunity 

to work with my fellow veterans, and it is through this job that I 

will be their voice today for victim survivors of military sexual 

trauma, as I will refer to as MST throughout. 

The Department of Veterans Affairs Web site states that about 

1-in-5 women and 1-in-100 men seen in VHA respond ‘‘yes’’ when 

they are screened for MST. This is a very high rate, and it is very 

alarming and concerning. 

The veterans in my county are struggling with the services that 

the VA can provide. Although a disabled vet myself, I do go to the 

VA, and I strongly advocate for veterans to utilize the VA, but we 

need to recognize that we are struggling with programs for specialized things like PTSD, TBI, and MST. 

The veterans in my community, when they do raise their hand 

and address themselves as being a survivor of MST, they are not 

getting the care that they received in the cases that I provided in 

my testimony. What I would like to see is that we recognize this 

as an ongoing problem, a current problem, and one that is not 

going away. It would be great if we could see every VA develop a 

plan to help these veterans. 

Currently, veterans have to travel very far distances. There is 

not a lot of facilities to treat women survivors of MST. Currently, 

one of my veterans had to go all the way to New York State just 

for the care that she deserves. So there is not care locally being 

provided. 

In the cases that I did give you, the women were subjected to 

being in all-men counseling groups and around individuals that 

they should not have been around when trying to struggle with a 

rape and the scars that it has left on them. 

A survivor and a victim of MST should be able to go to their local 

VA with confidence that they are going to receive the care that 

they deserve, and that care should be available, like I said, at 

every VA that is around. For my veterans, a drive one way to get 

care is over an hour. 

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The VA is responsible for serving the needs of veterans by providing health care, rehabilitation, and this just is not being done. 

I would like to just raise awareness on this subject today, and I 

won’t go into detail. I hope that everybody received a copy and can 

read the cases that I provided on the veterans in my community. 

Thank you. 

[THE PREPARED STATEMENT OF KRISTI D. POWELL APPEARS IN THE

APPENDIX]

Mr. BENISHEK. Thank you very much for your testimony, Ms. 

Powell. 

I really appreciate you all being here today. 

I think I am going to start by yielding myself 5 minutes for questions. I think I want to start with a question for Mr. Berry. 

I think you have some very compelling testimony there concerning the loss of your son, of course. Were you able to talk to a 

veteran service coordinator at the VA? Were you involved at all 

with your son getting care from the VA? Were you a part of it? 

Mr. BERRY. PTSD? 

Mr. BENISHEK. Yes. 

Mr. BERRY. For his care? 

Mr. BENISHEK. Well, apparently they have a family services coordinator that helps families of veterans with veterans that have to 

deal with the VA. So were you involved with a family service coordinator? 

Mr. BERRY. No, I wasn’t. None of my family members nor I were 

ever approached in any way to learn about PTSD or participate in 

what needed to be done as far as the care for my son, what we 

could do, what to look out for, anything. And when I did try to ask 

questions, they always kept tossing the HIPAA laws up, ‘‘We can’t 

communicate with you because of the HIPAA laws.’’ 

These soldiers are brittle. We need to surround them with a circle of care, and the door was closed. Even after his death, I found 

out that a lot of the things that—the HIPAA law doesn’t go away. 

I am, like, well, I don’t understand. But, see, I don’t understand a 

lot of things that took place regarding my son’s care, and all I have 

had have been questions since the day he died. I still haven’t had 

any answers. 

Mr. BENISHEK. Well, I hope today that the second panel will review your testimony and maybe come up with some answers for us 

regarding that question. I brought up the veterans service coordinator and making sure we try to have the family and friends of the 

veterans more involved with the care. So, I appreciate that. 

Mr. Pelletier, I have a question for you, too. You told me about 

a veteran that showed up at your house at 11 o’clock at night after 

being discharged from the VA hospital. Is that correct? 

Mr. PELLETIER. That is correct. 

Mr. BENISHEK. Didn’t they have a discharge plan for the patient? 

I mean, how is it that the guy ended up on your doorstep? 

Mr. PELLETIER. What I know, Mr. Chairman, is only what he told 

me, that he had finished the program and was not allowed to be 

there for another night based on, I guess, the regulations of the 

program. Now, he was able to go back the next day, so it was more 

or less a one-night event where he needed a place to sleep. 

VACREP180 with DISTILLER

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Mr. BENISHEK. All right. It just seems to me that, as a physician, 

I know when the patient has a discharge plan to be going the same 

day. We know where the patient is going that day, and it seems 

odd that there would be no plan for his discharge or a place for him 

to be, and then he would call you. So I was just wondering if there 

was a plan, it wasn’t carried out or the patient wasn’t satisfied 

with that plan, or he just didn’t have anything else to do and he 

finally showed up at your door. 

And how often has that occurred? Where do you get your people 

from? Are they from discharges, or are they just from people finding homeless people on the street? 

Mr. PELLETIER. That relates to Joseph House, your first question. 

I was contacted by a staff member at the VA hospital in reference 

to him and his need, and I talked to him on the phone. So it was 

from VA. Now, I don’t know—and I won’t speak on what I don’t 

know. So if he had a program aligned for him, he may have. I was 

not aware of it. All I know is that I felt the need for it to happen. 

Mr. BENISHEK. Right. Does it turn out that many of your patients come from discharges from the hospital? 

Mr. PELLETIER. Are you referring to the Joseph House? 

Mr. BENISHEK. Yes. 

Mr. PELLETIER. That house was actually my personal house 

where he came to stay with me, not at the Joseph House. 

Mr. BENISHEK. Right. 

Mr. PELLETIER. He stayed in my own home. It was not until 

about a year-and-a-half I took over the Joseph House. 

So at the Joseph House, we do receive clients from the VA. We 

receive clients from multiple sources. Given our location, we are 

right in the middle of the area, we have a lot of walk-ins because 

they are literally sleeping a block away from where we exist. 

But we do have a lot of referrals from the VA to the program, 

and keep in mind that a lot of clients that I serve have chemical 

dependency. It requires them to go through multiple programs. 

That doesn’t mean that one is better than the other, but it will 

take maybe a few different attempts to find the right fit, which also 

establishes, I think, why we need to have a great partnership, to 

understand the needs of each client to make sure we try to get 

them in the right place the first time. 

Mr. BENISHEK. All right. Thank you. 

Ms. Powell, let me just take another moment here and ask you 

a question. This military sexual trauma issue, I am very interested 

in this issue. It is my understanding that many people don’t report 

the fact that they have been a victim of military sexual trauma because of the fact that they are just afraid as to what is going to 

happen to them or if they are going to be discharged, are they 

going to be segregated. I am working on legislation to take the reporting and the prosecution of offenders out of the military chain 

of command. 

Do you feel that that would be helpful, removing the prosecution 

from the military chain of command? Are you familiar with that? 

Ms. POWELL. Yes, sir, I am. In the cases with the female veterans I am currently dealing with, that is an issue. None have reported. They did not report while they were active duty due to 

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being afraid of reprimand, and also being afraid to testify against 

their perpetrator. 

Mr. BENISHEK. You mentioned a circumstance where a victim, a 

female victim of military sexual trauma was in a treatment program that was all men involved. Is that a frequent circumstance? 

Ms. POWELL. When it happened the second time with the second 

case, a female, then I realized that it was a problem, and it is due 

to there not being separate wings or individualized treatment plans 

available for care. If there were separate female units, then they 

definitely would not have been put in the group counseling with 

the men. 

But, yes, this is occurring frequently, and that was the issue that 

I addressed. As soon as they identify themselves as MST, the red 

flag should go up and they should not be subjected to that type of 

group counseling. 

Mr. BENISHEK. Well, yes. All right. Well, I am hoping that the 

next panel will address some of these questions that you all have 

brought up here this afternoon. 

I will now yield the floor to my colleague, Mr. Wenstrup, for his 

questions. 

Mr. WENSTRUP. Thank you, Mr. Chairman. 

Mr. Berry, I want to again thank you for being here today. I 

think that your testimony clearly depicts the challenges that so 

many face when they return from war, and I think that it clearly 

depicts our need for a greater transition for our soldiers as they 

exit the military and go to the VA side. There seems to be a wall 

there and a disconnect, and I think that attention will be focused 

more on transitioning as we move forward, and I think it is very 

important, and your story clearly depicts that, and I thank you for 

bringing that out for us today. 

On that front with transition and support, I have a question for 

you, Mr. Pelletier. You identified the need for a stronger referral 

system between the VA and the community providers. Would you 

clarify some of the weaknesses in the current referral system and 

ways that maybe we can make it better? 

Mr. PELLETIER. Right. I think to sum up, if you have seen one 

VA, then you have only seen one VA. Speaking locally here, given 

that we have a very robust community effort to mobilize our 

sources externally from the VA, what we found in these convening 

sessions that we have is that there are vital people in the VA who 

could be part of those groups, whether it is around—particularly 

around health, but housing and chemical dependency are very 

interconnected when it comes to health issues, that they are not allowed to participate, period, due to restrictions on the administrative side, to participate in those convening sessions. 

We have five active teams right now in our community. They are 

focusing on the—well, every community is different, but five major 

efforts to support our veterans who don’t have that support. We are 

here to help because, like I said, the VHA has taken on so much 

responsibility that it is hard to do the primary tasks. But it is hard 

to help if we can’t interact in an effective way, and they have the 

most access to our clients. 

I am a big fan of the OIF/OAF clinic and Operation New Dawn 

and Karen Cartwright’s leadership there. She says that she has acVACREP180 with DISTILLER

18 

cess to the majority of the new veterans coming in. We need to be 

able to understand the landscape and for them to be involved. 

Mr. WENSTRUP. Thank you. 

Mr. Young, I believe you mentioned about the disability questionnaire. Were you speaking to that? And are those claims done electronically or hand-written? 

Mr. YOUNG. Hand-written. 

Mr. WENSTRUP. They are hand-written, the questionnaires? 

Mr. YOUNG. Right. 

Mr. WENSTRUP. Just one thought that I had on that. Sometimes 

with an electronic type of form, if they are obligated to fill it out, 

it won’t let them complete it if there are missing portions of it, and 

I think that that might be a solution for us. Does that sound like 

it may work? Because you commented on parts not being there, 

like the diagnosis, which is key. So if you can’t complete the form 

without having all the boxes checked, might that be of help? 

Mr. YOUNG. That could be one solution. Actually, the diagnosis 

would show up in CAPRI, which they could see up there at the VA 

regional office. The disability questionnaires we will actually expedite, and those are normally hand-written. I am not sure how we 

would get that integrated to their system so they could do that. 

Mr. WENSTRUP. Thank you. 

Ms. Powell, this has been a very major issue for us. I am on the 

Armed Services Committee as well as Veterans’ Affairs Committee, 

and the sexual trauma, military sexual trauma has been highlighted. 

One question I have is when you are seeing some of these victims, are they mostly clearly recent incidents, or are some people 

from 20 years ago that are now coming forward? What are you seeing? 

Ms. POWELL. Okay, sir. Yes. When I had the roundtable discussion in case number 3, I was really taken aback that the different 

eras of women that served were all survivors of MST. There is a 

woman who served in the ‘80s, one from the ‘90s, and then others 

from currently today. So it has been going on for some time now. 

The women from the past are misled and don’t have current information as well because they think that to receive care, that they 

have to provide information about their specific incident, so they 

stay silent. 

And I would like somehow to make that—they have to become 

aware of the services that can be provided and they don’t have to 

stay silent anymore, because that is a long time that she has been 

the way she is, where she cannot even leave the house, she cannot 

work, she self-medicates, just to deal. 

Mr. WENSTRUP. For those in uniform today that are victims, I 

just returned from Madigan Army Medical Center in Washington, 

and they started a new program that I hope is successful and that 

can carry on throughout the military, and it is a sexual assault response team where people can come in anonymously and start to 

engage, usually with a legal team and social workers, on what their 

options are. So when they take this step, they don’t have to be 

afraid because it is not anything that goes on their record, and they 

get better guidance through that. 

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Through the National Defense Authorization Act, this year, we 

put in many whistle-blower protections and things like that. So it 

is being addressed very seriously, and hopefully that will have 

long-term benefits. 

It doesn’t change your challenge for today on the VA side, but 

hopefully it will, and maybe some of the models of what we are seeing with that program can reap some benefits. I appreciate you 

taking that on. 

Ms. POWELL. Thank you. 

Mr. WENSTRUP. Thank you. 

Mr. Chairman, I yield back. 

Mr. BENISHEK. Now I will yield to Mr. Massie for questions. 

Thank you. 

Mr. MASSIE. Thank you, Chairman Benishek. I want to thank 

you for your work on the recent bill, the first appropriations bill 

that we passed, reallocating priorities so that we can try and get 

rid of the backlog in the VA filings, and that did pass the House 

of Representatives. Hopefully, we can get that through as part of 

the latest budget and continuing resolution. 

Also, I want to thank you for traveling such a long distance to 

come and help us in our region on this issue. 

Mr. Wenstrup, I appreciate you organizing this hearing. I think 

among all the congressmen, you are probably the most qualified to 

cover this issue given your service in the military, and also in the 

health care profession. 

What strikes me today is that we are trying to ameliorate or 

work on an issue for people that starts in the military. It starts 

sooner than when they are discharged. So the question that I have 

for really anybody on the panel here is, what policies could our 

military adopt during active service to reduce the onset of mental 

illnesses or to mitigate the effects of mental illness after military 

discharge? For instance, you mentioned one of the nodes was employment. Are we doing enough in the military to prepare people 

for employment, or are there ways that we can prevent MST by 

preventing the acts? Would anybody like to speak to that? 

Mr. PELLETIER. Congressman, I would be happy to. There are 

several ways to address it. The way I have been addressing it is 

looking at the holistic picture of someone who is about to get out 

of the service, who is about to sign that paperwork, and the next 

step will be to reintegrate into society. 

So if you look at kind of a TedX model, there are all kinds of 

things that could break down within transitioning warriors, as we 

like to call them, and it relates to employment, it relates to mental 

health. I just want to bring attention to that PTSD is certainly a 

diagnosis. It can go beyond what happens in combat. It can happen 

within the community. Something can trigger it after you get out 

that may not have been picked up. Or it could just be mental 

health issues related to combat stress, which is not always PTSD, 

transitional stress that can relate to mental health. 

So, yes, I do think it needs to be addressed before they get out 

and that we figure the accountability for it. I think what we need 

to do is when those soldiers or warriors have decided to make the 

next step and sign the paperwork, they don’t get out the next day. 

VACREP180 with DISTILLER

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There is a period of time. We need to figure out how long that period of time we can invest in their transition. 

My proposal is an actual recommendation of a process we could 

look at. It is not an answer, but it is a process where we address 

all those things that we need to look at with our veterans or soonto-be veterans. We do a very good job right now, at least where I 

came from at Fort Stewart, in addressing the mental health. PTSD, 

I had gotten out in ’08. Employment is not addressed, but it is also 

not the responsibility. 

So what we need to look at is where do the responsibilities lie 

in the system and that overlap of where, even before the DoD 

hands over, when can we bring in community or national partnerships to begin that work. The Joint Chiefs of Staff Family and 

Warrior Support Command is absolutely where I think the discussion can happen, because they overlap from DoD and community 

partnerships, but they are only facilitators. They are not the leaders. 

Mr. MASSIE. Thank you very much. 

Mr. Berry, along the lines of that question, do you think that 

multiple deployments or extended deployments contributed to your 

son’s condition? 

Mr. BERRY. My son served in Afghanistan, was only deployed one 

time. Ultimately, the incident that led to his taking his life, making 

that choice, was what took place at Fort Hood, and then the subsequent—I call it pussyfooting around for the next three-and-a-half 

years, or whatever. 

There were so many things that I couldn’t understand, and his 

skill sets were compromised. So how could I expect him to understand what decisions were being made regarding the trial and how 

it was being handled? I couldn’t wrap my brain around them. How 

could I expect him to? 

And I even actually have letters that were written on numerous 

occasions by doctors that were involved in his care, and I asked 

permission to use them, and I was told that if I did, that his physicians would terminate from their positions. 

I just thought that that was—I wasn’t doing anything to disparage anyone. It was just a statement that was made that just said 

that the decision that my son made to end his life was based on 

what happened at Fort Hood, and I am not allowed to share that. 

Mr. MASSIE. I also share your concern over how that incident 

was characterized in the official story, and I appreciate you coming 

today to testify. 

Mr. Young, you mentioned something that I don’t want to let it 

be swept under the rug. You said you are still getting complaints 

about the VA in Cincinnati. What are veterans telling you about 

the professionalism there, and are you concerned that they don’t 

seek treatment because of the stigma or something associated with 

that particular center? Can you elaborate on your comment? 

Mr. YOUNG. I will address the OEF/OIF clinic, very professional. 

I have heard nothing but good things come out of the OEF/OIF 

clinic. But there are other physicians down there that I hear they 

either tell them or kind of disregard of, ‘‘No, you don’t have that.’’ 

They kind of give them the brush-off, is what I normally hear, or 

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‘‘I don’t believe in that.’’ I have heard that one more than once. ‘‘I 

don’t believe in PTSD.’’ Coming from a VA, that is ridiculous. 

Mr. MASSIE. Is there a system or a method to report those incidents? 

Mr. YOUNG. Yes, there is. There is patient advocacy, and that is 

usually who we refer them to first. If we hear many incidents coming out of there, typically we will address the director on what is 

going on. 

Mr. MASSIE. Thank you. 

I yield back. 

Mr. BENISHEK. Thank you. 

Brad, do you have any other questions? 

Mr. WENSTRUP. I just have one question. 

We talked a lot today about transitions, deployment actions, 

things like that, and I do hear the DoD side trying to take part in 

that. I hope that that comes to fruition. 

My question to each of you is, for those that you serve, when 

they come to you, especially veterans that are new veterans, just 

leaving the military, do you feel that they come to you with any 

guidance before they get to you on how to navigate the VA system? 

We can go down the line. 

Ms. POWELL. My answer is no. The new veterans that are getting 

out today are not receiving any kind of beneficial information on 

what to do next. So they are getting out, and they experience a lot 

of separation anxiety. They don’t know what to do next. They 

weren’t told to copy their medical records, and now we are having 

problems locating those for when they got hurt in service. They 

know nothing about the VA at all until someone, an older person 

they see on the street tells them to come into our office, basically. 

Mr. WORLEY. And I just recently got out two years ago, and I left 

from Fort Stewart, Georgia. I saw a big transition when I first 

came in the Army from 2004 to where we were in 2011. I think 

these soldiers are armed with—everyone is armed with the right 

information, but a lot of times they are out processing when they 

get back from a deployment, and all that is on their mind is, I’m 

getting out, I have to show up to these mandatory classes, but they 

are not paying attention until when they get out and it has been 

a year and their unemployment has ran out, and then all of a sudden, well, I probably should have paid attention, but then they 

don’t have leadership in place. They can’t go to their team leader 

or squad leader and say, ‘‘Sergeant, can you tell me what I need 

to do?’’ 

So it is tricky, but at least in Adams County, we have made 

strides to make our veterans service office more available to our 

veterans. It is just hard with younger veterans because they are 

starting their lives when they get back. They are concentrating on 

their family, and it may be, like you said earlier, they may not get 

those issues until something triggers it later on. 

But I do believe that they are armed with the information. They 

just don’t pay attention. They are focused on other things when 

they leave. 

Mr. YOUNG. I concur with Mr. Worley there. I think the TAPS 

briefs are very good, and they have a lot of information, but I think 

the veterans with the—I think mine was a week-and-a-half long, 

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and I think they are just inundated with so much information, and 

they are more concentrating on family and employment upon discharge. 

The VA, I know back when I had a TAPS brief, they lightly 

touched on VA and moved on. The first thing that went through 

my mind is VA health care, I am thinking a guy is missing limbs. 

I am not thinking that is a health care for me. 

But I think they need to touch more on the VA and the VA benefits available to them. I think the employment information was 

good that they gave us, but they need to hit on a little more about 

the VSO offices so we can kind of guide them on where to go when 

they get out. I think that would definitely help. 

Mr. WENSTRUP. Thank you. 

I yield back. 

Mr. BENISHEK. I want to thank you all so much for appearing 

here this morning. It is very, very helpful for this Committee to 

hear this input. 

You all are now excused, and I will ask the second panel to come 

forward. 

Dr. Wenstrup introduced the second panel a bit earlier, and we 

were fortunate enough to meet with most of the panel yesterday in 

our visit to the medical center. I want to thank you all for being 

here today. I know that, Ms. Smith, you are going to be the one 

testifying, but I would hope that maybe you would address some 

of the issues that the first panel brought up in your testimony. We 

have your written testimony already, what you are prepared to say, 

but I think that some of the testimony that we heard in the previous panel is pretty compelling, and I know that we will later on, 

if you don’t address those or if I can’t think of all the things, we 

are going to submit questions to you later to try to address the 

issues that that panel brought up so that I don’t forget any of those 

details later, so we would appreciate that. 

But in saying that, please proceed with your testimony. 

STATEMENT OF LINDA D. SMITH, FACHE, MEDICAL CENTER 

DIRECTOR, CINCINNATI VA MEDICAL CENTER, VETERANS 

HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS 

AFFAIRS, ACCOMPANIED BY KATHLEEN M. CHARD, PH.D. DIRECTOR, COGNITIVE PROCESSING THERAPY IMPLEMENTATION; DIRECTOR, TRAUMA RECOVERY CENTER, CINCINNATI 

VA MEDICAL CENTER, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND EMMA 

BUNAG–BOEHM, PRIMARY CARE PROVIDER, OEF/OIF/OND 

CLINIC; CLINICIAN, PERSIAN GULF REGISTRY, CINCINNATI 

VA MEDICAL CENTER, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND 

CHADWICK WATIKER, CINCINNATI VET CENTER TEAM LEAD, 

READJUSTMENT COUNSELING SERVICE, U.S. DEPARTMENT 

OF VETERANS AFFAIRS 

STATEMENT OF LINDA D. SMITH 

Ms. SMITH. Thank you for the privilege of being here, for all 

those in the audience who are attending, and in particular for the 

previous panel. We definitely will follow up on every issue that was 

raised earlier this morning. 

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Good morning, Chairman Benishek, Dr. Wenstrup, and Representative Massie. Thank you for the opportunity to discuss the 

Cincinnati VA Medical Center’s efforts to provide high-quality care, 

specifically mental health care, to veterans in our catchment area, 

and our pilot Veterans Transportation Service. 

I am accompanied today by Dr. Kathleen Chard, Director of the 

Trauma Recovery Division of our Mental Health Care Line, and 

Professor of Psychiatry and Behavioral Science at the University of 

Cincinnati’s College of Medicine; Emma Bunag-Boehm, a primary 

care provider for the Post-Deployment Clinic, Cincinnati VAMC; 

and Mr. Chad Watiker, Cincinnati Vet Center Team Leader. 

The Cincinnati VAMC is a two-division campus located in Cincinnati, Ohio, and Fort Thomas, Kentucky. The medical center 

serves 17 counties in Ohio, Kentucky and Indiana, with six community-based outpatient clinics. We are a highly affiliated teaching 

hospital, providing a full range of patient care services, with stateof-the-art technology, medical education and research capabilities. 

The Medical Center provides primary care, the full range of mental 

health services, and tertiary and medical surgical care. 

Over 42,000 veterans are enrolled in VA health care through our 

facility. This number includes about 3,600 female veterans and 

3,500 OIF/OEF veterans. The medical center has 15 full-time staff 

in our OEF/OIF/OND clinic providing primary care, mental health 

care, social work services, pain management care, and other services for military personnel returning from all recent combat theaters. 

The Cincinnati VAMC’s Trauma Recovery Center consists of an 

outpatient PTSD clinical team and a residential PTSD program 

which offers eligible individuals family education, medication management, and evidence-based PTSD treatments in a variety of formats. These unique programs have been featured in national media 

for their patient-centered, evidence-based treatment programs for 

PTSD. The VAMC also provides care and services to veterans who 

have experienced military sexual trauma. 

Mental health services at the Cincinnati VAMC are unified 

under a multidisciplinary Mental Health Care Line. A comprehensive variety of mental health services is offered by the seven divisions of the Mental Health Care Line through 303 staff members. 

To date, the Mental Health Care Line provides care to an additional 1,482 unique veterans that were seen over the same period 

in Fiscal Year 2012. 

VHA has developed many metrics to monitor performance in the 

delivery of our health care services. Cincinnati VAMC consistently 

scores above targets set by VHA regarding key areas of mental 

health treatment, including follow-up rate for veterans discharged 

from acute inpatient mental health treatment and percentage of 

qualifying veterans receiving evidence-based psychotherapy sessions. 

The Cincinnati VAMC has also seen tremendous success in improving patients’ access to care, receiving an outstanding 5-star 

quality rating under the category ‘‘Mental Health Wait Time.’’ 

Recognizing that increasing access to care improves health care 

outcomes, the Cincinnati VAMC began operation of the Veterans 

Transportation Service in May of 2012, offering mobility manageVACREP180 with DISTILLER

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ment and transportation services. Mobility management guides veterans to the most medically appropriate and cost-effective means 

available through a private, veteran-focused agency or public transportation services. VTS fills in the remaining gaps, providing doorto-door, wheelchair-accessible transportation for those veterans living in the medical center’s catchment area who have no other viable transportation options. 

In August 2013, the Cincinnati VAMC hosted its first Community Mental Health Summit, where facility leadership and staff 

met with 66 individuals from 36 community agencies. At the summit there was an open exchange of detailed information about mental health programs and services available through VA and the 

community. 

In conclusion, VHA and the Cincinnati VAMC are committed to 

providing the high-quality care that our veterans have earned and 

deserve, and we continue to improve access and services to meet 

the mental health care needs of veterans residing in Cincinnati and 

the local surrounding area. We appreciate the opportunity to appear before you, and we appreciate the resources Congress provides 

VA to care for veterans. We are happy to respond to any questions 

you have. 

[THE PREPARED STATEMENT OF LINDA D. SMITH APPEARS IN THE

APPENDIX]

Mr. BENISHEK. Thank you very much for your testimony. 

Mr. Berry’s testimony is pretty compelling. He lost his son while 

the son was being treated for PTSD as an out-patient. How many 

patients in the last two years under your care have committed suicide? 

Ms. SMITH. In the last year, a total of three veterans in Fiscal 

Year 2013 actually committed suicide that were receiving our 

health care services. In Fiscal Year 2012 it was five, and in Fiscal 

Year 2011 it was nine. So we are seeing, I believe, improvements 

in our outreach for veterans at risk for suicide. We have a full-time 

suicide prevention coordinator. The month of September is designated as a special month to recognize the suicide risk, and we 

will be outreaching in the community and to all veterans who come 

to our medical center with a comprehensive package of information 

about suicide and ways to avoid it. 

Mr. BENISHEK. Mr. Watiker, you are with the veterans center, so 

it is somewhat different than the VA hospital. Tell me about your 

program and are you seeing an increasing number of patients, and 

is your staffing adequate to get people in on a regular basis, what 

is your wait time. Give me a little bit of an example of the challenges that you have and what could be better about your system. 

Mr. WATIKER. Yes, sir. Thank you for that question, Dr. 

Benishek. The vet center program is geared toward readjustment 

counseling services for war-zone veterans and their families to help 

them with the transition from military life to civilian life. There is 

no time-limit restriction, and the cost is free because they have 

paid for the service already with the time that they served, being 

in a deployment status. 

We have well-trained clinicians that provide individual counseling, group intervention, couples, marital counseling, military 

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sexual trauma, and bereavement counseling for those who have 

had loved ones die while in active duty service. 

Mr. BENISHEK. How long does it take to get in to see you? 

Mr. WATIKER. Our access to our services, if a veteran comes into 

our office today, they are going to be seen by a clinician, assessed, 

develop a plan, and coordinate a follow-up that meets the best to 

their schedule. 

Mr. BENISHEK. Is there like a suicide notation made on the initial visit? 

Mr. WATIKER. We definitely do it as part of our —— 

Mr. BENISHEK. Your evaluation? 

Mr. WATIKER. Yes, sir. As part of our initial assessment we do 

a comprehensive assessment, a bio-psychosocial assessment with 

the individual. But with everyone we screen, we screen any type 

of suicidal ideation or homicidal ideation. 

Mr. BENISHEK. Dr. Chard, we were talking earlier, but I don’t 

quite remember your answer to how long does it take for someone 

to call and get into an outpatient evaluation in your setting. 

Ms. CHARD. Thank you, sir. If someone called today for an outpatient appointment in the PTSD division, we can get them in 

within the week. So if you called me today, we can get them in 

within this week to see both an individual therapist and a psychiatrist or a nurse-practitioner for a medication consult. 

Mr. BENISHEK. And is there any sort of a suicide evaluation done 

on the phone when somebody calls in? Because to me, even a week 

seems like a long time if somebody is calling in desperate for help. 

Ms. CHARD. Exactly. When we do our initial phone screen, we do 

a suicide assessment, and we actually complete a suicide assessment on every visit that the patient has within the PTSD and the 

Mental Health Care Line. 

Mr. BENISHEK. All right. 

Mr. Wenstrup? 

Mr. WENSTRUP. Thank you, Mr. Chairman. 

A couple of questions. We saw a lot of things yesterday when we 

visited, and that is the Cincinnati VA. Can you share with us some 

of the differences from state to state? Do you feel that every VA 

is the same? Obviously, there are some differences. And how do you 

think we are dealing with that on a national level compared to 

what we have here in Ohio? 

Ms. SMITH. I really can’t comment nationally. I can comment on 

what we do, and I know that we get a lot of direction from VA central office through our network about changes and improvements 

in the ways that we provide care. It seems that the changes are 

evolving even more and more quickly. I have been with VA almost 

33 years now, and the pace of change and the pace of improvement 

in services is really remarkable, just from Dr. Chard’s program as 

an example, and the ongoing improvements that have been made 

in the treatment provided for PTSD, including now the three separate programs, Emma Bunag-Boehm’s program where we have 

gone from two staff and in our OIF/OEF clinic to now 15. So I 

would say the pace of change is just incredible and driven by, in 

large part, the interest that Congress has had in continuing to improve VA health care services, and I thank you for that. 

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Mr. WENSTRUP. Thank you. You know, I know when I returned 

from the war, I got notices from the VA saying you need to get in 

and get enrolled. The outreach was there, and I think it continues, 

and I do give the VA tremendous credit for that. 

On the lines of suicide prevention, in the Army there is a lot 

being done proactively in what to look for, how to watch out for 

your buddy, don’t be afraid to say, hey, I’m taking you in, you need 

help. That is great. We know that most of the suicides are occurring after they are out of uniform. How do we build that type of 

system once they are out, as opposed to when they are in? 

Ms. SMITH. And this is part of what I see as a really increased 

sophistication and improvement in the mental health care at Cincinnati, and I am sure at other facilities. I will let Dr. Chard provide details. 

Ms. CHARD. So with a team of three people in the suicide prevention office, we are able to do a lot more outreach than I think ever 

before. We do attend a lot of civic activities locally. We make sure 

that we attend all of the NAMI meetings that we are invited to. 

We always have our staff at the PDHRAs, and they are there to 

do the vesting visits because sometimes they don’t want to come to 

the VAs, as you spoke about. We do need to vest them early and 

let them see a face that they can see when they come to the VA. 

So we do a lot of outreach there. 

One of the things that I love that VA has created is a peer support technician program where we actually hire veterans as peer 

supporters so that you can attend a group that is not run by clinicians, but is run by a trained peer support person so they can have 

that private environment to share their experiences, talk about 

their needs with someone who has already been through the program and can speak about what it was like to go through it, what 

obstacles they encountered, what they found to be helpful, and I 

think that has been a really strong success throughout the VA and 

the Nation. 

Mr. WENSTRUP. That is something that comes with the length of 

time that this has been going on. You have alumnus, if you will, 

who can participate and help. 

I know it is sometimes difficult, too. I will ask you, Emma. You 

see patients for the first time, often. And as we talked about before, 

there are people who don’t want to come forward to mention what 

they are struggling with, and sometimes they refuse to go there. 

I can remember in Iraq, we had to do a physical on Saddam Hussein, who was on a hunger strike, and he wouldn’t let us evaluate 

his mental status. He refused psychiatry or psychology. So we had 

to use a little psychology and work within his physical exam to ask 

questions to really assess where he was mentally. 

So have you found that over the time of doing this, that you are 

able to sort of break through that, when you sense somebody 

doesn’t want to tell you something, that you can break that down 

a little bit? And how do you do that? And if you do feel like you 

have gotten through and detect something, where do you go from 

there? 

Ms. BUNAG-BOEHM. Thank you, Representative or Dr. Wenstrup, 

for this opportunity to come and speak with you. I thank you for 

your service to our Nation. 

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To answer your question, we, in our clinic, we have a team of 

nurses who does the initial intake, and we have those clinical reminders that we need to complete. Now, a lot of times, the 

servicemembers or veterans will not answer those questions. So 

when they come to my office and I develop this rapport with them, 

then along the way I go back in and ask them the same questions, 

and a lot of times they will be honest with me and start opening 

up more. 

In our clinic, after they see me as the primary care provider, we 

have a psychologist and social workers who are trained mental 

health providers as well. So if I identify that something is going on 

with this veteran, I also want to say that our clinic is like a medical home and it is a one-stop visit store or something. So they are 

aware that they might be there for a while because we want to 

make sure that everything that they need we give to them on that 

same day. 

Now, if they cannot do it because they are busy, then they have 

the option of coming back. But we try to do everything at that one 

visit, and a lot of times they will agree to that. So then it is handed 

off to the psychologist, and then we go from there. 

As you are aware, our clinic is—I mean, it has been very, very 

effective, and our clinic has really gone far. And thank you again 

to Congress for giving us those resources. Thank you. 

Mr. WENSTRUP. I think you have made a lot of strides. I know 

servicemembers that have been treated by you that have been very 

grateful for the care that they have received, and I know it is a difficult challenge. And this somewhat addresses Mr. Berry’s concerns 

today on how we get the families engaged, because I think that is 

important, and I hope that we can continue to do that. 

I just have one last question. So, we have been at war for 12 

years, and we have a lot of returning veterans, especially to this 

area of the country. What would you say are some of the major 

things that you have changed since, say, 2001, 2002, 2003, 2004, 

compared to today? 

I will ask both of you, all three of you actually. 

Ms. CHARD. Certainly. I think some of the most significant 

changes have actually been in the increase in mental health staff. 

So we have had an exponentially larger number of staff hired. 

Thank you, obviously, to your efforts. 

Speaking more specifically to the PTSD program, we have grown 

by three-fold. We have opened a women’s program, which we did 

not have until 2007, and now we have the Traumatic Brain Injury 

PTSD Residential Program, and we are currently the only one in 

the Nation. So we are able to serve veterans in our area with both 

male issues, female issues, or TBI/PTSD issues in that program, 

both residential and outpatient. 

Mr. BENISHEK. I would just ask that the speakers use the microphone because we have had some comments that it has been difficult to hear your testimony. 

Ms. SMITH. There are so many changes, it is hard to think 

through what has just happened in the last few years. Certainly, 

construction funding has allowed us, and also money for additional 

lease space has allowed us to really expand. We moved our eye program off campus, which opened up additional space for clinical 

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care. We have, I think, four concurrent construction projects going 

on at every corner of the hospital to not only increase our capacity 

to provide care, but also to make that care more convenient and 

easier to get to. 

Probably the biggest improvement in terms of ease of access is 

the parking garage that is just now in the process of opening that 

should make it very easy for veterans to get into our health care 

services. 

We are building a brand-new community living center, what used 

to be called our nursing home care unit, and this is in recognition 

of the fact that moving veterans back and forth from Fort Thomas, 

Kentucky across the river to Cincinnati creates a lot of unnecessary 

trips for many of those nursing home residents, and now we will 

be able to have them located closer to clinical care and at the same 

time give them private rooms and immediate access to all health 

care services. 

We have done a lot to renovate our domiciliary and PTSD programs in recognition of the large number of veterans returning 

needing mental health care, and also those veterans who either 

have substance abuse or homeless issues and need some residential 

treatment. I see us significantly expanding those services at Fort 

Thomas and really make that a real state-of-the-art and evidencebased program that I believe will rival any in the VA Nation in 

terms of the types and quality of services provided there. 

And again, this has all been done with funding that Congress 

has given us, and we are very appreciative that we have been able 

to add all those services. 

Ms. BUNAG-BOEHM. And with the increase of our staff in our 

OIF/OEF/OND clinic, we are able to do more outreaching. We have 

partnered up with units in and around the greater Cincinnati area, 

Reserve and Guardsmen units. So we are often invited into their 

30-day, 60-day and 90-day family gatherings. 

So on the 30th day, or actually whenever they come home, our 

program manager, Karen Cartwright, or our outreach coordinator, 

Mary Plummer, who is herself a veteran, they go into the units to 

give briefings. So with those briefings, they talk about the VA and 

what the VA offers them, from medical health care to benefits to 

everything else that they need to do. 

We have a mobile van which you saw yesterday, and we go outreaching to places where we are invited. So we take the opportunity to enroll veterans and at the same time get them vested into 

the VA health care, and then get them started. So if they need to 

be referred to a specialty clinic, then we get them referred, and 

these are from counties, and a lot of our community-based outpatient clinics offer those specialty clinics. 

Another thing that we would like to highlight is that we have the 

VITALS program wherein our psychologist is the liaison between 

our local universities in and around greater Cincinnati again, and 

a lot of times my veterans go back to school, and Dr. Jessica Theed 

is my liaison. So if they cannot come to me right away, they will 

seek her out, and then Dr. Theed will notify me if we need to see 

the patient, if I need to do more for the patient. 

And again, we would like to thank you for giving us the resources to do what we are doing now. Thank you. 

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Mr. WATIKER. First of all, I would like to thank you on behalf 

of the Readjustment Counseling Service for the resources that you 

provided for us, because one of the biggest changes for RCS is that 

you have allowed us, with the resources you have provided, to purchase 70 mobile outreach vet centers across the Nation. We have 

two here in Ohio. This allows us to do, not only mobile outreach 

to the local community, but outreach to the whole community to 

provide clinical and veteran services if we don’t have a community 

access point. It also allows us to work with our VA counterparts 

for emergency response teams to national crises, as needed, to support the veterans and families outside of the State of Ohio, or within the state as well. 

When I talk about the community access points, it is one of the 

things that, with our outreach efforts, we were able to provide faceto-face connections with our veterans and families to easily engage 

them into vet center and VA resources. For example, we have outreached now to Highland County where it is a rural community. I 

heard earlier about the difficulty in accessing mental health care. 

One of my clinicians goes up there to a community access point 

through the veterans service office and provides mental health care 

to those veterans and families and helps them get linked up to VA 

resources. 

I thank you for the question. 

Mr. BENISHEK. Thanks. 

Mr. Massie? 

Mr. MASSIE. Thank you, Mr. Chairman. 

Dr. Chard, we heard from Mr. Berry that no one from the VA 

reached out to him to help the family understand the effects of 

PTSD or to participate in care. And then he later also stated that 

the HIPAA laws were an impediment to learning about his son’s 

condition. 

Can you respond to Mr. Berry’s testimony and also share with 

us how you have to work within the HIPAA laws, and if there is 

anything that Congress can do to change those laws, or do they 

strike the right balance of privacy for the patient, or do they restrict you too much from involving the family? 

Ms. CHARD. Thank you. And, of course, any loss of any individual 

is one loss too many. It was very tough for me to hear that story 

because of my desire to always want to help every veteran that 

comes in our door. 

And the sad truth is exactly what you said. HIPAA laws prevent 

us. If an individual veteran does not want us to talk to their family 

members, they can invoke that right, and we are therefore not allowed to provide education, answers, support, any information at 

all to that person’s family. 

Now, you asked about the balance, and I think the hard part is 

the situations where the veteran wants to be protected. I can’t tell 

you the number of situations where I have had veterans going 

through custody hearings, going through difficult divorces, having 

difficult bosses who have asked for information from us and we 

have been able to protect them as they are going through those 

custody hearings where someone is trying to take away their child, 

saying they have PTSD and they cannot be trusted. 

VACREP180 with DISTILLER

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So it is a very difficult situation that we are in, in that we do 

have to have a balance where we both protect the rights or personal care of an individual, but also try to get as much information 

out to family members as we can. 

Mr. MASSIE. Is that a right they have to assert? Do they invoke 

it, or is it an opt-in? 

Ms. CHARD. HIPAA is a standard thing that all of us are given 

when we go to the doctor’s office. There is HIPAA information that 

we are given, and we sign a statement saying we understand the 

HIPAA law. It is a standard for every one of us every time we go 

to a doctor’s office. 

Mr. MASSIE. So it is basically an opt-in. 

Ms. CHARD. You can opt out of HIPAA and give someone rights. 

You actually have to sign that you agree to let me talk to someone. 

Mr. MASSIE. So it is opt-out. 

Ms. CHARD. Yes. 

Mr. MASSIE. By default, you can’t share that. They would have 

to voluntarily ask you to do that. 

Ms. CHARD. Correct. But I do encourage everyone here to talk 

about the National Center for PTSD Web site. We have one of the 

best Web sites, funded by Congress, for information for family 

members and veterans and civilians about PTSD, and it is the National Center for PTSD Web site at VA.gov, and there is great information for family members there. 

Mr. MASSIE. Can you encourage the veterans to engage their 

families? I mean, do you do that? 

Ms. CHARD. We certainly do. 

Mr. MASSIE. And let them know about their HIPAA rights, that 

they can be waived, that they can share that information? 

Ms. CHARD. We actually try in all the cases that I can ever remember to engage the family literally from step 1, because we do, 

at our orientation group, ask that the veteran bring a family member to our orientation group. We then, in addition to our psychosocial history, we ask if they have any family members that they 

are willing to have involved in their care. And then finally, we offer 

couples and family-based treatments that are evidence-based where 

we actually encourage the veteran to not just have them informed 

about their care but be a part of their weekly care, if they are willing. 

Mr. MASSIE. Thank you. 

Ms. Smith, Mr. Berry testified that his son was upset about the 

hassles involving going to the Cincinnati VA Medical Center, up to 

and including having to answer the same questions over and over. 

He felt that that caused him to relive his experience at Fort Hood. 

And then also, I think perhaps in his written testimony he stated 

that having doctors in residency treating vets kind of breaks this 

tendency that the patient would like to have the same doctor every 

time they go so they don’t have to answer the same questions, because you want to build a connection with the doctor and trust. 

Do you agree with Mr. Berry why or why not should folks who 

are undergoing treatment for mental illness see doctors in residency, or should there be some continuity? 

Ms. SMITH. Let me try to answer that question as broadly as I 

can. Every one of our mental health veterans will eventually have 

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a mental health treatment coordinator, and I believe we are close 

to achieving that, somebody that can kind of navigate their care 

through the various areas where they get care or treatment. 

Our veterans, when they come to clinic, whether it is to one of 

Dr. Chard’s PTSD clinics or with Emma, do have an attending physician or an attending provider responsible for their care. We are 

a site for training, and we have a large number of training programs which we are very proud of. But it is not the responsibility 

of a medical student or a psychiatric resident or a clinical social 

work trainee to provide care for our veterans. That responsibility 

resides with the individual provider, as in the case with Emma in 

our clinic, or the physician that also covers the OIF/OEF clinic, and 

also for Dr. Chard’s clinic. Those are permanent providers. 

Now, it may be true if a veteran is seen at a specialty clinic, especially med surge specialty clinics, where their first contact may 

be with a medical resident or surgical resident. But there is always 

an attending physician at those clinics. 

I will let Dr. Chard just briefly talk about how we assign mental 

health providers. 

Ms. CHARD. Certainly. So when someone comes into the VA, they 

are immediately attached to a provider, whether it is a psychiatrist, a psychologist, or a social worker, and whoever they first 

meet is attached as their mental health treatment coordinator. 

That person’s name is on the front page of their chart. So if that 

individual calls in the middle of the night, if that person comes into 

our psychiatric emergency room saying ‘‘I don’t remember who that 

person is, I have walked away from the VA for six months, but I 

need somebody,’’ we have a name on the very front cover page that 

everyone can see, including the vet center, and call that individual 

and say Mr. Jones, Mr. Smith is back and he needs care, where did 

he leave off, what can we do for him, and that individual will reinitiate care with him and get him to the best environment, or her 

to the best environment. 

Mr. MASSIE. Thank you. I yield back. 

Mr. BENISHEK. Mr. Watiker, I just have one more question. I understand that you have authority for bereavement counseling for 

families. Were you made aware of Mr. Berry’s son’s suicide, and do 

you reach out to families that have suicide that you are aware of? 

Mr. WATIKER. As far as in the specific case of Mr. Berry, we get 

referrals from a variety of different organizations. 

Mr. BENISHEK. I’m sorry, I can’t understand what you are saying. 

Mr. WATIKER. I’m sorry, sir. As far as speaking to Mr. Berry’s 

case, we get referrals from a variety of different organizations, 

whether that is through family members or through veteran service 

officers, or even from our national organization or our national bereavement headquarters out of Colorado. And from there, once we 

get a referral, for whatever family member is requesting services, 

we make contact with that family member and engage them for 

services. 

Mr. BENISHEK. So you have to be notified by the family, then. 

Mr. WATIKER. The family member or another representative, an 

organization who is acting on behalf of the family members. And 

once we get that referral, then we will make contact with that specific family member to offer bereavement services. 

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Mr. BENISHEK. All right. Thank you. 

Mr. WATIKER. Thank you. 

Mr. BENISHEK. Well, I appreciate you all being here this morning. I know you are very proud of the service that you provide 

there. As you said, Dr. Chard, even one suicide is one too many. 

You all know that there is definitely room for improvement despite 

the statistics that you have shown us that you are doing well. 

It is our job really to be sure that the system works as efficiently 

as possible. With 18 to 22 suicides a day among our veteran population, you can understand our concern as to what the VA is really 

doing to make it better. Despite your statistics that look good, it 

is very distressing to me and, I’m sure, my fellow Members here 

on the panel, that our veterans deserve the absolute best, and we 

want to make sure that your agency is doing the best they can. 

So I really want to thank all of our witnesses and members of 

the audience for joining us today. It has been a pleasure for me to 

spend time in southern Ohio and see the medical center and some 

of the other great medical facilities here in town. 

Before we conclude, are there any veterans in the audience? 

Could any veterans in the audience please stand up or raise their 

hands so we can recognize them? 

[Applause.] 

Mr. BENISHEK. Thank you. Thank you. I want to thank you very 

much for your service. We owe you a great debt that we still remain a free country. It has been an honor for us to be here with 

you this morning. 

And with that, I ask unanimous consent that all Members have 

5 legislative days to revise and extend their remarks and include 

extraneous material, and we may submit further questions for the 

panel, which we will expect answers to. So, without objection, I will 

order that. 

The hearing is now adjourned. 

[Whereupon, at 11:53 a.m., the Subcommittee was adjourned.] 

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A P P E N D I X 

Prepared Statement of Hon. Dan Benishek M.D. 

Good morning and thank you all for joining us this morning. It is a pleasure for 

us to be here in beautiful Cincinnati, Ohio, with all of you. 

I am honored to serve as the Chairman of the House Veterans’ Affairs Committee 

Subcommittee on Health and to be joined on the Subcommittee by your Congressman and my friend, Dr. Brad Wenstrup. 

As I am sure you know, Brad has served for the last fifteen years as a member 

of the U.S. Army Reserves, where he has achieved the rank of Lieutenant Colonel. 

In the spring of 2005, he deployed to Iraq for a year. While there, he served his 

fellow soldiers, sailors, airmen, and marines - as well as prisoners and civilians - 

in Abu Ghraib as the Chief of Surgery and the Deputy Commander for Clinical 

Services. 

For his brave and loyal service there, he earned numerous awards and accolades, 

including the Bronze Star. 

Brad is also Doctor of Podiatric Medicine and a former small business owner. 

Needless to say, the immense wealth of knowledge, experience, and insight that 

Brad brings to the Subcommittee is invaluable. I am extremely grateful to work side 

by side with him and for his leadership on behalf of our Nation’s veterans and their 

families. 

So, when Brad asked me to come to Cincinnati – his hometown - to address an 

issue of such importance to us all – the provision of high quality and effective mental health care to veterans in need – I seized the opportunity. 

Yesterday, Brad and I paid a visit to the Cincinnati Department of Veterans Affairs (VA) medical center. While there, we had an in-depth discussion with medical 

center leaders and toured the facility. 

Having worked myself as a surgeon at the Iron Mountain VA Medical Center, I 

most enjoyed meeting with some of the hard working Ohioans who strive day-in and 

day-out to provide the best possible care and services to the veterans in this community. 

I would like to take a moment to personally thank each of those health care providers, administrative personnel, and support staff for their dedication to our 

servicemembers, veterans, and their families. 

It is clear that there are some very special things going on in Cincinnati for our 

heroes and you have much to be proud of here in Ohio. 

However, where the health care and services provided to our veterans is concerned, exercising our responsibility for oversight of policy and practice is paramount. 

This past February, VA issued a sobering report which shows that - for the last 

12 years - there have been 18 to 22 suicide deaths among our veterans every single 

day. 

Ladies and gentleman, we have lost far too many of our veterans on the battlefield of mental illness. We have to do better. And we have to do it now. 

Key to that effort is breaking down barriers to care that veterans in the midst 

of struggle often face when attempting to access the care they need to successfully 

transition home and maintain happy, healthy, and productive lives. 

No veteran should be reluctant to ask for help because they are ashamed or embarrassed. And, no veteran who does take the brave step of seeking care should be 

told they have to wait for an appointment that is weeks or months away and/or 

travel long distances away from their homes and families to receive the services 

they need. 

Today, we will discuss the actions we must take to reduce stigma and increase 

the accessibility and availability of mental health care for veterans here in Ohio and 

across the VA health care system. 

We will also discuss the increasingly vital role that faith-based and community 

groups are playing in helping our veterans and what we need to do to increase and 

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improve meaningful partnerships between VA and these community resources, who 

are often the first and most trusted point of contact for veterans and families in 

need. 

Finally, we will also discuss the critical part that family members and other loved 

ones play in the healing of our heroes and the need to increase family awareness, 

involvement, and integration in mental health care services, particularly for those 

veterans most in need of support. 

I look forward to hearing from the local Ohioans – many of them veterans – who 

will testify today. I thank you for being here and for your devotion to improving the 

lives of Ohio’s veterans. 

With the help of communities like Cincinnati and discussions like the one we are 

having this morning, I am hopeful that we will shatter mistaken perceptions that 

mental health care is not available, not appropriate, or not effective and there will 

come a day when no veteran is discouraged from reaching out and seeking care and 

no family suffers alone. 

f 

Prepared Statement of Hon. Brad Wenstrup 

Good morning, and welcome to the House Committee on Veterans’ Affairs Health 

Subcommittee field hearing, ‘‘Making a Difference: Shattering Barriers to Effective 

Mental Health Care for Veterans.’’ 

Mr. Chairman, I want to formally and officially welcome you to Cincinnati! As you 

have seen these past two days, this district – a district I am so privileged to represent – has an incredibly rich tradition of military service. I want to thank you 

for the leadership you have shown on the issue of veterans’ mental health care and 

for hosting this field hearing here today. I am also grateful that Representative 

Massie, a strong supporter of our military and our Nation’s veterans, has taken time 

out of his schedule to be here. Congressman Massie, thank you. 

To the witnesses on our panels, to each person in the audience, and, especially, 

to every veteran present today: thank you for joining us. It is important for us all 

to be engaged in this issue if we are going to truly improve the care our veterans 

receive. 

This field hearing is an opportunity to bring Congress to Cincinnati. I’m pleased 

that the Subcommittee on Health will hear directly from the veterans, the family 

members of veterans, the service officers, and the community providers of this region. They will provide a valuable perspective on the common barriers to mental 

health care that our veterans face. 

The veterans of Southern and Southwest Ohio are a diverse group. They were 

raised on farms, in urban high-rises, and in suburban neighborhoods. But they 

share a common bond: they made the voluntary commitment to serve our Nation. 

Only one percent of Americans have served in uniform. Their accomplishments have 

been amazing and truly unmatched by the rest of the world. As a veteran of the 

war in Iraq and a member of the Army Reserve, I have witnessed the heroism of 

my fellow veterans and have deep respect for them. 

We can never repay them for their sacrifice, but we can honor it by ensuring that 

they and their families receive the care that they deserve. In Ohio, we have a robust 

system of Veterans Service Commissions that serve our veterans with zeal and dedication. I am grateful to have the representatives from commissions in three different 

counties present to testify today. 

There is growing recognition that we must develop better treatment for the ‘‘invisible wounds’’ that veterans bring home, including depression, posttraumatic stress 

disorder, substance abuse, and traumatic brain injury. These wounds affect veterans 

of all our past wars, but the veterans of Operations Enduring Freedom and Iraqi 

Freedom face unique mental health challenges. Because of technological advances, 

more soldiers are surviving physical combat injuries, but they present disproportionate neurological and psychological wounds. Studies suggest that one in five veterans of the wars in Iraq and Afghanistan has PTSD. A decade of war with frequent 

and extended deployments has made it more critical than ever before to create a 

quality mental health care system for our veterans. 

There are many challenges in our current system that do not allow veterans to 

get the care they need. Sometimes, veterans are simply unable to access care: they 

have difficulties in scheduling timely appointments or the office is simply too far 

away. Other times, veterans are unwilling to ask for or accept help. Each veteran 

has unique struggles and needs, and we need a mental health care system that is 

able to provide effective, individualized care. 

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Today, we will discuss how the Department of Veterans Affairs can better improve 

its approach to and delivery of mental health care. 

Truly effective care, however, will extend beyond the VA: it will require the involvement of veterans’ families and their communities, including veterans service 

organizations, community health care providers, and faith organizations. 

Each of us has a role to play in improving veterans’ access to mental health care. 

Again, thanks to each of you for being here for this important discussion. 

f 

Prepared Statement of Howard Berry 

My name is Howard Berry. I am the father of the late SSG Joshua Berry. He was 

wounded both physically and mentally as a result of the shooting at Fort Hood on 

5 Nov 2009. My son suffered terribly from PTSD. He chose to end his life on 13 

February 2013. I am not an expert on PTSD. I am however an expert on the pain 

that this disorder places on the surviving family members of soldiers who do not 

respond to treatment, soldiers who look to suicide as the solution to end their suffering. 

I am left with a lot of questions, many that will only be answered by the passage 

of time. Please bear with me as I attempt to share with you some of the experiences 

my son had while being treated for PTSD. I will also share some of the changes 

I believe will give other soldiers a better chance to find success in their recovery. 

Soldiers suffering from PTSD have skill sets that have been compromised. The 

simple things that we encounter in our day to day lives were extremely difficult, 

if not impossible, for my son. He had tremendous difficulty adjusting to civilian life. 

We do a marvelous job taking a civilian and turning him into a soldier. We do a 

lousy job helping that soldier make the transition back to civilian life. My son was 

one of those who could not successfully return to civilian life, as he was given limited training to transition, which was combined with the damage done to his skill 

sets. 

The invitation to this symposium listed four topics for discussion, and I will attempt to share my thoughts on each. 

(1) The impact of patient waiting and travel times on veterans’ ability to receive 

mental health care and actions needed to increase the accessibility and availability 

of mental health care services for veterans. 

Josh travelled by car to get to his appointments. During his treatment, he had 

valid concerns about travel time and fuel cost. He had to consider how long it would 

take to find a parking space at the Cincinnati VA, and if he would have enough 

gas left to go home after his appointment. Josh was upset about the hassles involved in going to the Cincinnati VA, up to and including having to answer the 

same questions again and again, resulting in reliving the horror he experienced at 

Fort Hood. He saw no benefit in answering the same questions repeatedly. 

Josh was even involved in an accident one afternoon when leaving the VA to go 

home. This was another excuse that he would give to not go to the VA. It was just 

one more bad experience, added to a list of bad experiences, to, in his mind, deter 

him from seeking treatment. His skillsets were so broken that he also failed to 

maintain auto insurance coverage, which created yet another financial obstacle. 

When I asked him why he had not paid his bills, I discovered that he was not opening mail, period. He said he only got bad news whenever he did, so he didn’t see 

the point. 

I am sure Josh’s story of broken skillsets is similar to the stories of other soldiers. 

It must be difficult to admit the need for help. Our goal is to find a way to improve 

their skillsets, and their ability to seek treatment for their injuries. 

One way to improve the accessibility of treatment is to consider the needs of the 

soldiers themselves. A lot of folks are parents. How many appointments are missed, 

or aren’t even scheduled, because vets cannot find someone to watch their children? 

Is there childcare available on site for veterans’ children while they are receiving 

healthcare? 

Many of these soldiers are busy people. Transitioning into life as a civilian includes taking on financial and family responsibilities. Are appointments currently 

consolidated, so the veteran makes one trip instead of several to get treatment? For 

instance, can a vet schedule appointments back to back to see a physical therapist 

and a psychiatrist? 

Many soldiers who suffer from PTSD also miss appointments. If they stop calling 

and stop coming in, does anyone take notice? Do they fall through the cracks? 

I believe taking a battle buddy approach to making sure their fellow soldiers are 

OK will greatly improve the care they ultimately receive. This will also work well 

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in rural areas where vets have limited access to care. Just talking with another person makes a world of difference. When my son enlisted, he told me that if something 

bad happened to him, someone had his back. After returning from deployment and 

trying to transition to civilian life, I asked him the same question. For him the answer was no. I could see and hear the pain he felt before he died. He felt that his 

country had wiped its feet on him. He felt that he had gone from a hero to a zero. 

I’m sure a battle buddy/mentor would have given him a better chance at recovering. 

I bet lot of soldiers returning home would jump at the chance to continue to be of 

service to their brothers and sisters in arms. 

Essentially, there needs to be a mentoring program, a pairing of a vet with a similarly ranked veteran. Consider the Alcoholics Anonymous concept of a sponsor/ 

sponsee relationship. They meet as equals, the sponsor listening to the sponsee and 

sharing their experience, strength and hope with him, simply showing what he did 

to recover. I know this works. I cannot explain why. I do know we are only as sick 

as our secrets. I wish Josh had someone to share his secrets with; knowing that he 

wouldn’t be judged or looked down upon would have helped him. 

In addition to a sponsor, there needs to be support groups where veterans can 

freely speak to one another anonymously, removing the fears and stigma that a person with PTSD suffers from. 

Furthermore, there needs to be a review of practices in all VA locations. Are the 

standards of care used to treat PTSD affected soldiers the same in all 50 states? 

If not, why? Are successful programs copied and less effective ones phased out? Do 

VA facilities across our country freely communicate with one another in a timely 

and consistent manner? What programs will result in a reduction of the suicide 

rate? We must determine what works and what doesn’t work. After all, the goal is 

to reduce the number of service men and women who take their own lives when 

they feel they have no other option. 

Another area in need of improvement is the early identification of warning signs 

in soldiers who are likely to take their lives due to the severity of their PTSD. We 

need to identify these brittle soldiers as soon as possible. This group of combat soldiers has a disproportionate suicide rate when compared to other groups of servicemen and women. Those who need additional attention, due to the severity of their 

PTSD, should subsequently receive a higher level of care. Can resources be allocated 

to provide for their needs? 

Although accessibility, timeliness, and availability are important, continuity is 

just as crucial. Having doctors in residency treating vets with PTSD inhibits the development of strong doctor/patient relationships. A vet may begin to build a connection with a doctor, someone he is starting to trust, only to have that person replaced 

on the next visit. Having to start over from square one only forces our vets to relive 

painful experiences. How many times would you be willing to tell your story before 

it felt futile? I have been telling my son’s story for over six months now. I know 

how it feels. 

(2) The effect of stigma on veterans’ willingness to seek mental health care and 

actions needed to eliminate it in the veteran community. 

The stigma placed on our veterans starts in the military. My son was trained to 

suck it up and roll on, as I’m sure countless others have and are currently taught 

to do. If there is not bone or blood showing, you don’t speak up, as it is looked on 

as a sign of weakness. Josh was told on one particular occasion by a superior that 

he was nothing but an old, broken down NCO, who needed to get out of this man’s 

army. This was after he had experienced the horror at Fort Hood and was getting 

treatment for his PTSD. I know he felt that he was betrayed by some of the people 

put in place to help him. 

Why don’t we begin by calling PTSD what it is? It is a wound. We need to give 

veterans a reason to hold their heads high and not be ashamed by the perceived 

weakness associated with PTSD. 

My son felt that he was as expendable as a broken rifle or a worn out pair of 

boots. I’m sure there are other veterans who are silently suffering and feel the same 

way. I believe that one way to help soldiers suffering from PTSD sustained in combat is to award them with a Purple Heart. They should be given the same considerations as servicemen and women who have shed blood for our country. This would 

help to even out the playing field in civilian life. Giving them the same benefits, 

including points towards employment, education and healthcare would be proof that 

their country acknowledges the sacrifices they have made to protect others’ freedom. 

Their injuries merit equal treatment. 

I know there is a lot of resistance to this. I have been disappointed to hear from 

older veterans who are reluctant to support this change. They feel their sacrifice 

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will be diluted by the inclusion of those with PTSD. I thought soldiers were trained 

to look out for one another. Why aren’t they included in this Band of Brothers? 

If Purple Hearts are not awarded, then Congress needs to step up and create a 

separate award, one with equal benefits, one that will give these vets the recognition they deserve, one that honors the sacrifice they have made. Give these veterans 

a reason to hold their heads up high. It is the right thing to do. 

I recently had a discussion with a director where I work. I gave him a scenario: 

‘‘you have one position to fill with two equally qualified candidates. One of them is 

a veteran with a Purple Heart. Who would you hire?’’ He responded with, ‘‘The veteran.’’ I then asked him to consider the same scenario, only this time, the veteran 

has PTSD. He did not immediately respond. I apologized for putting him on the 

spot. After all, he has an obligation to protect the company’s interests, including the 

other employees’ wellbeing and safety. If society puts these veterans at a disadvantage, it is no wonder that many don’t seek treatment for PTSD. I’ll bet many do 

not take their medication as directed or at all, fearing this may have an impact on 

their employability if their medication is discovered on a drug screen. 

(3) The role of faith-based and community providers in assisting veterans in need 

and actions needed to increase and improve meaningful, collaborative partnerships 

between VA and these critical community resources. 

One way we can support these veterans is through media coverage. Our society 

is driven by what we hear and see. Positive media coverage, starting from within 

the military, will help to remove the stigma associated with PTSD. Sharing the successes of programs that have proven to be effective as well as success stories of soldiers who have transitioned to civilian life will show the nation that vets with PTSD 

deserve a fair shake. 

We must strive to create connections, emotional bonds, with the rest of Americans, showing them that the veterans in their community are just like them. The 

difference is that they stand up in the face of danger and fight for our freedom. 

PTSD should not be a reason for fear in our society. Soldiers being treated for PTSD 

should be looked up to, not down on. We need to show our nation that they are not 

broken by the violence they have seen. We need to show them that they have worth 

and are included in the pursuit of happiness, something that is currently out of 

reach for many of them. The media can help create a bridge to bring churches and 

non-profit organizations together to support our vets. By including stories of success 

in our media outlets, we can change how society looks at PTSD affected veterans. 

I know I could not continue to speak for my son and others like him without a 

deep sense of faith. If a guy like me can learn how to do this, I believe anyone can. 

(4) The role of family in mental health care treatment and actions needed to increase family awareness, involvement, and integration in mental health care services. 

Families are directly and indirectly affected by soldiers returning home with 

PTSD. The anger, resentments and hopelessness carried by these returning vets are 

often carried over to civilian life. If nothing changes, the family suffers their own 

version of PTSD. We love them, but we don’t understand what to do. We don’t want 

to make things worse, yet we have no solution to work towards. We learn to suffer 

as silently as the veteran. 

Neither I nor any of my family members were ever asked if we wanted to learn 

how to help someone with PTSD. I could not communicate freely with anyone regarding my son’s care due the HIPAA laws. These laws were enacted to protect the 

individual. However, I see compliance to this law as a major contributing factor in 

the death of my son. 

I also feel the law is currently used to protect the agency, not the individual. Letters that were written on my son’s behalf could not be used by me without putting 

those who authored them at risk. The bottom line is this: if I choose to use them, 

the people responsible for authoring them would be dismissed. I don’t understand 

the reasoning behind this. It must be fear. If more administrators spend less time 

covering their backsides and use a common sense approach instead, more would be 

accomplished. 

My son felt that the PTSD he suffered from was acquired through such a unique 

experience, the shooting at Fort Hood, that no one could ever understand. He could 

not focus on any of the similarities between his experiences and those of other soldiers—all he could see were the differences. In his eyes, he could have managed the 

PTSD from his tour in Afghanistan, but that going eye to eye with a superior officer 

who was shooting to kill amplified his trauma to another level, a terminal uniqueness that grew from the fact that his injuries were sustained in the center of a military installation, and not in a war zone. 

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1 Clifford, P., Fischer, R. & Pelletier, N. (2013). Exploring Veteran disconnection: Using culturally responsive methods in the evaluation of Veterans Treatment Court services. Unpublished manuscript. 2Pelletier, N. (2012). Successful Warrior to Successful Veteran. Cincinnati, OH: Author. 

I am sure that there are other soldiers who feel just like Josh did, that their 

unique set of circumstances can’t be understood, that their experiences are too traumatic for others to comprehend. And to a degree, we don’t understand because we 

have not really tried to. But we have to find a way to break down these walls. We 

have to convince them that we want to understand, that they are not alone as we 

support them in their recovery. We need to make these soldiers feel like they’re a 

part of the solution, and not a part of the problem. Their ability to succeed begins 

with creating a circle of care that includes the military, the VA, the family, and our 

society as a whole. 

Families need the opportunity to work with the medical professionals, social organizations, both religious and non-profit. PTSD affected soldiers need to see support 

in every direction they look. If we work together to make their burdens lighter, we 

have a chance to have the kind of country my son fought for. 

The suicide rate is still rising among our veterans. I hope my speaking to you 

today was not a waste of our time. I hope it is the beginning of positive changes. 

After all, we are all responsible. 

f 

Prepared Statement of Nate Pelletier 

The Cincinnati VAMC is a best in class medical center; and, as a disabled Veteran, I’ve personally received outstanding care. As a Veteran leader, I have a vested 

interest in ensuring our federal and community resources enable all Warriors in 

transition and Veterans to successfully reintegrate. I’ve conducted research that 

studied the impact of transitioning Veterans and drafted a proposal 1 to assist not 

only the VHA, but the Departments of Defense, Labor, HUD and HHS 2, as well as 

supporting agencies and community partners on how to improve and implement a 

sustainable transition system. As an Executive Director of a local agency supporting 

Veterans in need, I’ve witnessed what can happen if those who have served our 

country fall into the ‘‘gaps’’ of an inefficient transition and support network. On my 

very first day of work at the Joseph House, Inc., one of our War on Terror clients 

overdosed on heroin and nearly died in his room. Thankfully, his roommate was 

EMT certified and saved his life that day. 

Over the next 3 years, more than 300,000 new Veterans will return to civilian 

society. Our communities need to be ready to serve them and utilize their talents 

in the community and in the workforce. To this end, there are two topics that are 

interconnected and deserving of this Committee’s attention- VHA’s scope expansion 

and VA administrative leadership’s support for community partnerships. 

During the transition of new Veterans into the community, the VHA currently 

feels the burden to fill ‘‘gaps’’ in the process due to the absence of a seamless 

transitioning system. I define this as ‘‘scope creep’’. The DOD, VA (VBA/VHA), DOL, 

as well as other agencies and community organizations have acknowledged that the 

transition process is very inefficient and that the responsibilities of each organization are unclear. With this in mind, some examples of VHA scope creep include but 

are not limited to: employment assistance, education assistance, benefits assessment 

and family supportive services unrelated to medical services. As we attempt to define the responsibilities of the VHA during this process, we can categorize the decision making process into three groups - 1) processes that VHA funds and owns responsibility to execute, 2) processes that VHA funds and outsources to community 

partners to execute, 3) processes that VHA outsources to community partners who 

are VA or privately funded and can own the responsibility to execute. In addition 

to addressing the systems and process responsibility to reduce scope creep, it is important for the VA administrative leadership to empower and leverage VHA and 

community partnerships. 

In an attempt to fully assess the effectiveness of our VHA and recommend areas 

to partner with the community to reduce scope creep, we must define ‘‘what are the 

primary responsibilities of the VHA?’’ The purpose of the VHA is very focused and 

clear- support the medical needs of Veterans who qualify for medical services post 

military service. Any services in addition to their primary responsibilities should be 

assessed according to the three process categories mentioned previously. 

The first step to effectively optimize the system of Veteran support is for the VA 

administration to take an active role in partnering and often time leading the conVACREP180 with DISTILLER

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vening of mobilized community action teams to collectively meet the needs of our 

Veterans. To quantify and provide some examples of how the VA administration 

could partner more effectively in Cincinnati in order to reduce scope creep, we can 

assess two areas of concern nationally and locally- employment and chemical dependency, as well as their potential relation to co-occurring mental health disorders. 

Employment is a critical ‘‘node’’ that a Veteran must attain and sustain to successfully reintegrate (with the exception of those who are 100% disabled and unable 

to work). If this node collapses, it is most often the catalyst that dissolves secondary 

nodes within the ecosystem of support for a Veteran such as mental health stability 

(i.e. triggers PTSD symptoms- depression, self-esteem, sense of purpose, etc.) and 

can cause a Veteran to retract from social reintegration as well as lead to even further breakdowns in the ecosystem of support such as family relations, and sustainable housing. Too frequently, these breakdowns lead to the use of unhealthy coping 

mechanisms such as a reliance on drugs and alcohol. This is often the beginning 

of the ‘‘downward spiral’’ and collapse of a Veteran’s sustainable reintegration. So 

where does the responsibility lie for disconnection in Veteran employment during 

the transition from Warrior to Veteran? 

According to sources at the Joint Chief of Staff’s Office for Warrior and Family Support, the DOD is accountable for more $960 million dollars in unemployment 

compensation to Veterans (unfortunately without the ability to fully evaluate their 

progress due to the fact Veteran’s are no longer tracked in the DOD system post 

out-process). However, more often than not, the VHA receives the primary burden 

of responsibility to assist unemployed Veterans given that they usually have the 

most access to the Veteran population in the region. This is an example of scope 

creep within our local VHA due to the inefficiencies related to ‘‘who owns what’’ in 

the transitional process from Warrior to Veteran. Therefore, the VA administration 

should emphasize the importance of engaging with the private sector and community partners who focus entirely on job placement. More often than not, this will 

be supported under category 3 mentioned above and secondarily, could reduce both 

the DOD and VHA scope creep. 

Besides Veteran employment efforts, the VA administration can also optimize 

their VHA partnerships with the community agencies providing clinical treatment 

for Veterans with addictions. As the Executive Director of the Joseph House, Inc. 

for homeless Veterans with addictions, my clients are prime examples of the systematic breakdown of a Veteran’s ecosystem of support. My clinical team has conservatively identified that 12 out of our 27 clients in our treatment program as of September 2013 have also been prescribed psychotropic medication for a co-occurring 

mental health disorder. It is important to note, that up to 78% or more of my senior 

clients (post-Vietnam) are suffering from co-occurring mental health and addiction 

disorders that are either unrelated to military service, possibly caused by socio-economic struggles, childhood adversity or other past experiences. However, a majority 

of our younger clients (War on Terror) are suffering from disorders related to PTSD, 

combat stress, and/or transitional anxiety in addition to these past experiences that 

have either led to chemical dependency or enhanced a pre-service addictive behavior. As it relates to our clients, mental health and chemical dependency are the primary nodes that have broken down within their ecosystem of support that likely 

caused their current state of homelessness. 

Although the local VA administration has provided exceptional support through 

their VHA Community Outreach Division to fund and evaluate current programs 

like the Joseph House, Inc., it has been reluctant to support VHA participation in 

community-based Veteran mobilization efforts or ‘‘community action teams.’’ The 

VHA could optimize the impact of Veterans recovering from chemical addiction with 

effective engagement in both the housing and health sub-committees of the local 

Veteran community action team. VHA participation at an operational level will 

allow them to better assess funding support for community agencies according to the 

three process categories mentioned above. Furthermore, a more interactive relationship with community agencies will enable them to share and assess best practices 

so that they can not only help improve the local agencies they currently fund, but 

their internal treatment program as well. 

Local agencies such as the Joseph House, Inc., Talbert House Parkway Center, 

Volunteers of America to name a few in our region, provide services and treatment 

for Veterans suffering from homelessness and chemical dependency. The majority of 

our funding is provided through the VA Grant Per Diem program. Although the VA 

provides a series of measures to validate our funding each year, they also operate 

their own internal substance use program within the VAMC hospital. After reviewing their internal hospital program compared to local agencies, it is evident that 

they fund a higher percentage of staff treating a smaller percentage of Veterans 

compared to our external agencies. It is important to note that the qualifications 

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3 Eggleston, M., Straits-Tr ̈oster, K. & Kudler, H. (2009). Substance use treatment needs 

among recent Veterans. North Carolina Medical Journal, 70(1), 54–58. 

and certifications per ODMHAS (Ohio Dept. of Mental Health and Addiction Services) for our cliental programs and staff are parity to the VAMC’s program. Also, 

many of our clients have been referred to us from the VAMC hospital program due 

to negative discharges or time limitations of the program. Thus, a more collaborative partnership could potentially enable a more effective program match as soon 

as a Veteran is identified for treatment. Moreover, it is important to acknowledge 

the changing landscape in chemical addictions. 

More Veterans, particularly the War on Terror Veterans are choosing opiates such 

as heroin vs. alcohol. It is important that we address the treatment options for opiate addiction vs. alcoholism and which programs are more qualified to provide treatment services - VHA or community agencies, or at minimum, create a stronger referral system between the two to ensure that the Veteran receives the proper care 

in a timely manner as soon as they are diagnosed. Recent studies have pointed out 

that, while substance use remains a key issue for Veterans, there has been a decline 

in specialized programs. Clients often respond better and stay engaged longer with 

specialized drug treatment programs. Therefore it is beneficial for the VHA and 

local agencies to partner to meet the treatment needs of new Veterans. 3 This is why 

it is essential that the VA administration encourage their VHA teams to partner 

with the community in order to channel resources into one of the three process categories mentioned above, optimize internal and external treatment programs, and 

ensure that a Veteran is referred to the most relevant program to meet their treatment needs. 

In summary, it is important to reiterate that the opportunities to optimize VHA 

scope creep and VA administrative leadership’s support for community engagement 

are not a reflection of the dedicated VA/VHA/VAMC leadership and staff, but the 

opportunity to optimize internal processes in order to sustain their primary responsibility of providing medical care for Veterans who qualify for benefits and treatment. To this end, it is the responsibility of all us who have ‘‘skin in the game’’ to 

operate more collaboratively to improve the transitional system and process of new 

Veteran reintegration and community efforts to sustain the well being of all our Veterans and their families. 

In 2011, I received a call from the local VAMC at 10:30pm on a weekday to see 

if I could house a War on Terror Veteran for the night that had. Although he had 

just completed the chemical dependency program at the VAMC, he now had nowhere to go, no friends to call, no family to help and his time was up per the VA 

program guidelines. At around 11:30pm he arrived at my home, and for the next 

2 hours he tearfully told me his story. Like many Soldiers, he signed up to serve 

his country, and suffered severe trauma related to combat that came home with him 

post deployment. If I recall correctly, his father had also recently passed away, and 

his mother was suffering from her own chemical dependency. Despite the breakdown of his support system, he ‘‘Soldiered on’’ and secured a meaningful job, but 

was later laid off like so many other Americans. Without stable housing or employment, he found solace on the streets and had built a relationship with local law enforcement to allow him to just spend a few nights on the street while he reached 

out for help during the day. And unfortunately like many homeless citizens in distress, he turned to alcohol as his coping mechanism. While he fortunately found his 

way to the VA where he completed their chemical dependency program, he did not 

have the support network to sustain his sobriety post treatment, and my home became his last resort that night. This story like so many others is simply unacceptable. We must think strategically, act operationally and continue to identify opportunities to improve the sytem while always keeping the end-state in mind- ensuring 

our Veterans thrive in our as productive members of our society. One Veteran left 

behind is one too many. 

f 

Prepared Statement of Rodger Young 

My name is Rodger Young, I’m a Veteran’s Service Officer for the Clermont County Veteran Service Commission. Veteran Service Officers assist veterans in obtaining their VA benefits. This can include enrolling into healthcare, applying for compensation/pension, education benefits, burial benefits, VA Home Loans, and financial assistance. We are also charged with aiding veterans with their appeals and 

dealing with overpayments and billing issues. We are the preverbal ‘‘one-stop-shopping’’ for VA benefits. 

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Our office was invited to attend this Committee to provide feedback on the services Veteran Healthcare Administration (VHA) provides and also comment on the 

programs/stigmata associated with Post Traumatic Stress (PTSD). 

1) Positive Feedback: 

a) The nursing teams are working well; open communications is the key to successful healthcare. 

b) MyHealtheVet is a great way to open the communication channels from veteran 

to doctor. 

c) Love the Ebenefits website which is the main hub for VA benefits/downloading 

VA correspondence ect . . . 

d) I commend the staff at CBOC Clermont County Ohio . . . great service, great 

teams, very cooperative/friendly with VSOs and they treat every veteran with the 

utmost respect. 

e) The quick reference flipbooks are great for passing on information concerning 

healthcare 

2) Areas to improve upon (our feedback from the veterans): 

a) Non-VA care (FEE Basis) – I attached the handout VHA mailed concerning 

paying for outside medical care due to a medical emergency. Many veterans are confused about the program and when VA will pay for emergency care/transportation. 

VHA needs to be clear on what VA will pay and the requirements before the care 

is covered; the handout makes it sound easy. There should also be a claim form to 

send to VHA along with the hospital bills. The processing time is another concern. 

It takes so long to obtain an answer many veterans are turned over to collections/ 

credit ruined while waiting for an answer; appeal take even longer. VHA needs a 

call center for billing/non VA care alone; normally will get an answering machine 

and no return call. 

b) Average wait time for surgeries 

c) Still getting complaints about the professionalism at VAMC Cincinnati (friendliness), little to no complaints on Georgetown/Clermont CBOCs 

d) DBQs 

e) If doctors refer veterans to file a claim, please ensure diagnosis/notes are annotated in CAPRI. Makes everyone’s life much easier when filing a claim. 

Veterans endure many adjustments when returning from deployment to include 

indoctrination back into family life, adjusting back into their home station and their 

rules, and trying to process what had happened while deployed. In general, many 

veterans are reluctant to seek help for mental issues due to the stigmata associated 

with PTSD (employment to include separation from the military, family and current 

gun laws). Feedback from the CBOC staff indicate cognitive therapy is working on 

many veterans. Success stories to be honest I don’t have any. 

Many who seek help for PTSD receive some relief through medications (to tone 

down the symptoms) but I’ve never seen a veteran completely cured. Realize in past 

wars veterans would endure 1–2 deployments into the 

warzone; contemporaneously, it’s not uncommon to see 5–8 deployments. PTSD 

programs have prevented many suicides but I think we still have a long road ahead 

in treating PTSD. In my opinion, we need to fix the stigmatas associated with PTSD 

so more veterans will seek help and then we need to rehabilitate them to function 

in today’s society outside the military. 

Our office appreciates the invitation today to outline some of the hurdles VA faces 

and the vast improvements it has made to ensure the veterans are taken care of. 

Partnerships within VHA/VBA/VSO will solidify a smooth transition for the returning veterans and their families. Standardization, consistency and communication 

within these three agencies are essential to minimizing the confusion within the veteran communities. 

Rodger Young, MSgt, USAF(Ret) 

Veterans’ Service Officer 

Clermont County Veterans Service Commission 

76 South Riverside Drive, 3rd Floor 

Batavia, OH 45103 

(513)-732–7363 

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42 

Prepared Statement of Paul D. Worley 

Mr. Chairman and Members of the Subcommittee, it is an honor to testify before 

you today. Thank you, for allowing me the opportunity to speak this morning about 

mental health care for veterans. My name is Paul Worley and I am an Army veteran. I served as an infantry rifle platoon leader and scout platoon leader in 2nd 

Battalion, 502nd Infantry Regiment, 101st Airborne Division (AASLT) in Iraq in 

2005–2006. In 2008, I served as an operations officer at Regional Command South, 

NATO Headquarters in Kandahar, Afghanistan. My last tour of duty in Iraq was 

from 2009–2010, where I served as a mechanized infantry company commander for 

3rd Battalion, 69th Armor Regiment, 1st Brigade Combat Team, 3rd Infantry Division. At times and places few will ever know we fought for each other against an 

unseen enemy. I was honored to serve my country and privileged to lead the best 

soldiers in the world. Today, I am equally proud to represent my fellow veterans 

and to talk about the issues we face in regards to mental health. 

When it comes to mental health care for veterans the major issues are access and 

availability. The VA is the largest integrated health care system in the country. 

There are going to be issues, as there are in every health care system, but that does 

not mean that the system is broken. 

In Adams County, Ohio, our veterans are faced with the issue of getting reliable 

transportation to their medical and mental health appointments. The nearest clinics 

are located in Portsmouth and Chillicothe, which are at least a forty five minute 

drive for most veterans. For those who receive services in Cincinnati and Columbus 

the task of getting to appointments is even more daunting. Our local veterans’ service commission and veteran service organizations, including VFW Post 8327 and 

DAV Chapter 71, currently provide transportation, but it is not enough to meet the 

demands of our veterans and their families. I believe it is essential that we provide 

more mobile veteran centers to provide access to our rural residents. 

Another access issue we face in southern Ohio is internet availability. Our internet infrastructure is extremely limited due to the terrain and the financial challenges of our local population. Many veterans do not have ready access to fill out 

forms online or to obtain the information they need about mental health services. 

As more information is shared online it is critical that we provide our veteran population with access to this basic modern need. 

I believe that the military as a whole has made positive progress to reduce the 

stigma of post-traumatic stress disorder within its ranks over the past ten years. 

However, I believe there is still a great amount of work to do reduce the stigma 

of PTSD among the American people. Young veterans seeking civilian jobs are reluctant to seek help because of the risk of employers not hiring them. All veterans deal 

with the stigma that seeking help for mental health is a sign of weakness. More 

education is needed to make sure the American public comprehends the issues associated with PTSD. 

It is very encouraging that the VA has recently hired an additional 1300 mental 

health care workers that will potentially alleviate some of the availability issues. 

I believe that the VA employees and leadership want nothing but the very best care 

and benefits for our veterans. However, we need to continue to improve the mental 

health care system. We need to be prepared to pay for veteran health care services 

as readily as we were to fund the wars that caused these issues. The price tag may 

be great, but that truth does not take away the nation’s duty to care for our veterans. The country sent us to war. 

Now is the time to make sure that this country is delivering on the solemn promise made to our veterans for their voluntary service. 

f 

Prepared Statement of Kristi D. Powell - USAF Veteran 

I would like to thank the panel for this opportunity to discuss the issues that veterans face when seeking mental health care services through the VA, especially for 

MST (Military Sexual Trauma). I will touch on the four particular topics of discussion that cause barriers for the veteran when trying to receive mental health and 

other care and also of specific cases/examples of these barriers that we have in my 

county and with the VA’s in our area. I would like to begin by introducing myself 

and giving you the specific examples of problems that veterans are currently facing 

when trying to receive treatment for MST. 

My name is Kristi Powell, I am a United States Air Force Veteran. I hold a Bachelor’s Degree in Substance Abuse Counseling and a Masters Degree in Criminal JusVACREP180 with DISTILLER

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tice. I am currently employed at a job which allows me to assist in the needs of veterans. It is through my job and outside involvement with veterans’ activities that 

I am able to hear veterans’ stories, hold roundtable discussion groups, and help aid 

in their healthcare. I have also been blessed to have the opportunity to be their 

voice today. These examples are of different veterans of different ages, different eras 

served in the military and all separate times frames of when they experienced their 

problems within the VA as far as their health care. 

Case/Example 1: A female veteran in her late 40’s came into the office very distraught. She showed signs of anxiety; she was crying and it was very apparent that 

something was wrong. After talking for awhile, she confided in me what had happened that was making her so distraught. She began to tell me how she was raped 

in the military by an officer and that it has impacted her life so severely that she 

can hardly function. She cannot work, she doesn’t leave her apartment very often 

and she is on numerous medications just so she can get through the day and also 

to be able to sleep at night. Through the VA she learned of a program referred to 

as PRRTP (Psychosocial Residential Rehabilitation Treatment Program) that could 

possibly help her with her MST. She also felt that if she went to this program that 

it would help her in getting her service-connected claim for MST/PTSD so atleast 

the VA would know that she has severe problems with the MST that she was trying 

to address. She entered the PRRTP program at the VA hoping to receive the care 

that the VA claimed that they could give her and that they advertise. (Note: when 

referring to the care that the VA advertises I am specifically referring to the Department of Veterans Affairs website on MST in which it gives the following information that I copied and pasted): 

Outpatient 

• Every VA health care facility has providers knowledgeable about treatment for 

problems related to MST. Because MST is associated with a range of mental 

health problems, VA’s general services for posttraumatic stress disorder 

(PTSD),depression, anxiety, substance abuse, and others are important resources for MST survivors. • Many VA facilities have specialized outpatient mental health services focusing 

specifically on sexual trauma. • Many Vet Centers also have specially trained sexual trauma counselors. 

Residential/Inpatient Care 

• VA has programs that offer specialized MST treatment in a residential or inpatient setting. These programs are for Veterans who need more intense treatment and support. • Because some Veterans do not feel comfortable in mixed-gender treatment settings, some facilities have separate programs for men and women. All residential and inpatient MST programs have separate sleeping areas for men and 

women. 

How can I get more information about services? 

• Knowing that MST survivors may have special needs and concerns, every VA 

health care facility has an MST Coordinator who serves as a contact person for 

MST-related issues. He or she can help Veterans find and access VA services 

and programs. 

So the veteran enters the VA PRRTP program as inpatient treatment for MST/ 

PTSD. The veteran’s anxiety began immediately upon arriving. After being admitted 

to the program the VA told her she was done for the day and that she go get chow. 

Upon entering the chow hall, she noticed that she was the only female veteran in 

the dining facility with all males. The veteran returned to her floor where she immediately found a VA nurse. She told the VA nurse she was having extreme anxiety 

and that she was told that the VA could help her with her MST/PTSD. The veteran 

felt betrayed that the VA would enter her in a program and then put her around 

all males throughout the day. On her first day of the program, she reported to 

where they told her to go, again she walked in the room to discover that she was 

the only female. Although confused and very uneasy about the situation she told 

herself that she had to stay because the VA briefed her that if she left the program 

early then she would not be allowed to be readmitted later and she still believed 

at the time she had to do it for her pending claim. In these group sessions she was 

told to participate, participation including stating the reason that you are there. She 

stated, when it was her turn, that she was there for MST. The males in the group 

automatically started in on insults and taunting her with comments about MST. A 

male in the group even stated to her ‘‘why would you put yourself in that position 

by joining the military knowing that would happen.’’ The same male then started 

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bashing homosexuals by calling them derogatory names. This veteran responded by 

saying that it offended her and he responded back by saying ‘‘you don’t get excited 

by men?’’ The facilitator of that group allowed this to go on and did nothing to stop 

or correct the conversation. After the group session was over, the female veteran 

went over to the facilitator and asked if there was a female psychologist that she 

could speak to. The facilitator gave her a name and so the female veteran immediately went and told the psychologist what transpired in group. The psychologist 

said that she would refer the veteran to the PCT program ( PCT programs I was 

told specialize in the treatment of combat-related PTSD). Even after this horrific 

event, the veteran still continued on with group. She completely isolated herself and 

refused to participate anymore while suffering severe anxiety attacks from being 

surrounded by all men. The same male from the group started following her around 

and making comments to her. He triggered her anxiety associated with her rape so 

much that the psychologist and the social worker stated that maybe this was not 

the program for her. The next morning the social worker came and talked to the 

veteran about what had transpired and what some options were. The comments continued by the male in the group in front of everyone, these comments were usually 

sexual in nature and as before, the facilitator did nothing to object to it. Finally the 

veteran had enough, she checked herself out of the VA and came back home. While 

at home, the veteran could not get the male or his comments to leave her mind. 

Something told her to Google his name, when she did numerous things came up. 

She noticed one was a mug shot so she clicked on it and it was that same male 

that taunted her in her group. He was listed as a convicted sex offender. He had 

raped a woman in Mansfield, Ohio and had his address listed on the website as the 

VA’s. This VA allowed an MST survivor who suffers from severe mental health conditions associated with her rape to be in a group counseling session and freely 

around a convicted rapist. This veteran is now so traumatized that she refuses to 

go back to the VA for any type of healthcare. This event has completely set her back 

in any progress that the veteran had made prior to entering the VA for help. 

Case Example 2: A female veteran in her 20’s came into the office. After talking 

to her, she disclosed that she was living in the homeless shelter and that she had 

a substance abuse problem. She was crying and stating that she did not know what 

she was going to do. I told her about the programs that are being offered at the 

VA and asked her if she would like me to help her see if one of the programs was 

open for her to enter treatment. She told me that she was already in a program 

up there and left and that she was not allowed back into any of them because of 

leaving. I asked her which one and what happened. She told me that she was raped 

while deployed to Afghanistan by her Lt. After being raped and her being harassed 

continually by him she started self medicating when she returned to the states. Her 

performance declined at work and she was eventually discharged from the military. 

When she came home, her substance abuse continued as she tried to mask her pain. 

She started using harder drugs such as heroin just to deal with life. Her parents 

did not know how to handle her so they kicked her out which forced her into the 

homeless shelter. She entered the VA in hopes of getting help with her MST and 

substance abuse problem. While at the VA, she also was put into an all male group 

session in which the taunting began immediately with name calling. They would 

call her ‘‘princess’’ and tell her to sit down when she told the group that she was 

there for MST. The taunting from the males became so bad that she left treatment 

and immediately got high to deal with pain that resurfaced from being raped. It was 

with this second veteran that I realized that this is not a coincidence; this is an 

on-going and unchanging issue at the VA. Since this vet was going through withdraws I took her back to the VA. While waiting for her to be admitted through Urgent Care, I took her with me to talk to the patient advocate. My first stop was 

the OEF/OIF patient advocate since she was from that era. I told the patient advocate that this was the second case that I knew of and that it was a severe problem. 

I asked him because I wanted to know what I personally had to do or who I had 

to talk to for this issue to be addressed and so it would not happen to another veteran trying to receive care. The patient advocate looked at me and asked ‘‘at what 

point do you feel that these MST veterans would be able to attend group sessions?’’ 

I honestly looked at him in disbelief, I could not believe that this was his first question and only concern. My reply was ‘‘probably never. It would only be when the 

veteran states for themselves that they are ready.’’ I then got up, left his office and 

went to the next person in line which was the Women’s Health Social Worker. The 

social worker listened to my concerns and complaints about how MST veterans are 

being treated and the lack of care that they are receiving; she could not however 

give me any explanation to why this was happening but more or less said that the 

VA does not have the space or resources to have an all-female area. I stated to her 

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although I completely understood budget restraints, as soon as a veteran discloses 

that they are a MST victim/survivor that should be the red flag for the VA to do 

an ITP (Individualized Treatment Plan). Under no circumstances should the veteran 

be subjected to the same sex and/or race of the person that sexually harassed and/ 

or assaulted them. The social worker agreed and said she would definitely let the 

director of the VA know. The social worker gave me her word that she would find 

the appropriate care for my fellow young veteran that was suffering from so many 

mental health and substance abuse issues. The catch to waiting for new treatment 

would be that it might take some time to find something so she would be stuck at 

the VA in the same scenario with all men until then. I talked to my veteran and 

I asked her what she wanted to do, she agreed stating it’s either this, the homeless 

shelter or die. Since I admitted her through the urgent care, the standard rule from 

what I understand is that the veteran goes to the psych ward for 3 days. I escorted 

this vet up to the psych ward and it was filled again with all male vets that were 

in their for numerous different types and levels of mental illness with no separate 

section for female and/ or male vets that were survivors of MST. I informed the staff 

on the ward that she was suffering from MST. The one guy that was working that 

floor did not even know what MST was. I told the vet to call me at anytime if she 

felt she could not handle it and it was triggering her anxiety or want to use drugs 

or anything else. She did call me but she also made it through her three days. The 

social worker did keep her promise to me and this vet by later transferring her to 

New York State where she has been referred to an all-female treatment facility with 

other female vets where she gets to stay for a year. In her correspondence she tells 

me that I saved her life by being active in her health care and being her voice when 

no one cared. She loves the facility where she is at and she celebrates every day 

that she is alive and sober and getting help for all the pain that she has hide within 

herself. This worked out for this particular veteran but not all veterans are given 

this opportunity for treatment. 

Case/Example 3: Due to the problems that I have seen within the VA when it 

comes to women’s healthcare, I had participated in a Roundtable discussion with an 

Ohio Senator. Again I voiced my concerns about what was taking place and what 

I was witnessing at the VA when it came to treatment for MST. Months later, a 

representative from his office called and asked if I would be interested in hosting 

another roundtable in which she could come down and sit with me and about 10 

other women veterans to discuss problems they are having in receiving care. I started calling women veterans from the area. I picked one (the veteran from case #1) 

to join me to discuss MST. The other four female veterans were random and I had 

never met them nor knew anything about their time in service or if they even utilized the VA. I called random women veterans in hopes of creating a roundtable full 

of different women to voice their concerns about VA healthcare. After meeting and 

talking for awhile, I brought up MST to the representative and started voicing my 

concerns. As soon as I opened this discussion up and the other women veterans 

knew that this was my passion and my new fight, they began to open up and all 

five women veterans were MST victims/survivors. As I listened to what they were 

willing to share, it occurred to me that this problem has been present for quit sometime and although progress is occurring, the VA is still not where it should be with 

the number of MST statistics that they are reporting on their website. According 

to the Department of Veterans Affairs website, ‘‘About 1 in 5 women and 1 in 100 

men seen in VHA respond ‘‘yes’’ when screened for MST. Though rates of MST are 

higher among women, there are almost as many men seen in VA that have experienced MST as there are women. This is because there are many more men in the 

military than there are women.’’ 

With the statistics that the VA has provided and from what I have witnessed in 

my county alone, I am in hopes that positive changes occur. Men and women who 

served their country and are victims/survivors of MST/PTSD should not be left to 

fight this battle alone. The VA should do the necessary steps to develop Individualized Treatment Plans and separate wings/facilities that are specially staffed to meet 

the needs of MST victims/survivors. Women veterans should not have to worry 

about encountering all men when they go to the VA for treatment; with separate 

wings/facilities a female could feel more confident in choosing to get care through 

the VA without fear. The services provided for MST/PTSD should be available at 

every VAMC. At the present time, only certain locations throughout the United 

States have all-female treatment areas and the wait time for a veteran to get into 

the program is very lengthy (6 months or more). The veteran also has to apply and 

be accepted into the program and they are then placed on a waiting list. Even in 

the cases I mentioned above, the drive one way to this particular VA is one hour. 

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In some areas of Ohio, a female veteran is expected to drive 3 plus hours one way 

for a gynecology exam. 

The VA is the federal agency responsible for serving the needs of veterans by providing health care, disability compensation and rehabilitation, education assistance, 

home loans, burial in a national cemetery, and other benefits and services. The VA 

bears the words, ‘‘To care for him who shall have borne the battle and for his widow, 

and his orphan.’’ Not only are these words a reminder to the VA of the commitment 

they made to care for those injured in our great nation’s defense but I am here as 

well to remind them and let them know that more needs to be done to fulfill their 

commitment to the veterans of this country. 

I thank you again for allowing me this opportunity to speak before you. 

Sincerely, 

///SIGNED/// 

Kristi D. Powell 

f 

Prepared Statement of Linda D. Smith, FACHE 

Good morning, Chairman Benishek, Ranking Member Brownley, and Members of 

the Committee. Thank you for the opportunity to discuss the Cincinnati VA Medical 

Center’s (VAMC) efforts to provide high quality care, specifically mental health care, 

to Veterans in our catchment area and our pilot Veterans Transportation Service. 

I am accompanied today by Dr. Kathleen Chard, Director of the Trauma Recovery 

Division of our Mental Health Care Service Line, and Professor of Psychology and 

Behavioral Neuroscience at the University of Cincinnati, College of Medicine; Emma 

Bunag-Boehm, Primary Care Provider for the Post-Deployment Clinic, Cincinnati 

VAMC, and Mr. Chad Watiker, Cincinnati Vet Center Team Leader. 

I will begin my testimony with an overview of the Cincinnati VAMC. I will then 

focus on our comprehensive mental health programs and end with a brief overview 

of the Veterans Transportation Service, which has improved access to care for many 

of our Veterans. 

Cincinnati VAMC Overview 

The Cincinnati VAMC is a two-division campus located in Cincinnati, Ohio and 

Fort Thomas, Kentucky. The Medical Center serves 17 counties in Ohio, Kentucky, 

and Indiana with six Community-Based Outpatient Clinics, located in Bellevue, 

Kentucky; Florence, Kentucky; Lawrenceburg, Indiana; Hamilton, Ohio; Clermont 

County, Ohio; and Georgetown, Ohio. The Cincinnati VAMC is a tertiary referral 

facility. We are a highly-affiliated teaching hospital, providing a full range of patient 

care services, with state-of-the-art technology, medical education and research capabilities. The Medical Center provides comprehensive health care through primary 

care, dentistry, specialty outpatient services, and tertiary care in areas of medicine, 

surgery, mental health, physical medicine and rehabilitation, and neurology. 

Our facility is the Veterans Integrated Service Network (VISN) 10 referral site 

for a number of surgical and medical programs and a regional referral center for 

posttraumatic stress disorder (PTSD). The PTSD program at the Fort Thomas division of the Cincinnati VAMC in northern Kentucky also provides training to practitioners from various active duty military branches and other VAMCs. Our Inpatient 

Mental Health Unit is frequently visited by other VA facility staff to learn about 

our Recovery Model of Care. 

The Cincinnati VAMC has an active affiliation with the University of Cincinnati 

College of Medicine and is connected both physically and functionally to the University. Over 500 fellows, residents, and medical students are trained at the Cincinnati 

VAMC each year. In addition, there are also over 85 other academic affiliations involving dentistry, pharmacy, nursing, social work, physical therapy and psychology. 

The Cincinnati VAMC is fully accredited by The Joint Commission, the College 

of American Pathologists, the Commission on Cancer of the American College of 

Surgeons, the Commission on Accreditation of Rehabilitation Facilities, the Accreditation Council on Education, the Accreditation Council for Graduate Medical Education, the American Association of Cardiovascular and Pulmonary Rehabilitation 

and accrediting bodies for residencies in Optometry, Pharmacy and Radiology. Our 

research programs are also fully accredited. 

Over 42,000 Veterans are enrolled in VA health care through our facility. This 

number includes over 3,600 female Veterans and 3,500 Operation Iraqi Freedom 

(OIF) and Operation Enduring Freedom (OEF) Veterans. Growth in terms of enrolled Veterans has increased by over 4 percent this fiscal year (FY) and approximately 25 percent over the past 5 years. We also have seen a 13percent increase 

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(322 cases) in surgeries performed and a 15 percent increase in referrals from other 

VAMCs this fiscal year compared to FY 2012. 

The Cincinnati VAMC recently volunteered for the first VA survey of our Patient 

Aligned Care Team (PACT)/Medical Home Program by The Joint Commission and 

was commended for the quality of care and services we provide. Seventeen out of 

43 four-person teams (physician, nurse, licensed practical nurse, and clerk) received 

national PACT recognition from the Veterans Health Administration. We also recently implemented a Hospital in Home Program that has enrolled over 100 Veterans since February 2013. This program has allowed us to avoid admission of Veterans to an inpatient unit by providing daily services in the home, thus avoiding 

some health care expenses. Since the program began in February 2013, we estimate 

a cost savings of over $700,000 and a 245-day reduction in Bed Days of Care. 

Our facility continues to grow in order to meet increased demand for services. 

Construction projects include a recently-completed parking garage, a new imaging 

center, patient-centered renovations to our first floor, a new research building which 

will break ground in September 2013, an off-campus, state-of-the-art Eye Center, an 

ambulatory surgery center, and an expansion of our operating rooms. We also have 

a number of construction projects of interest to include: a Sleep Study Center, a new 

Traumatic Brain Injury (TBI) Clinic and new Community-Based Outpatient Clinics 

in Florence, Kentucky and Georgetown, Ohio. 

The Cincinnati VAMC has 15 full-time staff in the OEF/OIF/Operation New Dawn 

(OND) clinic providing primary care, mental health care, social work services, and 

pain management care for military personnel returning from Iraq, Afghanistan, and 

all recent combat theatres. Efforts to reach returning military personnel involve redeployment briefings, post-deployment briefings, family readiness meetings, local 

Veterans Service Organizations meetings/functions, community events and letters, 

and personal phone calls to recently-discharged Servicemembers. Our pilot Veterans 

Integration to Academic Leadership Program (VITAL) places a psychologist on local 

college and university campuses with the sole task of connecting with student Veterans and providing services on-site. The Post Deployment Integrated Clinic model 

of care and outreach efforts by the Cincinnati VAMC staff for the OEF/OIF/OND 

population are considered best practices within VA. As a result, we have been able 

to enroll approximately 65 percent of eligible OEF/OIF/OND Veterans in our 

catchment area. 

One of the most exciting new initiatives at the Medical Center is our Tele-Intensive Care Unit (ICU), which allows the delivery of critical care services across a geographic distance through the use of electronic devices and connections. Critical care 

nurses and physicians perform sophisticated 24/7 remote monitoring of Veterans in 

VA critical care units throughout the State of Ohio and soon will be monitoring 

critically-ill Veterans in the VA Southeast Network (VISN 7). 

Trauma Recovery Center 

The Cincinnati VAMC’s Trauma Recovery Center consists of an outpatient PTSD 

clinical team (PCT) and a Residential PTSD Program. The PCT offers eligible individuals individual family education, medication management, and evidence-based 

PTSD treatments in individual, group, and couples formats including Prolonged Exposure and Cognitive Processing therapy (CPT), Couples-Based PTSD treatment, 

Virtual Reality Therapy and Dialectical Behavior Therapy. 

The Residential PTSD Program, described in Veterans Health Administration 

(VHA) Handbook 1162.02, Mental Health Residential Rehabilitation Treatment Program, is a 7-week, cohort-based program for men and women and an 8-week program for Veterans with PTSD and a history of TBI. The Residential programs are 

unique and highly-successful programs that have been featured in national media 

for their patient-centered, evidence-based treatment programs for PTSD. In addition 

to utilizing CPT, the residential groups focus on anger, communication, distress tolerance, life skills, interpersonal effectiveness, nutrition, communication, and sleep. 

The women’s residential program was identified as a best practice, and the TBI/ 

PTSD residential program is the only one of its kind in the Nation. 

The Cincinnati VAMC also provides care and services, including counseling, to 

Veterans who have experienced military sexual trauma (MST) and come to VA for 

care. Under Title 38 United States Code, Section 1720D, VA is authorized to provide 

counseling and appropriate care and services, as required, to Veterans to overcome 

‘‘psychological trauma, which in the judgment of a mental health professional employed by the Department, resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the veteran was 

serving on active duty or active duty for training.’’ Section 1720D defines sexual 

harassment as ‘‘repeated, unsolicited verbal or physical contact of a sexual nature 

which is threatening in character.’’ 

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Mental Health Care 

Mental health services at the Cincinnati VAMC are unified under a multidisciplinary Mental Health Care Line (MHCL). A comprehensive variety of mental 

health services is offered by the seven divisions of the MHCL. The divisions are 

Outpatient Mental Health, Substance Dependence, Assessment and Intensive Treatment, Trauma Recovery Center, Domiciliary Care for Homeless Veterans, Community Outreach, and Special Services. Presently, the MHCL employs 30 psychiatrists, 

53 psychologists, 72 social workers, and 83 nursing personnel. The total number of 

staff working for the MHCL is 303. From FY 2007 to FY 2012, our MHCL staffing 

grew approximately 74 percent, and the number of Veterans treated grew 55 percent. In the first 10 months of FY 2013, the MHCL provided care to approximately 

15.5 percent more Veterans than were seen over the similar period in FY 2012. That 

amounts to an additional 1,482 unique Veterans. During this period of growth, the 

Cincinnati VAMC has been successful in recruiting highly-qualified, mental health 

staff in all professions. 

VHA has developed many metrics to monitor performance in the delivery of mental health services. These monitors include the following: 

1) Patients who are discharged from acute inpatient mental health treatment 

have follow up within 7 days. VHA’s goal is that 75 percent of Veterans in this category should have contact. This year, the Cincinnati MHCL has successfully contacted approximately 85 percent of Veterans discharged from acute inpatient mental 

health treatment for follow up. 

2) Qualifying Veterans should have a Mental Health Treatment Coordinator 

(MHTC) assigned to them. VHA’s goal is that 75 percent of qualified Veterans 

should be assigned an MHTC. The Cincinnati MHCL currently has approximately 

85 percent of qualifying Veterans assigned to an MHTC. As new Veterans access 

Mental Health services, assignment of an MHTC is part of the treatment planning 

process. 

3) In the OEF/OIF/OND clinic, Veterans diagnosed with PTSD who agree to treatment are expected to have 8 evidence-based psychotherapy sessions over a 14-week 

period. VHA’s target is that 67 percent of Veterans who agree to treatment receive 

8 sessions in a 14-week period. The Cincinnati MHCL is currently at approximately 

72 percent. 

4) In FY 2013, VHA began using two measures to evaluate Veteran access to mental health care. For Veterans who have established mental health treatment, the 

Medical Center tracks the percentage of Veterans who are able to schedule an appointment within 14 days of their desired date, which is VHA’s goal. The Cincinnati 

MHCL has achieved that goal approximately 99 percent of the time. For Veterans 

who are new to seeking mental health care, the Medical Center tracks VHA’s goal 

of having Veterans complete an initial appointment in 14 days or less of when the 

appointment was made. For FY 2013, the Cincinnati MHCL has provided this level 

of access approximately 83 percent of the time. In July 2013, the average wait time 

for a new mental health care patient’s first appointment was 8 days, and approximately 85 percent of Veterans had their first appointment within VA’s goal of 14 

days. In the most recent VA Strategic Analytics for Improvement and Learning report, the Cincinnati VAMC received an outstanding 5-star quality rating which included the category ‘‘Mental Health Wait Time.’’ 

While these metrics are important, we realize they tell only part of the story of 

Cincinnati VAMC’s mental health accomplishments. In addition to the aforementioned Trauma Recovery Center, Cincinnati has an array of strong mental health 

services. For example, the acute inpatient mental health ward has 20 beds and has 

received multiple national recognitions for its patient-centered, recovery-oriented 

program. The Substance Dependence Division is also strong as a leader in tobacco 

cessation treatment and ambulatory detoxification. Our opiate substitution program 

is an important resource for local Veterans. Our Primary Care Mental Health Integration Program has one of the highest rates of utilization in the Nation. For 2013 

to date, the VAMC had 1,717 tele-mental health encounters, an 89 percent increase 

over FY 2012, and as a result, increased access to care for Veterans and reduced 

requirements for travel. 

The Cincinnati MHCL has had a Family Services Coordinator for many years, 

supporting the families of Veterans with severe mental illness. We are responding 

to the new generation of OEF/OIF/OND Veterans with programs such as brief family consultation, Support and Family Education, Behavioral Family Therapy, and 

couples counseling. A VHA-funded research project, Couple-Based Treatment for Alcohol Use Disorders and PTSD, is investigating the effects of couple-based counVACREP180 with DISTILLER

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seling for alcohol dependency, PTSD, and partner relationships. The Cincinnati 

VAMC has also been chosen as a site for the Practical Application of Intimate Relationship Skills (PAIRS) program. This is a 9-hour, intensive weekend training program to improve a Veteran’s relationship with their partner. 

Homeless Programs/Initiatives 

The Cincinnati VAMC is also working actively with many other Federal, state, 

and local entities to meet Secretary Shinseki’s goal of ending homelessness among 

Veterans in 2015. The homeless programs at the Cincinnati VAMC are robust, consisting of strong outreach/community partnerships, Grant and Per Diem (GPD), 

Housing and Urban Development/Veterans Affairs Supportive Housing (HUD/ 

VASH), Health Care for Homeless Veterans (HCHV) contract beds, and Veterans 

Justice Outreach (VJO) programs. We have developed a Homeless/Low Income Resource Guide and the HUD/VASH Quarterly Newsletter that VA Central Office recognized as best practices. Our VJO program was featured in a recent rehabilitation 

accreditation newsletter, CARF International’s ‘‘Promising Practices Innovation in 

Human Services,’’ April 2013. 

On May 3, 2013, the Cincinnati VAMC held its 4th Annual Homeless Summit, 

which was attended by a broad base of community partners, including Joseph 

House, Greater Cincinnati Behavioral Health, Talbert House, Drop Inn Center, and 

Strategies to End Homelessness. Additionally, the Cincinnati VAMC works closely 

with numerous faith-based organizations, such as City Gospel Mission, Interfaith 

Hospitality Network, St. Francis/St. Joseph Catholic Worker House, Mercy Franciscan at St. John’s, and the Mary Magdalen House. 

The Community Outreach Division of the MHCL, under which the homeless programs fall, will be moving to Downtown Cincinnati this month to a strategic location 

allowing increased access and walk-in service. A portion of the division will remain 

in Fort Thomas, Kentucky to allow access for homeless Veterans in Northern Kentucky. Listed below are the homeless programs and initiatives available through the 

Cincinnati VAMC: 

GPD - We have 173 beds, including seven beds for female Veterans. Our programs run at capacity and have a high success rate, short length of stay, and low 

cost per episode. 

HUD/VASH - We have 275 vouchers in Hamilton and Clermont counties in Ohio 

and Northern Kentucky and were awarded an additional 40 vouchers for FY 2014. 

The Cincinnati VAMC was among the first medical centers in the Nation to incorporate Housing First principles within HUD/VASH by piloting a 25-voucher program in October 2010 and retooling the entire program to incorporate Housing First 

principles in March 2011. According to the Homeless Operations Management Evaluation Systems (HOMES) Database, our chronically homeless housed rate is approximately 89.26 percent, among the highest in the Nation. We finished FY 2012 

with a 94.84 percent housed rate and the Medical Center is on target to exceed that 

rate in FY 2013. 

HCHV Contract Beds - We have 12 beds (six, two-bedroom apartments) under 

this program. Each bedroom is private and locked, ensuring safety, security, and 

privacy. 

Veterans Justice Outreach - We actively collaborate with four operational Veterans Treatment/Diversion Courts and look forward to collaborating with a fifth 

court in the planning stages moving towards implementation. The addition of this 

fifth court will give us partnerships with Veterans Treatment Courts in all three 

states within our catchment area, providing Veterans with help in meeting treatment goals instead of incarceration. 

Veterans Transportation Service (VTS) 

Recognizing that increasing access to care improves health care outcomes, the 

Cincinnati VAMC began operation of the VTS in May 2012, offering both mobility 

management and transportation services. Mobility management guides Veterans to 

the most medically-appropriate and cost-effective means available through a private, 

Veteran-focused agency or public transportation resources. VTS fills the remaining 

gaps, providing door-to-door, wheelchair-accessible transportation for those Veterans 

living in the Medical Center’s catchment area who have no other viable transportation options. VTS has served 750 unique Veterans, approximately 40 percent of 

whom are wheelchair-bound, providing nearly 10,000 rides, since its inception. 

Community Partnerships 

The Cincinnati VA has been building community mental health partnerships by 

holding annual homelessness prevention summit meetings for the past 4 years. 

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Those summit meetings inspired our development of the Cincinnati Homeless/Low 

Income Resource Guide. In addition to having been cited by VHA as a best practice, 

the guide has become a highly valued document for community agencies. Based on 

events like the homelessness summits, VHA has been holding Community Mental 

Health Summits during the Summer of 2013. 

In August 2013, the Cincinnati VAMC hosted its first Community Mental Health 

Summit. At the Summit, facility leadership and staff met with 66 individuals from 

36 community agencies. The facility was joined by staff from the local delegation 

of Members of Congress, one state agency, one county agency, and six universities. 

Presentations were made on the following topics: 

University Liaison. The Cincinnati VAMC has a well-established outreach program which partners with local colleges and universities to ease the transition of 

Veterans seeking higher education. 

PTSD Treatment. Cincinnati MHCL discussed its programs with Dr. Chard 

speaking on this topic. 

Suicide Prevention. Each VAMC has been allocated at least one full time suicide prevention coordinator. The MHCL has 3 full time social workers devoted to 

this task. VHA works steadily to reduce stigma associated with receiving mental 

health care. VHA has declared that September 2013 is Suicide Prevention Month, 

and VHA is sponsoring the public service announcement ‘‘Talking About It Matters’’. 

During September 2013, the Cincinnati MHCL Suicide Prevention team will give 11 

presentations in the community focusing on eliminating the stigma that complicates 

preventing suicides. 

At the Mental Health summit, there was considerable open exchange of detailed 

information about mental health programs and services available through VA and 

in the community. This was an opportunity to share ideas and promote further collaborations. Particular suggestions that emerged included annual follow-on summit 

meetings and for MHCL to develop a simple telephone access to respond to Community Agency queries about MHCL services. 

Conclusion 

VHA and the Cincinnati VAMC are committed to providing the high-quality care 

that our Veterans have earned and deserve, and we have continued to improve access and services to meet the mental health needs of Veterans residing in Cincinnati 

and the local surrounding area. We appreciate the opportunity to appear before you 

today, and we appreciate the resources Congress provides VA to care for Veterans. 

Dr. Chard, Ms. Bunag-Boehm, Mr. Watiker, and I are happy to respond to any questions you may have. 

Æ 

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