June 13, 2008 – Rep. Bob Filner (D-Calif.), chairman of the House Veterans Affairs Committee, charged Bush administration officials Wednesday with continuing to downplay the mental trauma and brain injuries suffered by veterans of wars in Iraq and Afghanistan.
Filner said an April RAND Corp. study, “Invisible Wounds of War — Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery,” justifies a tenfold jump in the U.S. casualty count versus the figure of 33,000 American dead and wounded used by the Pentagon.
RAND researchers extrapolated from a survey they conducted of 1,965 veterans to conclude that nearly 300,000 service members and veterans of Iraq and Afghanistan wars are suffering from post-traumatic stress or major depression. Filner told the pair of researchers, who had summarized their findings for his committee, that their work probably understates the problem.
“I personally think these are low estimates, just from my own studies,” Filner said. “But if you take even the 300,000, (it’s) 10 times the official casualty statistics from the Pentagon. Shouldn’t this 300,000 be included?”
Lisa H. Jaycox, a senior behavioral scientist and clinical psychologist who co-directed the RAND study, embraced Filner’s argument.
“Well, they are (suffering) an injury condition resulting from combat deployment, and so it’s a different kind of casualty,” Jaycox said. “But, yes, they are very important numbers.”
At the same hearing, Michael L. Dominguez, principal deputy under secretary of defense for personnel and readiness, said RAND had gathered solid data from its survey but then drew the wrong conclusions. The study, Dominguez said, “did not, and cannot, definitively say that there are 300,000 cases of clinically diagnosed cases” of post-traumatic stress disorder or depression among veterans who served in the two theaters of war.
Filner angrily interrupted him, telling Dominguez that RAND didn’t claim to show 300,000 clinically diagnosed cases of PTSD or depression. “It was an extrapolation to the possibility” of 300,000 cases, Filner said.
With over 1.6 million U.S. service members having served in Iraq or Afghanistan, Dominguez said, a finding that 300,000 veterans “have experienced some kind of mental health stress is very consistent with our data. And those people do need to be discovered (and) to get help.”
But, he continued, “many of them will, with very little counseling or assistance, resolve those combat stress issues themselves. A few — a few — will in fact manifest a clinical diagnosis of PTSD and they’ll need much more sustained intervention by medical health care professionals.”
“How many is a few?” Filner snapped.
The results so far, Dominguez said, show “less than one percent will actually have clinical PTSD that will need treatment over…”
“You believe that?” said Filner, cutting him off with sarcasm. “You believe that there are less than one percent of these deployed soldiers will have PTSD as a clinical diagnosis?”
Dominguez was stunned into silence momentarily but finally managed, “So far this is the number that we are seeing.”
“That shows why you don’t do anything,” Filner said, “because you think there’s only a few.”
Another purpose of the three-hour hearing, which included testimony from retired Navy Rear Adm. Patrick W. Dunne, assistant secretary for policy and planning for the Veterans Benefits Administration, was to assess progress by DoD and VA in implementing Wounded Warrior legislation passed in January in response to the Walter Reed scandal last year.
Dominguez and Dunne conceded that some congressional deadlines haven’t been met, including a late April target for establishing a Wounded Warrior Resource Center to give recovering service members, their families and primary caregivers a single point of contact for assistance.
But Dr. Terri L. Tanielian, co-director of the RAND study, acknowledged to Rep. Steve Buyer (R-Ind.) that the Wounded Warrior initiatives have set the Departments of Defense and VA “on the right track” for addressing most war-related mental health challenges.
The big hurdle now to proper care for many mentally wounded veterans is clinical capacity nationwide, Tanielian said. The pipeline for training mental healthcare providers in the most effective therapies for PTSD used by VA needs widening, she said, and that requires “transformation and system-level changes across the entire U.S. health care system.”
Filner, meanwhile, wants every service member and veteran who has served in Iraq or Afghanistan to receive a mandatory examination, which should include at least an hour with a clinician trained to detect the symptoms of PTSD, depression and even mild cases of traumatic brain injury.
In his tirade at Dominguez and Dunne, Filner said that, between the two of them, “I think there’s been a contest to see who can suck the humanity out of this issue better… I mean, we’re talking about our children!
“We’re talking about life and death! We’re talking about suicides… homelessness… a lifetime of dealing with brain injuries! And you guys sit there without anything to say. This is absolutely unacceptable.”
He asked Dominguez if he also disagreed with RAND that 320,000 veterans of Iraq and Afghanistan have a probable traumatic brain injury.
“Again,” said Dominguez, “you don’t have 320,000 brain injuries. You have 320,000 people who have been in or around a concussive event.
“Again, it’s a spectrum of experience (versus) a spectrum of need that manifests itself. So, no, there is not 320,000 people out there with brain injuries.”
That attitude, Filner charged, encourages clinicians to misdiagnose conditions so veterans are denied the care they need and the compensation they deserve. Dominguez took strong exception to those remarks.