The House Veterans Affairs Committee heard testimony Wednesday that was both encouraging and disturbing about PTSD programs and allegations that some vets are faking symptoms to get a disability check.
The Department of Veterans Affairs has greatly expanded its treatment programs for mental health problems overall, and for post-traumatic stress disorder in particular, said Dr. Harold Kudler, acting assistant deputy under secretary for Patient Care Services at the VA.
In fiscal 2016, the VA provided mental health treatment to 1.6 million veterans, up from 900,000 in 2006, Kudler said. Of the overall figure, 583,000 "received state-of-the-art treatment for PTSD," including 178,000 who served in Iraq and Afghanistan, he added.
Kudler said the number of Operation Iraqi Freedom, Operation Enduring Freedom and Operation New Dawn veterans receiving VA treatment for PTSD has doubled since 2010, while VA services for them have increased by 50 percent.
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In addition, the VA is increasingly open to alternative treatments for PTSD, including the use of hyperbaric chambers and yoga, but an Army veteran who went through VA treatment for PTSD said the expansion and outreach leave the program open to scams by veterans looking to get a disability check.
Brendan O'Byrne, a sergeant with the 173rd Airborne Brigade who served a 15-month tour in the remote Korengal valley of eastern Afghanistan, told the committee he was overwhelmed by "crippling anxiety, blinding anger" compounded by drinking when he left the service in 2008.
After four years, he was given a 70-percent disability rating for PTSD and was immediately advised by administrators and other veterans to push for 100 percent to boost his check, O'Byrne said.
"Now, I don't know if they saw something that I didn't but, in my eyes, I was not 100 percent disabled and told them that," O'Byrne said. But they continued to press him to go for a higher rating. His arguments for a lower rating went nowhere, he said.
In VA group counseling sessions, "I realized the sad truth about a portion of the veterans there -- they were scammers, seeking a higher rating without a real trauma. This was proven when I overheard one vet say to another that he had to 'pay the bills' and how he 'was hoping this in-patient was enough for a 100-percent rating.' I vowed never to participate in group counseling through the VA again," O'Byrne said.
"When there is money to gain, there will be fraud," he said. "The VA is no different. Veterans are no different. In the noble efforts to help veterans and clear the backlog of VA claims, we allowed a lot of fraud into the system, and it is pushing away the veterans with real trauma and real PTSD."
Committee members, who are accustomed to hearing allegations of fraud and waste within the VA but rarely about scamming by a veteran, did not directly challenge O'Byrne's allegations, but Rep. Mike Bost, R-Ill., told him he was unique. "That's the first I've ever heard of a vet wanting to reduce the amount of benefits they're receiving," Bost said.
O'Byrne was a central figure in the book "War" by author Sebastian Junger, who also testified at the hearing on "Overcoming PTSD: Assessing VA's Efforts to Promote Wellness and Healing."
Junger said society must share the blame for the prevalence of PTSD. "Many of our vets seem to be suffering from something other than trauma reaction. One possible explanation for their psychological troubles is that -- whether they experience combat or not -- transitioning from the kind of close communal life of a platoon to the alienation of modern society is extremely difficult."
Then there is politics. "In order for soldiers to avoid something called 'moral injury,' they have to believe they are fighting for a just cause, and that just cause can only reside in a nation that truly believes in itself as an enduring entity," Junger said.
"When it became fashionable after the election for some of my fellow Democrats to declare that Donald Trump was 'not their president,' they put all of our soldiers at risk of moral injury," he said.
"And when Donald Trump charged repeatedly that Barack Obama -- the commander-in-chief -- was not even an American citizen, he surely demoralized many soldiers who were fighting under orders from that White House," Junger said. "For the sake of our military personnel -- if not for the sake of our democracy -- such statements should be quickly and forcefully repudiated by the offending political party."
The allegation that some veterans are bilking PTSD programs is not a major concern for Zach Iscol, a Marine captain who fought in Fallujah and now is executive director of the non-profit Headstrong Project.
"If there are people taking advantage of us, that's OK, because we have a bigger mission," Iscol said, but he also noted that Headstrong does not give out disability payments.
In partnership with Weill Cornell Medical College, the project's goal is to provide free assistance with experienced clinicians to post-9/11 veterans for a range of problems, from PTSD to addiction and anger management.
Iscol said Headstrong currently has about 200 active clients, and "on average it costs less than $5,000 to treat a vet." He cautioned there are no panaceas for treating PTSD, and "there's no simple app that will solve this problem. I don't think you can design a one-size-fits-all for mental health."
The witnesses and committee members agreed that PTSD is treatable, but disagreed over the types and availability of treatment programs and whether the VA is adequately funded to provide them or should rely more on non-profits.
The issue of the estimated 20 suicides by veterans daily came up briefly when Rep. Jack Bergman, R-Mich., a retired Marine lieutenant general, questioned Kudler on VA programs to bring down the rate.
VA Secretary Dr. David Shulkin has made combating veteran suicides a major priority and has focused on making treatment available for veterans with less than honorable discharges.
Kudler said there is a "counter-intuitive" involved in addressing the veteran suicide problem. About 14 of the 20 daily suicides involve veterans who never deployed and experienced combat trauma, he said. "It would be premature to say we know why."
-- Richard Sisk can be reached at Richard.Sisk@Military.com.