Thomas J. Berger, Ph.D

Remarks submitted by Thomas J. Berger, Ph.D., Chair, PTSD & Substance Abuse Committee, Vietnam Veterans of America

No soldier goes to war and comes back unchanged.

There is no longer any doubt that the trauma of war inflicts mental health injuries that are every bit as real as the physical wounds inflicted by bullets and bombs. If left untreated, psychological traumas such as Post Traumatic Stress Disorder (PTSD) can affect combat veterans to the point that, over time, even their daily functions become seriously impaired. This places them at higher risk for self-medication and abuse with alcohol and drugs, domestic violence, unemployment and underemployment, homelessness, incarceration, suicide, and even medical co-morbidities such as cardiovascular diseases and cancer.

No one really knows how many of our troops in Iraq and Afghanistan have been or will be adversely affected by their wartime experiences. And despite some early interventions by military psychological personnel, no one really knows how serious their emotional and mental problems will become, nor how chronic will be both the neuro-psychiatric wounds and their impact on physical health. Given the nature of the conflicts in Iraq and Afghanistan and the fact that many service members are serving multiple combat tours, Vietnam Veterans of America (VVA) has no reason to believe that the rate of PTSD for veterans of OEF and OIF will be any less than that found for Vietnam veterans. What is beyond argument is that the more combat exposure a soldier sees, the greater the odds that he, and increasingly she, will suffer mental and emotional stress that can become debilitating. And in wars without fronts, 'combat support troops' are just as likely to be affected by the same traumas as infantrymen.

Female veterans returning from war face ailments and traumas of other sorts: More than 400 military women working in Iraq, Afghanistan and the SW Asia region have reported they were victims of sexual assault from 2003 through May, according to the U.S. Department of Defense. More female soldiers report mental health concerns than their male comrades: 24 percent compared with 19 percent, according to a Pentagon study released in March. Roughly 40 percent have musculoskeletal problems that doctors say likely are linked to lugging too-heavy and ill-fitted equipment. A considerable number - 28 percent - return with genital and urinary system infections. There are gender-related societal issues that make transitioning tough, psychologists who work with female veterans say. Women are more likely to worry about body image issues, especially if they have visible scars, and their traditional roles as caregivers in civilian life can set them back when they return. Currently there is debate about the exact influence of combat-related trauma on suicide risk. For those veterans who have PTSD as a result of combat trauma, however, it appears that the highest relative suicide risk is observed in veterans who were wounded multiple times and/or hospitalized for a wound. This suggests that the intensity of the combat trauma, and the number of times it occurred, may influence suicide risk in veterans with PTSD. Other research on veterans with combat-related PTSD suggests that the most significant predictor of both suicide attempts and preoccupation with suicide is combat-related guilt8. Many veterans experience highly intrusive thoughts and extreme guilt about acts committed during times of war. These thoughts can often overpower the emotional coping capacities of veterans. Since combat began in Afghanistan in October 2001, nearly 20,000 American military personnel have been wounded in action, according to the Defense Department. Many of these injuries have been life-threatening, requiring multiple surgeries, extensive rehabilitation and ongoing care. But the immediate financial and logistical challenges of coping with the thousands of severely wounded are just two of the problems military and civilian authorities face. Down the road, these active-duty, reservist and Guard military personnel will need employment, housing as well as both mental and physical health-care assistance for years to come. Accordingly, with the conflicts in Afghanistan and Iraq continuing with no end in sight, it is likely that more will be killed or wounded in action. Therefore VVA believes the veterans of America's current wars in SW Asia must be guaranteed the following through Congressional leadership and oversight:

• Resources for and access to diagnoses and effective treatment of complex physical wounds, including those for polytrauma injuries

• Resources for and access to accurate diagnoses and evidence-based effective treatment and recovery services from traumatic psychological injuries, including PTSD, MST and TBI (i.e., Traumatic Brain Injury)

• Effective and accountable delivery of integrated benefits, services and programs at both federal and state levels

• Development and effective, accountable delivery of educational programs and support services for veterans' families

There are numerous other points that I could make today, but I will close for now. Thank you for your kind attention. Upon conclusion of today's program I will be pleased to answer any questions you may have.