we have got nato. we've got the united nations. we've got the arab league. we have right on our side the pressure is building militarily, diplomatically, politically and time is running out for gadhafi. on the defense review, i would simply say this, for 10 years they have a defense review and now they want two in a row. at the end of this review we have the fourth highest defense budget for any country in the world. we have superb armed forces, superbly equipped and they're doing a great job in the skies above libya. >> thank you, mr. speaker. by the time prime minister's question time finishes, 450 children will have died from preventible disease and famine. is it not the case that increasing britain's aid budget is very much the right thing to do and will save millions of lives across the world? >> well, i very much welcome the support from the honorable gentleman for the policy of

increasing our aid budget and meeting the 1.7% target of gross national income. i think there is good reasons for doing this. i think we're keeping our promise of the poorest people of the world and we are saving world. and, of course, things are difficult at home but i think we should keep that promise even in the midst of difficulties. the second point i would make is we're making sure our aid budget is spent very specifically on things like vaccinations for children that will save lives. and the money we announced this week will mean a child vaccinated every 2 seconds and a life saved every 2 minutes and the last point i would make to anyone who has doubts about this issue is i really do think that as well as saving lives, it's also about britain standing for something in the world and standing up for something in the world, the importance of having a strong aid money-saving lives, mending broken --

>> mr. speaker, in this -- in this week when we celebrate the contribution of birmingham's care assistance and the lobbying families who lock after their loved ones, will the prime minister join with me in condemning birmingham city council for cutting care to 4,100 of the most vulnerable in our city branded unlawful by the high court and can i ask the prime minister what does he intend to do to ensure that the birmingham city council fail the elderly and the disabled? >> i think everyone in the house should recommend it is care week and i'll be celebrating with many people who take part and who are careers and the government is giving them more breaks and specifically nugget 800 million pounds for those looking after disabled children get regular breaks has what we have in birmingham is an

excellent conservative and liberal democrat alliance doing a very good job recovering from the complete mess labour made of that city for decade after decade. >> last night on channel 4 television there was a documentary called the killing fields showing the atrocities by the sharelakan government which resulted in about 40,000 people being killed. >> would the prime minister join me in calling for justice for the people who lost their lives? >> well, i didn't see the documentary but i understand it was an extremely powerful program. and it refers to some very worrying events that are alleged to have taken place towards the end of that campaign. and what the government has said, along with other governments is that the sri langan government needs to be investigated. >> was the prime minister aware of the shambles which is the

eurasian natural resources corporation. i would expect him to give explicit comment and specific comment on that but does he agree on behalf of million patient holders and small shareholders across the country that standards -- high standards of corporate governance in the city of london is absolutely critical of the role of the supporting of it? >> i'm aware of this monday and the honorable gentleman makes an important point and we want companies to come to london and to focus on the markets and it's one of the attractions in britain that we're an open global economy but when those companies come we do have rules of corporate governance that is, therefore, a reason and they need to obey those rules and i'm sure my friend the chancellor will be addressing this not only in his speech tonight but also in the papers that we'll be publishing in subsequent days. >> thank you. does the -- mr. speaker, does the prime minister agree with me that had they not adopted the

economic policy task rather than listening to the shadow chancellor mortgage interest rates could be 5% higher than what they are now? >> my honorable friend makes a very important point, today, tragically we have greek levels of debt but we've got german interest rates. that is an enormous monetary boost to our economy and we should all welcome the cut in unemployment today. now, if we hadn't taken action on the deficit, if we hadn't proved to the markets that we had a way of paying back the debt and the deficit, we'd be straight back in the mess that that lot left us in. >> order. we must now move on. statement to the secretary of state for international development. ñññññññññ

>> now the house veterans affairs committee looks into mental health care for veterans. they hear first from iraq war veteran daniel hanson who talks about his post-traumatic stress disorder. we'll also hear from physicians who treat ptsd. this is 2.5 hours. >> good morning. thank you to our witnesses who are in attendance. our hearing this morning is entitled, mental health, bridging the gap between care and compensation for veterans. on may 10th, the united states

court of appeals in the ninth circuit issued a decision that was heavily critical of the care and compensation that va provides to veterans with mental illness. the court cited va's unchecked incompetence, the unnecessary grief and privatization that delays in treatment and benefits caused veterans and families. i'm not here this morning to judge the court's decision. i'll leave that to others. the heart of the court's analysis of the issue is something with which all of us need to be concerned. namely, as va's system of care and benefits improving the health and wellness of the veterans that are suffering from mental illness. on behalf of a grateful nation we've invested heavily over this last decade and make treatment options that experts say are effective more readily available. but the question remains, are

veterans especially those returning from combat with the invisible wounds of war on a road of recovery and able to live full and productive lives. recovery, restoration and wellness, these should be the overamping objective of all va's programs. when i look at the trends and disability ratings with veterans with mental illness i see a very confusing picture. on one hand we have a medical system that boasts of evidence-based therapies, improved access and high quality of care. and on the other hand, we have data from va indicating that veterans with mental illness only get progressively worse. these confounding facts raise the question, are va's health and disability compensation programs oriented towards va's mission of recovery and of wellness? and i'm not the first who's noted this trend or suggested the need foreclosure integration

plans. in 2005 a report from the inspector general concluded the following and i quote based on our view of the ptsd claims files, we observed that the rating evaluation level typically increased over time indicating the veterans ptsd condition had worsened, generally once a ptsd rating was assigned, it was increased over time until the veteran was paid at the 100% rate, closed quote. we have a 2007 report from the veterans disabilities benefits commission and we'll hear from the share of that commission on our second panel this morning. it recommended, quote, a new wholistic approach to ptsd should be considered. this approach should couple ptsd approach and revocation and commonsense assessment, closed quotes. most recently we have the administration raising red flags

in its 2010 performance and accountability report, the va commented on how well its veterans benefits administration collaborates with the vha when providing services to veterans with mental illness. the report suggested with recovery as the essential goal to helping veterans with ptsd, that perhaps vba and vha was working at cross-purposes. let me quote from that report. the advent of the recovery model is central to the treatment of mental health and disorders. the current system fails to support and may even create disincentives to recovery, closed quotes. today we're going to move beyond the numbers that simply tell us how many veterans use the system and get into the fundamental whether they are on the road to leading full and productive lives. for veterans who don't seek va care, we need to know why they're not seeking that care. we need to know if there are inherent disincentives to

recover. we need to know if the quality of treatment provided at va is a reason to seek care elsewhere and we need to know what is effective and what is not effective. quoting from a recent policy paper from the wounded warrior project, va focusing on the high percentage of veterans who have been treated beg such questions as how effective was that treatment and how many more need treatment but resist seeking it? and i couldn't agree anymore. it's our duty to ask these tough questions and the veterans for whom these tough questions demanded on us. we have mr. daniel hanson. dan served in iraq and then came home troubled in mind trying to cope with the loss of so many of his fellow marines. this is atory i hope everyone listens to closely today. it's a cautionary tale where we may be inadvertently headed. looking back, dan has some interesting thoughts of what would have taken him -- what it would have taken him to get into

treatment sooner. and it's just as important it's got something to say about how he untimely or ultimately, excuse me, found help outside the va system. on our second panel we have dr. sally satell resident scholar at the american enterprise institute. the doctor will share with us the principles surrounding what she believes would be a more effective system of care and compensation for veterans seeking mental health treatment. as i mentioned we also have the former chairman of the veterans disability benefits with us general terry scott. we also have a va clinician dr. karen seal who will share with us her findings on the health care utilization of iraq and afghanistan veterans. and finally on our third panel we'll hear from the administration and share views and the views of two important veterans organizations, amvets and the wounded warrior project. i want to thank everybody

coming, members and those in the audience, those who are going to be testifying and i now yield to our ranking member. >> thank you, mr. chairman. and thank you for taking the leadership on this subject. of course, we have all raised serious concerns over many years about the backlog of claims and now there are a record of service men and women returning homes with scars from the war and now simply is not the time to delay their benefits. the report you mentioned, that was released last year by the va inspector general focusing on the delay of our service members getting an appointment for medical exam in order to process their claim for compensation is just one more example of how the va seems to be failing our veterans. that system has many obstacles for our warriors by putting them through numerous medical exams for each individual ailment for which they are filing a claim. the va, i think, could easily stream this process and allow

the veteran to receive one complete medical exam to expedite the claims process, alleviate the stress on our veterans and save our veterans and taxpayers money. you mentioned the recent decision by the ninth circuit court of appeals in veterans for commonsense and veterans united for truth versus sinseki and the veterans have a property interest to both va benefits and health care. ruling for the plaintiffs and to conclude that because there are property interests delaying access to health care claims violates veterans due process rights guaranteed by the fifth amendment. unlike you, i don't want to take a judgment on that ruling, i fully support the ruling. and i'm disappointed va has not done more rapidly to fix the problem. we know that every day 18 veterans of this nation commit

suicide. we also know that 1 in 5 service members of our current conflicts will suffer from ptsd. and, unfortunately, the suicide rate for these brave men and women is about one suicide every day 36 hours. many of them as outlined by the recent ninth circuit court ruling will be left undiagnosed, untreated and uncompensated. this is a travesty and an outrage. last year, the va inspector general's office made recommendations for the veterans health administration, the veterans benefits administration to collaborate more effectively and to share more information on issues affecting the timely delivery of exams. i'm disappointed as you are, mr. chairman, that we are still discussing this issue 15 months after those findings and recommendations. the va is simply not committing sufficient resources to meet the demands of our warriors when they return home. i hope the va will address these shortfalls and i expect them to come to the table with a plan to

fix the problem. mr. chairman, i would like you look forward to this testimony. >> thank you very much. virgin >> i would welcome dan hanson to the table. we appreciate you being here sharing you are your story, thank you for your service to your country and you're recognized for your statement. >> thank you, mr. chairman. i appreciate the opportunity to speak in front of the men and women that change our country so thank you. i'll get into why i'm here, with a brief testimony. i grew up in south st. paul, minnesota. i came from a large family. i went through high school. eventually, i joined did marine corps after two of my brothers did before me. i actually thought about joining the air force but they said they would break my arm, but so i

joined the marine corps. in 2003. and shortly after i was deployed to ramadi, iraq, in 2004, and it was a deployment that started with one of our marines shooting himself in the head. just kind of brushed that under the table and then 34 marines we lost throughout the deployment. had about 400, 450 marines injured. came back and went on leave and that was -- that was that. i started drinking pretty heavy. dealing with nightmares, dealing with things that wasn't really i was prepared to deal with, i would say. and i think one of the biggest reasons that i dealt within myself is because i was in a battalion of 1,000 marines and i don't think people wanted to hear my whining and complaining. and then shortly after we went in another deployment, noncombat, which just kept on drinking, kept on masking my

issues with whatever -- whatever would take away any of the pain. came back and then about six months later my unit was deployed again to iraq. this time i was behind the elements so i was kind of able to see the other side of things when we would get the casualty reports. we would get the kai's in and would have to notify and take, you know -- beyond that and anything as well. i decided that i was going to get out of the marine corps. but i was persuaded by a good friend sergeant major ellison in afghanistan. and he ended up getting killed and i ended up going to his funeral and a friend in second battalion fourth marines hung himself in the basement of his home. that kind of got me twirling out of control just before i was going to get out of the marine corps. and then finally on march -- i got discharged in february, 2007, and then on march 23rd,

2007, my brother who was also in the marine corps, he hung himself in the basement of his home. and at that point i think i decided i was going to do everything to avoid pain. that i was going to do everything to deal with it myself as i had been doing for the last three or four years. and i got into drugs. i got into alcohol. i got into whatever it was that would mask the pain that day. eventually i attempted to kill myself. i ended up in the st. cloud va medical center about 48 hours in lockout and then i was released and off to do whatever it is that i wanted to do which was go back to work because that seemed like the normal thing to do. after something like that. and eventually i found myself in and out of jail. not -- and i was getting treated on an outpatient basis for a while at the va medical center. but when you were as messed up

as i was it takes a lot more than one, you know -- one or two sessions a week to get through my issues. and so i eventually found my way into a dual diagnosis program to get help. it was mostly to avoid a longer stint in jail for my duis. eventually i got out after about 30 days. i think i started drinking the next day. about a year later i found myself in jail for i don't know the sixth or seventh time. and i decided for myself that i was done hurting myself. i was done hurting my family. i was done hurting my children. and i checked into a 13 to 15-month faith-based program that was what changed my life. about a week after jail, i stopped going to work. stopped going to school and i decided i wasn't going to be very productive unless i got help and that's what i did at minnesota teen challenge. it was more of a wholistic approach. it was -- i went to the va once a week to get help in combat and

military-specific issues and then i would stay there, you know, seven days a week. i wasn't able to get any funding through the va because it was not -- it was not a va-funded program, therefore, i got backed occupy bills. i wasn't able to pay things and eventually filed bankruptcy. so in my dealings with the va medical center, i always felt like i was in control, i was running my own rehabilitation although i couldn't even, you know, put my shoes and socks on most days. i felt like whatever i wanted to do, mr. hanson, whatever i thought what i wanted to do for me. what i thought was best for me was to get drunk and get high and forget all my troubles and forget all about my nightmares and pass out with a bottle in my hand. it was something i believe that could have been ended a lot shorter if i would have been

able to be forced or somehow just -- i felt like the va's role in my treatment over the last several years was more of a friend relationship instead of a parent relationship. where it wasn't, hey, you need to do this or else. it was, hey, you know, something is wrong we got things that can help you. you seem like, you know, you've been through some things. what can we do to help you? so i appreciate the time and the honor to speak in front of you. thank you, mr. chairman. >> thank you very much for your eloquence. you had a written statement and you didn't even look down at it. what you said obviously came from experience and from the heart. thank you for your service to our country. and thank you for your service and your continued desire to not only seek help for yourself but your fellow veterans who are out there. i'm interested in your written

statement. you said i know that when i was discharged from the marine corps i was not a healthy individual. but i certainly would not have let anyone know that. and i think why do you think it was so hard for you to speak up about needing help and, you know, what can we do as members of congress to help improve the system, you know, where there is a way to encourage people to seek the help that they need? >> yes, mr. chairman. i knew i was very messed up when i got out of the marine corps. it was apparent -- people told me you're not the same person. you're angry. and i was drinking. and i was -- i was depressed. and it was apparent to me -- and to go back a little bit, in the marine corps, my primary m.o.s. was a 0 in 5 which is administrative in nature. so i was attached to second battalion fourth marines a grunt unit sent to iraq so i

immediately felt like i didn't deserve to get help because i wasn't 03. i was an infantry by trade so, therefore, the things that i saw were things that are natural and, therefore,, you know, in kind of need to suck it up. so when i got out of the marine corps, you know, i started seeking treatment at the va. i felt like i didn't get help because if i admitted there was something wrong with me, there was something wrong with me. and the va, though, they were there and they were supportive, they never really said this is what's going to happen if you continue and you don't get help. you need to get help or if you don't get help, you're not going to get this disability check that, you know, you go and spend on booze and the strip club to be very frank. and that's what i did and so i think the biggest reason i didn't get help because i felt ashamed. i felt like i didn't -- there was another bed for someone more deserving than myself. and that was the main reason, mr. chairman. >> you raised two important issues in your testimony.

first, you said that although you needed to get help and you chose not to get it because and this is your own words i was afforded not to and explain what you meant by that and then also how common do you think that is for individuals not to seek help because they have other avenues in which they can go? and also how many out there who need help but don't get it because they can afford not to? i mean, do you think it's a large group? >> i do, mr. chairman. i obviously don't have an exact number, but i have plenty of friends that i feel, you know, who get their disability check and they're comfortable with it. they get it for, you know, whether it's a mental illness or a physical illness and a lot of the goal is to get it bumped up. and that way you don't have to, you know, it's $800, $1,000 that

you don't necessarily -- i shouldn't say work for but it makes life easier and for me, as you said i could afford not to because it was kind of supporting my alcohol problems, my -- and i'm not saying -- i mean, it's helped me tremendously but when i was in the -- in my mix, when i was unhealthy and making poor decisions, it was just a way for me to support my addiction, essentially, and i know plenty of people that i was friends with and that i served with that, you know, it's kind of the same thing. where it's a convenience thing. you know, it pays certain bills and it does certain things, so why get help when that will take away from the money you're making every month essentially. money that goes in the bank. >> thank you, mr. hanson. it's not easy to talk about your own life here, but in your written testimony you do mention certain things you think the va

could do to serve you and your comrades better. you want to go over those besides the one you just mentioned to the chairman? >> yes, sir. i felt that very often it was just kind of -- i was another number in a revolving door. i never felt there was much of an actual care; whereas, when i actually did go to minnesota team challenge i felt there was an actual effort for me to get help, to get better not because of it was their job because it was something they were passionate about. and that was a big part of it for me. and another big part of it for me i was able to go to the va medical center to get help once a week but then i was removed. i didn't have to be the marine, the combat veteran every time i went back to get help. i wasn't around a lot of veterans and i can understand that there's a certain benefit to it but there's also a benefit to not being with all the people that know what i went through. there was a certain -- there was a certain part of it that not being around people that didn't know what i went through was

beneficial. i didn't have to put on this, you know, macho man, yeah, i'm this tough guy, which i'm not, so it was a lot easier not to act most of the time and i think that was a big part of it, a big part of it for me was being removed from a lot of people who have been through the same things as i did myself. and there's also certain other parts about the va where i just don't feel they have -- at least for me i was able to go to the dual diagnosis program which is the st. cloud medical center which is 30 to 90 days. i mean, after years and years of abuse, and years and years of just masking my problems, i needed more than 30 to 90 days. i needed 13 to 15 months and that's what it did. and although it was painful at times and i hated it most of the time, there was a reason i did it. i wasn't able to get comfortable and i wasn't able to just pretend that everything was all right because eventually things are going to come out and eventually it takes time and that's what i needed.

>> thank you, mr. chairman. and thank you, mr. hanson, for being here today and giving some, i think, very tough testimony, what you've done and how things are going now for you? >> things are going great, sir. i'm going to school full time, working on another bachelor's degree. i'm married. i have children. i serve people instead of taking away. i live a life to, you know, volunteer for veterans. i'm a veterans affairs liaison at minnesota team challenge and all the years i took away, i give back. i'm very, very, very happy for the turn-around in my life. >> that's great to hear that. and i know it's tough to lose friends. i certainly understand that as a veteran and having done the same thing myself. it's very hard to talk about it. and you deal with it every day. i'm sure you think about these men that you lost, friends that you knew every day. do you feel any guilt for

surviving and they didn't? is that an issue with you? do you feel that? .. >> everybody is different. this clearly worked with you, and i think you made your mind of you're going to change her life. i think it had a lot to do what you also. >> i was at the point, i was on my knees in my jail cell praying, either use me or kill me.

i went to team challenge. the reason i feel that was so effective was it was more of a holistic -- i was such an immoral -- i use a social parasite. i was a liar. i was an alcoholic. i was a deadbeat dad essentially. when i went into the minnesota team challenge i was able to deal with the moral and not just the things that happened in combat the going all the way back to childhood, you know, some of those issues and get to the hard. for 13, 15 months you going to get through a lot of the issues. i still have issues but they are considerably less. it was physical healing, emotional, spiritual healing. and mental healing. like i said more of a holistic approach of getting help for not just what happens when i was in the marine corps but before and after, and the damage i had done and the survivor's guilt, and knowing what happened happened but i have a future and i have a chance to make the best of it. that's what i intend on doing

the. >> you've done a great job with it. a real asset not only as a soldier, as a marine, but as a citizen of the country and as a father. and again, to the chairman and mr. filner's question, how do you think the va could into some of the experiences you've had to make a better for other marines or soldiers or airmen who have experienced the same thing? >> i definitely feel that at times if i would have gotten a kick in the butt i needed to get into rehab where the va would've said, look, either you go, you go to rehab, you get better, our, you know, you're not welcome here. basically if you don't want to use what we have set up and maybe you should use somewhere else. because if those people that want to get help, this place needs to be open for those individuals. for years i had great opportunities to get help but i didn't because i didn't want to.

and i think if the va instead of a friendship role to that pinnacle, i know there's plenty of times my dad made choices were i hated him for it at the beginning but i saw the absolute necessity of it years down the road, i appreciated it much more, instead of him not parenting me. and i'm not, that's a weird analogy to use, i just think if the va would possibly be more assertive in their treatment and saying you're messed up, you've been through this, you have this police record, it's time to be to get help or find somewhere else to try to get help. >> tough love. thank you again so much for your service to our country. >> thank you, sir. >> thank you very much, mr. chairman. i want to thank you, mr. hanson, for your service to this great nation of ours, for coming here today, because i know as the others mentioned it cannot be easy for you to do that.

my questions, a couple of questions your personal, how did you find out about the minnesota team challenge program? >> i was actually in jail. i had gotten my 700th dui it seemed like, and i made a phone call to tell my sister to pick up my son for a trip to wisconsin dells, and i saw an advertisement on the wall, and to my brothers picked me up from jail and i heard the advertising on the radio and i said okay, i think that's a sign. a week later i told work i've got to go get better and i will be gone for a year. that was how i heard about it. and my family had known about it because it is a faith-based program, and my mom is a very religious person. and so should mention it actually previous but i said come on, 13-15 months. >> thank you.

do you think that it would be beneficial for those who're serving in the military today is actually before they are discharged that they actually are aware of different programs out there in trying to get some of those service while you're asked in the service versus once you are discharged from the military? >> yes, sir, absolutely. 100%. i know when i was -- you know, back to iraq and i still had a couple left -- couple years left in the morning core, i had no idea i could have spoken to the chaplain, but other than that i really had no idea what i would do if i really wanted to get help. so i wasn't in the mindset of getting help but i think if i would've been more aware and i would've been under the understanding that a lot of people did and i would would've been only one and for me to do that i would've been much more apt to do it and get help before

this discharged, and you know, saved a lot of pain and suffering for my family and my children, my wife. >> how do you think those services would've been beneficial, for instance, i've been to iraq and afghanistan several times and every trip that i've been to iraq and afghanistan, i talk to the generals and ask them if they need help, particularly with those of traumatic brain injury or severe post-traumatic stress disorder, what do they need, we get the same answer. we've got the resources we need to take care of them. but the interesting thing is on one of those trips, someone with much lesser rank approached me, pulled me aside and said he need a lot more help. one of the suggestions that they actually made was that i talk to the clergy, and so since that trip to iraq, every trip i've taken since then i did talk to the clergy. the interesting thing that they were telling me that more and more of the soldiers are going

to them because they were afraid to seek help from a doctor, afraid of what other of the soldiers would say. do you find that true as well, that they might be afraid to actually seek help while they are in the service because of they might not get the promotion that they are looking for? >> yes, sir, absolutely. i feel like it needs to start probably from the top on down because when you are in a unit like that, you know, you take the risk of asking for help. i mean, you might be considered a broken marine or you might be considered someone that isn't ready for the next promotion or isn't ready to lead marines are be put in that village which you have a lot more responsibility from then on out. i think if you were to do that, i feel like yeah, you would be putting yourself at risk because you're basically looked at

possibly as someone who is broken and that is no good to them, or be given a job, you know, cleaning toilets or something like that. that's probably not the case in every unit but i know definitely in my unit i would've been probably terrified to actually ask somebody for help and say hey, i'm having nightmares or i'm having issues like that. because i would have felt like that would've been the start of just a domino effect of discussions about where i'm headed in my next rank and my cutting score and things like that. so i definitely feel like, there needs probably to be an atmosphere of that's all right, you know. inward you draw the line? is everyone going to be raising their hand? i'm sure they'll be the next question asked. i think that is where it starts is the top on down, and because i worked pretty closely with our chaplain and then someone in there every single day. but if you have possibly asked the sergeant major or somebody

else, they probably would have had no idea of. >> my last question, and everyone is different, you mention when he went to the va it was more of a friendship type of situation versus being a parent type situation. and especially when you're dealing with traumatic brain injury or posttraumatic stress, i think individuals react differently, and my next question is, and last question is, actually there's a report inspector general had done actually with the marine -- with a firming they invested whether not the va provided this particular marine the proper health care you deserve. and actually it came out the fact that it was not the case, and primary is probably a different situation than yours where the va actually was going to cut the disability benefits

from this marine. and it pretty much i think put the marine over the edge as far as he lost his benefits versus, you know, how can we better serve this particular individual. so in your comments about you need that tough love so to speak, you think that would be the case in every situation, or should the va look more at the individual and more or less take down the silos between the benefits versus the vha on the health care side? do you think they should look differently at different situations versus saying, well, you have to show that tough love in all cases? >> yes, sir. i definitely agree it's on a case by case basis. and for me i was financially secure in a what if they would have shown a tough love and said we're going to cut you off, i mean, i would've been able to

survive and would've angered me and i probably would've had some harsh words to say but i would have been able -- i'm sure it would've forced me into some sort of rehab. and i think that would have helped. but i definitely agree with you. there are some circumstances where people are not abusing that compensation, and they do still need help but i'm sure there's other ways to go about it than just got compensation. but i think for some people like myself it would've been beneficial to do so, but for some, for some people i agree that it's not the best route to go. >> thank you very much, mr. >> mr. stutzman. >> thank you, mr. chairman. and thank you mr. hanson for being here. your testimony is an amazing story. it's so good to see you here and for taking the opportunity share with us your experiences and which have experienced not only military but also after the military and how you are finding success.

also to your wife, i know she's been through a lot as well. i can tell she's very proud of you sitting back there. my question is, after you left the military did the va ever give you any direction to programs question mentioned you the/s radio, and i'm familiar wh team challenge. a good friend of mine growing up, hit the bottom in his life attacks without a lot of success at teen challenge. it's encouraging to hear this. but did they give you any direction of different programs, any ideas on where to find help, anything like that? >> when i did finally decide that i needed to get help and they were supported and saying yeah, you should find a place, they offered the treatments which was a dual diagnosis program that was 30-90 days, and then they offered an outpatient

one at the minneapolis va medical center that was i believe it was six weeks, and it was monday through friday, something like 8 a.m. to 4 p.m. but also, you know, at the dual diagnosis program i was able to leave on the weekends so, you know, i'm there monday through friday in patient the whole week, but then a week and i'm able to get out and do whatever i really want to do. so i think that was also part of the reason i didn't get, gain as much success from the program as well because i was given the freedom, and it's what i wanted but freedom isn't what i needed at the time. i needed also a kick in the butt and some serious help. so those were the two programs that the opportunity. they were both va funded and through the. >> so in team challenge you with their 24/7, committed for almost a year? >> yes, sir. i lived there. there are special occasions where, you know, you can get a couple days where you can go on a pass or something like that,

but for the most part you are there 24/7. you wake up and you get breakfast. i worked out, go to chapel and then the second half you're doing chores, doing all those things but you are there every single day. and like i said it was nice because i was there, i was able to go to the va for treatment and come back to a safe place, safe environment where i could be my own self which was not dan hanson marine, better, i was just damn. >> one of the biggest ruggles you dealt with was not have the funds. what kind of cost did it take to attend a program for one year? >> for a year it was about 850, $860 a month. so i had other priorities at the time that i was trying to pay for, and yet, there were times i got, you know, i was behind in my payment to minnesota team challenge. i asked them several times to try to fund the program but they

said that was not possible because that was a program that wasn't funded. and i tried to do some other things and eventually they both my service connection after i was done with the program but by that time i was behind on all sorts of bills, and it was a little bit of a disaster financially. >> did you meet any of the veterans in the program by jim? >> yes. i've met some vietnam veterans that were really struggling that have been struggling for three just. i met oif, oef veterans. there weren't a lot of them but there were a handful. that's why i still do work with team challenge to get veterans, to get veterans in there. and i know that the veterans that were in there, it's easier because the structure is almost like the military where you wake up, you go to bed when they tell you, there's strict rules. if you want to get into a fight, you're gone. there's nothing to talk about.

it was something where i fit in very well because of the structure and was able to excel. >> so about 10,000 a year than for the program? >> yes, sir. >> thank you. thank you, mr. chairman. i will yield back the. >> sergeant major. >> thank you, mr. chairman, and mr. hanson, thank you as he fell minnesotan. did you go to south minnesota high? >> yes, sir. >> i coached football there. we probably played against you. >> we won many times. >> thank you for adding that. there's that word that we're going to share with you they're going to ease that pain, other than for you to recognize that we take our responsibility very strictly. so you're coming you and your family, your wife coming, hugely important uncertain not going to tell you that in 2003 and in the early stages of this current conflict we were ill-prepared for the influx of veterans. we did not have that. what i would say is big issue

that i think we're getting at and is very important, the next panel i will discuss some issues on the case of coercion versus autonomous care. but for you it work. that's what we want. one veteran that succeeds is what we're after. my approach to this and i see this and i take it very sees as a senior nco, this culture of care and how you get your soldiers into the. minnesota has a long legacy in this with former senator or late senator wellstone and jim ramstad on this idea of mental health parity is, something we fought for hard that this idea should be treated for mental health issues just as if you're lost a leg. we are trying to get this right. we're trying to anything what's coming up, mr. mershon brought up i think mr. stutzman about this individual care, how do we get that right. one of the things which be concerned with is evidence-based policy and those types of things. century first testified over the senate side, have used the va

for anything? >> yes, sir, when i was in minnesota team challenge -- i apologize. i was after. i have a very -- i met with psychiatrist doctor brown who has seen me since i got out in 2007. i've met with him and can't talk about things other than physical therapy for my back and neck. but as far as mental health goes, i've pretty much done no follow-up as far as that goes whatsoever of. >> i want to assure you and make sure you know as minnesota's only member of the delegation that's on this va committee, i spent a lot of time at those, three weeks ago i was in st. cloud and met with dr. ball and the administrator and talked a lot. i want you to know i take the job very seriously of sync with working there and i think it's important to note that we are having successes there, which you got friends have gone through their and we are having that. i also want you to know, anytime there's a failure in any way my job is to get to the end of the.

we have spent countless time understand what happened, where things went wrong, where we could've done better, what the outcome was. you do need to know that you come here and testifying is as the motivation, if you will, makes it clear to us what our job is to try to deliver. what we're going to figure out is how do we best treat care for folks like yourself, how do we do it that respect your personal freedoms and your rights, but how do we make sure that you are given the opportunities to enter back into saw side he dashed into back into society. this holistic approach. i'm concerned about this employment issue. in conjunction with therapy and family that is committed. one of the problems we have is with let some of those programs >> no, sir. a veterans affairs liaison but i

northwestern college. >> it's working great for me. >> you are able to provide your >> yes, sir. i'm sure i would have no problem getting a job right now. challenge i was utilizing those. and the biggest reason was i did school full-time and get that money. if that was held back i think good job of pointing in the right direction sing okay, they are serious now. has motivated you to a? >> absolutely. if they would've said you can't go to school and take it out because if we look back at your

history and your doctors, you need help, here's your incident. if you want to go to school, go get help. >> i've been spending a lot of time reading the literature on this to try to see over all how many times that works or what it does. that's helpful to me. again, thank you for your service. i appreciate your courage, and in coming forward talking about these issues but i assure you, i think we've learned during this conflict, at least i would like to believe this, especially the senior ncos we're getting better at seeing this issue of mental health parity and early treatment when the wounds are fresh is the best way to go instead of just sending it back to fend for yourself. that's not the right way to do it so thank you for that. i yield back. >> thank you sir. >> thank you, mr. chairman. mr. hanson, thank you so much. i want to commend you on your courage for being here today and providing us with the testimony

because i can tell would be easy for me to get that story if it was me. so i really commend you and your wife for being here today and i appreciate the education. i just have a couple simple questions. wasn't any kind -- when your discharge from the reins is any sort of mental health evaluation upon discharge? would you have been willing, you know, talk about your problems upon discharge so you could get help? i was curious about how, if you worry reluctant to seek attention because you felt embarrassed about it tell me about the discharge process. there's a final fiscal you go through to make sure your 100%, you know, as well when you joined the marine corps. and then if you're not then you get hooked up with the va. but for me, i passed my final fiscal and it was easy for me to

say yeah, i don't have nightmares and i don't have this, that's what i did. they say are you going to any of these things go if you just and that's really bad as far as that goes. they have a program which is about i think four days, and that's about integration back into society with civilians. but for the final fiscal, you go through a physical part of it and then the mental stuff you fill out some paperwork. and for me i just pretty much circleville and everything and that was that. i can ask any follow-up questions, they didn't go deeper into. they just said okay. they looked on the paper that you're doing pretty good. >> so you basically didn't tell the truth and that? >> yes, sir spent you didn't have an evaluation with someone sitting down talking about -- >> no, sir. they basically had me fill out the paperwork and send it looks like you are doing well. yes, let me get out of the marine corps now. >> another question i have is,

tell me about what you are doing with this group, this team challenge group. what exactly are you doing for the other marines? >> with team challenge basically i go, whether it's like the stand down, the a stand down or i will go to any sort of veterans event and i will have a table and i would just try to get the word out that this is a great place for veterans, it's a good option. it worked for me. here's my story. i'd like to see more people going to the pixel anywhere i can, like and testifying at a court case on friday about trying to get someone sent there instead of prison. he's a combat veteran struggled with ptsd and want to send him to prison. in the time i can speak at things like that, get ahold of someone who is a combat veteran or just a veteran, not just a veteran but a veteran. and try to student into this long-term care because i feel they key is the long-term care,

and for me i put it off for as long as i could but i know i would not be why am today it was a year-long program, and which it was. so that's essentially what i do 14 challenge, just go to events, recruit any way i can. network and try to get a hold of veterans that are hurting and get them into the program. >> thank you very much for your testimony, and i yield back the remainder of my time. >> mr. mcnerney. >> thank you, mr. chairman. daniel, i want to thank you like every member of the spell for serving our country and for sharing your insights. you are sharing stuff with those that i hadn't heard before, so it's useful. i just want to talk a little bit about the team challenge. it's obviously not deemed that veterans come is that greg? >> it is not. it's just for normal nonveterans. >> i'm a little unclear about the relationship between the va and the team challenge. were those two organizations able to work to make the program

work for you, or was it to something you have to fight through? >> no, it was more minnesota team challenge working with the va. the va was open for me to do a program while i was in team challenge. so essentially i had to get it approved because they have their rules and they have there monday through friday, everything planned out. but i was able to ask them, you, can i go to this, it was cognitive process therapy about three months. three was out of the i was there i was able to go to the va, you'll need with my psychologist. then i would go to a group meeting with some other veterans, and then i would be sent back to the program. so it wasn't really much of a working relationship. i would say team challenge said yes if you want to go there one day a week you can do that, and the va set up a program for that. >> so there could be better cooperation between the va and some of these community-based operations?

>> yes, sir. absolutely come at a is something i struggled with. something i continue to try to help with when i graduated. the program was the more open to programs like this because every time i tried to talk to people, you know, someone at the va about this is a great program, will you fund this, can i put up a sign for people, it was just they didn't want anything to do with it because it's not a government-funded program, and that's understandable but i feel it's a great program and hopefully someday that can be a better relationship there. >> i'm sure they would love to work with you on how to make that happen, or anyone on this panel. i can get you. so if you feel like you want to do that, any of our offices will be open, my office specifically. now, about team challenge we are compelled to stay there? did you have to stay there? >> no, sir, i didn't have to stay there. i could have less. there are certain people that as i said, they are court ordered

there but for myself i checked myself and, therefore i could leave at anytime. there was plenty of time i thought i was going to leave, but i stuck through it and pushed through a a lot of the pain. >> the interesting thing is that you decided that you want to go to the program, you need help, you reached rock bottom or the decision they came to you that you wanted to do this program. would there be any way to compel folks that didn't want to go through that program that needed help, as you did, to go through the program's? >> yes, sir, i believe so. there's a program that is part of minnesota team challenge called extended care program. that's a 30-90 day program and then if you feel like you are not where you need to be, then you can transition right over into the year-long program where those 90 days you were already there out towards your year-long stay, so you can get basically a small part of what the program is about through the 30-90 day

program to see if it's a good fit for you. if it's not you complete the short term program and you can lead. if you feel like this is what i need it, i'm getting the help i need, any transition right over to the long-term program spent i'm glad to hear about this. we just had a tragic case where a young man at a three-day program and he left and he walked in front of a train that afternoon of two hours after he was released. clearly that wasn't giving him what he needed. he had been through several two-week programs that didn't help, so now i see the value of that. so thank you for your testimony today. >> thank you, sir. >> thank you, mr. chairman come and thank you, mr. hanson, for your service to this country.

>> and that's i felt solely -- it was either about the alcohol or it was either about the combat. it wasn't about some of the other issues like the guilt. sure, that ties in with it, but specifically, the guilt and the shame and the hate i had for myself. it was never really addressed, whatsoever. >> and i know what you're saying. sometimes i think most people agree with me it's hard to get to the root of those issues until we get the chemicals out of the way. >> absolutely. >> and i don't think there's -- there needs to be, as you say,

specifically tailored to your issue. obviously, your issue kept ballooning and ballooning on the substance issue. we can't treat the mental issue till we get the drugs and the alcohol out of the way. it was a short comment on the va's -- on their program when it was in itself there. and -- >> yes, sir. and going back to your question actually, you know, we would be released on friday afternoon. well, you can drink friday night, saturday night and you'll be fine if you come in on sunday and you can have a clear urinalysis test. yes, i agree with you. you're in in there for a chemical addiction, we have an opportunity to drink and come back and look like you're not drinking and pass the urinalysis test and keep on going. >> i think that says it all. and with that i yield it back, mr. chairman. >> i thought you were leaning

back. i couldn't see you behind the sergeant major there, sir. >> i thank the chairman and with my thanks and to the witness and all he represents, i'll defer to my colleagues. >> thank you. >> thank you, mr. chairman. i additionally want to thank mr. hanson for his courage of being here and sharing his -- i think part of this is a faith testimony and i appreciate it and i come from a very rural district in western kansas, and this is a story i've heard from a number of my constituents as well, as family members, i hope their presence will save lives and change things better with the va and with that i yield back my time. >> thank you for your service, sir and thank you for your testimony. just a couple quick questions. what's the greatest barrier you

saw in getting treatment. >> getting past myself. i knew the options was there but i was working full time. i was going to school full time. i had a life. i wanted to party. so it was getting passed -- it was getting passed the inconvenience of having to get help. whether it would be outpatient and inpatient and inpatient was out of the question so that is why for some time i did outpatient care because there were times i would feel like walking out of there and feeling better and the biggest barrier was getting past and being able to control whether i get help or not was the biggest thing because i didn't want to be inconvenienced because i knew what was right for me at the time. >> how about -- what can the va do to further encourage treatment? >> well, i think as i touched on a little bit earlier, i think just maybe being a little bit more forceful in their approach saying, you know, not just saying we have these rehab programs. you're definitely a good candidate for them.

instead saying we have these rehab programs and you need to get help. and, you know, if you don't get help -- i mean, there's going to be some sort of a consequence and i guess i don't know if it should be, you know, financial or you can't get help there. but i just feel like once a person -- it's clear that they need help possibly somehow it should be not just a good idea between myself and the psychiatrists or the psychologists i'm talking to. it should be something more where more assertive. more take-charge -- you're messed up, we're going to -- we're going to get you into treatment one way or the other. not just giving me options as you're a good candidate for help. you need help. >> okay. thank you very much. i appreciate it. >> thank you, sir. >> i yield back. mr. stearns? >> thank you, mr. chairman. and thank you for holding this hearing. let me reiterate to my colleague to mr. hanson. we appreciate your service and your willingness to come here and to really be honest and

read through your opening statement, you indicated that when you were discharged from the marine corps, you knew you healthy individual. but at the same time, you did anybody. and it was a feeling, i guess, in your own mind -- you said it in your opening statement that you felt indestructible. that because you were in the marine corps and yet you had served yet you were struggling. you suggested that perhaps everyone should realize that they should get some help and perhaps as an incentive to have compensation withheld. let me ask you this, do you think -- if you not talk about and talk about the military services, do you think the marine corps itself should have briefed you before you were discharged to say, look, it's not being less of marine if you realize you need help?

and that somehow this feeling not in the marine corps but all the military, that you're week if you say i need help. i've been to these hearings before and generally i find that persons like yourself are courageous and are willing to give your life for your country and so when it comes to signing on the dotted line that i'm weak and i need help, people won't do it because they say it's a sign of weaknesses in america. so had you ever thought -- i know you suggested that as an incentive to not -- to withhold conversation but is there a way to education perhaps that he could with have got you in the very beginning either through the marine corps or the va through education? >> yes, sir, i do believe so. like i said, when i got back from iraq, and was in the marine

corps for a few years after i was really not aware of any sort of program that i could do while i was a marine. and i had really no idea as far as how that would look anyways. and there's definitely a certain amount of pride that goes along with, you know, admitting that you do have that problem. so when you're coming to work every day with 1,000 other marines it's kind of like, you know, does he know? does he know? you know, you don't want to feel like the odd man out so if there was much more openness, at least when i was in the marine corps, to getting help and to at least talking about it or taking the initial steps and so at least realizing that there is help. you have a problem and it's okay to get it and just maybe having some sophomore of an open communication line between the top heavies and on down on the chain to the -- you know, the privates, pfc's, whatever, that

it's okay to get help. and here's the way to do it. and you're not going to be looked down if you do. we encourage it. it happens. i think -- i think it's pretty safe to say that if anybody goes to combat they're changed for the rest of their lives. it's just sometimes there's more cases like myself that, you know, aren't quite able to take it as well. it's definitely based on the person, but i know if there was probably more of an open communication line between myself and the higher ups, i would have been more apt to get help sooner. >> you indicated that everybody has changed in the military service, that's true. that's also dependent upon the amount of stress and combat and what you see, you know, judging from your opening statement you saw a lot and all that impacted you in ways you didn't know until it almost got too late. so in a way the va has responsibility but in a way i think you're saying the marine corps, the navy, the air force, the merchant marines all have

responsibility to at least let the people in combat know that it is not a sign of weaknesses if you feel you're struggling. >> yes, sir, absolutely. >> and that before you discharge, this kind of message should be presented to the soldiers. so he or she knows that it's not a sign of weaknesses. just realize that you have this option and so that everyone doesn't think that it's a liability on your part? >> absolutely, yes, sir. and i feel like it would be just as important to get that communicated with the families of veterans coming back -- of marines. if i'm not willing to get help, then the pressure from my family once they know from the chain of command that, you know, there's an open forum -- if they're having these issues, nightmares, if they're drinking a lot, you know, talk to us and it's okay they're all right. we're not going to look down upon them. we're not going to withhold a promotion. talk to us, it's okay. he's a marine. he's done that but keeping that open line of communication between the military member and then their family as well because if that person is not

apt to go, their family is going to be the biggest reason that forces men to do it because oftentimes i believe it's the family that gets them in and not the actual individual service member. >> thank you, mr. chairman. >> thank you, mr. chairman, thank you, mr. hanson, thanks to your service for this nation and for your courage to be here this morning. i just have one question. you mentioned that the biggest obstacle that you had was getting past yourself and understanding and realizing that there was a need there for help. >> yes, ma'am. >> now, something in teen challenge versus the va system -- there was a difference in those two programs. what was it with the teen challenge that let you get past yourself that was missing in the va's approach to mental health? >> well, ma'am, i believe it was really just -- it was a couple of things. one the environment was where -- which i mentioned earlier was,

it wasn't a bunch of, you know, combat veterans. it was, you know -- it was people that, you know, are from all over the state in that who had different experiences but all had problems and we could talk about our issues. and they were very different but yet they were the same, so there was -- yeah, there was a sense of -- it was a lot easier for me, i feel, to let go and talk about my issues with people that didn't know exactly what i went through. and i think also in my time at minnesota teen challenge i felt that it was much more -- i wasn't just a number going through a revolving door. i felt like i was a person that they loved and that they cared about. and they wanted -- regardless of what they got paid, regardless of what -- they wanted to see me better and they wanted to see me better for my family, for my kids and the faith-based part of it. once i was getting better, you know, ultimately hanging on to that religion, hanging to god, you know, who has a plan for me. god has a reason for me to live and although i went through some

of the things i went through, there's a reason for it. and i can be used and i can be loved and that's -- that was a big part of it as well was the faith-based aspect. that really led me to believe, you know, what? even though everything that happened happened. i'm loved and i have a future. and there's a plan for me. >> thank you very much. and i yield back, mr. chairman. >> any other questions? >> my question have basically already been asked and answered. i thank you for your service. >> thank you, sir. >> you said that teen challenge wanted you to be better. >> yes, mr. chairman. >> do you think the va wanted you to be better? >> i do, absolutely, mr. chairman. i just feel that it was -- i don't know if i want to say a generic feeling of feeling better i don't know if that makes sense. it was much more at minnesota

teen challenge. it was -- >> personal? >> yes, it was much more personal, yes, mr. chairman. >> you said that even though va screened you positive for ptsd, they never mentioned any option for immediate care and there was no immediate action on their part? >> no, mr. chairman. i actually got screened the first time and they said that i was fine. and then in a follow-up appointment, they just gave me a random survey in which i answered positively to on several questions on a scale of 1 to 10 and then they sent me a follow-up letter that said you seem like you might have some ptsd issues so we would like to do a follow-up. then i did a follow-up. they suggested some outpatient things but they didn't suggest anything really on a larger scale. >> so again we all have voiced our opinion.

we thank you for your service to our country, your courage to testify both before the senate and the house. we appreciate what you're doing and you're making a difference. and with that we thank you for being here today. [applause] >> thank you. thank you very much. >> i now ask the second panel if they would begin making their way to the table. dr. karen seal, a clinician and researcher at the san francisco department of veterans affairs medical center. general terry scott, the general is the former chairman of the veterans disability benefits commission. and dr. sally satele, president, resident scholar at the american enterprise institute and we thank you all for being with us here today. let's begin with dr. seal.

you're recognized. >> first, i just want to recognize mr. hanson for his bravy and courage coming forward to tell his story which, you know, as a clinician at the va i hear weekly and it motivates me to do the job that i do. it also motivates us at va to figure out how we can better individualize treatment so i just wanted to acknowledge and that thank him very much. good morning, mr. chairman miller, ranking member filner and members of the committee. thank you for giving me the opportunity to testify today. >> i will begin by placing my comments in context. i'm a primary care internist based at one va facility, the san francisco va medical center. in this capacity, i direct the integrated care clinic for oef veterans. the clinic at the san francisco va medical center is novel in that it offers all new oef veterans a one-stop three-part initial visit with a primary care provider, a mental health clinician and a social worker. the integrated care clinic providers are all integrated and

colocated within the primary care clinic. and are trained to address post deployment health concerns. i'm also an associate professor of medicine and psychiatry at the university of california san francisco and in this capacity conduct clinical research that is focused on a better understanding on veterans who use va health care. based on my experience as a clinician and researcher, i offer my perspective first on the mental health problems on veterans who use va health care. second, on utilization and barriers to va mental health services and third, current efforts by va to overcome barriers to mental health care for oef/oif and i want to help the several thousand men and women who have served this country and deserve the best care possible. rates of mental illness but particularly rates of ptsd among oef/oif veterans have increased

steadily since the conflicts began in 2001. closely followed by increasing rates of depression. according to the most recent data released by va in january, 2011, over 300,000 oef/oif veterans of 51% or 1 in 2 veterans has received one or more mental health diagnoses and 1 in 4 veterans have received diagnoses have ptsd. our research indicates not all veterans have been affected by war in the same way. younger, active duty veterans are at particularly high risk for ptsd and drug and alcohol abuse whereas older national guard reserve veterans are at higher risk for ptsd and depression. rates of depression, anxiety and even eating disorders are higher in women than in men. female veterans who have experienced military sexual trauma are at 4 times the risk for developing ptsd as women who

have not war on terrorism who have not experienced military sexual trauma. appreciating these subgroup differences in oef/oif veterans seeking health care will help va better implement more targeted interventions and treatments as well as guide future research. in 2007, the institute of medicine determined that only two therapies for ptsd prolonged exposure and cognitive processing therapy had sufficient evidence for the effective treatment of ptsd. both therapies have been endorsed by va and many va mental health specialists have been trained to deliver these therapies to their patients in mental health clinics. these therapies require a minimum of nine or more sessions ideally spaced at weekly intervals. our research showed that 80% of oef/oif veterans with new ptsd diagnoses attended one mental health visit within one year of their ptsd diagnosis. however, unfortunately, less than 10% of veterans with new ptsd diagnoses attended a minimum number of sessions

within the time frame required for evidence-based ptsd treatment. we found that being young, less than age 25 and male, having received a mental health diagnosis from a nonmental health clinic such as primary care and living far from a va facility greater than 25 miles away are failing to achieve ptsd treatment. because of evidence-based ptsd treatment, the va needs to focus on developing interventions designed not only to improve initial engagement in mental health treatment but also retention and care. patient barriers to mental health care among oe officials/oif veterans include stigma, logistical barriers and even the mental health disorders themselves as you heard today. avoidance in ptsd, apathy and depression and denial with drugs and alcohol will prevent

veterans from seeking care and symptoms of hyper vigilance are adaptive rather than problematic when returning home have prevent many veterans from seeking the care they need. va has not always been able to keep pace with the growing demand for specialty mental health. it includes shortages of mental health personnel trained in these evidence-based mental health treatment there's a lack of universal to video teleconference such as telemental health which is rural veterans can have services delivered at medical center. in addition to the barriers we hear about veterans, difficulty navigating the veteran system, to make appointments lack of extended hours and drop-in appointments and lack of services for families and children, which tends to differentially impact women, there's some other potentially challenging barriers to mental health care. for instance, while i.t.

security is clearly important, excessive security concerns may be limiting the development of more novel, internet and telephone-based mental health treatment options that would expand access to mental health services and appeal to the younger generation of veterans. in addition, privacy concerns about the department of defense concerns access of veterans medical records have storaged veterans from coming forward and disclosing more sensitive mental health systems such as substance abuse and domestic violation and in contrast to the underization of mental services oef/oif veterans disproportionally use va primary caramel services. capitalizing on this trend va might consider further a restructuring va services such that more specialty mental health providers trained in evidence-based mental health treatments are embedded within va primary care. this may even involve infrastructure changes to existing medical collins to

accommodate the co-location of more specialty mental health providers in primary care. these structural changes could literally break down the walls that exist between medical and mental health services, overcome stigma and narrow the gap between primary care and mental health. for instance, prescheduling mental health visits to occur at the same time as a veterans primary care visit as we do in our one stop integrated care clinic at the san francisco va medical center could make it more likely that patients will attend and be retained in mental health care. in addition, new clinic resources available through the va medical home patient line care teams and va primary care such as nurse care managers could be leveraged to facilitate engagement of veterans in mental health treatment. for instance, pack nurses could act as motivational coaches to remind or encourage veterans to attend mental health appointments while at the same time working with veterans on behavioral concerns or physical complaints that often accompany

the mental health problems. pack nurses could also provide veterans access to new technology such as the va internet site my healthy vet or smart phone applications such as ptsd coach to enhance access to online mental health treatment or treatment adjuncts. finally, there's a need for more research to develop and test modified evidence-based treatments for ptsd that are better suited to primary care settings. in summary, oef/oif veterans have extremely high rates of accruing combat-related mental health problems. despite this large burden of mental illness, many oef/oif veterans do not access or receive an adequate course of mental health treatment. veterans with mental health problems disproportionately use va primary care medical services. the va has made advances through the va primary caramel health integration initiative and more recently the va medical home

primary patient alliance care team pack model. the va is now well positioned to take the next step and address many of the remaining barriers to mental health care by incorporating more specialty mental health services within va primary care settings. in this way, va can continue to work to meet the growing mental health needs of this current generation of men and women returning from war. thank you. >> thank you, doctor. general, it's good to see you again. and you're recognized. cr closure my oral remarks will b and i hope my complete statements will be made part of the record. >> nobody else. >> i'm presently the chair of the advisory committee on disability compensation. chartered by the secretary and in compliance with the public lan 110-389 and this committee reports to the secretary that's

addressed our efforts. our focus has been on disability compensation. on the revision of the vassar d on procedures for service members prisoning -- on the services and for noncompensation of life. recently we've a review of individual unemployment and a methodology for presumptions and the appeals process on its execs on disability compensation. my discussions with your committee staff included a request that i review the pertinent findings and recommendations of the veterans disability commission that met from 2004 to 2007 and made 113 recommendations covering a wide range of veterans disability issues. specifically, i was asked to discuss the vdbc recommendation to include compensation, treatment, vocational assessment and training and follow-up

examination for veterans suffering from mental disability to include ptsd. they invested significant time and effort with the current methods of diagnosing, evaluating and adjudicating of claims suffering from mental illness including ptsd. the principal source documents that we used in the analysis was those as you mentioned mr. chairman as outside of the hearing, a 2005 report by the va office of the inspector general and an institute of medicine study completed in 2006 titled post-traumatic stress disorder diagnosis and assessment. these studies and the testimony of veterans, family members, medical professionals and va subject experts provided the basis for six recommendations that the vdbc offered. the complete recommendations and accompanying explanations are in my written statement. the key recommendation of the vdbc was to change the va

approach to diagnosing, evaluating, adjudicating and trading mental disability by establishing linkage among compensation, treatment, vocational assessment, rehab and rehabilitation and follow-up examinations. the purposes of the follow-up examination would be to determine the efficacy of the treatment that's being undergone. the benefits of linking these factors might very well enable us to reduce homelessness, suicide, and substitute substance abuse as well as to evaluate the effectiveness of various treatment programs. most importantly, it greatly improves the opportunity for a veteran suffering from a mental disability to maximize his or her future contribution to society which is what we should all be about. now, understand that this recommendation is somewhat controversial in many circles. for one thing it dramatically changes the role of the department in