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asking you how can veteran's health programs be improved and ryan wright posted a national single-payer system that allows vets to go to any hospital or put them in medicare system. we go into the help not to feel like we dreamed up symptoms. three family members of veterans told their story on capital hill and discussed how the veterans affairs could do a better job.

>> if i could get everybody to take their seats, please. the hearing will come to order. before we begin i would like to ask consent for scott peters from california and representati representati representative arizona to sit up here with us. i would like to welcome you to service should not lead to suicide: access to va's mental health care. following a committee investigation that uncovered widespread data manipulation this committee has held a full committee of oversight hearings

over the last several weeks to evaluate the systemic failures that have consumed the veteran's health care system. none of them have contained the face of the failures so much as today's hearing will in fact do. a hearing that will show the horrible human voice of va's dysfunction and i dare say corruption. at its heart access to care isn't about numbers. it is about people. recently the committee heard from a veteran who had attempted to receive mental health care at an outpatient clinic in pennsylvania. this veteran was told by the va employee he spoke with that he would be unable to get an appointment for six months. when that employee left another employee leaned in to tell the

veteran if he told her he was thinking of killer himself she would be able to get him an appointment in three months. luckily he wasn't considering suicide. but what about the ones that have? how many of the tens of thousands of admitted members have been left on the waiting list for weeks, months or years were seeking mental health care appointments? how many are suicidal or edged through that? despite increases in va's mental health and suicide prevention budget, program and staff, the suicide rate among veteran patients has remained more or less stable since 1999 with approximately 22 veterans

committing suicide every day. however the most recent va data has shown rates of suicide over the last three years have increased by nearly 40% of male veterans under 30 who use va health care services and by 70% of male veteran between the ages of 18-24 who use va health care services. this morning we will hear testimony from three families. t they will tell us about their sons daniel, clay, and brian. three operation iraq freedom veterans who sought va mental health care following combat and each faced barrier after bar

area. each men came to suicide. dan's somers wrote in a note he felt his government abandoned him coming home and facing neglect and indifference. va owed daniel, clay and brian so much more than that. with that i yield to our yanking member for opening statement. >> thank you for holding this hearing. we have had many discussions and debat debat debates about how to deliver the best health care to the veterans and ensure accountability for the leadership ranks in the veterans affairs. we have touched on a number of important issues but one we have not zeroed in on one has been

access to mental health care and suicide prevention. that is why this hearing so important and i would like to thank the panelist for joining us particularly the family member whose have lost a loved one. i know that speaking about a loss of a loved one, particularly a child could be a difficult and exhausting experience, but in this case, i think we have to listen to your stories, identify what went wrong, and we can take action to ensure those failures are not repeated again. so i want to thank you very, very much for joining us today to share your stories. 18-22 veterans commit suicide each day. in my opinion that is 18-22 brave men and women each day who our system has let down in some capacity. it is totally unacceptable. when a veteran experiences

depression or early warning signs that may indicate mental health issues or suicide that must be treated like an immediate medical crisis because that is what it is. veter veterans in that position should never be forced to wait months on end for medical consult because quite frankly that is time they may not have. we have taken steps to help put in place programs and initiatives aimed at early detection and we have significantly increased our funding. the department of veterans affairs spending on mental health has doubled since 2007. but it isn't working as well as he had hoped and we have to figure out why and how to crack the problems. our veterans are the ones paying the price for this dysfunction. a 2012 ig report found that vha data on whether it was providing timely access to mental health

services is totally unreliable. in the report from that year confirmed that finding and said inconsistent implementation of the va scheduling made it difficult, if not impossible, to get patients the help when they need it. that is a problem we have seen repeatedly as we dig to the va's dysfunctions and enough is enough. our veterans and their families deserve a va that delivers timely mental health services, covers a spectrum of needs from ptsd, counseling for family members and veterans, to urgent around the clock to response to a veteran in need. a recent va report found that in one facility patients waited up

to 432 days. well over a year for care. so once again we are finding that our veterans deserve much better than the care they are receiving in all of the areas that we must address we have to look at this comprehensive and i would argue that fixing mental health services is among the most important area. i look forward to a productive discussion that will begin today as we look forward to solve the problems with a dysfunctional department we have seen over the last several months. i want to thank you, mr. chairman, for having this hearing and for the panelist and with that i yield back. >> thank you very much to the ranking member. we are humbled and honored to be joined by the first panel of

witnesses. family members of the three veterans who sadly and tragically lost their lives to suicide and i am sure that i speak for each of my colleagues when i say that each of you have our deepest sympathy for your loss. i am grateful and angry that you to have been here to share your stories of your sons with each of us. so if you could approach the witness table, please. joining us is dr. howard and jean somers. the parents of daniel summers. susan and richard selke. the parents of clay hunt. and peggy portwine the mother of brian portwine. we are also joined on the panel by josh wrenchler.

a veteran of the united states army who will share his personal story of attempting to seek mental health. thank you for your service and being here. ms. somers continue. >> we are grateful for this opportunity to testify today and we are pleased to see arizona's representative and our own california's representative as well who has been very good to us. >> as many of you know the journey sarted on june 10, 2013 when daniel took his own life following a second return from deemployment in iraq. he suffered from post traumatic stres disorder, traumatic brain

injury and gulf war syndrome. daniel spent six years trying to access the va health and benefit system before collapsing under the weight of his own dispare. we have attached the daniel solmers story and hope you will read it if you have not done so. it is our objective to provide care to the 22 veterans a day who are ending their lives. >> just over a year ago feeling lucky we had a message from daniel. howard and i spent 30 years in the business of health care sat down with daniel's wife and his mother and together we felt qualified to prepare a 19 page

report we titled systemic problems at the va. we have shared that document with many of you over the years and it is attached to the testimony as well. we want to improve access to first rate health care at the va, to make the va accountable to the veterans it was created to serve, and to make every va employee an advocate for each veteran. >> daniel was turned away from the va due to the national guard inactive status. he was denied therapy essentially. he had problems with va staff being uncaring, insensitive and adversarial. no one at the facility advocated for him and they sited hippa for not letting family members in

and not using technology. >> the va's scheduling system is not adequate. the va technology infrastructure p prevents related agencies from sharing critical information. there is a need for compatibility between systems within the vh ark, the vba and the dod. con tenuity of care wasn't a concern. >> there were no contracts in place, and a fierce refusal to outsource anyone or anything. at the time daniel was at the phoenix va there was no pain management clinic to help him with his chronic and acute

fibromyalgia pain. the fact the formula of the dod and va are separate and different makes no sense because the patient must rejustify their needs when they transfer. there were inadequate facilities and charting process. >> there was no way to him to get a copy of the status claim. there wasn't a prioratized decisions. this report is offered in the spirit of a call to action and reflects the experiences of daniel with va program services beginning in the fall of 2007 until his death last june as seen through our eyes. >> our concern was the

deficiencies daniel encountered were symptoms of broader issues within the va and potentially it will effect the other members of service. many of the reforms outlined in our report require additional funding for the va but with that new funding should come greater scrutiny and a demand for better measurable results. >> there is an alternative to attem attem attempting to fixing the system. we believe the government should revamp the entire system and it would turn into a special care system for retune injuries and

the other care would be open to care providers like tri-care. that would cause people to compete for veterans. and it would allow all veterans to seek the best care available and allow va to focus on the treatment of complex issues suffered during modern warfare. >> we thank you for your time and would be happy to discuss our recommendations. we hope the issues raised here will provide a platform to bring the new va together with lawmakers, vso's, veterans, and private sector medical administraa administrat administrators for a reform of the entire process. and if the va committee or congress as a whole make the decision to involve other stakeholders in the process we would be honored to be among those chosen to represent the views of affected families.

thank you. >> thank you both for your testimony. mr. s mr. and mrs. selke you are recognized. >> thank you. members of the committee, thank you for the opportunity to speak with you about this important topic of mental health care access at the time va, suicide among vet nrens and the story of clay as well. i am here today the mother of clay hunt a marine core veteran who died by suicide on march 2011 at the age of 28. he enlisted in 2005 and in 2007 he deployed to iraq. he was shot through the wrist by a bullet that barely missed his

head after arrivinarriving. he was diagnosed with ptsd later that year. he graduated from the sniper cool in march of 2008 and a few weeks later he deployed again. this time to southern afghanistan. much like this experience during his deployment to iraq he witnessed the death of many friends. after discovering his condition prevented him from maintaining a job and he appealed the 30% rating he was giving only to be met with many issues including the va loosing his files. 18 weeks later and five weeks after his death clay's appeal went through and they rated his

ptsd 100%. he used the va exclusively for care. he lived in the los angeles area and received care at the va medical center there in la. clay constantly voiced concerns about the challenges he scheduled with appointments and the treatments he received which consisted primarily of medication. he only received counseling that regarded whether the medication was working or not. if not he was given a new medication. he used to say i am a gunny pig for drugs. he moved to grand junction, colorado briefly and then finally home to houston to be closer to family. the houston va wouldn't fill the

prescriptions from the grand junction va because he said they were not transferrable and a new assessment would have to be done before prescribing them. he had two appoints and neither were where a correct doctor. he did see the doctor and after that appointment he called me on his way home and said mom, i cannot go back there. the va is too stressful and not somewhere i can go. two weeks after that appointment clay took his life. after clay's death i went to the va medical center to retrieve his medical records and i encountered a stressful environment. large crowds, no one at the desk and i had to flag down a nurse.

i cannot imagine how anyone dealing with mental health injuries could access care in a stressful setting without making their systems worse. he was open about ptsd and surviv survivors guilt. he worked hard to move forward and found healing by helping people including participating in work in haiti and chile after the earthquakes. he served in a public service campaign aimed at helping the wound weariewariers. clay fought for veterans and participated in the annual storm the hill to advocate for legislation to improve the lives of veterans and their families. clay's story details the urgency

needed in this issue. despite his open approach to seeking care the va system didn't address this needs and today we hear about individual and systemic failures by the va to provide adequate care and address the needs of veteransmeveterans. not one more veteran should have to go through what clay did and not one more parent should have to testify before the committee to tell the va to fulfill their responsibilities that will va will do their responsibilities. i understand you are starting the suicide prevention act and it will be critical to help the va better serve and treat veterans suffering from the mental injuries. had the va been doing this all along it might have saved clay's life.

we appreciate the opportunity to share clay's story and our recommendations on making sure the va will uphold its responsibility for properly care for its veterans. >> thank you both for your testimony this morning. ms. portwine you are recognized. >> thank you committee members. my son brian portwine gave a 100% to every task he performed and his military service was no exception. by the time he was 19 he was awarded the purple heart and the army accommodation medal. i am before you to share brian's story. at 17 brian enlisted in the army after his training in in fintry he was deployed to baghdad when he patrolled the streets. it was a daunting service. this occurred before the search of troops. during this tour brian lost 11

brothers. while serving in iraq in 2006 brian's tank was struck and the flames engulfed the tank and the driver was knocked unconscious and the men fought for their lives as the driver was unable to lower the ramp. they scrambled through the flames, lowered the ramp and existed. brian had a concussion and cuts to his face and legs. this was his first experience with traumatic brain injury. on another mission brian and his first sergeant were patrolling in a hum vee. his partner had him switch seats and 20 minutes later an iud hid the car killing the first sergeant and throwing brian from the vehicle. beside these two incidents he

said six other idu explosions. i would like to pause and ask isn't this enough to warrant for investigation? the powers at be thought to send him to walter reed bud didn't. isn't this enough to stop him from another deployment? apparently the va felt his care wasify enough to go put no but it was crossed out. how and why this decision is beyond me. after his first deployment brian was happy to be home again. he enrolled in daytona state college, worked in the admission counseling office and created videos, hosted events and linked

students with part-time employment around their schedules. he suffered with short term memory loss and had to write everything down. many times his friends told me when he was out with them he would say where are we going again? you know i have scrambled brains from iraq. in 2010, military recalled brian one month before the college year ended and brian immediately dropped his classes that he excelled in. and when i asked him why and he said you have to get your mind in a different place and you have no idea what is coming. during this second deployment he didn't call home to any friends. he was struggling with anxiety attacks, panic attacks,

traveling the same roads as the first tour and new stigma of admitting ptsd as all of them do so you man up and move on. upon returning from the second deployment brian was evaluated and he was diagnosed with ptsd, tbi, depression and anxiety. i would like you to refer to the documents at this diamond that you received. brian couldn't remember the questions asked from the therapist during the interview. he had extensive back pain. he could not sleep. he felt profound guilt. he suffered from low self esteem and he was a risk for suicide but was immediately discharged and told to follow up. how in the world can you ask someone that doesn't remember the questions asked can follow

up with the va is beyond me. brian went down hill quickly. he couldn't stand how he would be angry, depressed, anxious but he didn't know how to cope. it took a toll on his relationships. if the dod and assessed brian for suicide risk it was their duty to treat him but received nothing. brian has lost three others beside himself to suicide since the 2006-2008 tour. as you know suicide surpassed combat fatalities for the first time history. it is a very slippery slope. our soldiers didn't hesitate to

protect, serve and sacrifice for our country and now it is time for the va to prove their commitment to our soldiers. i never knew of brian's risks. i think he felt if i could survive two tours of iraq i could survive anything. i think it is a life-threatening situation and it should be shared with the family so we are able to help. the va needs to work with the service organizations including the families in the plan for care. i am requesting, i am begging this committee to pass act 2182, the save act. this has been the most devastating war in history in terms of suicide. our whole nation continues to suffer and every day we continue to lose 22 brian's a day. i promised my son at his funeral i would stop this injustice.

these are quality young men who had so much to offer society. please pass 2182 and support any legislation that gives or soldiers the timely and loving care they deserve. >> thank you, ms. portwine. sergeant you are recognized. >> chairman miller, ranking member and members of the committee i appreciate the opportunity to discuss va mental health care and i want to acknowledge the loss and the courage of these family members ensuring they are not in vein. i struggle with the similarities of the stories. as an infantry fan who lost so

many in war and struggled with thoughts of suicide from the overwhelming chronic pain and injuries. i thank you all for being here. my experience with the va health care system began in 2008. sorry. >> that is okay. you have plenty of time. >> after i was medically retired from the army due to severe injuries from a motor blast in iraq -- excuse me. i have been a patient but i am an advocate for other warriors who are struggling with deployment-related traumas. for a period of 12 months i did receive excellant mental health care at a facility that provided one-stop easy access staffed by

medical, mental health and pharmacy providers. unfortunately, hospital administrators decided this well staff care was too costly. now veterans go through an impersonal in take assessment and have to find their way around a sprawling facility to access the care they need. for many warriors just navigating around the facility is anxiety provoking and for others it is so frustrating they drop out all together. there is less lessons to be learned. veterans with mental health issues will seldom open up about issues with people they have never met. it takes time to build trust and talk about the deeper issues and not every person is skilled at

earning the trust or insightful enough to see the problems. working with a team helps increase seeing something others have missed. veterans will rarely volunteer they are thinking about suicide. and there are not necessarily obvious signs that are veteran is a suicide risk. one thing is for sure, we mean not prevent suicides by doctors mechanically going down a list asking questions like have you thought about suicidal thoughts or harming others. sometimes there is red flags that a clinic can catch like the breakup or other life changing events that can cause you to take action. but for building three for a neuro for back pain and a building 61 for a sleep doctor and building 81 for a

relationship issues appointment no one is getting the full picture and no one is going to see if my life is spinning out of control. as an integrated system the va can give the care i once received where they shared information and perceived problems before they became explosive. so the most important step to prevent suicide is dramatically improve its mental health care delivery. access is an issue but we have to ask ourselves access to what. access to mental health care isn't enough if it isn't effective. they need to understand the warrior mentality and may have to work hard to get the trust. if they lack the cultural awareness or have too many

patients they'll get frustrated and drop out. and soldiers not ready for exposure based therapy will drop out of these kinds. the va care must be veteran centered. that has to mean recognizing each veteran's unique situation and individual treatments and flexible systems to meet the needs and preferences. when the text books say they should but most don't come into treatment until they have reached a crisis point in their lives. a veteran who asks for help on a mental health condition needs to get into treatment immediately. we will not solve that problem by establishing a requirement like a 14-day rule. it doesn't help a warrior who is

at the end of the rope to get assessed but not begin treatment within three months. this is the way the va has implemented policies. their added additional steps to get in so you can see someone in 14 day and now you can intake to intake to finally get the treatment you need. some believe the way to solve the veteran problem is expand the access to non-va care. i doubt that is any solution. the concerns are detailed in my statement showing many studies point fto a shortage of mental health care providers. and there is quality care issues. va could benefit from a greater use of care when and where it is available but it would not help them to be seen by providers who are not equipped to provide

effective care. whether it is lack of training and treating combat related ptsd or cultural confidence. it isn't just a matter of access but access to what. i do believe there are va facilities that are providing timely care to patient effective care but it isn't system wide. from my perspective the starting point at all levels is to adopt the principle that providing timely care must be a top priority. the va achieved that with its efforts to combat veteran homelessness and that tells me the va can have an impact when the direction and priorties are clear. when artificial don't create extortion and they advocate for

care. improving the care requires a comprehensive prove and one of those is to put in place the model i said before. we need a system that serves the veteran not one that requires the veteran to accommodate the system. i hope this hearing brings us a step closer to that kind of va system. i thank you for the time and i would be happy to answer any further questions you have. >> thank you very much, sergeant. if i could go back to you since you were the most recent one to testify. you talk about the interdisciplinary care team you had for 12 months and then after that you eluded to the fact the hospital director or somebody

said it cost too much to do it that way. i think we would benefit from you elaborating about how that occurred and what did you transfer to? what type of care? >> yes, sir. in 2008-2009 the va rolled out four different deployment health care models nationwide. the deployment model i speak of was rolled out in washington state for the american lake va medical center and it was put together by dr. steve hunt with the va. this model provided one ring of a hospital floor in which an interdisciplinary care team for deployment health post-911 veterans exclusively. it had pharmacies, social workers, mental health care and primary care on one team and they would meet to discuss the case load of that team weekly.

and the wait times were short for care, the quality care was up, the management of our medications were the best we had seen within the va. however, after 12 months the team dissipated and what i was told and have been told by dr. steve hunt and others within have the va was it was a temporarily funded program and too costly to provide this level of care to 911 veterans when a facility care has to provide care to all veterans to set aside the funds to provide service for one portion of the population wasn't practical. >> ms. somers, i would like for you to elaborate a little bit on the fact that you talked about daniel having problems with va

staff being uncaring and insensitive and saying no one at the facility advocatiadvocatee- advocated for him. -- can you give us examples? >> absolutely. if i don't make it through this howard will finish. probably the most worst event was when daniel presented to their er -- >> it took daniel a lot to go to the va facility and some of the things that have been mentioned were in part of the fact that even along the highway in phoenix there were speed traps and when the lights flashed that would give him flash backs. even if he wasn't the one

speeding. so it was difficult to drive down to the va. it is busy but he presented there in crisis. he presented to one of the departments, to the mental health department, he said he needed to be admitted to the hospital. this is something that we have been told my his wife who as jean mentioned as a bsn in nursing and his mother-in-law who was a opsychiatrist. he was told they had no beds in the mental health or emergency department. this brings up another few issues but the fact is that he went into the corner, he laid down on the floor, he was crying, there was no effort made

to see if he could be admitted to another facility. there were two other major centers within a mile and half from the va. he was told that you can stay here and when you feel better you can drive yourself home. that is just an example of the lack of advocacy and compassion that we know daniel encountered through the va but we have met other veterans specifically in oklahoma city who had very, very similar circumstances at verify va's. >> do you know if we ever spoke to any va official about how he was treated?

>> we do not. the other problem, of course, is that these visits, the appointment system is so antique that things are not even documented. there is no way to go back into the system and document a contact in the system. so as far as we are aware daniel didn't seek to anybody at the va about this. it isn't something he would do. it was a feeling of i tried and this is just another example of what the pressures that are brought to bear. we brought the vha and the vba issues into account. these are just things that all together just became overwhelming. >> my belief is he still had the mentality of the military where this is what someone of authority told me and i have the accept it and i cannot go above

and beyond. >> thank you. >> i want to thank the panel for coming again today to talk about your stories and your family and really appreciate it. i know it can't be easy. my question dr. somers is can you go into further detail about why you think it is important to encourage every veteran serving with ptsd to supply a list of points of contact and get a hippa waver? >> interesting you should say hippa because once that is said someone stops the conversation. we have been trying to deal with this issues because it takes a village, a large village, to not

only treat but to recognize and to approach our veterans who might be in crises. we feel it is critically important to expand what we call the support network. at this point, actually a hippa change would be wonderful. we ran a medical practice and jean can tell you what hippa really says isn't how it is a practiced. people are afraid of hippa and take the regulation that is there and take it to the ninth degree. and you do have options under hippa especially if you feel that person is a threat to himself or the family or community and you can reach out to family members or a caregiver

in the situation like that. we feel it is critical to identify prior to deployment, during deployment, and after deployment what we call is a support network so they can be experienced on what their loved one -- or maybe it isn't a loved one maybe it is your football coach or math teacher -- but they can be educated as to what the experiences might have been, what the signs of symptoms and crisis might be and educated to the fact you don't take no for an answer. if you see somebody is in trouble you can direct them to the proper treatment, authority, and medical facility. and that is not actually something that you have to worry about with hippa. so that is one way that we feel that hippa doesn't even come

into the equation. hippa would come in when you are in treatment. we feel that if you are in treatment and there is an issue than the therapist should certainly take the opportunity to contact the closest people to the patient. -- then -- >> thank you. my second question related to hippa because i heard a case where even though it was the department of veteran's administration where vha employees couldn't contact to vba employees and they used the excuse of hippa. have you had that problem with your son? >> we have not heard it was a hippa issue we just thought was a breakdown issue because the computer systems were not compatible and phoenix uses the

post card system for appoi appointments and no one could document that post guards were even sent. we know for a fact after daniel died and the suicide prevention cordinator contacted his widow they were talking and going to send her information on what kind of counseling was available and she asked where you have going to send it and they had an address that was four years old. and he had been involved with the vba and vha over the entire period. >> my time is running out but for mr. and mrs. selke, how long was clay taking medication for his ptsd and how long was he denied medication from the va?

>> he started in 2007 when he was back at 29 palms recooperating from the gunshot wound in iraq. my understanding is that he again received medication that he needed when he was active duty. his care seemed to be good and he felt comfortable with it. when he transitioned to va care he was never denied medication. what happened when he moved to houston was he was told that they could not refill his prescription that followed him from the la location and grand junction. he was having to start over as a new patient and i had this reinforced yesterday in a meeting that was one of his major frustrations and that i have heard from fellow veterans

of his that when they go to another facility they have to go back through everything. all the recounting of everything and that seems ridiculous to have to have that system. when he was told in houston they could not refill his prescription he was told you need to call the va that wrote the prescription earlier and see if they will refill it. he was going to haiti for a couple weeks and needed information. clay was proactive enough and was able to do that. he was determined and did get it from the grand junction va. when he came back from haiti and went to his appointment in

february that was with a psyc l psychologist and he wasn't given a new prescription until then on march 15. so beginning of january and finally on march 15 gets the medicine there. when he was active duty lexapro was found to be the best to work. he was on paxil, zoloft and a variety of or others. when we came out generic was the

drug of choice and he was given one that was close but thought the same thing because there was no generic for lexapro. when he arrived at the houston va and asked for a refill and somewhere in the first couple of appointments he said he would like to go back to lexapro. and when he met with the doctor in march on the 15 and did give him a prescription. he goes down stairs to the va and fill the prescription. he spent two hours in the pharmacy. he was call up to the pharmacy desk to pick up the prescription and given ambian for sleep -- y

more on that. and told they don't stock lexapro, it isn't a generic and it will have to be mailed to him. so it was mailed to him sometime within the next week. i think they said a week to ten days he would get this. a couple issues there. if you know about anti depressant and anti anxiety m medicine you cannot stop them cold or wait for them to come in the mail and expect them to work. it takes a while for it to work. he was frustrated and called me as i said in my testimony on the way home and said i cannot go back there. the doctor at the houston va, i have spoken with him several times since clay's death and he

has been forthcoming and i appreciate the information he has given me. something in our last conversation which was just a couple weeks ago that i have not heard -- i have been concerned about ambian as there have been a lot of conversations among spouses and family members of veterans who died from suicide and they have been on ambian for sleep problems. whether it is a connection i don't know but it is a high number of prescriptions given back. a doctor said ambian wouldn't be for the type of sleep problems and i believe the term is

hyperaruseal but i am not sure, but for the type of problems like the nightmares and flash backs. there is another drug starting a p -- i don't have it with me. he said that is the drug that works better. i was stunned so i could not ask why didn't you prescribe? that has been something that has haunted us for three years. in that two-week window something went wrong. clay had moved back home. he had just returned from haiti doing volunteer work when gave him great hope, it was great

therapy for him. he had started a job. he had bought a truck the friday before he called and asked me to meet him and he bought a truck for work and by thursday, the next week, he was dead. we were with him over the weekend on that saturday. the whole family at various points saw him. he had lunch with his dad. we went to a movie that evening. i just couldn't believe that within five days he was dead. so we know he suffered post traumatic stress, we know he was treated for it, he was very open about it, sought help and that two week window is just a mystery that haunts us. and we have done everything we can to find out answers.

... d we have done everything we can to try to find out answers. >> mr. lamborn for five minutes. >> i want to thank you all for being here. you've given so much. i thank you i know the committee thanks you. and the country thanks you. i want to ask about the role of families in treatment and therapy. i have a constituent who came to me and her husband was stationed with the tenth special forces at fort carson, colorado, where i represent. and he took his life. andan advocate for a program that has a holistic approach that involves families, whether parents or spouses. and i would like to ask any one of you who has insight as to whether there should be more of a role for families in the treatment programs that are offered through the va. or is there a lack there? >> we certainly, during the time

that daniel was with the va, certainly feel that there is a -- there was a lack. and, again, we feel it has a lot to do with fear of repercussions under the hipaa law. and also a total misunderstanding of what the law currently is. and i would like to take your point further and say that it shouldn't just be family, i think we would all like to say we did not have dysfunctional families, but there are dysfunctional families out there and so we started using the term support network. a lot of young men and women undoubt ledly join the service get away from families. that doesn't mean they don't have a support network. we would like to get away from the whole blood kinship and say it is a support network. i think it goes without saying, i recently read a report by national association mental illness that there is no

question that family involvement is beneficial. there is just no question. it becomes more of an issue, i believe, and it is why howard an i have been trying to work with the dod to get them to identify a support network, because certainly in daniel's case, daniel was a geek. but he was at his absolute healthiest, mentally and physically after he joined the army. and he went through basic training. he was in great shape. if they have could have identified right then and said, daniel, give us a support network for you, who would you write down, you know? he had really, really good friends, we hope we would have been on it, his wife would have been on it, his mother-in-law probably would have been on it, his brother-in-law. it would have been so helpful to have that list then. because when he got back home, he wasn't capable of that

anymore. i like to say, you know, not from a legal standpoint, but he had diminished capacity. he was not making correct decisions. >> okay, okay. anyone else? mr. selke? >> thank you. our experience, like most -- probably a lot of families is we didn't know what pts was. we had no idea. clay was, again, very open about it. told us he was destinationed with it. told us he was on medication, seeking counseling. but we didn't know the ramifications of that. and like most of our warriors, they're strong. and so he was, you know, put on a real good act. had we known the extent of even what he talked to his counselors about, the idea that the somers

have approached about regardless of the hipaa, you know, legalities of that, for -- if in fact somebody has that conversation with their -- that counselor, somebody outside of that counselor and the patient needs to know that the patient could identify somebody who would then be able to be aware of what is going on, and to say, you know, this person needs help. clay, looking back, there was all kinds of things going on in his life. there were just red flags. and we didn't know. and there is a lot of literature out there, there is a lot of information. i believe that any family who has an individual involved in the military, after they had come back, or really anytime, they should probably just assume that there may be some sort of

pts involved there. the suicide deal, clay actually had a conversation with susan and said, hey, mom, i thought about it, but i would never do that to you all. he actually addressed the issue and lied about it to us. and so the family plays a huge part in really being advocates for the individual and being able to just watch and watch for signs and then maybe be able to do something about it. >> in conclusion, i would have to say, the va needs to learn best practices and have programs available that include families. everywhere. >> if i could add something to that, going back through clay's medical records, for whatever reason, when he died, i immediately wanted his medical records. i wanted to read everything i could and try to grasp what was going on. he had apparently as early as november or december of 2009

spoken to someone in the va in the l.a. va about suicidal thoughts, that's on one of his reports, at the end of 2009. he had separated from the marines at the end of april of 2009. i knew nothing of that. we didn't learn until the fall of 2010 when he told us, he said, i have struggled with this thought, but i could never do that to you all. i just can't. and i don't think -- i think in his mind he believed i'm thinking these thoughts, but i could never do that. as far as we know there were two times during the fall of 2010 that he did have enough serious suicidal thoughts that he did

reach out, one time he called and talked with me, and another time he spoke with a close friend, and then after that second time he shared with me, you know, that -- or with all of us. so we knew in 2010 at the end of the year, we knew he had struggled with suicidal thoughts. and we also knew that he was on medication and we're assuming that with post traumatic stress and suicidal thoughts and that that the va knew best how to take care of him. i begged him, please, let's go to private care. we will pay for it. we know great psychiatrists, counselors in houston, let's do that. he would not do that. he was adamant. he said, i have served in the marine corps for four years, my medical care is to come from the va, they owe that to me, i don't want to go to private care.

i want to talk to someone who has either been in war or knows about war and post traumatic stress and the things that i have seen and done in are war. i don't want to go to private care. and that was just his personal feeling. we have heard that from other veterans as well. that's as difficult as the system is, that's their comfort zone. and they need to be feel they can be taken care of. >> my hearts go out to you. >> mr. takano, you're recognized for five minutes. >> thank you, mr. chairman. it is very difficult to listen to your story. i'm very touched by them. so i definitely want to thank all of the families for being here today. so, let me ask this question of miss selke, i believe a lot of

veterans have that same feeling and therefore i do believe that we have to, it is incumbent upon us to make sure that we get it right at every facility, because veterans are expecting that. they don't want to see this be be a burden to their families financially. i am very much open to making it easier for nonva care to be available. and with that i want to ask dr. somers, you are also a medical doctor, dr. sommer esom? >> i'm a urologist. >> you're from the phoenix area. >> i practice in phoenix. we currently live in san diego. >> in san diego. i'm from riverside, north of san diego, as you know. i went to visit my own va, in loma linda. they're able to -- they get -- they're able to get veterans to

see a family practitioner in 24 hours if need be. i'm not so sure about mental health care or psychiatrists. they indicated to me there is a shortage of psychiatrists. and i recently visited a new kaiser facility and i asked him if there was a -- what shortages he was experiencing. can you tell me if there are general shortages in your area of these kind of practitioners? >> there is a shortage of mental health professionals nationwide. and there are many issues that go into it. certainly reimbursement is one. we know one of the people that daniel had been seeing

because -- and this is another issue of continuity of care, he was forced to go outside the va system, just because he couldn't be seen in phoenix. there was just no availability, no mental health available. and i think you have to divide psychiatry and psychology. for these people suffering from ptsd, it is the psychologist and the psychiatric social workers who are providing most of the care as opposed to the psychiatrist themselves. but psychiatry and psychology are incredibly important and what happens is if we try to recruit into the va, the community is losing that mental health component. and it is a huge issue. it is an issue that has to be addressed by our medical schools, by society in general. but it is not just an issue here and there. >> here is the thing.

dina titus and i represent a bill that would increase the number of residencies at va hospitals. i expect a number of those -- if we approve it, a number of those residents would stay, but also something would go into the community as well. >> right. >> my thing is even if we do approve -- make it more easy, easier for vets to use, that areas like mine, they're still going to have trouble finding that care, you know, in the community. >> they will. and they'll have trouble even if you have people in the community, you'll have trouble finding people in the community aware of military culture and who are aware of the issues that veterans face, and, again, that's just brings up a whole other issue, whole other series of issues. >> i wish i had more time. maybe i could get your information through my staff, because i'm trying to understand also your criticism of the vista

medical records. there is also an issue of the -- >> be trying to with the pc-3 program and with the other issues that are being promulgated now, there has to be communication between the va and the providers who are seen the veterans being referred out. so huge, huge issues that have to be addressed. >> i think i understand your point of view as well about your doubts about radically restructuring, that we got to try to get it right in the va facilities because of that expectation that miss selke -- and the selke's son had, that they -- that was their comfort zone. so we got to do both things at once, make sure that every va center has excellent mental

health care and try to provide some options. >> yes, sir. my concern with the bill that just increases the number of practitioners at a hospital, we're not solving the issue with effectiveness of care. so it really has to be a systematic approach to solve the efficacy of what care is being provided as well as the numbers to accommodate the sheer overwhelming amount of veterans that are trying to access that already broken system. i just wanted to add that, sir. >> thank you. mr. chairman? >> dr. roe, you're recognized for five minutes. >> thank you, mr. chairman. and i thank, as a father of three, and a veteran, i appreciate your courage to come here today and speak. it is a really heart warming and i know this is very difficult for you to do. and it has been difficult to sit and listen to the testimony. there are a good number of veterans sitting up here.

i'm a veteran of vietnam era. and just want to thank you for that. and in being here. i can tell you this past weekend, i returned to something very joyous for me. it was a reunion of a bunch of young boys growing up in the '60s, who were all eagle scouts. and all but one was there, of our friends, he didn't make it out of vietnam. so i can tell you that this loss that you have, that you're sharing with us, is very, very helpful, that loss will go with you as it does for my friend of almost 50 years. so thank you for your courage to be here. i know it is very difficult. and sergeant renschler, you bring up a great point, all of you have today, and the coordinated effort you brought forward, that team approach i think was very good. and i certainly do understand what the va was saying, if this

works for the oif, oef veterans, it should work for all veterans. the majority that they're serving are veterans of my age. i think this needs to be expanded if that method that you put forward, it looks like it worked extremely well, should be looked at. and dr. and mrs. somers brings up an incredible point. dr. somers, you probably dealt with, as i did, some primary care in your practice when you were in urology. you don't just get to be a urologist, your patients get to know you and share a lot of things with you. and dealing with this is very complicated. as you all have pointed out, and miss selke so eloquently pointed out, is that it -- this approach of caring for people with pts or chronic mental illness is extremely difficult. dr. somers and i could go in operating room and remove a tumor. that's easy. this is much more difficult to

do. and those signs and symptoms are very difficult to spot because miss selke, you saw your son, when he was actually, you thought, doing very well, that week before he passed, and i think as a doctor, that's been one of the things that troubled me all of my career, is trying to figure out when you have a patient that would take their life, it is why did this happen, and many times that week or two before, things seem to be going well. you think things are going better. i think dr. somers, you and your wife brought up something that is extremely important, that a good friend is probably as important as a good doctor, good person to lean on. and i think you have to do what sergeant renschler was talking about to have this very sophisticated team together for people in need, but you also just need someone, it may not be a family member, like you pointed, it could be a coach or pastor or whom ever it might be in your life, it could be a family member, i think putting all that together is a real challenge. i will hear later from the va about what they plan to do.

but any further thoughts along that line would be helpful, if anybody would like to share some of the -- your thoughts about what we could do. >> i think it is important for the transition program. i know before that brian went to iraq the first tour, he went to california where they have a base where they teach them all, like, they make it like an iraqi town. so they learn how to control crowds, take buildings and all that. but had th but when they come back, it is boom, you're there for a week and then out in the community. there is no transition. why can't they use those centers they use to send them where they could have psychiatrists, psychologists, and look at them, give them assignments, see if anybody has poor concentration, poor memory, you know, and use these resources that we have, you know, say, okay, now you need to go do laundry, give them

a list of things to do see if they're able to do that, and, you know, observe them, we can't just take them like cattle and put them up through a bunch of questions and then let them go in the community where they don't have their brothers to confide in. when they come back, they have put their life on the line to trust these other brothers, they would die for them. they come home, they don't have anybody they're going to trust that much. and nobody that has been in war is going to understand so they don't open up. the most people that open up to is their brothers. michigan has a program called buddy to buddy. that they put together one veteran, you know, that has been home with the veteran. so that if they have any problems, that are going to open up to that person much more than they are a therapist. or have group therapy, let the veterans talk among themselves. they could, you know, have a group of ten veterans and then

have group therapy and maybe they could confide in each other. because it is going to take a while to build up trust with a therapist, if you do. >> totally agree, thank you very much for your courage of being here today, mr. chairman. i yield back. >> mr. brownly, you're recognized. apologize, mrs. kirkpatrick, you're recognized. >> i appreciate what you said about once a diagnosis is made, and medication is prescribed, staying on that, on that medication. and i'm really want to know how often our veterans have to refill the prescriptions, and i would like to hear from each of you what you've learned about that experience, are you given a 30-day supply, they have to go back constantly back, or on sergeant, we can start with you and then work our way down the panel. >> yes, ma'am. so at our facility in washington state, medications are given on a 30-day supply.

there is an option for mail refills. the system is pretty confusing and i normally mess it up pretty well, so my wife has to manage that for me for most part. you have to be able to put in a request three weeks before you need it, and i usually forget until i'm about to run out and so then i'm off my meds for a long period of time, which is never good. as far as the other medication issues that have been discussed, continuity of medications from one facility to the next. i'm in southern part of washington state, and people who are coming up from portland, oregon, which is about an hour away, are on medications that are not transferrable to the va facility where i'm at. so they have to start all over as a guinea pig is what was discussed earlier, try medications they may have already tried in the past to get to the point where they're able to approve a nonformulary

medication. it took four years for the dod to balance nine medications for myself, and when we transitioned to va care, many of those medications were not on the f m formulary and we had to go back through the guinea pig phase again and we ended up with 14. there are many issues as we talk about that. >> that is just unbelievable. any other families want to -- >> brian was never put on medication. they diagnosed he had depression, pts, but never put on any medication, he was put on medication for his back when he was thrown from the humvee, naparcin and muscle relaxer and that was temporary, but they never even prescribed, screaming out three times a week with nightmares and having your brothers wake you up and then telling the therapist how embarrassing that was, i think you need to be on some medication. >> agreed.

>> these medications are so subtle, and they're so particular to the individual. it is just mind boggling that there is not an easy way to identify and work with the individual vet, determine exactly what that cocktail, if you will, looks like. and then be be able to without -- to just seamlessly transfer that to wherever that bed is. these people are young and they're on the move. and, you know, they're all over the place. and so that -- those barriers need to be taken down. >> dr. and mrs. somers. >> yes. thank you. and thank you, representative kirkpatrick, for being such a support and a help for us. there is multiple issues that have to do with the medications. just the fact that the formularies are not the same is

a huge issue. and it doesn't just affect veterans at the va system. there are veterans who are retired from the military who see both -- who see physicians both at the va and the dod. so they are seeing people at both different medical centers and they cannot be on similar medications from one to the other because the formularies are not the same. the problem is that not only does the va use 99% generics, but they use the cheapest generics. so daniel, who had not only ptsd and tbi, but full blown gulf war syndrome, which included irritable bowel, had only certain medications he could tolerate. maybe the chemical in the medication is the same, but the bonding agent is different. maybe he's on a medication he only has to take once or twice a day, but the va gets a better

price, so now he has to take it three or four times a day. and the change in the medication changes everything. so i mean the issues, the issues are just huge. it is not only that -- and the other thing that we have heard, and from unimpeachable sources, is that vas vary as we heard with their pharmacy policies. there are some vas where you can go and get a brand name medication with no problem, other vas that essentially it is impossible to get a brand name medication. so, i mean, that brings up this huge issue that we have is why there is so much variation in the entire system. why we can't have more uniformity within the va system as a whole. >> thank you. thank you, dr. somers. my time is up, thank you. >> sorry. >> let me just conclude by

saying your testimony is heart breaking. and i can barely hold back my tears and i thank you for being here. i yield back. >> thank you, mr. runyan, you're recognized for five minutes. >> thank you, mr. chairman. and i thank all of you for sharing your stories and truly being great americans and great patriots because your stories are going to help people in the future and thank you for all that. a couple of points and i think dr. somers was talking about it, and i think we see it all day. we talked about this in the hearing the other night. it almost seems like the va is so fragmented, that there is no overwhelming mission from the top with flexibility below. that's -- and i think there is a structural breakdown on how you're actually going to conduct business. and that's really where we're

at, whether you're talking vha or vba. it is the same issue. and we have yet to -- i think next week we're digging into some of the vba issues also. it's a culture. and one other point, and then i'll ask one question, and it -- and miss somers was talking about it and dr. roe also validated it, when you talk about community and talk about support networks, these men and women are spending more time away from the health care facility than they are in the health care facility. so friends, family members, you know, classmates, buddies, all have to be part of the healing process. not doing that. and i know the term wholistic has come up a few times. i think the sergeant mentioned it a couple of times. it is part of the healing process. there is no silver bullet to cure somebody. you got to be able to help them in many different ways.

that being said, in the va's testimony, they mentioned suicide prevention coordinators are supposedly placed at all va medical centers and the large clinics. they're supposed to follow up with veterans at high risk. were any of your sons ever contacted in that first month after they were designated high risk by a va suicide prevention coordinator? >> we're not aware of that. the fact they didn't even know where he lived would bear proof of that. >> that's one of the issues that we're dealing with also and that goes into the whole support network issue, is that -- and we have spoken to so many, so many families in the same situation is that daniel was married. and that basically shut us out of the equation. and that's where if we had the opportunity, if we could do some

changes in this misinterpreted hipaa regulation where we could have been more in touch with his therapist and they would have felt free to talk to us, where we feel that we could have been more help. but since he was married, it was as if we didn't exist. >> i think that's important point is, like, when brian was injured in the tank explosion, i was notified, 3:00 in the morning an they called me from fort hood saying he was injured, where they had taken him, he's back with his unit, but yet you diagnose somebody with ptsd and tbi which can be life threatening injuries and nobody notifies you. that just doesn't make sense to me. >> anyone else? >> your point, or question of

being flagged as a high risk, this is something that came up that really baffled us, i guess. when clay was transitioning or moving to houston and started to go to the va in houston, his records apparently from what i was told, those records were not seamlessly, electronically sent. they did not have his records from l.a. and that's where the bulk of his time was once he had gotten out of the marines. so as i look back through those medical records, as i said, there were at least two or three times in there that it talked about and he talks and admits to having had suicidal thoughts, so i assume that he was flagged, would have been flagged as a high risk. i mean, it says on the medical record, high risk, highlighted. when he comes to houston va,

nobody knows he's a high risk. the psychiatrist didn't have anything other than clay saying, this is what my past history has been, and this is the medication i've been on. so that's a great point is to when are they flagged as a high risk? do any family members know that? the only way i ever knew that anybody called him a high risk was when i got his medical records and poured over them after he had died. >> thank you. chairman, i yield back. >> miss brownley, you're recognized for five minutes. >> thank you, mr. chairman. i want to join my colleagues in thanking all of you for being here, and sharing your stories and certainly through your stories about your sons, it certainly, to me, i feel their patriotism through your stories

and their overall most sincere risk commitment and service to our country. so thank you for being here. i wanted to ask sergeant renschler a question. and so in your service, when you were in theater, was there any support system in place for you to go to get any kind of, you know, mental health support while you were there. hearing brian's story, it was re gut wrenching to hear it, and, you know, just to wonder if brian had a place to go to, why he was in theater, how helpful that might have been in terms of his time there, and his transition coming home.

>> ma'am, thank you. when i deployed was 2003, it was right after the initial surge, it was a completely different war theater. we really didn't have anything set and established at that time. so to answer the question, no, there wasn't anything. however, again, i work with many, many veterans, currently, in active duty members and i have been told in recent deployments in afghanistan that after major events take place, there is sometimes availability to have a type of crisis debrief. it is somewhat available. it is not -- it is not streamlined, not across the board, but it has been implemented on some level. >> if i may, the problem is that we know that there is an effort

in the dod to destigmatize mental health issues. but if you're in theater, i would venture to guess that it is going to be incredibly rare for somebody to take advantage of that because all of a sudden they're going to be taken off duty. and the whole idea to destigmatize it is to say, okay, you come in for treatment, but then once you're better, then you'll be able to rejoin your unit or you'll be able to regain your security clearance. but while you're under treatment, you're not with your unit, and you lost your security clearance. so i mean the issue is a huge issue. and we know from people that we have spoken to that the people at the top are aware of this, and they're trying to deal with it, but there is just so much you can do on a boots on the ground level. >> well, if i may, so there is

two separate levels here. there is a crisis response, muc type of a situation. if you experience this, find somebody to talk to. more of an education and immediate response. that has been available as stated, most military service members and veterans as i stated earlier in my testimony are not going to say, gee, that was a horrible experience, i should talk to somebody before i have issues. they are going to wait for it become a crisis point before they seek treatment. >> i just feel like if it was part of the culture being in theater that there is kind of constant dialogue that is going on, that that would have to be helpful to the men and women who

are are there. >> brian did tell me one time when they were on the 15-month tour there was at one time they lost four people in one mission. when he was out there, the morale was very low after that because these were people high up, sergeants and lt and that. so they sent someone in, and when the soldiers would go in and talk with them, he asked the same question, was it sort of like a movie? that just insulted them almost. it was like, why would you ask such a silly question, so they all shut down. i think by not processing those thoughts you are going to internalize them so they are never dealt with. i think even before they are in theater, i think in basic training they should be taught ptsd and while they are deployed and report on each other for their own good and in

transitioning home. i don't think we can say it enough. that's my opinion on it. >> thank you. thank you. i think it just confirms we prepare our men and women to go to serve and to go to war. we don't prepare them very well to transition back. dr. somers, you talked about hipa and the barriers to hipa. you mentioned also modern technology? am i? i yield back. i apologize. >> thank you very much. >> thanks to the moms and dads and sergeants for your testimony. i will look forward to asking the va question. i yield back.

>> thank you very much. >> thank you, mr. chairman and thank you to all the families being with us today. for many of us sitting here today, the pain is to recognize your commitment to give meaning to your sons' lives. i'm the mother of two sons 22 and 25. i can't fathom what you are going through. i want you to know we will do our part to give meaning to their lives. it makes me feel, personally, i'm becoming more and more anti-war/pro-veteran. i think our country had those priorities misplaced getting us into conflict, but not being focused on the cost, societal cost to our country and to the population. these extraordinary young men and the promise that they held going to haiti and making a difference right here. i want to focus in because i

think from your experience you can really help the va and the dod to understand what could make a difference. i want to commend you all with the specificity of your recommendations. in particular, i've been trying to understand best practices, and whether there is any effort or known groups or the types of medications that are helpful, have any of you in any of your discussions, whether within the va or since then, the experience you had meeting with people, have any of you come across any effort to share best practices with the transition, particularly around pts and tbi and just the trauma, how we can

help people coming back from this level of trauma? maybe we can start with the sergeant, if you're aware of any types of programs that are effective. >> thank you, ma'am. there are great things that are effective, but the problem is is even though we can group veterans together in a large sum and combat veterans in another category, it's hard to label one program as effective for all. so many find group therapy programming very successful. many find combat veteran support groups very helpful. some find one-on-one peer mentoring very effective and helpful. this is why when we are talking about evidence-based therapies, best practice of the va pushing

pct, these things can be deemed as best practices, but many veterans aren't ready to go through such intensive therapy. they would rather pace themselves. though they can be very effective squashing the problem, i can't say there is one thing that is straight across the board going to work for everybody. that's why i stress the importance of a team that works together to bring together what's best for each individual veteran in a veteran-centered care rather than a systemic care a veteran has to adhere to. >> you are looking for an individualized approach, but a team approach. you mentioned others on the team may see something in the care. >> yes, ma'am. >> i also want to visit this issue of hipa. i'm an attorney. i worked 25 years in health

care. there's definitely a waiver process. this happens in private sector medicine. are any of you aware, and through your review of the records after the fact, have any of you experienced the va asking the patient at any point in their service for a waiver to identify people that they would be willing to have their medical record shared with? >> i know we had specific -- daniel ended up going outside the va because his psychiatrist retired and they said we don't have anybody for you to see. at the time he was having suicidal thoughts. his mother-in-law who is a private sector psychiatrist referred him to somebody she knew in the community. as she was seeing that person, we asked him, can we be a part of what is happening and he said

he would ask her, but my guess is that he never asked her and we never got the feedback. it was embarrassing is probably the closest word we could come to with him to share that information. >> i can speak to that a little bit, as well. going through clay's medical records from houston from the va, there was a form in that assessment and there is a question that says, do you want us to or will you allow us to, or it said do you want your family to be contacted regarding your care? and he had checked no. as difficult as that was to read, i know him and i can't even imagine, and i really -- i just can't even imagine. these people are so strong in

the first place to raise their hands and say i'll go. and they go to war and they have these injuries, and especially with the mental injuries. it's so difficult to feel that you are a burden on other people. i know clay felt that, even though he knew how much he was loved, unconditionally. any of us would do anything to help him, but he was 28 years old. he had been a marine scout sniper. you just want to be able to take care of yourself and get the medical care you need. so it didn't surprise me to see that, that there was a question of would you allow your family. >> thank you. my time is up. thank you, mr. chair. i yield back. >> thank you. mr. kaufman, you are recognized for five minutes. >> thank you, mr. chairman. first of all, thank you so much for the service of your sons and

sergeant, in your case your own service. my heart goes out to you for your losses as a veteran myself. the question i have is, i mean, do you think, certainly sergeant in your case and then for the parents in the cases of your sons, was va overmedicating them in lieu of giving them therapy? >> thank you for that question. this is an issue we battle with on a daily basis as we provide support and service to veterans and active duty members. part of what i do through the

ministry i'm in is providing support groups through the chaplain's channels. so ideal with this very closely on both sides. medication is no longer being used as a tool to subdue the symptoms while we work on the deeper issues. >> no. what does the va do? >> the va specifically utilizes medication to control it and keep them, suppress the symptoms without working on the deeper issues. >> thank you. please. >> brian was never put on any medication. only for his back when he had that problem. >> okay. >> yes. clay was on quite a bit of medication. as i said, he felt like a guinea pig, constantly being begin something different. >> do you think they chose medications in lieu of therapy? >> sure. >> one-on-one therapy? >> yes. the only one-on-one therapy that

he spoke of that seemed to be effective at a certain point in l.a. he went to a vet center and had a counselor there that he really liked and felt he finally found somebody he to talk with. >> okay. >> from daniel's point of view, i think part of his problem was that he also had gulf war syndrome which manifested with so many physical symptoms. so, yes, he had a 24 inch by 24 inch drawer full of pill bottles, but i think it was because he was having such incredible interactions between the different drugs he was taking for pts and the gulf war syndrome. >> and daniel was not being seen by a va psychiatrist six months after he was home, just because he never got the post card that he was supposed to get to assign

him another provider. >> how much of the stress of the factors leading to suicide do you think might have been related to the fact that -- i can tell you having been to iraq, first iraq war then the second, that when you come home there is a huge, i guess maybe separation anxiety that you develop these interdependent bonds in this team around you and all of a sudden it is gone. it is just gone. people fall into very dark and deep depressions sometimes. i think it's easier for those that come back and they have a long period of active duty with the same people that they served with. i wonder if you might comment. we'll start with this side of

the table. >> this is a problem certainly with national guard. daniel was a member of california national guard with the military intelligence. they are routinely separated from their main unit and assigned to other units. daniel went to iraq with an mp unit out of texas. so he was already not with the unit he trained with. he went to iraq. when he came back, his wife had moved to arizona to be with her parents. he's california national guard deployed through texas and ended up in arizona. so he had no support group whatsoever close by. it would have been phone call and e-mail. >> this is a news magazine issue. reserves and national guard, it's a huge issue. not to take away, of course, from regular service members and all branches of the service, but it's a much bigger issue for those who do not have the

opportunity to come back to a defined facility and spend time, like you said, with the people they were deployed with. >> great question. the bonds that these men and women form in combat are just incredible. so it's very difficult for them to leave service and come back to their communities. lay probably stayed in, he struggled about going home to texas or staying in california. i think one of the reasons he stayed there for a while was because his close friends, marines were staying there and continuing in his life. one of the tragedies with clay was he moved back to texas and he really wanted to consider going into working for the fire department, paramedic, that sort of thing, and was having some struggles with that. after he died, he found out that, i think, three of his group were actually in the

greater houston area. one of them in particular had gone through all the steps. he was like a year ahead of him going through the fire department. it would have helped just the knowledge those people are there would have helped. there is a big break leaving service and going back to the community. >> when brian went first he was with first caf. that was deployment that was supposed to be 12 months and they extended it to 15. he was very, very tight with all those brothers and they are still very, very connected online and text and everything. when he was in college then for the year, then when he was called back the second time, his unit was already home for the year. so he was put with louisiana national guard. he had no idea those were completely new people. so you can imagine then when you

are already damaged and you wake up screaming three times a night and have anxiety and panic attacks, you know, it's very difficult. i think he did bond with the people. he was very social, but it wasn't the same type of bond he had with the first group. >> i think it's been stated well. to highlight on that, the battle buddy system is so culturally engrained in the military community. you really become a family unit with those around you that you serve with. separating from that, and especially our wounded as they are shuffled from their units to a warrior transition battalion, they are separated from that unit. they transition out and lose connection and begin to isolate themselves after that loss. that's a very difficult thing. i think that's why a program such as the va's peer mentor and navigator program are so

essential. we should look at that and look at the way it's being implemented and improve upon that. service members and veterans connect best with other veterans. especially those who have shared experiences and can help navigate through the experience es they experience through this system. >> thank you. >> mr. o'rourke for five minutes. >> thank you, mr. chairman. i would like to join my colleagues thanking you and telling you what you have shared with us today is so powerful. sergeant, your story, the story of brian and clay and daniel, i hope will force us and the administration and this country to treat this issue with the respect that it deserves, with the attention it deserves, and to get the results that our veterans deserve. and beyond the power of the

stories, which are just -- it's hard to put into words the effect they are having on me and i think my colleagues on this committee. you've also come to the table with solutions and proposals to improve the system. i love the idea that we think about the va restricting its responsibilities to becoming a center of excellence for war-related injuries. i haven't thought about that before. i don't know what the effect would be. i would love to hear from other veterans and veteran service organizations. i love that you are thinking about a big idea to transform a system that is obviously not working today, but hasn't worked for a very long time from everything that i've learned so far. this idea of an interdisciplinary approach to taking care of veterans when they return, i'd like to know more about that. i think it makes a lot of sense begin your earlier testimony. the buddy-to-buddy system you brought up. identifying a support network when these service members are still enlisted are all excellent

ideas. i'd like to ask you is, i've received so much value from this testimony today than i ever have from a representative of the va, including the reasons why we should be focused on this, the ideas and suggestions on how to fix it. i'd like to ask you if there was some formal process to involve you in fixing the va, would you like to participate? secondly, if you have any other ideas because there have been so many good ones that have come through so far that we haven't raised today, i would love to give you an opportunity to share that. maybe we can start with dr. somers and work down. >> we want to be part of whatever efforts. we submitted as part of our testimony 15 pages of problems and potential solutions. there are a lot of really good

people who can be very beneficial to try to help the syst system. we just don't have the time to get into specifics right now. to answer your question, for sure we would like to be involved, if at all possible. >> thank you. >> absolutely. we would be happy to do whatever we can to help. i want to kind of shift the focus a little bit off of us as parents who lost sons and lost childr children. words can't describe that, but i sit here and look at sergeant rensler and listen to his story, and we are surrounded by veterans behind us, a lot of them from the iva group. if there is any blessing or silver lining in clay's death, we have become friends with so

many of these young veterans that have enriched our lives. i don't know where i'd be without them. i mean that sincerely. they just have enriched our lives so much. so whatever we can do. we can't do anything to bring back clay or brian or daniel, but what we can do is do something, whatever it is, to make life better for all these veterans behind us and all of them all across the country, all veterans. not just iraq, afghanistan, but all of them. we shouldn't have to be reminded of that, and yet we seem to have to be reminded that we need to do a better job. so we are happy to do whatever we can to help. >> thank you. >> any time, any place, we're available. part of the process for us to heal, and i think for everybody at this table is to have the opportunity to go beyond our

personal losses and to address the veteran community as a whole, and to do whatever we can to take care of those fine men and women. so the opportunity to be in this community here and to be able to talk and to be able to be heard by people who hopefully have, i believe certainly have the heart and hopefully have the ability to make some things happen. the va is very, very complicated. it's a huge animal. i know there are a lot of things that need to be dealt with. there's a lot of really good stuff it does. there are some big problems. i think if we can just focus on the individuals, just focus on them as people in need, as patients on their care. what do they need today? and then build the system, modify the system, do whatever

based on that. i think that will take us a long way. the focus needs to be these veterans. >> thank you. >> totally. >> my time has expired. miss portwine and sergeant rensler, would you indicate if you would like to be involved perhaps in a more formal way to include your ideas? >> it would be an honor for me to help make a change for the veterans. it would be like paying it forward. >> thank you. >> any time, any place. i not only bring my battlefield perspective, but all the veterans i work with. i only off that ... >> thank you. >> mr. cooke, you are recognized for five minutes. >> thank you, mr. chair. i want to thank the group for being here. i know this is really, really tough. sergeant, for your input, this is tough to listen to and it's

even tougher for you guys. the comment about the parents not knowing, i'm not surprised. a lot of people, the worst thing in the world, after my second purple heart, i didn't want my parents to know what was going on. this is going to be the problem that i think all of you are sharing, that common denominator. you know, everybody that goes through these experiences will have huge psychological problems, but who are they going to share it with? are they going to share with a psychiatrist or a psychologist that doesn't understand the military culture, the veteran culture? they are not going to open up. you need that connection. i think the sergeant made a great point. your comments about