From: Democratic Leader Pelosi <>
To: Democratic Leader Pelosi <>
Sent: Thu, 11 May 2006 11:56:35 -0400
Subject: PTSD Release and 3 Articles (USA Today, KC Star & Wash Post)

Democrats have fought for increased funding and outreach services to address the mental health needs of our returning combat veterans, including introducing H.R. 1588 - comprehensive veteran's mental health care legislation.  Just yesterday in the Appropriations Committee, Democratic amendments to add $2.6 billion in VA funding were defeated on party line votes.
CONTACT: Geoffrey Collver @ 202-225-9756
At-Risk Vets Not Getting Follow-up Mental Health Evaluation, says GAO
Washington, DC - "Screening servicemembers for PTSD is absolutely the right thing to do, but if we have no confidence that those who need further mental health evaluation will actually receive it, then what purpose is it serving?" asks Rep. Mike Michaud (D-ME).  "The process, as it is now applied, is failing our service personnel."
Michaud, ranking Democrat on the House Veterans' Affairs Subcommittee on Health, was commenting on a Government Accountability Office (GAO) study   ( ) released today that found nearly 8 out of 10 servicemembers returning from Iraq and Afghanistan identified to be at risk of developing Post-traumatic Stress Disorder are not being referred by the Department of Defense (DoD) for follow-up mental health evaluations. 
The GAO found that 178,664 OEF/OIF servicemembers who were deployed from October 1, 2001, through September 30, 2004, and who have since been discharged or released from active duty completed DoD's post-deployment screening questionnaire.  Of those servicemembers, 9,145 responded positively to at least three of the four PTSD screening questions, which would be considered by mental health experts to place them at-risk for developing PTSD.  GAO found that only 22 percent of the servicemembers who were at-risk for PTSD were referred by DoD providers for further mental health or combat stress reaction evaluation. 
"When 78% of the servicemembers who are at risk of developing PTSD do not get a referral for further evaluation, then it's clear the assessment system is not working.  Early assessment can prevent tragedy.  Untreated PTSD can lead to substance abuse, severe depression and even suicide," said Michaud, adding, "We cannot afford to wait any longer to address this issue.  This Congress needs to press both DoD and the Department of Veterans Affairs to do a better job when it comes to helping veterans with PTSD and other mental health issues.  I intend to introduce legislation to ensure this process is more accountable."
# # #
Many war vets' stress disorders go untreated   
Posted 5/10/2006 10:59 PM ET
By Gregg Zoroya, USA TODAY
Only about one in five Iraq and Afghanistan war veterans who screen positive for combat-related stress disorders are referred by the Pentagon for mental health treatment, according to a draft of a report to be released today by the Government Accountability Office.
According to the draft, obtained by USA TODAY, the Pentagon told investigators with the GAO - the investigative arm of Congress - that it relies on screening and the "clinical judgment" of military medical workers who meet with each returning veteran.
Based upon the screening and assessment, military officials then decide who should received follow-up mental health care.
In the report, the GAO criticized the Pentagon for failing to specifically explain how it identifies troops who may be suffering from post-traumatic stress disorder (PTSD).
Pentagon spokesman Terry Jones says military officials were reviewing the findings.
A leading Democrat on a House Veterans' Affairs Committee says the GAO findings proved that the Pentagon's health screening process is flawed.
"When 78% of the servicemembers who are at risk of developing PTSD do not get a referral for further evaluation, then it's clear the assessment system is not working," says Rep. Mike Michaud of Maine.
The military health screening process includes four questions to help identify combat-induced stress.
The questions relate to nightmares, severe memories that will not go away, feeling numb and being constantly on guard, watchful or easily startled.
Positive answers to three or four of the questions indicate a possibility of PTSD, the report says.
Of 9,145 servicemembers who returned from combat from 2001 to 2004 and answered yes to three or four of the questions, 2,029 - or 22% - were referred for mental health treatment, the report says. The Army and Air Force referred about 23% of their personnel who answered the questions positively; the Navy referred 18%; the Marines 15%.
"Knowing the factors upon which (Pentagon) health care providers based their clinical judgments in issuing referrals could help explain (these) variation in referral rates," the GAO report says.
Find this article at:

        Posted on Thu, May. 11, 2006                   
Most at risk aren't evaluated further
U.S. failing stressed-out soldiers

The Star's Washington correspondent
WASHINGTON - The Pentagon has referred for further treatment only 22 percent of the soldiers it found in danger of developing post-traumatic stress disorder, a government report due out today says.
That means nearly eight out of 10 soldiers possibly at risk for the disorder were left to cope on their own.
The study by the Government Accountability Office said officials with the Department of Defense did not explain how they determined whether at-risk soldiers received further evaluation for combat stress or other mental health problems.
"As a result, DOD cannot provide reasonable assurance" that all of the Iraq and Afghanistan soldiers who needed more treatment got it, the GAO said in a draft of its report obtained by The Kansas City Star.
A Pentagon spokesman said he had not yet seen the report and could not comment. Veterans groups reacted swiftly.
"We want to know how the secretary of defense has allowed this to happen," said Paul Rieckhoff, executive director of the nonpartisan Iraq and Afghanistan Veterans of America, who also led an infantry platoon in Iraq. "Untreated PTSD and bad followup by DOD can have this country repeating many of the same mistakes the government made during the Vietnam War. PTSD can lead to homelessness, suicide and crime."
Post-traumatic stress disorder is the most widespread mental health problem experienced by soldiers in combat. It can cause nightmares, flashbacks, depression, survivor's guilt and other types of anxiety.
The Star recently reported that the government had seriously underestimated the number of troops expected to return from Iraq and Afghanistan this year suffering from the disorder.
Congress required in the 2005 defense reauthorization bill that the GAO review how the Defense Department dealt with soldiers who needed further mental health evaluations.
The GAO studied 179,000 soldiers deployed to Iraq and Afghanistan between Oct. 1, 2001, and Sept. 30, 2004. All of them had answered questions used to screen service members for post-traumatic stress disorder. The questions are part of a more extensive post-deployment medical screening given to all returning troops.
On post-traumatic stress disorder, troops are asked if they've recently experienced an upsetting or frightening event that caused them to: have nightmares; avoid similar situations; be always on guard; feel jumpy, emotionally numb or detached from their surroundings.
The GAO found that 9,000 of the 179,000 soldiers gave answers indicating that they may have been at risk for developing post-traumatic stress disorder. But the agency said that only slightly more than 2,000 - 22 percent - were referred for further evaluation.
The GAO noted that Department of Defense officials said that not all of the soldiers identified by the screening questions to be at risk for PTSD would need referrals.
"However," the agency stated, "DOD has not identified the factors its health-care providers used to determine which ... service members needed referrals."
The draft report recommended that the Defense Department clarify how it determines which at-risk soldiers get referrals and which don't.
To reach David Goldstein, Washington correspondent, call 1-(202) 383-61 05 , or send e-mail to   
GAO: Few Troops Are Treated for Disorder
Post-Traumatic Stress Risk Gauged
By Shankar Vedantam
Washington Post Staff Writer
Thursday, May 11, 2006; A08
Nearly four in five service members returning from the wars in Iraq and Afghanistan who were found to be at risk for post-traumatic stress disorder (PTSD) were never referred by government clinicians for further help, according to a Government Accountability Office report due for release today.
The report says Defense Department officials were unable to explain why only some troops were referred for help. Many veterans groups have accused the government of playing down the risk of PTSD because of concerns over skyrocketing costs.
Service members were determined to be at risk for PTSD, a serious psychiatric disorder characterized by disruptive memories and anxieties following traumatic episodes, if they gave three or more positive answers on a screening questionnaire asking whether they had nightmares about frightening experiences, had avoided situations that reminded them of such events, were constantly on guard, or felt numb or detached from everyday life.
In all, 9,145 of 178,664 service members who took the screening test were found to be at risk. Of those at risk, 22 percent were referred for help. The Army and Air Force each referred 23 percent of those at risk, the Navy 18 percent and the Marines about 15 percent, according to a draft of the report obtained by The Washington Post.
The final report will have the formal responses from the Defense and Veterans Affairs departments. In the draft report, Pentagon officials are quoted as saying that not all service members who gave positive responses on the screening test needed help, but the report said the officials could not specify what factors are involved in referring some people but not others.
Asked to comment late yesterday, the Defense Department said only that it has "several comprehensive and proactive programs to deal with PTSD." Spokeswoman Cynthia Smith said the most knowledgeable officials were not available so late in the day.
"You would think that [referrals for treatment] would be the point of the whole screening tool," said Veterans Affairs spokesman Jim Benson. He said that the Defense Department was solely responsible for administering the screening test and making referral decisions.
The questionnaire is given to returning service members as part of a post-deployment health assessment. Veterans Affairs and Defense Department experts jointly determined that three or more positive answers indicate a risk of PTSD, according to the report.
After the questionnaire is completed, the responses are reviewed by a Defense Department health-care provider, who interviews the service member and decides whether to make a referral for a thorough mental health evaluation, the report said. Providers range from physicians to medical technicians.
Deciding whether to refer service members for help involves judgment, the report said, but the Defense Department "cannot provide reasonable assurance that all [Iraq and Afghanistan] service members who need referrals for further mental health or combat stress evaluations receive such help."
Rep. Michael Michaud (Maine), the ranking Democrat on the House Veterans' Affairs subcommittee on health, said screening service members for PTSD was the right thing to do, but questioned the utility of the screening if people at risk did not receive help.
"When 78 percent of the service members who are at risk of developing PTSD do not get a referral for further evaluation, then it's clear the assessment system is not working," he said in a statement. "Early assessment can prevent tragedy. Untreated PTSD can lead to substance abuse, severe depression and even suicide."
Tom Manatos
Advisor to the Leader
House Democratic Leader Nancy Pelosi
(202) 225-0100