RESPONSE OF THE AMERICAN LEGION TO WRITTEN QUESTIONS SUBMITTED BY HON. ALAN K. SIMPSON, CHAIRMAN OF THE SENATE COMMITTEE ON VETERANS' AFFAIRS Question 1. With regard to the alcohol treatment provision in your written testimony you said, "We do believe that some controls on recidivism need to be defined and established, whether by statute, which would be difficult, or by treatment guides developed by Central Office." How would such controls be reconciled with legislated eligibility for services? Answer 1. In your first question we are asked how, with regard to alcohol treatment, recidivism controls would be reconciled with legislated eligibility for services. The answer to this question is best seen in light of the proposition that eligibility does not necessarily have to constitute a guarantee that treatment will be rendered. If it is desirable to establish continuity in VA's alcohol treatment programs by asking VA to establish treatment guidelines, and we think that it is, at least part of those guidelines should address the problem of recidivism seriously. The American Legion has no interest in seeing veterans move in and out of VA alcohol treatment in revolving door fashion. Many who either do or would, are veterans lacking in motivation for rehabilitation and who use the VA as a refuge. We disapprove of this prospect and believe a veteran serious about alcohol rehabilitation be required to establish both his seriousness and eligibility by agreeing to submit to the entire program, regardless of the number of stages prescribed by VA guidelines and regardless of program length. Question 2. Sometimes around this place, we are faced with ideas and situations which have enormous emotional appeal. Yet, in this time of limited resources faced with enormous deficits, we need to take a hard look at what we are doing, what we want to do, and then, what we would like to do, but must postpone or deny. One of these appealing ideas is contained in a provision of S. 2269 which would authorize the VA to provide bereavement counseling services to family members of a deceased veteran if the family members were recipients of counseling services at the time of the veteran's death. The nature of counseling services provided to assist family members with emotional and psychological stress of death is quite different from counseling services provided before the veteran's death. Thus, the bereavement counseling provision in S. 2269 might be seen as a new service, no matter how meritorious its benefits, rather than as a eligibility question. What do you think about this distinction? Answer 2. The next question concerns bereavement counseling, as provided for spouses of deceased veterans in S. 2269. Might this come to be viewed as yet another service offered by VA rather than as an eligibility extension? We have to believe, Mr. Chairman, that such spouses who would seek counseling at Vet Centers would be few in number because eligibility would be limited to only those spouses who had already been getting assistance at the Vet Center prior to the veterans death. Under the circumstances, it seems likely that such spouses would have emotional problems directly related to the veteran's psychological readjustment problems. Assuming this to be the case, the nature of the counseling rendered by the Vet Center would encompass more than just bereavement counseling per se. In that regard, it is difficult to imagine a clinical circumstance in which a Vet Center counselor could distinguish that counseling given for bereavement and that given for some other psychological problem. This is because in treating psychologically afflicted individuals, it is a practical impossibility to treat individual problems separately regardless of the modality employed. Question 3. S. 2269 proposes to expand eligibility for VA readjustment counseling to certain active duty military personnel within the limits of VA facilities. This raises for me two kinds of questions which I would ask each of you to address. A. First, where is the division of responsibility between the VA and DOD? Should the VA, in the absence of a sharing agreement with DOD, treat active duty personnel in this manner? B. Second, what is the meaning of the words 'within the limits of Veterans' Administration facilities". The idea of making use of all of the capacity of the VA is good, but we all see problems of how to implement priority eligibilities at medical centers. Do we want to create the same problems in a program we already know is in high demand from veterans? Answer 3. Another of the questions concerns extension of Vet Center eligibility to active duty military personnel who might be encountering psychological difficulties as a result of service in Vietnam or some other trouble spot in which U.S. combat troops were engaged in hostilities. As with bereavement counseling, the numbers of active duty personnel availing themselves of Vet Center counseling would be small. The most obvious reason for this is the limited availability of Vet Centers geographically situated near military bases. Another, perhaps more compelling reason for the limited use of Vet Centers by active duty personnel stems from what is now known about Post Traumatic Stress and other combat related psychological readjustment problems. For example, the Vietnam experience in which veterans were denied sufficient time to decompress and ventilate anxieties between the time they were moved out of combat and returned to the United States has been shown to constitute a psychological shock. Also, Vietnam veterans were rotated in and out of the war individually rather than in unit groups. This marked a significant departure from the experience of World War II in which unified groups of combatants were placed on troop ships and slowly returned with their buddies to more peaceful settings in either Europe or the United States. Moreover, knowledge of the value of decompression and ventilation over time with one's combat peers has served to explain much of the psychological phenomenon of the Vietnam veteran. Perhaps ironically, the incidence of this psychological phenomenon can be expected to be much less in the case of the Vietnam soldier having opted to make a career of military service. This is because for many of these individuals,, the decompression or ventilation denied the soldier having left service and become a veteran has been provided to the careerist whose peers have shared the same experiences in Vietnam. The close proximity of many such peers on the military base has to be seen as having afforded careerists an informal opportunity to either prevent or significantly reduce the potential for developing psychological problems secondary to combat in Vietnam or elsewhere. Another facet of this question concerns the propriety of VA provisions of services to DoD personnel in the absence of a sharing agreement. As we pointed out in our written statement, active duty personnel desiring counseling for combat related psychological problems probably would avoid requesting counseling from DoD for fear of career advancement reprisals steming from the stigma attached to this type of treatment. For these individuals, confidentiality is critically important and could not be assured if treatment were offered by Vet Centers through a formal sharing arrangement. Question 4. Last year we talked about moving the beginning date for the Vietnam Era from its current date of August 5, 1964, to July 8, 1959. Each of you spoke in a way that reflected your appreciation of the several considerations of such a move. So, I would ask each of you again, what impact would the change in definition of the Vietnam Era have on Vietnam veterans and how do your members now view the proposed change? Answer 4. The final question asks for clarification of our views on redefining the Vietnam Era. The redefinition provided in S. 2269 would change the current beginning date of the Vietnam Era from August 5, 1964 to July 8, 1959. Our position, on redefinition is unchanged from last year. The American Legion simply has no existing authority in the form of a resolution from our membership to either support or oppose a change. RESPONSE OF THE AMERICAN LEGION TO WRITTEN QUESTIONS SUBMITTED BY HON. ALAN Question 1A. On page 3 of your statement, you note your support for the issuance by the Central Office of "treatment guides" relating to alcohol and drug treatment programs. Would your support for such guidance extend to the issuance, as would be required by section 3 of S. 2514, of regulations which "establish maximum periods of treatment" for alcohol or drug dependence or abuse disabilities, including "specific maximum periods" for specified treatment steps? B. (i) (If yes) Do you also support such maximum periods being "consistent with average periods" of treatment for such conditions by non-VA programs? (ii) (If yes) Would not this preclude longer-than-the-minimum-period stays that are common in the community and which along with shorter-than-usualperiod stays contribute to the community "average period"? C. Would you also support, as is proposed in section 3 of S. 2514, establishing by statute a maximum period (60 days) for an episode of treatment in a halfway house? Answer 1A. As the statement indicates the Legion believes the overall VA treatment programs for these conditions have now been in place for a sufficient length of time so that Central Office should coordinate the programming in the VAMCs to use those modalities that have proven most effective and eliminate those that are less so. We make this statement because it is our perception there is not very much Central Office coordination presently in this field. Most treatment units seem to be developing programs based on the ideas of the responsible medical officer, and these ideas vary widely. We do not believe legislation can mandate the length of treatment programs. Central Office can and, in our judgment should set treatment guidelines. But even then, some flexibility should be left in the guidelines to accommodate the perceived needs of individual cases. Similarly, we do not believe the length of needed detoxification can be mandated. That is entirely a matter of medical judgment to be applied in individual cases. We do believe there should be provision for detoxification preparatory to rehabilitation - when possible on the Treatment Unit. Some VAMCS do the detoxing on the medical service, and some VAMCs will not admit for detoxing absent a medical emergency. To repeat, we do see the need for Central Office guidelines for treatment lengths. Some Units maintain programs that are too long. In the private sector most rehabilitation programs are 28 days in length - and in most cases this is sufficient. The other problem is recidivism, which, in some programs is far too prevalent. Some alcoholics, lacking in motivation for rehabilitation will use VA as a refuge, and we disapprove of this because that is not the purpose of the VA's alcohol and drug abuse treatment programs. Answer 1B(i). We would prefer to see the Congress not get into any legislation mandating treatment lengths. We believe Central Office has ample authority to set treatment guidelines. Answer 1B(ii). As above. Answer 1C. Here again, we do not believe it advisable to legislatively mandate length of treatment in Halfway Houses, although there certainly must be limits put on that element of a rehabilitation program. We do not see why Central Office cannot manage this aspect through guidelines. We will say that if the oversight Committees became aware that veteran patients were being maintained in Halfway Houses for inordinate lengths of time, contrary to established guidelines, corrective legislation might come to be seen as necessary. The objective is to prevent any element of a rehabilitation program from being used as a refuge by persons not motivated to rehabilitation, or by those who tend to become institutionalized. Question 2. On pages 2 and 15, you discuss provisions in S. 2514 and S. 2269 relating to the pilot program under section 620A of title 38 as though that pilot program related to the VA's entire overall program for the treatment and rehabilitation for alcohol or drug dependence or abuse disabilities. Question 2A. Do you agree that section 620A relates only to the VA's authority to contract with halfway houses and other community-based facilities and that even if it were not extended--and I fully expect that it will be--the VA would still have authority to provide a full range of in-house care and treatment to veterans suffering from such disabilities? Question 2B. With this clarification, do you support making the pilot halfway-house authority permanent? Answer 2A. Yes, we do agree. Answer 2B. As we indicated, we hope clearly, in our statement of April 11, 1984, The American Legion believes it is appropriate at this time to eliminate the reference in statute and in the title, to programs for alcohol and drug abuse disabilities as "pilot programs. These programs, and the need for them is clear for all to see. The VA is doing good work in this field and much more needs to be done. 37-524 0-84-28 RESPONSE OF THE VETERANS OF FOREIGN WARS OF THE UNITED STATES TO WRITTEN QUESTIONS SUBMITTED BY HON. ALAN K. SIMPSON, CHAIRMAN OF THE SENATE COMMITTEE ON VETERANS' AFFAIRS Question 1. As you know, Public Law 95-202 provides for an administrative determination respecting whether the service of any non-military group of individuals was equivalent to, or tantamount to, active military service. This law has been implemented by the Department of Defense as the Defense/Civilian Review Board. A finding that service was tantamount to military service confers veteran status. What is the view of your members regarding the defense civilian military review board and what is your view toward providing federal benefits for those whose service is not deemed to be tantamount to military service? Answer 1. We have no objection to "Federal Benefits" being conferred upon those federal civilian employees whose service is not deemed to be tantamount to military service. We believe such benefits may be paid for and provided by the agency in question; we would not support the application of VA resources to such an end. "Federal Benefits" currently are available to those employed in the public and private sector who experience work related injuries and illness. Our view with respect to the Defense/Civilian Review Board is that such, under the auspices of the Secretary of Defense, constitutes the proper forum for making decisions with respect to whether or not service is tantamount to military service. Question 2. S.2269 proposes to expand eligibility for VA readjustment counseling to certain active military personnel within the limits of VA facilities. This raises for me two kinds of questions which I would ask each of you to address. A. First, where is the division of responsibility between the VA and DOD? Should the VA, in the absence of a sharing agreement with DOD, treat active duty personnel in this manner? B. Second, what is the meaning of the words "within the limits of Veteran's Administration facilities." The idea of making use of all of the capacity of the VA is good, but we all see problems of how to implement priority eligibilities at medical centers. Do we want to create the same problems in a program we already know is in high demand from veterans? Answer 2A. It should be noted that the VA is the primary backup to the DOD insofar as hospital care for those injured in the line of duty. Needed counseling services may be provided active duty personnel who require such, first, in the military community. If such is not available, then we believe those services may be provided as indicated in our testimony on page 4 by the VA. Answer 2B. We do not perceive there will be an overwhelming demand, by huge numbers of active duty personnel, on Vet Centers. We believe providing counseling to those individuals would be minimal in nature. Question 3. Sometimes around this place, we are faced with ideas and situations which have enormous emotional appeal. Yet, in this time of limited resources faced with enormous deficits, we need to take a hard look at what we are doing, what we want to do, and then, what we would like to do, but must postpone or deny. One of these appealing ideas is contained in a provision of S.2269 which would authorize the VA to provide bereavement counseling services to family members of a deceased veteran if |