Legislature(2015 - 2016)GRUENBERG 120
03/15/2016 01:00 PM House MILITARY & VETERANS' AFFAIRS
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| HCR25|| HJR30 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HJR 30 | TELECONFERENCED | |
| *+ | HCR 25 | TELECONFERENCED | |
HCR 25-POST-TRAUMATIC STRESS INJURY DAY
HJR 30-POST-TRAUMATIC STRESS INJURY
1:36:29 PM
CHAIR HERRON announced that the only order of business would be
HOUSE CONCURRENT RESOLUTION NO. 25, Designating June 27, 2016,
as Post-Traumatic Stress Injury Awareness Day; and
HOUSE JOINT RESOLUTION NO. 30, Urging the American Psychiatric
Association to change the term "post-traumatic stress disorder"
or "PTSD" to "post-traumatic stress injury" or "PTSI"; and
urging the governor to support usage of the term "post-traumatic
stress injury."
1:37:14 PM
KENDRA KLOSTER, Staff, Representative Chris Tuck, Alaska State
Legislature, presented HCR 25 on behalf of Representative Tuck,
prime sponsor. She stated that HCR 25 would establish June 27,
2016, as Post-Traumatic Stress Injury (PTSI) Awareness Day. She
added that HCR 25 would also encourage the terminology change
from "post-traumatic stress disorder (PTSD)" to "post-traumatic
stress injury." Ms. Kloster said that she has been working with
the nonprofit organization, Honor for ALL, whose goal is for
similar legislation to be passed in all 50 states. She
maintained that already eight states have passed legislation
promoting PTSI awareness, as well as, the U.S. House of
Representatives and the U.S. Senate.
MS. KLOSTER explained that the word "disorder" frequently
portrays a negative image with associated stigma, and that the
word "injury" is a better descriptor. Ms. Kloster stated that
260 million people suffer from PTSI worldwide and, in the United
States, about 3.5 percent of adults are being diagnosed with
PTSI in any given year. She added that the incidence of
military related PTSI is on the rise, but conceded that the
increase may be due partly to increased awareness and better
detection. She noted a Veterans Administration (VA) assessment
reported that the VA was only reaching about 20 percent of
people with military related PTSI. Ms. Kloster attested that
establishing a day for PTSI would increase awareness of PTSI and
educate the public about detecting the signs of PTSI and
connecting with services.
1:39:59 PM
REPRESENTATIVE CHRIS TUCK, Alaska State Legislature, presented
HCR 25, as prime sponsor. He said that most families have been
affected by PTSI. He related his personal experience with his
brother, who served in the U.S. Navy, and now suffers from PTSI.
He contended that his brother was born a normal child and raised
normally, and he expressed his belief that calling PTSI a
disorder does a disservice to great men and women who served
their country and to others suffering from PTSI.
REPRESENTATIVE TUCK reiterated that an awareness day for PTSI is
a first step in educating the public on the issue and connecting
people with services. He noted recent information asserting
that children with adverse childhood experiences can suffer from
PTSI.
1:41:52 PM
REPRESENTATIVE HUGHES asked if there is anything significant
about the designated date in the proposed concurrent resolution,
and if the designation would be for just one year.
MS. KLOSTER responded that June 27 was chosen for Alaska because
it is the day named in legislation passed by the eight states,
the U.S. House of Representatives, and the U.S. Senate. She
added that this year the day would be named by concurrent
resolution, and the sponsor would decide later whether to
introduce legislation making it an annual recognition.
1:43:15 PM
REPRESENTATIVE HUGHES asked if the sponsor envisioned any
special activities associated with the day besides a press
release.
MS. KLOSTER responded that retired Colonel Bob Doehl, Deputy
Commissioner of the Department of Military & Veterans' Affairs
(DMVA), is online to testify and can better answer that
question. She also mentioned a letter of support from the
commissioner of DMVA, retired Colonel Laurel Hummel, included in
the committee packet.
1:44:24 PM
REPRESENTATIVE LEDOUX asked how many Alaskans currently suffer
from PTSI.
MS. KLOSTER also deferred that question to Colonel Doehl.
REPRESENTATIVE LEDOUX asked if Ms. Kloster knew what type of
services are currently provided to those suffering from PTSI.
MS. KLOSTER responded that service members are tested for PTSI
during debriefing and that there are a number of services,
including therapeutic, that can be accessed through the
[Federal] Veterans Health Administration (VHA). She added that
DMVA also helps people with PTSI to connect with services.
1:46:49 PM
CHAIR HERRON advised that Rob Earl will present HJR 30, and both
resolutions will be in front of the committee when asking for
testimony.
1:47:09 PM
ROB EARL, Staff, Representative Bob Herron, Alaska State
Legislature, presented HJR 30 on behalf of Representative
Herron, prime sponsor. He suggested that given the large number
of veterans and the high rates of child abuse and domestic and
sexual violence in Alaska, the number of people suffering from
post-traumatic stress injury (PTSI) is easily in the thousands.
Mr. Earl echoed the remark made previously by Ms. Kloster that
the word "disorder" carries a stigma and is considered degrading
by many who suffer from PTSI. He added that referring to the
condition as a disorder suggests that it is untreatable but, in
fact, it is a treatable injury. He also stated that
historically the condition has been viewed as a mental illness
caused by a pre-existing flaw. He added that replacing
"disorder" with "injury" would make it clear that this is not
the case. Mr. Earl said that the stigma of the word "disorder"
discourages some sufferers from seeking treatment. He added
that timely treatment is critical, especially considering the
high rate of suicide associated with PTSI.
MR. EARL paraphrased the last paragraph of the sponsor statement
for HJR 30, which read as follows [original punctuation
provided]:
HJR 30 specifically resolves that the Alaska State
Legislature:
· Believes that the term "post-traumatic stress
disorder" be universally changed to "post-
traumatic stress injury"
· Urges the American Psychiatric Association to
consider changing the term "post-traumatic stress
disorder" to "post-traumatic stress injury" for
the next revision of the Diagnostic and
Statistical Manual of Mental Disorders
· Urges the Governor to support the usage of the
term "post-traumatic stress injury"
MR. EARL mentioned the letter of support from the nonprofit
organization, Honor for ALL, the letter of support from DVMA,
and the two zero fiscal notes, included in the committee packet.
1:50:05 PM
REPRESENTATIVE HERRON stated that he introduced the joint
resolution due to his personal experience with people having
post-traumatic stress. He referred to the double murder at
Bethel High School in 1997 causing post-traumatic stress in
people who had witnessed the incident. He opined that although
they were not harmed physically, they were still harmed.
Representative Herron referred to Socrates and the Shakespeare
play, Macbeth, to make the point that post-traumatic stress has
been in existence all through history. He reiterated Mr. Earl's
claim that "disorder" connotes weakness and Representative
Tuck's claim that continued use of the word "disorder" is a
disservice to the individual, the family, the community, and
society as a whole. Representative Herron conceded that the
effort to change the label may be difficult and take time, but
expressed his belief that the awareness promoted under HCR 25
and HJR 30 would be very important.
1:52:50 PM
REPRESENTATIVE HUGHES asked if other states have passed
resolutions similar to HJR 30.
CHAIR HERRON responded in the affirmative.
REPRESENTATIVE HUGHES asked if PTSD is referred to in Alaska
statutes and, if the joint resolution passed, would require
amending.
CHAIR HERRON responded that change would take a long time. He
noted that currently the word "disorder" is referenced
throughout the Department of Health and Social Services (DHSS)
regulations and information. He reiterated that "this will be a
long journey" and expressed his hope that society would
recognize post-traumatic stress as an injury and not a condition
from birth.
REPRESENTATIVE HUGHES offered her support for the proposed joint
resolution and agreed that the term "disorder" does not imply an
event as the cause as does the term "injury."
1:54:56 PM
REPRESENTATIVE LEDOUX stated that she does not see a pejorative
associated with the term "disorder." She did express, however,
that she supports using the terminology preferred by those who
are affected. She asked if anyone from the psychiatric
profession could testify as to the difference between the two
terms.
CHAIR HERRON responded that it is his intention to have such
testimony put into the record. He conceded that there are those
on either side of the issue.
1:57:16 PM
REPRESENTATIVE SPOHNHOLZ said that she supports the proposed
joint resolution and related that she adopted a child who
suffers from PTSI. She added that this resolution would be
important for military service members with PTSI who express
concern for the term "disorder." She stated that she agrees
with the suggestion of securing a psychiatric opinion. She
offered that brain science indicates that the brain is a
growing, changing organ, and injury to the brain is treatable
and recoverable.
1:59:11 PM
REPRESENTATIVE TUCK stated that the dictionary definition of
disorder is "an abnormal physical or mental condition." He
maintained that the definition implies a condition from birth
and that "injury" implies an event that happens to someone. He
further claimed that a label does have an impact and the
proposed resolution would stimulate discussion about PTSI.
2:01:04 PM
CHAIR HERRON relayed that at the Chris Kyle Patriots Hospital's
grand opening in Anchorage, he learned that Alaskans who have
gone to that hospital have experienced remarkable success. He
stated that changing the label is about striving for awareness.
REPRESENTATIVE HUGHES stated that she wanted to know from a
psychiatrist's perspective if a disorder is considered to be an
ongoing condition to be managed rather than something from which
one could recover. She added that if that were true, then
terminology would impact the treatment approach to PTSI.
2:03:45 PM
REPRESENTATIVE LEDOUX asked whether there were implications for
medical insurance or workers' compensation insurance associated
with treating PTSI as a recoverable injury.
REPRESENTATIVE TUCK reminded the committee that not all injuries
are recoverable but that timely services are important.
KENT HALL, Vice President, Honor for ALL, relayed that he is a
Vietnam combat veteran who has been diagnosed by the Veterans
Administration (VA) as having post-traumatic stress disorder
(PTSD). He said that in 2010 he saw a video by a renowned
psychiatrist, Dr. Frank Ochberg, describing PTSD as a wound, not
a weakness. Mr. Hall emphasized the importance of that
recognition for him in that he stopped blaming himself and
started looking for a solution to his problem. He said that
since then he has become involved in Honor for ALL, a national,
nonprofit organization based in Michigan. He went on to say
that he speaks publically on the issue and travels widely to
events and rallies. He added that Michigan became the first
state to pass a PTSI Awareness Day. He claimed that last year
eight states passed resolutions recognizing PTSI, and this year
seven more states did the same.
MR. HALL referred to his own experience with PTSD and PTSI and
affirmed the positive changes in his life since receiving help
from the VA. He expressed significant benefits from his
participation in Vietnam veteran group therapy sessions
sponsored by the VA and lead by a psychologist. He claimed that
a strong, proud soldier does not want to have a mental disorder,
yet knows that it is alright to seek help for an injury. He
relayed that Dr. Ochberg participated in the team that defined
PTSD [in the third edition of Diagnostic and Statistical Manual
of Mental Disorders (DSM)] in 1980, but now laments the use of
the word "disorder," understanding that it has contributed to
the stigma that prevents veterans from reaching out for help.
Mr. Hall stated that there is no difference between PTSD and
PTSI as far as diagnosis or benefits, but said he believes the
use of the term PTSI makes a difference to veterans faced with
issues and needing help.
MR. HALL explained that the date for the awareness day, June 27,
was inspired by the birthday of North Dakota National Guard
Staff Sergeant Joe Biel, who suffered from PTSD after two tours
in Iraq and took his own life on April 26, 2007. He added that
former U.S. Senator Kent Conrad of North Dakota initiated PTSD
awareness day.
2:12:04 PM
CHAIR HERRON asked Mr. Hall about the resistance to the change
in terminology from PTSD to PTSI.
MR. HALL responded by saying that even renowned psychiatrists
disagree regarding the change.
CHAIR HERRON stated his intent to have Dr. Ochberg testify at
the second hearing on HJR 30.
2:14:51 PM
ROBERT DOEHL, Deputy Commissioner, Office of the
Commissioner/Adjutant General, Department of Military &
Veterans' Affairs (DMVA), Joint Base Elmendorf-Richardson
(JBER), testified that DMVA strongly supports both HCR 25 and
HJR 30 to better address a condition that affects at least 30
percent of Alaska's 57,000 combat service veterans and those
still serving. He stated that about 18,000 veterans in Alaska
suffer from PTSD. He claimed that PTSD does not always affect
just an individual, but often takes its toll on family, friends,
and co-workers. He attested that he has had experience with
people suffering from PTSD his whole career - in the military,
with the Department of Justice, and with the Office of the
Attorney General. He described the many consequences of PTSD,
including loss of job, loss of family, and suicide. He claimed
that the term "disorder" exacerbates a stigma that discourages
treatment among those who struggle with the condition. He
maintained that PTSD is not a disorder in an individual but the
natural response to an unnatural situation or event that has
been externally imposed upon that individual.
2:19:12 PM
COLONEL DOEHL stated that after meeting with partner agencies,
he believes that together they would be able to plan awareness
day activities that would attract media attention. He also said
that he sees the awareness day as a springboard for connecting
PTSD sufferers with treatment and services. He maintained that
any contact with the Veterans Health Administration (VHA) or
Veterans Benefit Administration (VBA) provides a veteran with
information on PTSI and available services. Colonel Doehl
relayed that assistance is also available through DMVA and
through vet centers located in some of the larger cities in
Alaska. He claimed that peer groups are phenomenal assistance
devices for veterans. He related a VA claim that for a veteran
who requests assistance for an acute PTSD related concern, the
response time for contact with a qualified provider is less than
twenty-four hours.
COLONEL DOEHL relayed that he is not aware of any changes that
would be needed in DMVA statutes or regulations due to the
change in terminology proposed by HJR 30 but surmised that
statutes in other state departments may require changes.
2:21:42 PM
REPRESENTATIVE LEDOUX asked if family, friends, and co-workers
can be impacted by someone with PTSI to the extent that they in
turn suffer from PTSI as a result.
COLONEL DOEHL answered that in order to have PTSI, one must have
suffered an injury-causing event. He stated his belief that if
the PTSI manifested itself by violence, then there could be a
second direct effect of PTSI on someone else. He added that
from his experience reviewing several hundred depositions, there
are other diagnoses appropriate for spouses living with someone
with PTSI.
CHAIR HERRON mentioned an incident in which the National
Veterans of Foreign Wars (VFW) commander, speaking at a
congressional hearing, reacted very negatively to the idea of
replacing "PTSD" with "PTSI." Chair Herron said that after the
hearing, many veterans came up to congressmen to offer their
support for the change. Representative Herron asked Colonel
Doehl how this controversy can be addressed.
2:25:07 PM
COLONEL DOEHL opined that mental health injuries have been
difficult to recognize as not being a weakness or fault. He
suggested that more education is needed to understand the injury
component, not just for those suffering from PTSI, but for the
broader population. He claimed that one source of confusion is
related to the fact that only 30 percent of combat veterans
report PTSD, but 100 percent of people who are shot report a
bleeding wound, which results in being awarded with a Purple
Heart. He reiterated that defining post-traumatic stress as an
injury and designating the awareness day would greatly advance
the knowledge and discussion needed.
2:26:38 PM
REPRESENTATIVE LEDOUX said that she was curious about the
controversy, and she asked what the rationale was for resisting
the change in terminology.
COLONEL DOEHL deferred to the American Psychiatric Association
(APA) for its position regarding "disorder" versus "injury." He
stated his belief that the broader population has difficulty
adjusting to change and struggles with recognition of something
they can't see. He reminded the committee of the great strides
made in recognizing and understanding PTSI since 1970 and opined
that with greater awareness and education, the public's ability
to visualize and accept PTSI will increase.
2:29:00 PM
REPRESENTATIVE HUGHES asked Colonel Doehl to review again the
number of veterans and active duty military personnel estimated
to have PTSI.
COLONEL DOEHL stated that the Alaska VA Healthcare System
reports 57,000 combat veterans in Alaska, and 30 percent of them
are being treated for PTSD. He said that there are about 30,000
active duty military personnel, but not all of them have been in
combat. He gave an estimate of about 8,000 active duty military
personnel in Alaska suffering from PTSI, based on an estimated
20,000 who have been in combat.
2:30:43 PM
REPRESENTATIVE HUGHES asked what activities Colonel Doehl
envisioned besides a media campaign for the PTSI Awareness Day
under the proposed concurrent resolution. She questioned if
there would be events making services more available or any
plans to coordinate with the U.S. Army or U.S. Air Force located
in Alaska.
COLONEL DOEHL stated that the DMVA envisions creating events by
heavily leveraging federal resources through the VA and the vet
centers with a focus on providing services. He said that the
active duty military personnel would be invited to participate.
2:33:11 PM
FORREST POWELL, Program Coordinator I, Office of Veteran Affairs
(OVA), Department of Military & Veterans' Affairs (DMVA), said
that he represents the interests of the Office of Veteran
Affairs in regard to the PTSI Awareness Day proposed under HCR
25 and agreed with Colonel Doehl's answers to the questions. He
stated that he is a veteran with PTSD.
CHAIR HERRON asked Mr. Powell for his thoughts regarding the
change in terminology, from PTSD to PTSI.
MR. POWELL replied that his concern was for his own behavior and
controlling it, and added that he did not feel that the
awareness activities and terminology change would make a
difference for him.
JEFF SLAIKEU, Office Manager, Office of Veteran Affairs (OVA),
Department of Military & Veterans' Affairs (DMVA), offered his
agreement with Mr. Powell's testimony.
2:37:03 PM
CHAIR HERRON said he would invite Dr. Ochberg and retired U.S.
General Peter Chiarelli to testify at the next hearing on the
proposed joint resolution.
REPRESENTATIVE LEDOUX requested that a representative from
either the American Psychiatric Association or the Alaska
Psychiatric Association be invited to the next hearing to
testify on the rationale for not making the terminology change.
CHAIR HERRON responded that he would locate a representative who
could speak to Representative LeDoux's concern.
[HCR 25 and HJR 30 were held over.]