Legislature(2015 - 2016)GRUENBERG 120
03/22/2016 03:00 PM MILITARY & VETERANS' AFFAIRS
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HJR 30-POST-TRAUMATIC STRESS INJURY 3:05:05 PM CHAIR HERRON announced that the only order of business would be 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." REPRESENTATIVE LEDOUX moved to adopt the proposed committee substitute (CS) for HJR 30, Version 29-LS1483\E, Shutts, 3/15/16, as a work draft. REPRESENTATIVE COLVER objected for the purpose of discussion. 3:06:13 PM ROB EARL, Staff, Representative Bob Herron, Alaska State Legislature, explained the changes to HJR 30 in the proposed committee substitute (CS) by referring to the document labeled, "Explanation of Changes from HJR 30 ver 'W' to HJR 30 ver 'E'," included in the committee packet, which read as follows [original punctuation provided]: P.1, lines 3-6 INSERTED: "respectfully requesting that the Alaska delegation in Congress champion this change of designation in the United States Congress; and designating June 27, 2016, as Post-Traumatic Stress Injury Awareness Day." P. 2 lines 2-8 INSERTED: "WHEREAS combat-related post-traumatic stress is significantly pronounced, given that many men and women in the armed forces are highly exposed, often daily, to traumatic events, including life-and-death situations, for weeks, months, and even years; and WHEREAS service members and veterans often struggle with combat-related posttraumatic stress for years after leaving service; and WHEREAS the extreme survival skills and defensive behaviors acquired as a result of service are often difficult to manage; and" P.3, line 26 to P.4 line 6 INSERTED: "FURTHER RESOLVED that the Alaska State Legislature respectfully requests that the Alaska delegation in Congress champion this change of designation in the United States Congress, and be it FURTHER RESOLVED that the Alaska State Legislature designates June 27, 2016, as Post-Traumatic Stress Injury Awareness Day to bring awareness to the people suffering from post-traumatic stress injury and encourages people to reach out to their fellow citizens to provide support and eliminate the stigma associated with this injury; and be it FURTHER RESOLVED that the Alaska State Legislature encourages the Department of Military and Veterans' Affairs and the Department of Health and Social Services to continue educating service members and veterans, victims of abuse, crime, and natural disaster, their respective families, and the public about the causes, symptoms, and possible treatment of post-traumatic stress injury." 3:07:55 PM MR. EARL presented Conceptual Amendment 1, on behalf of Representative Herron, stating that on page 2, line 3, of HJR 30, it would insert the word "many" before "men and women". [Conceptual Amendment 1 was treated as moved.] CHAIR HERRON asked if there was any objection. He announced that there being no objection, Conceptual Amendment 1 was adopted. 3:08:51 PM REPRESENTATIVE HUGHES [moved to adopt Conceptual Amendment 2], which would add the president of the Alaska Psychiatric Association to the list of people, on page 4, to which copies of the resolution would be sent. There being no objection, Conceptual Amendment 2 was adopted. MR. EARL offered that the American Psychiatric Association (APA) was listed because only that organization could change the designation [of PTSD]. He said the president of APA could be added as well. REPRESENTATIVE HUGHES offered that the name of the current president of APA is Joshua Sonkiss, M.D. 3:11:03 PM KENT HALL, Vice President, Honor for ALL, said that he gave testimony on HJR 30 at the previous hearing and is available for questions. He alluded to the previous House State Affairs Standing Committee meeting in which Chair Herron related hearing negative comments from a member of the Veterans of Foreign Wars (VFW) [regarding PTSD terminology change]. He conceded that he has experienced that viewpoint but maintained that it is rare. He reiterated the need for further education and awareness. 3:12:51 PM THOMAS MAHANEY, President/Executive Director, Honor for ALL, stated that he was the founder of Honor for ALL. He opined that the results of the hearing in Alaska's House Special Committee on Military and Veterans' Affairs "can have far-reaching effects on the lives and families of past and present members of our Armed Services, and in the end the fight against stigma is a war against words, and the more voices we can muster the larger our arsenal." He went on to say that "the establishment of PTSI awareness day is the first step in creating a springboard from which to launch community events in recognition and understanding of invisible wounds." 3:15:00 PM CHAIR HERRON closed public testimony on HJR 30. REPRESENTATIVE LYNN referred to Mr. Mahaney's suggestion that the negative testimony suggests a need for more education. Representative Lynn opined that a different opinion on an issue doesn't necessarily mean more education is needed or that someone with an opposing opinion is uneducated. 3:16:13 PM REPRESENTATIVE SPOHNHOLZ recommended revisions [in two WHEREAS sections, beginning on page 2, lines 6 and 11, respectively]. She [moved to adopt Conceptual Amendment 3], as follows: Page 3, line 7, following "affected": Insert "who" Page 3, line 7, following "voluntarily": Delete "to" Page 3, line 12, following "serving": Delete "to defend the right to freedom" Insert "our country" MR. EARL suggested that the word "nation" be substituted for the word "country" in the proposed amendment. 3:19:47 PM REPRESENTATIVE HUGHES expressed her desire to keep "the right to freedom" in the language being addressed in Conceptual Amendment 3. She suggested that the language beginning on page 3, line 12, read: "and those who have received those wounds while serving our nation, defending the right to freedom, deserve respect and special honor". 3:21:15 PM REPRESENTATIVE LEDOUX suggested the following language instead: "while serving our nation and defending the right to freedom deserve respect and special honor". 3:21:53 PM The committee took a brief at-ease at 3:22 p.m. 3:22:00 PM CHAIR HERRON [moved Amendment 1 to Conceptual Amendment 3] so that the WHEREAS section on page 3, line 11, would read as follows: WHEREAS all citizens who suffer from post-traumatic stress injury deserve recognition, and those who have received those wounds while serving our nation and defending our freedom deserve respect and special honor; and [Amendment 1 to Conceptual Amendment 3 was treated as adopted.] CHAIR HERRON announced there being no objection, Conceptual Amendment 3, [as amended], was adopted. 3:25:14 PM REPRESENTATIVE HUGHES referred to two articles in the committee packet written by two prominent psychiatrists representing two different views on the matter of using the terminology "PTSI" in lieu of "PTSD." She further noted that the idea for using "PTSI" came from a general who served in Iraq. 3:26:34 PM REPRESENTATIVE LYNN asserted that PTSI or PTSD definitely exists, but he offered his view that the condition can be used by veterans as an excuse for bad behavior as well. 3:27:29 PM REPRESENTATIVE LEDOUX referenced the article in the committee packet titled, "PTSD is 'PTSD'," by Matthew Friedman, M.D., Ph.D., and noted Dr. Friedman's suggestion that the terminology for the condition could be left as is, "PTSD," or changed in favor of the Canadian term, "operational stress injury (OSI)." She opined that another issue mentioned in Dr. Friedman's article was of greater concern than terminology - the fact that those with OSI in Canada are eligible for Canada's sacrifice metal, equivalent to America's Purple Heart, whereas Americans with war-related PTSD are not eligible for the honorable recognition of a Purple Heart. REPRESENTATIVE TUCK stated that the term "PTSD" was created in 1980, and before 1980 there was no term for the condition. He pointed out that establishing the term "PTSD" lead to research, insurance coverage, and treatment. He conceded that the term discourages many people from seeking help and getting the services they deserve. Representative Tuck said that when an injury is earned in battle, the injured individual is eligible for a Purple Heart; however, because PTSD is not looked upon as an injury, it does not qualify for a Purple Heart. 3:30:02 PM REPRESENTATIVE TUCK pointed out that there are other conditions defined by the APA that don't have the word "disorder" in the name, and without that stigma, sufferers are more apt to seek services. Representative Tuck stated that former Vice Chief of Staff of the U.S. Army, General Peter Chiarelli, strongly advocated for getting rid of the word "disorder" in PTSD because he believed the term "disorder" perpetuates a bias and connotes a preexisting problem that the individual had before he/she came into the army, which makes a person seem weak. He reminded the committee members that PTSD doesn't just affect the military but anyone who has been traumatized, and he mentioned "adverse childhood experience" as an example. He emphasized that those in military service have greater exposure to trauma, and he went on to make the point that with the many physical and mental exams required for entering military service, it is apparent that military service personnel have a clean bill of health going into the service. 3:32:11 PM REPRESENTATIVE LEDOUX reiterated Dr. Friedman's contention that PTSD should be called OSI. She asked if designating PTSD as an injury would make the condition eligible for Purple Heart recognition or, if not, what needed to be done to qualify PTSD for Purple Heart recognition. 3:33:27 PM ROBERT DOEHL, Deputy Commissioner, Office of the Commissioner/Adjutant General, Department of Military & Veterans' Affairs (DMVA), Joint Base Elmendorf-Richardson (JBER), testified that regardless of the change in definition [of post-traumatic stress], changing the criteria for Purple Heart recognition requires regulatory or statutory changes within the different service branches. CHAIR HERRON brought up various issues related to the awarding of a Purple Heart - friendly fire vs. enemy fire, concussion and traumatic brain injury (TBI), invisible wounds - and reiterated the importance of raising awareness. He related an incidence during World War I in which Great Britain executed about 300 soldiers for cowardice but changed the designation of the soldiers from cowards to heroes about 90 years later and apologized to the families. 3:36:38 PM REPRESENTATIVE LEDOUX said that she understands Colonel Doehl's testimony to say that unless the injury is visible, a Purple Heart is not awarded to military service personnel, and even changing "PTSD" to "PTSI" would not change that eligibility. COLONEL DOEHL stated that she was correct, and that the change requires a regulatory change made independently of the action before the House State Affairs Standing Committee. He opined, however, that increased awareness could contribute to encouraging that change to be made in the future. REPRESENTATIVE LEDOUX reiterated that America's criteria for awarding a sacrifice medal, the Purple Heart, is in contrast to Canada's criteria for awarding a sacrifice medal. REPRESENTATIVE LYNN reminded the committee that the criteria for awarding a Purple Heart is under federal jurisdiction, and he stated he was uncomfortable pursuing this at the state level. 3:39:13 PM CHAIR HERRON claimed that a Purple Heart may be awarded to a service member for PTSD received during combat if caused by enemy fire but not if caused by friendly fire. He relayed that men and women who served in the Vietnam War often experienced constant noise and vibration causing concussive injury. He further offered that invisible injuries have presented a challenge for individuals and society, but the relabeling of PTSD to a treatable injury has made a difference to those with that diagnosis. REPRESENTATIVE LYNN stated that he was not opposed to renaming PTSD an injury but didn't want to pursue the issue of the awarding of a Purple Heart. CHAIR HERRON confirmed that the issue of a Purple Heart was not in the proposed joint resolution. 3:42:13 PM REPRESENTATIVE LEDOUX asked for clarification regarding the awarding of a Purple Heart for PTSD. COLONEL DOEHL stated his understanding that a TBI from repeated concussions or repeated exposures to improvised explosive devices (IED) creates a physiological change and constitutes eligibility for a Purple Heart. He said that he is not aware of a Purple Heart being awarded solely for PTSD or not being awarded because of the absence of enemy fire. CHAIR HERRON said that he would provide the committee members the official criteria for receiving a Purple Heart. 3:44:19 PM [The previous objection made by Representative Colver to adopt the proposed CS for HJR 30, Version 29-LS1483\E, Shutts, 3/15/16, was treated as withdrawn.] REPRESENTATIVE LEDOUX moved to report CSHJR 30, Version 29- LS1483\E, Shutts, 3/15/16, as amended, out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, CSHJR 30(MLV) was reported from the House Special Committee on Military and Veterans' Affairs.