lent to $105 in 1989 dollars. The Committee bill thus would raise the current $60 limit to $105. Cost: According to CBO, the enactment of section 103(a) and (b) would entail estimated costs of $4 million in budget authority and outlays in FY 1990 and total estimated costs of $27 million in budget authority and outlays in FYS 1990-1994. Estate Limitations for Incompetent Institutionalized Veterans Section 103(c) of the Committee bill would increase, effective January 1, 1990, from $1,500 to $6,000 the value of the estate allowed a hospitalized incompetent veteran without dependents before VA suspends the veteran's compensation or pension benefits. The Committee bill also would increase from $500 to $2,000 the amount to which an estate must be reduced before compensation or pension payments may be resumed. This provision is substantively similar to legislation reported by the Committee in section 504 of S. 1887 in 1986 (S. Rept. 99-200) and passed by the Senate on December 2, 1985. Under section 3203(b)(1) of title 38, an incompetent veteran who has no spouse or dependent children and is hospitalized or otherwise institutionalized at government expense generally may not receive disability compensation or VA needs-based pension benefits if the veteran's estate equals or exceeds $1,500. Such benefits may not be reinstated until the veteran's estate is reduced to $500 or less. Other than this small estate, most incompetent veterans have few posessions of their own. However, on October 24, 1984, Congress enacted Public Law 98-543, section 402 of which generally excluded the value of an incompetent veteran's home from the computation of the veteran's estate for purposes of the $1,500 limitation. That law also authorized VA to waive the interruption of compensation or pension benefits, for up to 60 days in any calendar year, in cases of hardship. The Committee notes, however, that even under this very limited waiver authority VA benefits are still interrupted until a waiver is requested on behalf of the veteran and granted by VA. A veteran discharged from hospital care in 1989 with only the minimum amount ($500) of estate value allowed before benefits are resumed has assets equal to much less than one-half of a month's disability payment at a 100-percent rating (currently $1,468). This is because the $1,500 and $500 limits have not been adjusted for inflation since they were first codified in 1946. The Committee is greatly concerned that inflation since 1946 has reduced dramatically the purchasing power of the funds available to an incompetent veteran subject to this provision. The Committee believes that, compared to the inflation since this provision was first passed, the proposed estate limitation increase would be a small yet important change to ensure fair treatment of veterans who are unable to take care of themselves. Mandatory Disclosure of Social Security Numbers On June 1, 1989, Chairman Cranston, at the request of the Administration, introduced S. 1110, which would amend section 3001 of title 38 to authorize the Department of Veterans Affairs to re quire mandatory disclosure of claimants' and dependents' Social Security numbers (SSNs) in all claims for VA disability and death benefits. Secretary Derwinski, in his May 22, 1989, letter transmitting the proposal (printed on page S6014 of the June 1 Congressional Record) noted that under section 7(a) of the Privacy Act of 1974 (Public Law 93-573), Federal State, and local government agencies generally are prohibited from denying any right, benefit, or privilege provided by law because of an individual's refusal to disclose his or her SSN unless Federal law requires disclosures. However, he asserted the VA currently had limited authority to require disclosure of claimants' and their dependents' SSNs in cases of claims for VA pension, which are income-tested, and claims for compensation in which outside income is relevant-that is, where the veteran's service-connected disabilities do not qualify for a 100-percent rating under VA's disability rating schedule but VA grants a total-disability rating based on a determination that, in the individual veteran's particular case, the disabilities render him or her umemployable. The Secretary noted that disclosure is required in connection with "benefits affected by 'outside income' " so as to facilitate income verification order to "detect and eliminate fraud and abuse." The statutory basis asserted for this limited authority was not cited in the Secretary's letter. However, the requirement itself is set forth in section 1.575(b) of title 38 of the Code of Federal Regulations. In response to Committee inquiries, VA General Counsel's office provided a copy of an April 17, 1978, General Counsel's opinion concluding that VA had broad authority under section 7(a)(2)(B) of the Privacy Act to require the submission of SSNs by compensation and pension claimants. Section 7(a)(2)(B) allows requiring SSNs where "the disclosure of a Social Security number to any Federal, State, or local agency maintaining a system of records in existence and operating before January 1, 1978, *** was required under statute or regulation adopted prior to such date to verify the identity of the individual." The General Counsel concluded that VA had implemented a qualifying requirement prior to 1975 and thus had the authority to continue to require SSNs in claims for pension or compensation benefits. However, an August 6, 1986, Assistant General Counsel's opinion concluded that VA may not have the authority to amend 38 CFR 1.575(b) to include all claims for VA disability or death benefits and recommended the pursuit of legislation authorizing VA to require disclosure of SSNs by all compensation and pension claimants and recipients. Secretary Derwinski's May 22 transmittal letter stated VA's justification for this legislation as follows: [B]enefits which may not be contingent upon income also require monitoring to protect against fraud and abuse. For example, disability compensation may not be paid concurrently with military retired pay or drill pay for reserve duty. Dependency and indemnity compensation may not be paid concurrently with Survivor Benefit Program pay ments made by the Department of Defense. To control ef- The Committee carefully considered the Administration's request but believes that VA has not provided adequate justification for this provision. VA currently has access to names, birth dates, and other identifiers that it uses for verification purposes and did not demonstate either the extent to which there are fraud and other abuses which the use of those identifiers has uncovered in the benefits areas in question or the magnitude of the number of cases in which the currently available identifiers do not suffice. Thus, the Committee lacks specific information as to the extent to which the proposed requirement for disclosure would likely be useful in detecting and discouraging fraud. The Committee is concerned, however, that the Secretary implied in his letter transmitting the draft measure that there is a need for increased monitoring to "protect against fraud and abuse" in the cases of benefits as to which income is not an eligibility criterion. Therefore, the Committee directs the Secretary to report to the Committee (1) the nature and extent of any abuses VA has discovered through use of names and other identifying information of claimants, beneficiaries, and dependents in the cases of compensation and pension benefits as to which VA now lacks authority to require SSNs, and (2) in the case of each such benefit, the estimated number of cases in which VA believes SSNs are necessary to identify claimants, beneficiaries, and dependents in income verification processes, along with the estimated average monthly dollar amounts of the benefits involved. TITLE II-HEALTH CARE Part A-Mental Health Care for Combat Theater Veterans With Service-Related PostTraumatic Stress Disorder Section 201 of the Committee bill, which is derived from section 201 of S. 13 and is similar to section 601 of S. 2011 as reported by the Committee last August and passed by the Senate on October 18, 1988, in H.R. 4741, would require VA (1) to provide treatment for PTSD on a priority-care basis once (a) a diagnosis of PTSD related to service in a combat theater has been made by a mentalhealth professional designated by the Chief Medical Director, and (b) the veteran's service in a combat area is verified (by the most rapid means possible), without the need for a pre-treatment adjudication on the issue of service-connection; and (2) to accomplish an evaluation of a veteran within 7 days after the referral of the veteran to a VA health-care facility from a Vet Center. Background It has long been the Committee's view that, inasmuch as service in combat is frequently associated with the development of PTSD, VA should be the leader in the diagnosis and treatment of this dis order. However, several sources of information, discussed below, available to the Committee indicate that the prevalence of PTSD among Vietnam veterans is alarmingly high and that veterans suffering from PTSD have been largely unsuccessful in gaining access to needed treatment. The most illustrative evidence of the pervasiveness of PTSD among combat veterans is contained in the National Vietnam Veterans Readjustment Study, conducted by Research Triangle Institute (RTI) under a contract with VA pursuant to Public Law 98160. The final report of this study was released on December 28, 1988. According to the RTI study, approximately 15.2 percent of male Vietnam theater veterans (479,000) and 8.5 percent of female theater veterans (610) are currently suffering from full-blown cases of PTSD. Another 11.1 percent of males and 7.8 percent of females, or a total of 350,000 theater veterans, suffer from trauma-related symptoms which, due to the lack of either intensity or breadth of symptoms are not characterized as "full-blown" PTSD cases. The RTI study also examined the extent to which veterans with PTSD utilized mental-health serivces. RTI found that 61.7 percent of male Vietnam theater veterans with current cases of PTSD had made at least one visit to a mental-health-care provider at some point in their lives, and 20 percent of those with current PTSD had used VA mental-health services at some point. However, in the 12 months prior to the study, only 22.3 percent of those with PTSD had used some mental-health service and only 10.3 percent of those with PTSD had used VA mental-health services. The RTI study is the most extenisve examination to date of the post-war readjustment problems of veterans. In conducting this study, RTI gave in-depth, face-to-face interviews to over 3,000 individuals, including approximately 1,600 veterans who served in the Vietnam theater, 750 veterans who served during the Vietnam era but not in Vietnam, and 650 individuals of similar demographic background who did not serve in the Armed Forces. In addition, a subset of over 300 Vietnam-theater veterans and 100 Vietnam-era veterans underwent followup clinical interviews with expert mental-health professionals. During the Committee's July 14, 1988, hearing on PTSD, VA's Chief Medical Director, Dr. John Gronvall, was asked by Chairman Cranston if VA had any reason to believe that the findings made, or the methodology employed, by RTI in conducting the study were defective in any way. Dr. Gronvall replied: No, I have no reason to challenge the stated findings. We've had a very close working relationship with the study investigators, and we have had a team of technical experts involved in the study design and agreeing to the escalation of the budget of the study to ensure that the final output of the study was valid and could be used. We clearly will give major attention to the study. And as I say, there is no reason that I am aware of and I have asked that question very specifically-why we do not think that is a credible and valid finding. In fact, in talking with our staff about some kind of earlier "guesstimates" or judgments that they have made, they think this [the RTI RTI found that among certain racial/ethnic subgroups of Vietnam-theater veterans, prevalence rates for PTSD were higher than for white veterans-about 19 percent, or 68,000 cases, among black veterans, and "as high as 27 percent," or approximately 45,000 cases, among Hispanic veterans. Black veterans, Hispanic veterans, and women veterans were the only subgroups that were specifically oversampled by RTI. This aspect of the study is discussed and addressed in connection with section 203 of the Committee bill. In addition to the RTI study, the Committee notes the publication of various research papers relating to findings of PTSD in older veterans and veterans of prior wars. One such paper, entitled "Group Treatment of Post-Traumatic Stress Disorder in Older Veterans", was presented at the Annual Convention of the American Psychological Association in Los Angeles in August 1985. This paper describes the authors' findings of "evidence of PTSD in veterans of World War II and Korea which has persisted for as much as 40 years." A case study in the September 1985 American Journal of Psychiatry entitled "Post-traumatic Stress Disorder: A Thirty-Year Delay in a World War II Veteran" describes in detail a WW II veteran's history with PTSD manifested after a delay of many years, following the veteran's forced early retirement. This case study generated two letters to the American Journal of Psychiatry, one in July 1986, and one in November 1986, in which other cases of PTSD in older veterans were discussed. An article in the October 1986 issue of Military Medicine entitled "Post-Traumatic Stress Disorder in the Older Veteran" discussed a group therapy program begun in 1981 at a VA medical center in Texas for older veterans with PTSD. An article in the February 1987 issue of Hospital and Community Psychiatry entitled "Post-Traumatic Stress Disorder in World War II Naval Veterans" discussed the authors' findings of PTSD among a group of World War naval veterans who were attending a reunion of the crew of a U.S. destroyer that saw heavy combat in the Pacific during the war. An article in the September 1987 issue of the American Journal of Psychiatry, "Survivors of Imprisonment in the Pacific Theater During World War II" summarizes data obtained from 41 survivors imprisoned by the Japanese during World War II. The data suggested that 40 years later, half of the subjects met the full set of DSM-III criteria for PTSD. An article entitled "Traumatic Stress Disorder: Diagnostic and Clinical Issues in Former Prisoners of War" in the March/April 1989 issue of Comprehensive Psychiatry examines a variety of clinical issues in the diagnosis and treatment of PTSD in former prisoners of war. A July 1988 article in Military Medicine entitled "Case Report: Flashback as a Post-traumatic Stress Disorder (PTSD) Symptom in a World War II Veteran" alerts health care personnel to an often unrecognized diagnostic entity, namely PTSD in a combat veteran expressed after more than 40 years of apparently healthy functioning. In the April 6, 1989, Committee oversight hearing on VA's health care funding, Chairman Cranston raised concerns about reports of |