WASHINGTON, DC—Nearly 25 years ago, Congress directed VA to arrange for an independent, scientific study of the adjustment of Vietnam veterans, with the goal of providing an empirical basis for the formulation of policy regarding veteran’s mental health. The result was the National Vietnam Veterans Readjustment Study, which included a survey of thousands of Vietnam veterans, and became part of the foundation for federal policy relating to combat veterans.

In 2000, VA was directed to conduct a follow-up study—the National Vietnam Veterans Longitudinal Study. However, that initiative stalled and has gone neglected for a decade. In September, VA Secretary Eric Shinseki called for the continuation of the project. However, VA officials are skeptical about whether the study can be completed and of the viability of the proposed deadline of 2014.

Relevant for Veterans Old and Young

VA awarded a sole contract for the undertaking of the project in 2000 at a cost of $5 million. Three years later, when the original estimate ballooned from $5 million to $17 million, VA chose not to continue the contract, and the project languished for the next eight years.

“The VA took no further steps and ignored the law until this committee received a proposal from former Secretary Peake in January of 2009.  Former Secretary Peake recommended substituting the NVVLS with a study of twins who served in the Vietnam War and a study of women Vietnam War veterans, which would cost about $10 million,” explained Rep Bob
Filner, D-CA, chair of the House VA Committee at a hearing on the subject last month. “Given the cost of the alternative, it seems to me that the VA could have completed the NVVLS on time had the department chosen to allocate the $10 million to the original contract award back in 2003.”

The committee did not see the merit in the alternative proposal, and continued to advocate for the completion of the NVVLS.  “While I applaud Secretary [Shinseki] for his commitment, I remain cautious and vigilant about this issue,” Filner said.

The potential benefits of such a study have a time limit. There are fewer living Vietnam veterans each year, and many of the problems that they faced returning home from combat are being faced by the most recent generation of veterans. “The importance of the NVVLS must be placed in the context of returning veterans,” explained Dr Charles Marmar, chair of psychiatry at NYU, and one of the physicians involved in the original Vietnam veteran study. “There are 1.9 million veterans in OIF/OEF [and they] are at risk for the consequences suffered by the Vietnam generation. There is evidence of suffering from the same problems—PTSD, depression, substance abuse, and physical problems.”

The current timeline has VA soliciting for bids over the summer, with the study to begin in early fall. Between 2011 and 2013, the awarded contractor will obtain IRB and OMB approval for the project and begin conducting the study under VA monitoring. By 2014, VA expects the data to be available for analysis.

Unlike the first time this was attempted in 2000, VA will be requiring the contractor to have a research plan and to abide by performance measures—factors that were not considered previously.

Doubts and Challenges

Still, despite the importance of such an undertaking, VA officials have reported to GAO that the challenges of conducting the study may be too great. According to GAO testimony, VA is concerned about locating prospective study participants and gaining their consent. “It’s important that NVVLS participants are given assurances of confidentiality, but VA has yet to give that assurance,” explained Randall Williamson, GAO director of health care. “The bottom line is that VA officials told us that they do not know whether the NVVLS can be completed.”

During the initial part of the study, VA expects the contractor to conduct a feasibility study. “I think we have to take with a grain of salt that 2014 date,” Williamson said. “While we all want the 2014 date to materialize, there’s certainly no guarantee of that.”

Marmar argued that the difficulties of conducting such a study have only decreased in the last 25 years. “At the time it was very difficult to locate the [participants] in the study. The political climate was not as favorable. And the public’s understanding of PTSD was very immature compared to what it is now. And the study was very successful, in terms of identifying and being able to recruit and bring into the study the majority of those deemed eligible for the study. Now, 20 plus years later, there are new tools for identifying people and locating them [and] Vietnam veterans as a group have galvanized and understand the importance of serving their country by reupping and enlisting in this study.

“I believe the question of finding people and getting their commitment is not the major thing. The most important thing is moving quickly now with the law in its present form.”

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