APA Meeting: Worse Physical Health Follows Combat PTSD

Last week in Toronto, at the American Psychiatric Association's 2006 Annual Meeting, medical researchers presented data to their peers on a recently completed study of US Army combat veterans. The study revealed a connection between the incidence of PTSD and decreased physical health.

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First a few details on the meeting:

The American Psychiatric Association (APA), the leading psychiatric medical society in the United States, convenes its 159th Annual Meeting this weekend in Toronto, Canada, from May 20-25. ... The APA Annual Meeting, which assembles during Mental Health Month, continues to be the largest gathering of psychiatric physicians on the globe and attracts more than a thousand clinical papers, symposia, new research poster sessions and workshops.

A few study specifics from MedPage Today:

Combat troops meeting the criteria for post-traumatic stress disorder (PTSD) who are still on active duty are much more likely to have physical health problems than their comrades, according to research presented here.

Most earlier studies of PTSD have focused on veterans many years after they have returned from combat and found strong associations between the disorder and poor physical health, said Artin Terhakopian, M.D., of the Walter Reed Army Medical Center in Silver Spring, Md., at the American Psychiatric Association meeting here. The new research is on active duty personnel—"working soldiers"—he added.

The researchers studied 2,863 soldiers of U.S. Army combat brigades that had been rotated back to the U.S. after duty in Iraq, Dr. Terhakopian and colleagues found dramatic differences between the 16% who were diagnosed as suffering from PTSD and those who were not.

Using an anonymous survey a year after the soldiers' return from combat duty in Iraq, Dr. Terhakopian and colleagues examined PTSD symptoms, self-rated health, sick call visits, and missed work days, as well as physical symptoms evaluated on a 15-point Patient Health Questionnaire (PHQ-15).

Stats arrived at following the study:

• 16.6% (468 of 2,815) of survey respondents had PTSD
  
• 46.7% of those with PTSD (vs. 19.8% without) rated their health as fair or poor
  
• 37.6% with PTSD (vs. 20.5% without) had 2 or more recent medical care visits
  
• 11.8% with PTSD (vs. 6.5% without) recently missed 2 or more days of work due to illness
  
• 34.4% with PTSD (vs. 5.2% without) had a PHQ-15 score indicating ill health

Continuing MedPage Today's excellent coverage:

Dr. Terhakopian noted that the study was cross-sectional, so that no conclusion can be drawn about whether PTSD causes ill health or vice versa. But he added that the clinical implication is that veterans with ill health without other obvious causes should be suspected of suffering form PTSD and offered treatment.

The Walter Reed researchers did not report the effect of injury on PTSD, but scientists from the Naval Medical Center at San Diego showed that battlefield injuries are more highly linked to PTSD than the usual run of medical conditions that can cause soldiers to be evacuated from a war zone.

In a retrospective chart review, David Oliver, M.D., and colleagues at the center, analyzed the relationship of PTSD with both branch of service and reason for being evacuated from the war zone. Since 2004, the San Diego center has been the receiving station for military personnel medevaced from Iraq, he said.

The majority of the personnel with PTSD or acute stress syndrome were marines, Dr. Oliver said, and most of the remainder were sailors, many of them hospital corpsmen. However, there was no statistically significant link between branch of service and the chance of having PTSD, he said.

On the other hand, the researchers found, there was a significant link to the reason for evacuation. Those who came home because of a battlefield injury or for psychiatric reasons were significantly more likely to suffer from PTSD, compared to those with non-battlefield injuries or other medical circumstances.

Specifically, 26% of those with battlefield injuries and 48% of those with psychiatric issues had PTSD, compared with 17% of those with non-battlefield injuries or other medical concerns.

USA Today also reported on the study:

A year after combat soldiers leave Iraq, those with symptoms of post-traumatic stress disorder say they're in worse physical health, suffer more pain and are more likely to miss work than veterans without PTSD symptoms, according to a military study out Monday.

The anonymous survey of nearly 3,000 Iraq veterans is the first to look at a link between PTSD and physical symptoms. ... "Their mental health problems may be taking a toll," says psychiatrist Charles Hoge, chief of psychiatry and neuroscience at the Walter Reed Army Institute of Research in Washington, D.C. Physical complaints may send a disproportionate number of these stressed soldiers to primary-care doctors, he says. ...

Anxiety can contribute to these health problems, Hoge says. Also, nightmares and flashbacks — symptoms of PTSD — can interfere with sleep, leading to worse health, he adds. About one out of five soldiers without PTSD symptoms said they were in fair to poor health, compared with nearly half of those with PTSD symptoms.

Soldiers are screened for mental and physical problems when they leave Iraq, then three and six months later, Hoge says. New "practice guidelines" are alerting military and Veterans Affairs doctors to possible ties between physical and mental symptoms in soldiers, says Charles Engel, director of the Deployment Health Clinical Center at Walter Reed Army Medical Center.

Soldiers sometimes downplay their stress reactions, so the number of soldiers with PTSD who also have physical health problems is, "if anything, conservative," says psychologist Charles Figley, a traumatic-stress expert at Florida State University. "When they come in with back pain, doctors are going to have to keep asking what happened to them in the war, not just now but five years from now."

There's strong evidence in civilian studies that trauma survivors use more health care at a higher cost, says University of Tulsa psychologist Elana Newman, who has studied health and traumatic stress.

As the costs associated with warfare mount, we need to be vigilant in our advocacy for proper veteran healthcare funding.


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• Study: Military Kids Have Higher Blood Pressure, Heart Rates, and Stress Levels

Memorial Day Taps

There are no official words to Taps, but these are said to be among the most popular:

Day is done, gone the sun,
From the hills, from the lake,
From the skies.
All is well, safely rest,
God is nigh.

Go to sleep, peaceful sleep,
May the soldier or sailor,
God keep.
On the land or the deep,
Safe in sleep.

Memorial Day: Honoring ALL of the Fallen

A number of weeks back, I was contacted by Penny Coleman. She's the author of the thoroughly provocative and deeply researched work, Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War.

I'd personally like to dedicate this Memorial Day to those who've worn the uniform, served in combat, yet go unrecognized on our KIA lists or memorial walls at their death. Penny Coleman's late husband, Daniel O'Donnell, became one such casualty of the Vietnam War when he took his life after battling something later referred to as posttraumatic stress disorder [PTSD]. As she says in her book:

The overwhelming evidence proves beyond a doubt that war is a disease that kills and maims, not just by tearing apart soldiers' bodies, but also by ravaging their minds. In every war American soldiers have fought in the past century, the chances of becoming a psychiatric casualty were greater than the chances of being killed by enemy fire.

Today, I remember these fallen casualties of war...

NYT Magazine Covers Experiences of National Guard in Iraq

A fully-loaded piece arrives from the New York Times today showing the unique ways new combat assignments affect our National Guard troops serving in Iraq. Great reporting. Click on 'Article Link' below tags for more...

A 'few' snippets from the NYT -- be sure to read the entire article (spanning 10 web pages):

In a small park at the center of the town of Butler, the county seat, a collection of stone memorials speaks to the disproportionate sacrifices this small county has made in America's various armed conflicts: 321 dead in World War II, 60 more in Vietnam. Even the name of the county and town honor a fallen soldier: Maj. Gen. Richard Butler, a Revolutionary War hero who was killed by Miami Indians at the battle of the Wabash in 1791.

Usually it has been Butler's youngest factory workers and farmhands who have been called to arms. But that changed in the winter of 2004, when the local detachment of the Pennsylvania National Guard — Alpha Company, First Battalion, of the 112th Mechanized Infantry Regiment — was ordered to Iraq, part of the largest battlefield deployment of the National Guard since World War II. Among the 200-odd men of Alpha Company (unlike some other National Guard units, they were all men) fully two-thirds were married, more than half had children and at least 50 were over the age of 30. Even within this demographic, Chuck Norris was something of an anomaly: at 37, the father of three was one of the "old men" of Alpha Company.

Chuck Norris' road to enlistment is covered, as well as how the small business owner eventually found his way to Iraq.

As a result of a recent merger with another National Guard garrison in Ford City, 22 miles down the road, the company was overstaffed, giving the military the luxury of cherry-picking some 130 men from the 200-man unit, depending on their specialties. Among those excluded from the roster was Sgt. Chuck Norris. "That came as a real blow," he told me, "because here all my buddies were going over, and I was supposed to stay home."

When Norris heard the news, he went to meet up at the American Legion hall with his best friend in Alpha Company, Carl Morgain, a fellow sergeant, to discuss the situation. At first glance, the two seemed an unlikely pairing. Norris was gregarious and outspoken, while Morgain, an electronics technician for the T.W. Phillips Gas and Oil Company and the father of two, was an intense and deeply private man with a wry wit. Still, Norris had developed a bond with Morgain, who was two years older, in the time they had spent together in Alpha Company. "A lot of what you do in the Guard is a real grind," Norris explained. "Hiking, sweating, being eaten by bugs. But those experiences also have a way of bringing you close. And one thing Carl and I always talked about was that if it ever came to a deployment, at least we'd be going over there together." Except that in the call-up for Iraq, Morgain was on the roster and Norris wasn't.

Norris would eventually get an assignment, and the two men went to desert-warfare training together in Fort Bliss. The two would not get their wish to serve together, however.

As it turned out, though, the two friends were not going to be together. Morgain and the rest of Alpha Company pulled into Forward Operations Base (F.O.B.) Omaha in Tikrit, Saddam Hussein's hometown, while Norris and his recovery team continued 30 miles up the road to F.O.B. Summerall in Baiji.

"I didn't really know what to expect," Norris said. At first, he recalled, "it all seemed kind of mellow. Nothing happened on our drive up from Kuwait, and from what I'd seen on the news about Iraq, I figured everything was pretty much under control." That assessment changed a few days after his arrival, when Norris and the rest of his eight-man recovery team were led into the back room of a maintenance shed on the base by the team they had come to replace. One veteran had a laptop on which he had stored images of the missions his unit had gone out on. "You're going to see things out there no one should ever have to see," the departing team leader told the new arrivals. "You need to tow a vehicle — you'd better be prepared to reach through a man's intestines to put it in neutral."

As the grisly images scrolled by on the laptop — the aftermaths of car bombings and mortar attacks and roadside explosions — Chuck Norris gradually realized that he had no idea what he was getting into.

As things became more dangerous for Norris, the same escalation was occurring in Morgain's unit.

For Morgain, the steadily mounting number of attacks on Alpha Company began to harden his views on the war. As a Humvee gunner, he occupied the most dangerous position on the vehicle, but it was also the one that allowed the most face-to-face contact with ordinary Iraqi civilians, and this provided him with a unique window onto the baffling complexity of the place. At first, he enjoyed clowning with the children who would crowd around his Humvee, but as the months passed and tension mounted in the area, he recognized some of those same children among the ones now throwing bricks and pipes at him. On one occasion, he distributed shampoo to a group of grateful women in a village outside Tikrit; returning a few days later, he discovered that the women had been beaten by their husbands for accepting gifts from the Americans.

Norris, too, had come to understand that his presence was not appreciated, or worse. His officers, he told me, "were always drumming into us: 'Hearts-and-minds, hearts-and-minds. We've got to win these people over."' He gave a laugh. "These people just wanted us dead."

One peculiarity of the battlefield was that though separated by a mere 30 miles, Norris had very little interaction with his Alpha Company buddies down in Tikrit. While his recovery missions frequently took him to F.O.B. Omaha, it seemed that his closest friends were always out on patrol when he arrived. One person he never saw there, he said, was Carl Morgain.

"In fact, the only time I saw Carl through the whole deployment was when I was coming back from leave," he told me. "I was at a base down-country, waiting to catch a ride up to Baiji, and I'll be damned, the guys pulled in and Carl was with them. Well, we hugged, of course, and talked for a few minutes, but then my ride came and I had to go."

Carl Morgain never made it home. When Norris eventually did make it home, he quickly learned things weren't going to go quite as smoothly as he might have liked.

At first, his problems had been fairly subtle, not much different from the reimmersion issues other Alpha Company soldiers were dealing with: a reluctance to be in crowded places, a heightened startle reflex, a tendency to watch the side of the road for anything unusual, as if even in rural western Pennsylvania a roadside bomb were still a possibility. Then, some three weeks after the homecoming, came the morning that Norris woke up to discover that everything had grown much worse.

"It was the weirdest damned thing," he told me. "I didn't want to get out of bed. I didn't want to leave the house. I didn't want to do anything. I knew something was wrong, so I went up to the V.A. hospital." Doctors there quickly diagnosed post-traumatic stress disorder, or PTSD.

The piece goes on to include a number of important points revolving around the added stress and difficulties for National Guard (or Reserve) members compared to the more traditional combat forces of the Army or Marines.

Martin A. Sweeney, a behavioral-health social worker at the V.A. hospital in Butler and a Vietnam veteran, estimates that the rate for National Guardsmen returning from Iraq may ultimately surpass the 30 percent mark seen among Vietnam veterans.

"The way this war is, everyone is free game and there's no back-base," Sweeney explained. "You have to be very aggressive, very vigilant, and you live that way day in and day out for a year, and when you come back here, you can't just turn that off. On top of that, the National Guard guys never really signed up for this. They'll all tell you they were proud to serve, that it was their duty, but the fact is, when they joined up, they thought they'd be dealing with floods and local disasters. They never thought they'd be part of the regular Army and put in the middle of a war zone."

Compounding the problem is that, once home, National Guardsmen are largely left to their own devices. "If you're a regular soldier," Sweeney continued, "you come back to a base that has all kinds of support services available. But if you're National Guard, what do you do? You come into Fort Dix, you spend a week doing demob there, you come back to your armory and — bingo — you're back in the community with families that have no idea of what you've gone through. That's where I see the problems coming. When these guys get back here, they're essentially on their own."

By mid-December, six weeks after their homecoming, the men of Alpha Company seemed to be confirming Sweeney's concerns. One of the first things Chuck Norris said to me was that perhaps the hardest part of being home was his inability to describe Iraq — and along with that, of course, an inability to explain its effect on him — to anyone who hadn't been there. "Sure, you can tell them stories or whatever," he said, "but unless they were there, they're not really going to get it."

This same sentiment was echoed by every other member of Alpha Company I spoke with. One of them was a 33-year-old sergeant named Ron Radaker. "It's just very hard, very stressful," he told me, sitting in a coffee shop near his factory workplace in East Butler. "I mean, it's great being back with my wife, spending time with my kids, but in other ways. . . well, I guess I kind of miss it. I miss my fellow soldiers. I miss the camaraderie. And I don't mean to sound arrogant when I say this, but I miss the power. Over there, when we would do a patrol and have a car approach us and we fired warning shots, that's a thrill, that's power. Over there, everybody knew we were there. We were the king of the road, and they either respected or hated us for it. And now you're back here, and you ain't king of nothing. That's very hard to explain to anyone else, but it's why I try to avoid these situations that set me off — like being in crowds or people doing stupid things on the road — because when that happens, I get hyper, and I don't like being hyper here because there's nothing I can do about it."

More details on Norris' bout with PTSD are revealed:

Just after Christmas, Chuck and Alecia went on a retreat with five other couples from the Baiji recovery team to a resort outside Pittsburgh called Seven Springs. For three days, the couples stayed in one large chalet, ski-tubing and going on sleigh rides in between long sessions of the men sitting around swapping war stories. "That was really great," Norris said afterward. "It was just so nice to see the guys again, and I think for the first time maybe Alecia and the other women started to understand a little bit of what we'd gone through over there."

Only days after coming home from Seven Springs, however, Norris fell into a depression so severe that he was unable to work or leave the house for nearly a month. ..."I didn't answer the phone, I didn't go to the door, I didn't even want to see my kids," he said. "I just lay on the couch rolled up in an orange caftan. It got so bad my father started coming over every day and forcing me to get up. He would just walk me around the neighborhood to get some fresh air."

A few days before, Norris decided that his crash was caused by a new antidepressant the V.A. had put him on, and he had quit cold turkey. Almost instantly, he told me, he felt much better.

"Thank God I quit that stuff," he said. "I feel like I've got my life back again."

Although he certainly looked well and seemed in high spirits, it appeared that his depression had given way to a mood that tilted toward the other end of the spectrum. In the middle of recounting one harrowing experience he had in Baiji, he abruptly told me that he was thinking of trying to go back over to Iraq.

"What do you think?" he asked.

In fact, a number of Alpha Company guardsmen had told me of their desire to return to Iraq — some out of boredom with civilian life, others for more prosaic motives. Ron Radaker, for example, had actually done far better financially in Iraq than in his civilian life, where he was pulling down $10.30 an hour as a steel melter in his factory job in East Butler; now that he was home, the bills were mounting and the creditors were calling.

Money wasn't Norris's motivation, though. "I'm thinking that if I go back, it might really help me put this PTSD stuff in perspective, let me get past it," he explained. I glanced at Alecia. She bore a vaguely worried expression, but beyond that, I couldn't gauge her stand on this idea. As diplomatically as possible — because Norris seemed rather enthused — I replied that from my own experience reporting in war zones and interviewing soldiers, repeated exposure to terror tended to make stress-related problems worse, not better. Norris nodded thoughtfully at this, as if it were a possibility he hadn't really considered.

Please read the rest; and email the New York Times to thank them for this important coverage.


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Minnesota Returning Veteran? Employment Resources For You

The Minneapolis Star Tribune covers the facet of employment reintegration for our returning veterans today. Take a look at a photo gallery of troops who've returned home and are back at work again and a quick article taking a look at some of the employment issues newly-returned veterans face. They also provide links to the following local employment resources:

• State of Minnesota Employment Services List
  
• Transition Assistance Program (TAP)
  
• Military Reservist Economic Injury Disaster Loan Program - financial help for the self-employed/small business owner
  
• The Recovery and Employment Assistance Lifelines (REALifelines) - help for injured veterans

A paper committed to truly supporting our veterans!

Click on 'Article Link' below tags for related posts...


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Des Moines Register Star: Soldiers Need Our Advocacy

Yesterday, a passionate editorial from the Des Moines Register Star appeared -- the paper that ran an incredible series of reports last weekend on combat PTSD. The editorial board says that every single recently-returned combat troop interviewed for their series said they are afraid to ask for help (for example, via VA programs) out of fear that the decision would affect their careers. The paper is calling for mandatory counseling of some sort for returning troops -- echoing the sentiments of many military families who've been witnessing the destruction of untreated combat PTSD.

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In the interest of carrying this important information forward, I'm reprinting the Register Star's editorial in full in the hopes they agree it's a worthy break in the usual copyright policy:

After the Vietnam war, some psychiatrists argued that features specific to that war, such as not being able to distinguish friends from enemies, extreme violence and unclear military goals, made it especially likely that soldiers would have long-lasting psychiatric problems. Some doctors called it "post-Vietnam syndrome."

Now American soldiers are involved in another war, this time in Iraq. A war of extreme violence. A war where it's difficult to know whether an approaching child is an innocent victim or a suicide bomber. A war in which political and military goals are intertwined.

Thousands of soldiers are returning home from Iraq and Afghanistan with symptoms of post-traumatic stress disorder, an ailment resulting from exposure to the threat of serious injury or death. Symptoms can include nightmares, flashbacks, withdrawn moods and emotional numbness.

But too few soldiers are seeking help for their problems.

A recent report by the Government Accountability Office found that only about 20 percent of soldiers considered at risk for post-traumatic stress disorder had been referred for further treatment. In Iowa, new veterans number more than 9,125, but fewer than 2,000 have enrolled for veterans' benefits, which include mental-health treatment. That's about 21 percent, which is lower than the national average of veterans accessing benefits.

Yet military officials insist help is available.

Group therapy for veterans of the wars in Iraq and Afghanistan is offered weekly at the Des Moines VA Medical Center. One person has attended. In a survey given to reservists, there is a space to put your name and request help. The director of the U.S. Army Reserve's family programs in Iowa told the Register no one has asked for help.

Why not?

Every single soldier Register reporter Jennifer Jacobs interviewed for Sunday's articles on post-traumatic stress disorder told her the same thing: They fear getting help because doing so may harm their military careers.

That indicates a problem in the tone being set by the military. Commanders must send a clear message that seeking help for post-combat stress is not only OK, it's encouraged. In fact, soldiers should be told that not getting help for psychological problems may jeopardize a soldier's future career.

All branches of the military also should consider mandating that soldiers report for group therapy and counseling on a regular basis after they return home. If everyone has to attend, those who need help won't feel singled out. Required attendance at support meetings or counseling would help remove any stigma that accompanies post-traumatic stress disorder.

War is a series of horrific events. The experience can trigger problems in previously well-adjusted individuals. Indeed, it's hard to imagine anyone not being affected by exposure to extreme violence and threats to their lives. Soldiers should be no more afraid to seek counseling than someone who lost a leg.

The tone must be set that the mark of true bravery comes in seeking help, not suffering in silence.

Please email the Des Moines Register Star, and let them know that you appreciate their solid support of our troops on this issue. This a refreshing and much needed attitude. Bravo to them!

Tags:

• local
• editorial
• veterans
• group
• counseling

Veterans, Share Your HeroicStories

Little acts of kindness make life a lot more enjoyable; stories of the goodness found in others can also be a tonic when you're feeling down about the world around you. (And who doesn't feel that way from time-to-time?) From the website, "Our mission is to publish examples of people being good to each other, to inspire similar heroic actions in others." If you're looking for a little brightness in your day, you might consider subscribing to HeroicStories (an email subscription is free).

And I know many of you out there who've worn our nation's uniform have many a story of heroism to share with us; I highly recommend adding yours to the beautiful chorus at HeroicStories.

Women in Combat: Females and PTSD

According to the Department of Defense (DoD), 11% of those serving in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) are women. Officially, they are restricted to non-combat roles; however, in wars such as that being waged in Iraq, there are no front lines. Combat roles or not -- they are in the thick of things. Last week, the Chicago Tribune covered how war has lingered with some of the women returning home. I'll round things out by reposting a related January commentary of mine which appeared online before PTSD Combat was up and running.

Click on 'Article Link' below tags for more...

From the Chicago Tribune:

Keri Christensen spots an empty pop can on the side of the road in McHenry County, and in a flash she is back at the helm of a heavy-equipment transporter maneuvering along Iraq's treacherous highways. Her two children are strapped into seats in her mini-van, but Christensen finds herself scrutinizing roadside trash for signs of a makeshift bomb. "Everything is weird," said Christensen, 33, a Wisconsin National Guard soldier who returned in November to the Chicago area after serving 10 months in Iraq. "I went from a stay-at-home mom to a soldier instantly."

Traveling that path in reverse has been equally tough for Christensen and a rising tide of other female veterans. Since 2003, the number of former soldiers seeking help for combat-related post-traumatic stress disorder has grown so much that the North Chicago Veterans Affairs Medical Center has shifted its women's mental health program to respond to combat stress disorders.

Formed in 2001, the program was originally geared to help women suffering trauma from sexual harassment to rape. The program still helps women with what the Armed Forces calls "military sexual trauma." But therapists now are seeing female vets who exhibit the same signs of post-traumatic stress disorder as men who served in infantry units. "Flashbacks, hyper-vigilance, sleep disorders. They're always on edge," said Katherine Dong, manager of the Women Veterans Health Care Program at the North Chicago facility, who helped form the mental health program. "If somebody drops a book, they hit the floor."

A higher percentage of women returning from the combat zone seek help for symptoms associated with PTSD. This could point to female troops having a greater likelihood of suffering emotional damage following traumatic experiences or they may be more willing than men to reach out for help.

"There are all these roadside bombs," said Barb Wisott, a former social worker at the North Chicago hospital who recently moved to the VA's Eastern Colorado Health Care System in Denver. "Women driving in convoys and delivering supplies are experiencing more combat exposure."

Though the symptoms are similar in both men and women--nightmares, flashbacks, a fear of crowds, irritability--more women than men are coming home to fulfill the role of primary nurturer. A growing number are finding the transition from soldier to mom difficult, vets and veterans administrators say. "Women are often trying to reintegrate into a family with young children," Dong said. "They're expected to go back to being with the kids."

For Christensen, that part of her homecoming was especially hard. Sobbing at silly things like patriotic songs on a country radio station was frustrating enough. It was worse to do it in front of her children, Madison, 7, and Olivia, 4. "I'd try to hold it together in front of the kids," she said.

Between 2002 and 2006, about 20,000 men and 6,000 women were diagnosed with mental health issues, including 2,500 women assessed specifically with post-trauma stress, according to VA data. But officials caution that the numbers likely represent a fraction of those who suffer from the stress disorder, since only about 10 percent of veterans seek medical help at VA hospitals. Some go to private clinics; others may not seek help at all.

Those who seek treatment often need help functioning in day-to-day tasks, such as raising children, going to work, even going to the store. Elaine Rosado of Chicago, a single mom and Army Reserve staff sergeant who drove 18-wheelers across Iraq, needed help keeping her temper under control.

Before her deployment she had been easygoing and happy, she said. When she got home, she found herself snapping easily at her son, Issac, 4. It wasn't until her mother mentioned her behavior that Rosado, 25, realized she was acting out of character. Talking with a therapist helped. "I'll still snap," she said. "But now I'll catch myself."

Christensen worked tirelessly to keep from feeling like she was slipping. She cleaned obsessively, filling trash bins with old junk from the basement. "I have a totally purged house," she said. She cried for no apparent reason, considered suicide and once had what seemed to her a real conversation with her husband, Brian, while he was upstairs sleeping. "I thought, `Oh my God, I'm going crazy. I'm hallucinating,'" Christensen said. "I didn't want to go anywhere. I was afraid to drive with the kids in the car. I'd wait until my husband got home to run errands."

In Iraq, Christensen endured roadside bombs, small-arms fire or grenades on every mission she made. And she was assigned the heartbreaking task of working at a port in Kuwait through which soldiers' caskets passed. "They'd have the name and date of birth on them," she said. "You'd think, `God, these kids are so young.'"

No Going Back

"If you tried to pull women out of the equation, this country could not fight a war." -- Lory Manning, a retired Navy captain and director of the Women's Research and Education Institute

Although women have served in one capacity or another in every major war in U.S. history, Iraq has easily become the largest deployment of women to a combat zone: one out of every seven is female. As their numbers have increased, so have their responsibilities. No longer relegated to being spies or nurses, they now find themselves in the heat of battle.

As Retired Air Force Brig. Gen. Wilma L. Vaught puts it:

"You've got more women carrying weapons with the possibility that they'll use them to fight or defend themselves," Vaught said in a phone interview. "That's one of the big differences between this war and others. Women haven't done this type of war before."

They are serving admirably and proving their metal daily. Because of the nature of the Iraq war, the policy preventing women from serving in combat positions doesn't shield them from stressful combat situations. For example, in the opening days of the war:

1st Lt. Adrien Thom prepared for the journey toward Baghdad.

It was the day before the ground offensive on the city and she would lead a platoon of 15 Marines on a support mission for advancing troops. The mission required that she travel alongside ground combat divisions; a move that was against Marine Corps policies that prohibit women from participating in direct ground combat operations. But Thom said her commander told her to go ahead and that she was just as capable as any man.

Thom, a 26-year-old combat engineer from Louisiana, sat in the passenger seat of the front truck, a map in one hand, a phone in the other and a radio next to her as the convoy rolled past burning buses, abandoned military vehicles, big pits of burning oil. ... During the next few days, frequent fire fights broke out between Iraqi insurgents and the combat Marines with whom she stayed. Incoming mortar rounds could be heard from every direction. It was a chaotic scene.

Current federal law is meant to shield women from armed conflict. As such, females are technically banned from serving in any of the following groups:

• infantry
  
• tank, artillery and armored vehicle units
  
• coastal patrol boats and submarines
  
• special operations units such as Army Rangers and Navy SEALS

Althought President Bush has determinedly stated, "no women in combat," the Pentagon has begun relaxing their ban, placing women in more dangerous roles in the combat zone.

In February, the Army's 3rd Infantry Division acknowledged it has assigned women to units in Iraq that directly support combat troops by providing food, equipment maintenance and other services. The process, called "collocation" - literally to place side by side - is at odds with an 11-year-old Army policy that bans women from serving in front-line support groups.

"This is an incremental change that will gradually lead to a more direct deployment of women in combat," said Elaine Donnelly, president of the Center for Military Readiness.

Listen to an NPR interview with another female veteran's experience on the front lines here.


The First Female Casualty of War

Although the names Jessica Lynch and Soshanna Johnson are more commonly recognized in most homes across the country, their friend who perished that day in Nasiriyah is not. Army Private Lori Piestewa, the first female to lose her life in Iraq -- and the first Native American woman to die in combat on foreign soil -- has been mostly forgotten. When their support convoy wound up lost on the third day of the US invasion, it was picked off by Iraqi soldiers. The course error was fatal and costly: 11 American soldiers dead and nine wounded.

In the end, policy or no policy, women are in the thick of things, right along with our men. Of the ambush, the military later described it as a "torrent of fire" that had rained down on the unsuspecting unit of clerks, cooks, and repairmen. [For more on this incident, please read the excellent Rolling Stone piece, A Wrong Turn in the Desert by Osha Gray Davidson.]


Women and PTSD

PTSD affects women at twice the rate of men. Furthermore, studies show that their symptoms are more striking and incapacitating.
In a July 2005 article, Newsweek reported that:

• 20 years ago, only 2% of patients at VA hospitals were women
  
• Today, 14% of VA patients are women
  
• About 85,000 OEF and OIF vets have sought VA medical care
  
• 11% (9,688) have been diagnosed with PTSD (current figure: 16,000)
  
• Of these 9,688 with PTSD, 1, 277 are women

To better understand how to successfully treat deployed women returning with combat-related PTSD, the VA has launched a first-ever $6 million study focusing on female veteran PTSD.

"PTSD is a very real problem for women who serve in the military," said Paula Schnurr, one of the study's lead researchers and the deputy executive director of the VA's National Center for PTSD in White River Junction, Vt. "This study is specifically addressing that, and we hope it will not only help us treat women coming home from Iraq, but all those who have ever served and struggled with PTSD in any conflict before."

The study's findings are not due until the end of the year, but researchers already have made some startling discoveries that are illustrative of the nature of PTSD among female veterans and of the U.S. military.

Male and female physiology being what is it, not surprisingly each has a unique way of coping with the demons they may have brought back with them from war.

Men, for example, are more prone to pick up drinking or drugs as a way of self-medicating themselves, attempting to numb their pain. Women, conversely, are more likely to seek help. This difference may be one reason for the larger percentage of women who have been identified suffering with PTSD; however it's not the only factor.

From a March, 2005 piece in the Chicago Tribune:

"[D]ata indicate that female military personnel are far more likely than their male counterparts to have been exposed to some kind of trauma or multiple traumas before joining the military or being deployed in combat. That may include physical assault, sexual abuse or rape.

The speculation is that many of them are joining the military to get away from adverse environments," said Schnurr, also a professor of psychiatry at Dartmouth College. ... The implication of such a finding on PTSD research is considered significant. Because most research indicates that a person is at greater risk of developing PTSD--or developing more severe PTSD--when he or she has had past traumas, many female troops are deploying to war zones already heavily predisposed to react adversely to the intense fear, killing and loss routinely encountered there.

"The evidence is conclusive," said Rachel MacNair, an expert in the psychological effects of violence and PTSD. "The greater the trauma in your life, the greater the symptoms of PTSD."

An additional factor that has some bearing on female veteran PTSD is the added reality of rape and sexual intimidation from her fellow troops. Since PTSD is slow to show itself, we have no way of knowing how grave a problem this will be for our soldiers, their families, their communities, and our nation.

Only time will tell.


Resources for Women Dealing with PTSD

To cope with PTSD, female soldiers have formed Internet support groups (MSN Group Sisters Bound by Honor, for example). They've also begun using a book on PTSD called Why Is Mommy Like She Is? to help them when they transition back to their children's lives after being deployed.

See also:

• US Army's Soldier's Guide to Female Soldier Readiness
  
• PTSD in Women-VA-DOD Cooperative Study No. 494
  
• Patience Bookstore: free pamphlets/newsletters on PTSD
  
• Good medicine: A collection of humorous military stories by women.
  
• VA: Traumatic Stress in Female Veterans and PTSD in Men and Women: Understanding Some of the Differences

 Related Posts

• Female Vets 4 X, Male Vets 2 X as Likely to Become Homeless Vs. Non-Vets
  
• Military Sexual Assault: 'The Other PTSD'
  
• New York Times Magazine Reveals the Double Dose of Danger in The Women's War
  
• Female Fort Lewis AWOL Soldier Has PTSD
  
• One-Third of OEF/OIF Women Vets Suffer Psychological Injury
  
• Study: 'Prolonged Exposure' Therapy Superior Treatment for Female PTSD
  
• Women in Combat: Females and PTSD
  
• Psychological Bulletin from APA: Females Have Higher Rates of PTSD
  
• A Look at the VA's Women Veterans Health Program
  
• Combat, Women, and PTSD: Details and News on Upcoming VA Retreat
  
• One Female Soldier's Struggle with PTSD

VA Response to Military Personnel Data Theft

An unsettling and serious breach of personal data security has been reported today by the VA. Due to an employee's disregard for VA rules coupled with a home burglary, personal information (including the Name, Social Security Number, and Birth Date) of U.S. veterans who have been discharged since 1975 may be compromised. Details follow in a letter released by the VA, along with a list of frequenty asked questions on the matter.

Click on 'Article Link' below tags for more...

Letter to Veterans from the VA:

Dear Veteran:

The Department of Veterans Affairs (VA) has recently learned that an employee took home electronic data from VA, which he was not authorized to do and was in violation of established policies. The employee's home was burglarized and this data was stolen. The data contained identifying information including names, social security numbers, and dates of birth for up to 26.5 million veterans and some spouses, as well as some disability ratings. As a result of this incident, information identifiable with you was potentially exposed to others. It is important to note that the affected data did not include any of VA's electronic health records or any financial information.

Appropriate law enforcement agencies, including the FBI and the VA Inspector General's office, have launched full-scale investigations into this matter. Authorities believe it is unlikely the perpetrators targeted the items because of any knowledge of the data contents. It is possible that they remain unaware of the information which they possess or of how to make use of it.

Out of an abundance of caution, however, VA is taking all possible steps to protect and inform our veterans. While you do not need to take any action unless you are aware of suspicious activity regarding your personal information, there are many steps you may take to protect against possible identity theft and we wanted you to be aware of these. Specific information is included in the attached question and answer sheet. For additional information, VA has teamed up the Federal Trade Commission and has a website http://www.firstgov.gov/ with information on this matter or you may call 1-800-FED-INFO (1-800-333-4636). The call center will operate from 8 a.m. to 9 p.m. (EDT), Monday-Saturday, as long as it is needed.

We apologize for any inconvenience or concern this situation may cause, but we at VA believe it is important for you to be fully informed of any potential risk resulting from this incident. Again, we want to reassure you we have no evidence that your protected data has been misused. We will keep you apprised of any further developments. The men and women of VA take our obligation to honor and serve America's veterans very seriously and we are committed to seeing this never happens again.

Sincerely, R. James Nicholson

Secretary of Veterans Affairs

FAQs, compliments of the Washington Post:

1- I'm a veteran, how can I tell if my information was compromised?

At this point there is no evidence that any missing data has been used illegally. However, the Department of Veterans Affairs is asking all veterans to be extra vigilant and to carefully monitor bank statements, credit card statements and any statements relating to recent financial transactions. If you notice unusual or suspicious activity, you should report it immediately to the financial institution involved and contact the Federal Trade Commission for further guidance.

2- What is the earliest date at which suspicious activity might have occurred due to this data breach?

The information was stolen from an employee of the Department of Veterans Affairs during the month of May, 2006. If the data has been misused or otherwise used to commit fraud or identity theft crimes, it is likely that veterans may notice suspicious activity during the month of May.

3- I haven't noticed any suspicious activity in my financial statements, but what can I do to protect myself and prevent being victimized by credit card fraud or identity theft?

The Department of Veterans Affairs strongly recommends that veterans closely monitor their financial statements and visit the Department of Veterans Affairs special website on this, http://www.firstgov.gov/ or call 1-800-FED-INFO (1-800-333-4636).

4- Should I reach out to my financial institutions or will the Department of Veterans Affairs do this for me?

The Department of Veterans Affairs does not believe that it is necessary to contact financial institutions or cancel credit cards and bank accounts, unless you detect suspicious activity.

5- Where should I report suspicious or unusual activity?

The Federal Trade Commission recommends the following four steps if you detect suspicious activity:

Step 1 -- Contact the fraud department of one of the three major credit bureaus: Equifax: 1-800-525-6285; http://www.equifax.com/; P.O. Box 740241, Atlanta, GA 30374-0241 Experian: 1-888-EXPERIAN (397-3742); http://www.experian.com/; P.O. Box 9532, Allen, Texas 75013 TransUnion: 1-800-680-7289; http://www.transunion.com/; Fraud Victim Assistance Division, P.O. Box 6790, Fullerton, CA 92834-6790 -More-

Step 2 -- Close any accounts that have been tampered with or opened fraudulently

Step 3 -- File a police report with your local police or the police in the community where the identity theft took place.

Step 4 -- File a complaint with the Federal Trade Commission by using the FTC's Identity Theft Hotline by telephone: 1-877-438-4338, online at www.consumer.gov/idtheft, by mail at Identity Theft Clearinghouse, Federal Trade Commission, 600 Pennsylvania Avenue NW, Washington DC 20580.

6- I know the Department of Veterans Affairs maintains my health records electronically; was this information also compromised?

No electronic medical records were compromised. The data lost is primarily limited to an individual's name, date of birth, social security number, in some cases their spouse's information, as well as some disability ratings. However, this information could still be of potential use to identity thieves and we recommend that all veterans be extra vigilant in monitoring for signs of potential identity theft or misuse of this information.

7- What is the Department of Veterans Affairs doing to insure that this does not happen again?

The Department of Veterans Affairs is working with the President's Identity Theft Task Force, the Department of Justice and the Federal Trade Commission to investigate this data breach and to develop safeguards against similar incidents. The Department of Veterans Affairs has directed all VA employees complete the "VA Cyber Security Awareness Training Course" and complete the separate "General Employee Privacy Awareness Course" by June 30, 2006. In addition, the Department of Veterans Affairs will immediately be conducting an inventory and review of all current positions requiring access to sensitive VA data and require all employees requiring access to sensitive VA data to undergo an updated National Agency Check and Inquiries (NACI) and/or a Minimum Background Investigation (MBI) depending on the level of access required by the responsibilities associated with their position. Appropriate law enforcement agencies, including the Federal Bureau of Investigation and the Inspector General of the Department of Veterans Affairs, have launched full-scale investigations into this matter.

8- Where can I get further, up-to-date information?

The Department of Veterans Affairs has set up a special website and a toll-free telephone number for veterans which features up-to-date news and information. Please visit http://www.firstgov.gov/ or call 1-800-FED-INFO (333-4636).

 Related Posts

• IG Report: Veterans Administration Lax in Implementing Database Security Measures

HBO's Baghdad Er: Army Issues Warning to Combat Troops w/PTSD

A documentary airing tonight on HBO, Baghdad ER , has received a warning from the Army's chief surgeon, Lt. Gen. Kevin Kiley, via a memo sent out to Army post medical staff across the country. The worry is that the graphic content may trigger flashbacks and nightmares for those troops coping with PTSD. From CNN:

In a memo dated May 9 and obtained by CNN, Lt. Gen. Kevin Kiley said the film "shows the ravages and anguish of war. Those who view this documentary may experience many emotions," he said in the memo. "If they have been stationed in Iraq, they may re-experience some symptoms of post-traumatic stress, such as flashbacks or nightmares." ... "This film will have a strong impact on viewers and may cause anxiety for some soldiers and family members."

Des Moines Register Delivers Strong PTSD Coverage Today

A big pat on the back to the locals, yet again, for doing an outstanding job of covering the combat PTSD story. This weekend, it's The Des Moines Register's turn. They deliver a massive amount of reporting on the experiences of Iowa's returning combat troops coping with PTSD in not one, but 6 articles (2 are web exclusives). Start with PTSD: Soldiers in Distress, and then navigate to the other articles from the page's left-hand column (labeled 'related stories').

Click on 'Article Link' below tags for more...

From the Des Moines Register:

It's a jarring image: A U.S. flag flies upside-down outside Terri Jones's home. It's a distress signal she took straight from the federal flag code - and it's her way of calling Iowans' attention to what she believes is an unfolding crisis of post-traumatic stress disorder among Iraq and Afghanistan veterans. One of its victims, she said, was her son, Jason Cooper, 23, who took off his dog tags, fastened a noose, and stepped off a chair.

"Our soldiers are being failed," said Jones, who lives outside Russell. "I'm extremely proud of our soldiers. They responded to the call to duty. They're willing to do anything for that American flag, but what that American flag stands for is not willing to do anything back for them."

Aid for returning veterans has become a hot-button issue across the country, with Democratic politicians and veterans' advocates crying for better detection and treatment of combat-related mental health problems. But military and Veterans Affairs officials in Washington, D.C., and in Iowa say they have to practically beg troops to take advantage of the unprecedented help that's already offered.

"We're out there in their faces. We insist. We give them examples. We're all there for them," said Victor Tate, a VA outreach specialist in Iowa. "At no time in the history of America has more attention been paid to veterans."

Having the deepest respect for the work being done by the individuals at the VA across the country, I still bristle a bit at this statement. The VA or the DOD do not insist; true insistence would include required debriefing programs following combat.

Much like boot camp is required to teach a soldier to fight, many military families who've lost loved ones to suicide following deployment (including the Omvigs introduced later in the article) say the military should also be required to teach the soldier to live in peace again once they return home.

No one knows exactly how many Iowa service members suffer from combat-related mental health issues. But when the family of 22-year-old Grundy Center resident Joshua Omvig, another Iraq veteran who committed suicide in Iowa, created a Web site (http://joshua-omvig.memory-of.com) with a clearinghouse of PTSD information, it had more than 14,430 hits in four months. And the e-mails and message posts from service members about failing relationships, job troubles, assaults and thoughts of suicide led Ellen and Randy Omvig to believe problems with untreated PTSD run deeper than Iowans might have guessed.

Studies show that between 12 percent and 20 percent of troops returning from Iraq and Afghanistan have symptoms of post-traumatic stress disorder. That could mean that as many as 2,000 Iowans - with more than 9,000 Iraq or Afghanistan veterans living here, and at least 1,249 more currently serving in the Middle East - are suffering now or could develop symptoms.

Families like Ellen and Randy Omvig and Terri Jones are asking: If the psychological trauma of combat has ruined soldiers' lives following every war, why haven't military and Veterans Affairs officials learned how to treat it yet? "We can treat it," said Paula Schnurr, deputy executive director of the VA's National Center for Post-Traumatic Stress Disorder, which opened 17 years ago in response to a Congressional mandate to address military-related PTSD. "We don't have all the answers, but we can help a number of people substantially. The earlier the treatment, the better."

Yet the stigma against reaching out is deep and sure.

Military officials admit more needs to be done to help service members' overcome their reluctance to get treatment. When returning reservists report after 90 days for their first post-combat drill, they have to fill out an anonymous risk assessment survey. There's a space where they can reveal their names and request help, but so far, no one has done that, said Travis Bartholomew, director of the U.S. Army Reserve's family programs in Iowa.

Both of Iowa's post-combat suicide victims were soldiers in the Army Reserve. "It's on us to keep up the marketing," Bartholomew said. "We have to get to the families. Families, please, please, if you see something going on, call."

Therapists are available for Iowa's veterans - and some are underused, VA officials said. Group therapy exclusively for Iraq and Afghanistan veterans with post-traumatic stress disorder is offered weekly at the Des Moines VA Medical Center. Only one person has shown up."Their opinion is they're doing fine. They don't need any help," said Patrick Palmersheim, executive director of the Iowa Department of Veterans Affairs.

The Reserve realized it wasn't doing enough for unmarried soldiers, so it now holds weekend retreats to talk about everything from emotions to job skills, Bartholomew said. And it sends staff members called "soldier and family life consultants" to mingle with the soldiers as they do their duties and to ask how they're doing.

Meanwhile, one of the Iowa Army National Guard's tools for dealing with combat stress is a one-day workshop called Enduring Families. It used to be optional any time during soldiers' first three months back; it's now required at 90 days.

Iowa is one of only 15 states where the National Guard offers an after-deployment program - and the Pentagon liked it enough to ask organizers to share it with other states, said Cathy Luther, director of the National Guard's Iowa family programs. The workshop offers peer-to-peer discussions, briefings on health care, and sessions on anger management, parenting skills, couples therapy and unmarried soldier issues. "You can kind of see them coming in saying, 'Oooh, we have to go to this?' and by the end of the day you practically have to kick them out," Luther said. About 250 mental health professionals volunteer their time; the 2,481 soldiers who have attended in the last two years were paid

The Iowa National Guard is so serious about soldiers' well-being that the staff even does interventions, said Becky Coady, a family programs assistant. They've done at least 50 in two years, gathering with families to convince the soldier to get help "before everybody is hurt, emotionally and physically," she said.

There are no repercussions for getting help with PTSD, said Lt. Col. Todd Jacobus, commander of the 224th Engineer Battalion. "To say, 'It'll affect my career,' that's a cop out," he said. "There are people hungry to help them. "Our soldiers' failure to pursue assistance is something they've made a decision to do on their own. It's the wrong decision."

As I end by applauding the Des Moines Register for their excellent reporting on this issue, the idea forwarded by Lt. Col. Jacobus of blaming the soldier or the military family for not pursuing assistance is unsettling.

We can do better than this, can't we, as a nation?


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• Phone House Representatives Today in Support of Joshua Omvig Veterans Suicide Prevention Bill
  
• Call Representatives Today on the Joshua Omvig Suicide Prevention Bill
  
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• McClatchy Digs Deep into VA PTSD Care Records

Tags:

• legislation
• veterans
• suicidal
• incidents
• local

Update: PTSD and the 'The Marlboro Man'

Snapped by embedded Los Angeles Times photographer Luis Sinco, tagging along with Charlie Company, 1st Battalion, 8th Marines in Fallujah on November 9, 2004, this photo would run in 100 newspapers worldwide. The Times gives us an update on how the iconic Marine is doing. Through both a new article, and a photo gallery, you'll peer into Lance Corporal James 'Blake' Miller's life as he fights his latest battle -- with PTSD. All my best to him.

Click on 'Article Link' below tags for more...

From the LA Times:

He survived a harrowing all-night firefight in November 2004, pinned down on a rooftop by insurgents firing from a nearby house. Filthy and exhausted, he had just lighted a Marlboro at dawn when an embedded photographer captured an image that transformed Blake into an icon of the Iraq war.

His detached expression in the photo seemed to signify different things to different people — valor, despair, hope, futility, fear, courage, disillusionment. For Blake, the photograph represents a pivotal moment in his life: an instant when he feared he would never see another sunrise, and when his psychological foundation began to fracture.

A year after the photo spread like wildfire around the world, Miller would receive an early but honorable discharge from the military due to his PTSD.

He feels adrift and tormented, dependent on his new bride, his family and his military psychiatrist to help him make sense of all that has befallen him. He barely sleeps. On most mornings, Blake says, he has no good reason to get out of bed. Often, his stomach is so upset that he can't eat. He has nightmares and flashbacks. He admits that he's often grouchy and temperamental. He knows he drinks and smokes too much. "He's not the same as before," said Blake's wife, Jessica, who has known him since grade school. "I'd never seen the anger, the irritability, the anxiety."

Blake says he feels guilty about taking money — $2,528 in monthly military disability checks — for doing nothing. Yet he's also frustrated that two careers made possible by his military training, police officer or U.S. marshal, are out of reach because law enforcement is reluctant to hire candidates with PTSD.

So he broods, feeling restless and out of options: "I'm only 21. I'm able-bodied as hell, yet I'm considered a liability. It's like I had all these doorways open to me, and suddenly they all closed on me. It's like my life is over."

The article goes on the document a recent trip to a restaurant with this wife; although he was able to control it, Miller admits he became enraged when he believed a man was was looking at his wife Jessica's bottom.

Jessica, who graduates this spring from Pikeville College with a psychology degree, has persuaded her husband to undergo visualization techniques in which she helps him confront his demons.

"It's understandable that Blake has PTSD, after all he's been through," she said. "Ordinary people can't comprehend what it's like to be constantly shot at and have to kill other human beings. They need to know what it means to send people like Blake out to fight wars. You're going to have a lot of people breaking."

Five other members of his platoon of about three dozen have been diagnosed with PTSD, Blake said. A dozen men from his unit were killed in action. A Journal of the American Medical Assn. study published in March found that more than a third of troops who served in Iraq sought help for mental health problems within a year of returning home.

After offering more details on how the photo itself was snapped and made its way into the history books, the piece then moves on to reveal how Miller's PTSD made itself known in the days following his return home.

In early January 2005, as Blake's unit prepared to leave Iraq, what Marines call a "wizard" — a psychiatrist — gave a required "warrior transitioning" talk about PTSD and adjusting to home life. Blake didn't think much about it until he returned to Jonancy in late January and his nightmares began.

He dreamed about the 40 enemy corpses that he counted after the tank demolished the house, he said, and that he had been shot. "He'd jump out of bed and fall to the floor," Jessica said. "I'd have to hold him to get him to wake up, and then he'd hug me for the longest time."

Sometimes, Blake mutters Arabic phrases he learned in Iraq or grimaces in his sleep, and Jessica will keep whispering his name until he wakes up. Some nights, he doesn't sleep at all. "I tend to drink a lot just to be able to sleep," Blake said. "Nothing else puts me to sleep."

He decided last summer to see a military psychiatrist at Camp Lejeune, N.C., where he was based. In August, he was diagnosed with PTSD. But before he could be put on "non-deployable status," his unit was sent to New Orleans to assist with Hurricane Katrina recovery.

While aboard a ship off the Louisiana coast, Blake was taking a cigarette break when a petty officer made a whistling sound like an incoming rocket-propelled grenade. Blake says he remembers nothing about the incident, but was later told that he slammed the officer against a bulkhead and attacked him.

By November, Blake was forced to take a medical disability discharge. "They said they couldn't take the risk of me being a danger to myself and others," he said. He fears that he may have another blackout. "It's terrifying that at any moment I could lose control and not know what I'm doing," he said. "What if next time it's Jessica?"

He suffers from flashbacks along with his nightmares (flashbacks are images that appear 'real' in the person's mind while awake).

This February, while smoking a cigarette and staring out Jessica's dorm room window, Blake said, he thought he saw a dead Iraqi man on the grass. Later, he had visions of an Iraqi father and son fishing — a scene he'd witnessed in Iraq just before a grenade exploded nearby. "I can't tell anymore what really happened and what I dreamed," he said. "Sometimes I feel like I'm dying."

Blake visits a Veterans Administration psychiatrist in nearby West Virginia and speaks with him by phone several times a week. He said his psychiatrist told him that his PTSD has to be managed; his disability will be reevaluated in March 2007.

Meanwhile, he has slowly turned against the war. "We've done some humanitarian aid," Blake said, "but what good have we actually done, and what has America gained except a lot of deaths? It burns me up." Jessica, who sports an "I Love My Marine" sticker on her car, says she and Blake are behind the troops though they no longer support the war.

The piece moves on to describing the Kentucky community in which Miller grew up, then closes with Miller reflecting on things.

For Hillbilly Days, an annual street festival late last month in Pikeville (pop. 6,304), Blake shaved his scruffy beard and got a military "high and tight" haircut. He agreed to help at a Marine Corps recruiting booth at the festival. Just putting on his Marine fatigue pants and boots for the first time since his discharge brought back more memories, and he tried to tamp them down.

He was so worried that the Marlboro Man photo would dominate the recruiting booth that he begged the recruiters not to display it. He also persuaded them to remove a large version of the photo that had hung in the recruiting station in downtown Pikeville. "I can't stand to look at it anymore," he said. Even so, he says the photo has provided him a platform to try to educate others about PTSD.

At the festival, Blake's mood brightened as he chatted with the recruiters. Wearing a Marine T-shirt with the message "Pain Is Weakness Leaving the Body," he was cheerful and animated. He playfully harangued young men, challenging them to a pull-up contest.

Though he has turned against the war, he said, he often wishes that he was back in the Corps and with his buddies. He still recommends the Corps to potential recruits, but advises them that it's a job, not a way of life. He recommends noncombat positions. "In order to do your job in combat, you have to lock up your emotions," he said. "Basically, you're turning people into killers."

Please consider thanking the Los Angeles Times for their coverage of this important issue. We need more of this kind of reporting to get more engaged and ready to advocate for our returning troops.


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Sens. to DOD: Stop Sending Troops with PTSD Back to Combat

In answer to last weekend's revealing Hartford Courant piece reporting that the DOD was returning troops suffering with posttraumatic stress disorder back into the combat zone, anti-anxiety medications in hand, the Courant now reports that Senator Barbara Boxer has sent a letter to Secretary of Defense Donald Rumsfeld. Senator Joe Lieberman has also come out publicly to ask for an investigation into these charges.

Click on 'Article Link' below tags for more...

From the Hartford Courant:

U.S. Sen. Joseph I. Lieberman called Wednesday for a federal investigation of mental health screening for troops deploying to Iraq, after The Courant reported in a series that mentally ill service members are being sent to war and kept there, sometimes with tragic consequences.

Also Wednesday, U.S. Sen. Barbara Boxer, D-Calif., sent a letter to Secretary of Defense Donald Rumsfeld expressing "disgust" at a revelation in the series that the military was sending troops with post-traumatic stress disorder back into combat. "You cannot simply have doctors prescribe psychiatric drugs such as Zoloft and send these men and women back to a combat zone," Boxer wrote. "No matter what the Defense Department's recruiting shortfalls, it is absolutely immoral to send soldiers who have been diagnosed as suffering from PTSD back into a combat zone."

Lieberman, a member of the Senate Armed Services Committee, sent letters Wednesday to the Government Accountability Office and the inspector general of the Defense Department, asking each agency to investigate the military's pre-deployment screening practices. Lieberman said he was particularly concerned by The Courant's finding that among troops who indicated a possible mental health problem, only 6.5 percent were referred to a mental health specialist before they were deemed deployable. "Clearly, our soldiers are experiencing unusually high levels of stress," Lieberman wrote in his letter to the inspector general, "but if the military is doing an inadequate job of assessing the severity of mental health problems in those deploying, and then placing them in further danger, their lives are [at] greater risk."

Lieberman, D-Conn., said Wednesday that he was also "exploring legislative options" to improve mental health screening for troops, which consists of one question on a self-reported questionnaire. "We put our faith in the men and women of our armed services to protect us every day; they should expect and deserve to have the same faith in us," Lieberman said. The Courant's investigation, he added, "reveals that the deployment system's faulty implementation of mental health screening has betrayed the trust of our soldiers and their families. This is unacceptable and inexcusable."

Assistant Secretary of Defense for Health Affairs, William Winkenwerder Jr., this week defended the practices of the DOD regarding mental health screening and treatment provided to its combat troops. Army Surgeon General Kevin C. Kiley also defended current practices, adding that he would support additional screening, "if we have evidence it would make a difference."

U.S. Rep. Rosa DeLauro, D-3rd District, who has pushed for the military to conduct face-to-face mental health evaluations of returning troops, said Wednesday she believed using a questionnaire for pre-deployment screening may be inadequate as well. "If they self-report, you're never going to get a full [mental health] assessment," DeLauro said. "You've got to see them when they're going in; you've got to see them when they're going out."

DeLauro said she was also concerned by The Courant's findings that the military was relying increasingly on the use of antidepressants in the war zone, sometimes with minimal counseling and monitoring. Antidepressants carry government warnings about a risk of side effects, including increased suicidal urges, when they are first prescribed. "We've now established a link between antidepressants and suicide. We know you have to strictly monitor them," she said. "Who's making that assessment [in the combat zone]?"

The military also uses a self-reported questionnaire to assess the mental health of troops completing tours in Iraq - a practice some say fails to detect PTSD and other combat-related disorders. "We can't be satisfied with questionnaires," Sen. John Kerry, D-Mass., said Wednesday in a statement. "We need to give our troops and our veterans hands-on care, no matter what it costs."

The Hartford Courant does it again. Great reporting.


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• Important GAO Request Made By Senators Seeking Answers on PTSD-Deployed Troops
  
• Resolution: No More Troops Sent Back w/PTSD
  
• PTSD Timeline: The Latest Incidents
  
• Back in the News: Troops Returned to Combat Zone with PTSD
  
• NPR's On Point: Troops in Combat Zone on Anti-Depressants
  
• Drug War: More Details on Medicated Troops in Combat
  
• Kansas City Star: DOD Needs to Do Better on PTSD
  
• Hartford Courant: DOD Ignoring Troop Mental Health
  
• Troops Medicated, Returned to Combat

Kansas City Star: DOD Needs to Do Better on PTSD

The editorial board of the Kansas City Star has a few suggestions for the DOD today regarding its treatment of troops suffering with posttraumatic stress disorder. You can't get any more 'middle America' than the Kansas City Star, now can you? Let's see what they have to say about an issue really heating up in the news lately. Click on 'Article Link' below tags for more...

From the Kansas City Star, reprinted in full for eductional purposes:

Defense should move quickly on PTSD

The U.S. Defense Department should move quickly to deal with problems highlighted in a report on how it handles troops at risk from post-traumatic stress disorder.

The recent report [pdf] by the Government Accountability Office, first revealed by the Kansas City Star, pointed out a worrisome problem with current policy: Pentagon officials couldn't clearly define how medical personnel decide whether troops at risk for the disorder need more treatment.

The Defense Department agreed that such criteria should be clear. But officials disputed a related GAO finding, which asserted that Pentagon officials were unable to verify that all troops needing such care actually get it.

Pentagon officials say the amount of care delivered is actually more extensive than the GAO findings suggested. Help comes "in a variety of ways," said William Winkenwerder Jr., assistant secretary of defense for health affairs.

But if officials can't say how doctors determine whether at-risk troops need treatment — something the Pentagon admits — it's not clear how they can know whether troops are getting the help they need.

As the Star has reported, Defense Department officials have underestimated how many troops were expected to return from combat in Afghanistan and Iraq with stress disorder. And a key finding of the recent GAO report said only 22 percent of soldiers considered at risk for post-traumatic stress disorder had been referred for further treatment.

The disorder is the combat veteran's most common mental health problem. It can cause nightmares, anxiety and flashbacks — and it can severely undercut a veteran's ability to readjust to civilian life. The Pentagon has a lot of work to do in this area.

Thank you, Kansas City Star for your strong backing of our troops on this one.


 Related Posts

• VA Reports Nearly 300 Estimated OEF/OIF Veteran Suicides
  
• More than 50% of Army's 948 Suicide Attempts in 2006 Sought Help First
  
• OEF/OIF Vets Seeking PTSD Care from VA Jumps 70%, Mental Health Counseling Tops 100,000
  
• Is the Army 'Spinning' its Increase in Suicides?
  
• Last Year's 99 Army Suicides Highest in Recorded History
  
• Important GAO Request Made By Senators Seeking Answers on PTSD-Deployed Troops
  
• Resolution: No More Troops Sent Back w/PTSD
  
• PTSD Timeline: The Latest Incidents
  
• Back in the News: Troops Returned to Combat Zone with PTSD
  
• 20 War Zone Suicides So Far in 2006
  
• NPR's On Point: Troops in Combat Zone on Anti-Depressants
  
• WUSF 89.7 News: Report on Combat Zone Suicides
  
• Army: 83 suicides in 2005, 67 in 2004
  
• Drug War: More Details on Medicated Troops in Combat
  
• Sens. to DOD: Stop Sending Troops with PTSD Back to Combat
  
• Hartford Courant: DOD Ignoring Troop Mental Health
  
• Troops Medicated, Returned to Combat

Chicago Vet? Job Fairs This Week

Are you looking for a good job? Illinois is looking for a few good men -- and women. If you're a veteran looking for employment in the Chicago area, you're in luck this week. You've got not one, but two veterans-only job fairs to choose from:

• Salute Our Heroes Job Fair, 11-5, Wednesday (May 17, 2006) at the Navy Pier Grand Ballroom, 600 E. Grand Ave., Chicago. More info/pre-registration.
  
• Veterans Outreach Program Job Fair, 9-1, Thursday (May 18, 2006) at West Side Technical College, 2800 S. Western Ave., in Chicago. Info: (708) 371-9800

Click on 'Article Link' below tags for more details...

From the Suburban Chicago Herald News:

Slots for employers at Thursday's job fair are filling faster than ever, largely because of the spotlight thrown on veteran unemployment by the Daily Southtown and other papers in the Southtown's publishing group, said Jim Jazo, executive director of the Veterans Outreach Program. "Most people are wonderful in this country," he said. "All they needed was a little reminder from the media to step up and make it happen."

Veterans Outreach is sponsoring the job fair at West Side Technical Institute [on] Thursday. More than 2,000 veterans attended last year's fair. The response has been even greater this year, Jazo said. For the first time in the decade-plus he's been coordinating the fair, all the employer booths were filled a week before the event, he said.

The 65 booths will be manned by both blue-collar and white-collar companies, including FedEx, LaSalle Bank, five security firms and seven police departments.

A few details on Wednesday's Navy Pier job fair:

[S]ponsored by the New York Times and a host of veteran organizations, including the American Legion and USO. John Scully, a retired Army major general and the senior vice president of human resources at LaSalle Bank, said the job fair can be a good kick-start for veterans just returning from Iraq or older vets looking to scale the corporate ladder. "These people come back with managerial skills," he said. "They come back with skills in IT, in engineering. They know how to follow orders. They know how to lead people. They've got real strong backgrounds." ...

Returning veterans, however, must do a better job of showing how their military skills translate in the civilian world, Enelow said. That's why the Salute Our Heroes job fair not only will offer employer booths, but also seminars on writing resumes, succeeding in a job interview and starting your own business. "There is such a huge need in this market," said Enelow, who is speaking at the job fair. "They need to know how to show all they've done."

Don't forget to bring a photo ID, your discharge papers, and plenty of resumes. Good luck if you head out to either!


 Related Posts

• 44% of Reserve Forces Dissatisfied with Labor Department Employment Discrimination Help
  
• Advice for OEF/OIF Vet Employers and Co-Workers
  
• Veterans: Job Search Resources
  
• Insurance Information Institute Study: Employers May Not Be Ready for the Wounded
  
• Returning Troops Battle Unemployment

The Courier: Iraq War Veterans' Unique Experiences

Continuing in the footsteps of its local media peers, The Waterloo/Cedar Falls [IA] Courier delivers an informative bit of reporting highlighting the unique flavor of combat found in Iraq vs. that of other battlefields in history.

Click on 'Article Link' below tags for more...

From the Courier:

In war, bad things happen. That is unchanged throughout history. Just as surely, each confrontation introduces twists previously unimagined. "Every conflict has unique departures from the conventional definition of what warfare is," says Martin Edwards, a counselor in Cedar Falls.

World War I offered chemical weapons --- chlorine and mustard gas. World War II conjured the kamikaze pilot, concentration camps and the atomic bomb. And now there is Iraq, which offers unusual conditions all its own. High on the list is the fact soldiers must maintain an unprecedented degree of vigilance.

The idea of a front is archaic. Battle can occur anywhere. Improvised explosive devices and other acts of terrorism --- including kidnapping --- threaten everywhere. "One of the things coming out of this particular war is that the enemy is particularly hard to find, even more so than Vietnam," says Edwards, a military veteran of that era.

Consequently, troops have no place to let down their guard and are under constant stress. A study in 2004 found 62 percent of soldiers in Iraq said they encountered threatening situations but could not react as aggressively as wanted. One reason for restraint is concern about injuring or killing innocent bystanders. "There really was no safe place," says Ron DeVoll Jr. of Cedar Falls.

More differences: an enemy who wears regular clothes; deadly convoys that in previous wars may have been relatively secure; and the statistic that 94% of Iraq veterans have come under small-arms fire while deployed.

"There are no safe jobs if you're in the theater of operations," DeVoll says. Advances in technology to protect troops --- and in medicine to treat the wounded --- are welcome. However, one result in Iraq is the highest wounded to killed-in-action ratio in U.S. military history, according to a second study from 2004. Soldiers who died on the battlefield in previous wars are surviving. And those survivors are likely to face mental health issues, Edwards asserts. "If they have a traumatic injury, there's a real good chance they will have PTSD," he says.

Brett Litz, an associate director at the National Center for Post-Traumatic Stress Disorder, explains the significance for witnesses, too. In an article on the center's Web site, Litz writes being part of violence and death raises the risk for anxiety, anger, aggressive behavior and post-traumatic stress disorder.

In Iraq, a high percentage of troops are engaging the enemy. Research, according to Litz, shows 77 percent of soldiers in Iraq fired a weapon in combat. About 50 percent killed an enemy. And about 30 percent claimed responsibility for killing a bystander.

The physical stresses on the body are noteworthy, too:

"New technologies have significantly increased the range, reduced the time and changed the conditions over which battles are fought," reads Field Manual 6-22.5, a document distributed by the U.S. Marine Corps.

Machines allow combat at night and during inclement weather, periods soldiers in previous eras might have had time to rest. Mechanization, however, carries unintended consequences. "A Service member is not a machine and is, therefore, the weak link in the chain," the Marines' manual states. "The equipment can operate longer than the Service member who operates it, as the Service member must have sleep."

DeVoll says during the 21-day race to Baghdad he routinely performed for up to 72 hours at a time without sleep. For 45 days he was unable to remove his chemical suit or bathe. In the end, DeVoll says medics removed his socks with scissors because they were imbedded in his flesh. "It's like you're a zombie. You're so burned out. You're there, but you are [not] there," DeVoll says.

Litz writes about what he calls "the extensive and extended sacrifice made by soldiers, especially National Guard and reserve troops," as a unique factor in the war on terrorism. How guardsmen and reservists may react remains an open question, however. "Unfortunately, we don't know. But we can expect some difficulties," Litz said. He bases his opinion on the fact guardsmen and reservists train differently than active duty soldiers. And the fact those volunteers perhaps signed on under the assumption they would not face combat.

"They're being asked to perform duties that they were not necessarily expecting. They're doing things they didn't bargain for," Litz says. "And that abrupt change in expectations and in their jobs is bound to be stressful."

Readiness is also a concern. 40% of US forces in Iraq come from the Guard or Reserve; one problem this creates is lack of support for the service member upon their return to the states. Since they're not returning to a military base, it's easier for them to slip through the cracks.

"They go back into the community and are not immersed in active-duty culture. It may be a recipe for additional post-traumatic burden," Litz says. On the positive side, troops in Iraq and Afghanistan enjoy support not seen during some recent conflicts, notably Vietnam. Studies in 2002 and 2003 maintain public opinion bolsters soldiers' attitudes and morale.

Addressing the mental health issue among veterans, though, may prove difficult. Soldiers are reluctant to admit problems. Though about 80 percent of Iraq and Afghanistan veterans with a serious disorder acknowledge a problem, only about 40 percent want help, Litz reports. Soldiers fear a stigma they believe is attached to mental illness will hurt their careers, either in the military or the private sector. "The reality is mental health is stigmatized generally in our culture," Litz says.

DeVoll is seeking treatment for post-traumatic stress disorder. "The hardest thing I've ever done was stepping on the path to getting help," he says. Besides facing family, friends and society, DeVoll says, soldiers also fear memories. "Because now you've got to talk about these things. You've got to let it out."

Because of that, Edwards maintains, veterans who need counseling --- from World War II through Iraq and Afghanistan --- aren't seeking it. "No doubt about it," he says. As the war on terrorism progresses, Edwards predicts, post-traumatic stress disorder will play a role in increasingly large number of veterans' lives. "I can't imagine it not."

Please contact the Courier to let them know you appreciate their coverage of this issue. We need to see more of this kind of reporting.


Related Posts

• What Makes Iraq Combat Stress Unique?
  
• Today's Combat Roles Not Only for Army and Marines
  
• Military Chaplain: Different War, Different Stress
  
• Combat PTSD Affects Non-Combat Troops, Too
  
• Psychiatric News: Iraq and Afghanistan Combat Experiences Compared
  
• PTSD Statistics, WWII to Iraq
  
• Newsweek Covers Combat PTSD and Brain Trauma
  
• Unacceptable: National Guard Makes Post-deployment Mental Health Screening Optional

Tags:

• local
• oif
• stories
• guard
• reserve
• WWI
• WWII

A Mother's Day Wish

To recognize those who carry the burden of worry during periods of war.

Worry Balm
by Arlene Gay Levine

Good will prevail
Peace will come
Open your heart
to welcome them

Hartford Courant: DOD Ignoring Troop Mental Health

What a week. The first strike was the GAO Report [pdf] stating that only 22% (1 out of 5) of troops who are at risk for developing combat PTSD -- as determined via a mental health screening form, the PDHA [pdf], administered by the DOD -- are referred for further mental health evaluations. The DOD then released its response following the media's coverage of the report stating:

"The level of our effort and our outreach is unprecedented," he said. "We have broken new ground."

New ground, indeed. Today comes the news that the Hartford Courant has completed a exhaustive report based on Freedom of Information Act requests which concludes that "U.S. military troops with severe psychological problems have been sent to Iraq or kept in combat, even when superiors have been aware of signs of mental illness." Click on 'Article Link' below tags for more...

From the AP:

The Hartford Courant, citing records obtained under the federal Freedom of Information Act and more than 100 interviews of families and military personnel, reported numerous cases in which the military failed to follow its own regulations in screening, treating and evacuating mentally unfit troops from Iraq. In 1997, Congress ordered the military to assess the mental health of all deploying troops. The newspaper, citing Pentagon statistics, said fewer than 1 in 300 service members were referred to a mental health professional before shipping out for Iraq as of October 2005.

Twenty-two U.S. troops committed suicide in Iraq last year, accounting for nearly one in five of all non-combat deaths and the highest suicide rate since the war started, the newspaper said.

Some service members who committed suicide in 2004 and 2005 were kept on duty despite clear signs of mental distress, sometimes after being prescribed antidepressants with little or no mental health counseling or monitoring, the Courant reported. Those findings conflict with regulations adopted last year by the Army that caution against the use of antidepressants for 'extended deployments.'

"I can't imagine something more irresponsible than putting a soldier suffering from stress on (antidepressants), when you know these drugs can cause people to become suicidal and homicidal," said Vera Sharav, president of the Alliance for Human Research Protection, a New York-based advocacy group. "You're creating chemically activated time bombs."

I posted on this issue on March 20th.

At the time, the San Diego Union-Tribune reported that the DOD was reinserting troops back into the battlefield while prescribed anti-anxiety medications. Senator Barbra Boxer was, in turn, planning to address the controversy through the Department of Defense Task Force on Mental Health that was scheduled to get underway in April.

Well, that task force has yet to begin its work. Why? Some details from last week's Stars & Stripes:

Democratic California Sen. Barbara Boxer blasted the Pentagon again Tuesday for missing a deadline to appoint a task force to study troops’ mental health, saying the military faces a “mental health crisis.” Defense officials acknowledged they missed the April 7 target but said the panel is being assembled quicker than comparable task forces, and will be in place in coming weeks.

Happen to catch that pattern? Again, the DOD responds that they're doing better than comparable task forces, so why are you complaining, Boxer? What's your hurry?

The task force, mandated by Congress in December as part of the 2006 military spending bills, is designed to be an independent voice on how the services handle mental health treatment issues. The 14-member board will be half military personnel and half civilian appointees, several of whom will be medical experts.

In a letter to Defense Secretary Donald Rumsfeld, Boxer called the delay in appointing the task force “abhorrent,” noting that post-traumatic stress disorder and related problems still are major concerns. She also pointed to 25 suicides among active-duty soldiers in Iraq and Afghanistan in 2005, up from 20 soldiers the year before. “I find it simply astonishing that the sheer magnitude of the mental health crisis facing our Armed Forces does not compel you to action,” she wrote.

Again, what's your hurry, Boxer? It's just the mental health of our troops in the battlefield. No biggie!

[O]fficials with Boxer’s office said the senator has not received any feedback from the DOD and won’t be satisfied until the task force meets for the first time. They also said even if the group begins meeting soon, the department already is about a month behind schedule.

Task force members are required within a year of their appointment to submit a report to the defense secretary and Congress on a long-term plan on ways to improve the effectiveness of the military’s mental health treatments, including ideas for new education programs and medical services.

Highly recommend taking a look back at my March post for additional details and contex on what's been going on with this issue behind the scenes. Back to the AP article:

"I'm concerned that people who are symptomatic are being sent back. That has not happened before in our country," said Dr. Arthur S. Blank, Jr., a Yale-trained psychiatrist who helped to get post-traumatic stress disorder recognized as a diagnosis after the Vietnam War.

The Army's top mental health expert, Col. Elspeth Ritchie, acknowledged that some deployment practices, such as sending service members diagnosed with post-traumatic stress syndrome back into combat, have been driven in part by a troop shortage. "The challenge for us ... is that the Army has a mission to fight. And, as you know, recruiting has been a challenge," she said. "And so we have to weigh the needs of the Army, the needs of the mission, with the soldiers' personal needs." Ritchie insisted the military works hard to prevent suicides, but said that is a challenge because every soldier has access to a weapon.

Commanders, not medical professionals, have final say over whether a troubled soldier is retained in the war zone. Ritchie and other military officials said they believe most commanders are alert to mental health problems and are open to referring troubled soldiers for treatment. "Your average commander doesn't want to deal with a whacked-out soldier. But on the other hand, he doesn't want to send a message to his troops that if you act up, he's willing to send you home," said Maj. Andrew Efaw, a judge advocate general officer in the Army Reserves who handled trial defense for soldiers in northern Iraq last year.

The mind, literally, boggles.

Here's What YOU Can Do

Since it's through politics -- via our legislators -- that programs, bills, and laws are made, making this issue a big part of our platform as we move forward is the surest way for us all to win.

• Co-sponsor the New GI Bill of Rights for the 21st Century Act, H.R. 2131, by clicking here.
  
• Contact your Senators in support of S. 11, the Standing With Our Troops Act.
  
• Contact Senator Boxer and let her know you've got her back!

Don't Forget to Read the Groundbreaking Report

The Hartford Courant report is now up on their website (had to make do with the AP piece for the diary). It's an indepth article -- 5 pages long online -- so I would recommend everyone take a spin over to read through it if you're interested in this topic.

 Related Posts

• VA Reports Nearly 300 Estimated OEF/OIF Veteran Suicides
  
• More than 50% of Army's 948 Suicide Attempts in 2006 Sought Help First
  
• OEF/OIF Vets Seeking PTSD Care from VA Jumps 70%, Mental Health Counseling Tops 100,000
  
• Is the Army 'Spinning' its Increase in Suicides?
  
• Last Year's 99 Army Suicides Highest in Recorded History
  
• Important GAO Request Made By Senators Seeking Answers on PTSD-Deployed Troops
  
• Resolution: No More Troops Sent Back w/PTSD
  
• PTSD Timeline: The Latest Incidents
  
• Back in the News: Troops Returned to Combat Zone with PTSD
  
• 20 War Zone Suicides So Far in 2006
  
• NPR's On Point: Troops in Combat Zone on Anti-Depressants
  
• WUSF 89.7 News: Report on Combat Zone Suicides
  
• Army: 83 suicides in 2005, 67 in 2004
  
• Drug War: More Details on Medicated Troops in Combat
  
• Sens. to DOD: Stop Sending Troops with PTSD Back to Combat
  
• Kansas City Star: DOD Needs to Do Better on PTSD
  
• Troops Medicated, Returned to Combat

OEF/OIF Vets: Still Helping Each Other Once You're Home?

Are you an OEF/OIF veteran who's been back in the states, done your time, and wondering what to do with the rest of your life? Are you feeling like your best years are already behind you, and there's no greater mission you can be a part of? Well, if you're one of the majority of our veterans who've been fortunate to have a pretty smooth reintegration process, I have a request for you guys and gals. Have you checked in on your fellow battle buddies lately?

Click on 'Article Link' below tags for more...

Not everyone has the same solid support network in place that you may have had. Not every returning veteran has someone they can talk to when they have questions or concerns...especially if it's about combat experiences. Some people end up having a hard time transitioning, a hard time finding that same support you guys and gals gave each other while you in the military together. Jesus Bocanegra is one such guy. Late last year, he gave NPR's All Things Considered an interview [audio | transcript]. Talking about how hard the transition was, how much he missed that camaraderie, I was struck by the idea that it's too bad he's having such a hard time finding someone to talk to.

So, I have a challenge tonight: for those of you who are honestly doing all right (and I mean you really have to be doing great and feeling like you have enough juice charged up that you can give of yourself to someone who might need some help), can you check in on your battle buddies? Even better, would you consider volunteering with your local VA or perhaps phoning up a veterans group and asking if they need your help?

Who knows? Maybe making yourself available to talk with the newer batch of veterans coming home behind you might work its way around to enhancing your own post-deployment experience. You might even find that it's a great way to put your unique experience and special knowledge to use for a greater good.

In any event, thanks again for your service.

And welcome home!

Tags:

• oef
• oif
• stateside
• counseling
• audio
• interview

First Aid for Combat PTSD

Bridget C. Cantrell, Ph.D. is a leading clinical psychologist specializing in the area of combat-related PTSD, Chuck Dean is a veteran of the Vietnam War. Together they've created a vital little resource for PTSD survival: Down Range to Iraq and Back. I'll share a few helpful tips from Chapter 5 with you tonight.

Click on 'Article Link' below tags for more...

The following excerpts comes from Chapter 5, First Aid for PTSD. As this is meant for educational purposes only, I'd hope the authors will agree to my sharing these snippets of their valuable and helpful points with you:

You are no longer an "Army of One." Once you return home it is important to realize how critical it is not to battle the nightmares, anxious feelings, unexplained anger, depression, and other PTSD symptoms alone. Many Vietnam veterans came home and tried to "stuff" their experiences in hopes their symptoms would just go away. However, most have found that things only got worse when a solitary journey was attempted. ...

In 1997, I (Dr. Cantrell) conducted a research study of Vietnam veterans in the state of Washington. I specifically examined how social connections, length of combat exposure, and homecoming experiences all contributed to the effects and intensity of the veterans' PTSD symptoms. Those who were exposed to combat for longer periods of time, and returned home to negative situations, were less willing to reach out for help. They were more likely to act out their anger, and use avoidance and isolation to cope with their PTSD symptoms. Furthermore, those who did not have supportive people at home were more negatively affected by their stress. These factors led to a breakdown of the veterans' resiliency to the triggers of PTSD, including criticism for their service. Unfortunately, this did not lend itself to cushion the impact of rejection they experienced from a society who had little understanding for their psychological pain and estrangement. My research study indicates that social support is always a mediating factor in curbing potential difficulties with life performance and coping choices. This is just one more reason why we want to reiterate the important role that family and loved ones play in a healthy reintegration process (Cantrell, 1999).

Stress affects everyone differently. People find their own ways to cope, but keeping to oneself and trying to handle stress alone is not wise. Here are some approaches to help you manage negative stress in your life:

Talk it out. First and foremost it is important to find a professional with whom you feel comfortable and has the clinical skills to help. This should be the priority starting point for you to begin your journey out of the dark night of the soul.

If you do not talk about your experiences, and attempt to hold them inside, you may repress bad memories without resolving the issues. This can lead to many undesirable results such as increased anger and frustration.

The fact is that you can only hold these experiences inside for so long before they explode through fits of rage, violence or self-destructive activities and behavior. Like physical wounds that need to be cleansed, psychological and emotional wounds have to cleaned out before they can also heal.

Next, it is good to realize that you are not alone. There are many veterans and service people who have experienced similar events in their lives. They are more than likely feeling some of the same anxieties as you. Seek them out and listen to their personal stories. When you are ready, you may also want to share your experiences, and this will help you find a genuine relief from your own stress. There is a certain sense of security that comes from knowing that many service members have probably done similiar things during their wartime experiences. This will help you be honest with yourself -- perhaps for the first time since the war. Talking it out helps cleanse the wound, and lessens your emotional burden.

Other suggestions the authors provide in this chapter include writing your feelings and experiences out, developing a regular exercise routine, avoiding self-medication via drugs and alcohol, and learning to relax. Highly recommended advice and resource.

Tags:

• reintegration
• anger
• avoidance
• counseling

GAO Report: 4 of 5 at Risk for Combat PTSD Not Getting Help

An important draft of a GAO report looking into combat PTSD has surfaced, and the Washington Post's premiere reporter on this issue, Shankar Vedantam, will deliver the news on page A08 tomorrow. Let's take a look at it tonight.

Click on 'Article Link' below tags for more...

From the Washington Post:

Nearly four in five service members returning from the wars in Iraq and Afghanistan who were found to be at risk for post-traumatic stress disorder (PTSD) were never referred by government clinicians for further help, according to a Government Accountability Office report due for release today.

The report says Defense Department officials were unable to explain why only some troops were referred for help. Many veterans groups have accused the government of playing down the risk of PTSD because of concerns over skyrocketing costs.

178,664 service members were screened for PTSD risk via a survey. Of those same 178,664, 9,145 tested postive for PTSD risk. Yet, only 22% were referred to receive medical help. Breaking it down: Army and Air Force each referred 23% for further treatment; the Navy referred 18%; and the Marines about 15%.

The final report will have the formal responses from the Defense and Veterans Affairs departments. In the draft report, Pentagon officials are quoted as saying that not all service members who gave positive responses on the screening test needed help, but the report said the officials could not specify what factors are involved in referring some people but not others.

Asked to comment late yesterday, the Defense Department said only that it has "several comprehensive and proactive programs to deal with PTSD." Spokeswoman Cynthia Smith said the most knowledgeable officials were not available so late in the day.

"You would think that [referrals for treatment] would be the point of the whole screening tool," said Veterans Affairs spokesman Jim Benson. He said that the Defense Department was solely responsible for administering the screening test and making referral decisions.

The article goes on to explain that the PTSD risk questionnaire is administered as the troops return home from combat via their post-deployment health assessment [pdha]. After the form is completed, it's reviewed by the DOD; the DOD then determines who will be referred for further medical evaluation and help.

Deciding whether to refer service members for help involves judgment, the report said, but the Defense Department "cannot provide reasonable assurance that all [Iraq and Afghanistan] service members who need referrals for further mental health or combat stress evaluations receive such help."

Rep. Michael Michaud (Maine), the ranking Democrat on the House Veterans' Affairs subcommittee on health, said screening service members for PTSD was the right thing to do, but questioned the utility of the screening if people at risk did not receive help.

"When 78 percent of the service members who are at risk of developing PTSD do not get a referral for further evaluation, then it's clear the assessment system is not working," he said in a statement. "Early assessment can prevent tragedy. Untreated PTSD can lead to substance abuse, severe depression and even suicide."

We'll wait to see what further response there will be to this information -- which is troubling, to say the least.


 Related Posts

• JAMA: Mental Health Longitudinal Assessment of Returning Iraq War Veterans Study
  
• Hartford Courant: DOD Ignoring Troop Mental Health
  
• JAMA's Iraq Combat Mental Health Study: A Review

Senate Armed Services Comittee OK's PTSD Funds

It looks as though the Defense Authorization Bill for Fiscal Year 2007 has been approved by the Senate Armed Services Committee as it moves for a vote. Please see the Lincoln Tribune for all the specifics. Here's a snippet:

The bill also includes $17 million for efforts to treat post-traumatic stress syndrome (PTSD), and funds other mental health initiatives, including a pilot program started at Ft. Bragg to provide early diagnosis and treatment of PTSD. “It must be a priority to diagnose and treat service members and veterans who suffer from the psychological traumas of war and help them lead healthy, productive lives,” said Senator Dole. “This care is crucial in helping people through the demands of the on-going Global War on Terror.”

Tags:

• senate
• ptsd
• funding
• legislation
• dole

Attleboro, MA Covers Combat PTSD Story

Since I began focusing my research on combat-related posttraumatic stress disorder in our Afghanistan and Iraq war veterans last September, one thing that has jumped out at me time after time is this fact: small town coverage of this issue is really to be commended.

Sure, on the national level we hear the reports of how many soldiers have been killed in action on any given day; but, we very rarely hear or see how those directly affected by the wars are faring. This is where the local coverage really picks up the slack. Here's another story that ran in yesterday's Attleboro, MA Sun Chronicle.

Click on 'Article Link' below tags for more...

From the Sun Chronicle:

Sgt. 1st Class Russell Anderson survived mortar attacks and roadside bombs during his year leading Army Reserve troops and escorting fuel tankers along Iraq's insurgent-infested highways.

But Anderson may have found a more persistent enemy in the nightmares, occasional jumpiness and sensitivity to noise he's encountered since coming home. "People see that you look healthy, so you must be healthy," said Anderson, 55, who served in the Army both during Vietnam and Operation Iraqi Freedom. "They don't see what you've been through."

Anderson was diagnosed with post traumatic stress disorder after first attempting to write off stress as part of readjusting to civilian life. The Norton resident spoke about his experiences in the made-for-TV documentary Hidden Wounds about the war's psychological effects. The program will be telecast May 29 on New England Cable News.

Anderson's story is one that many of our veterans, but not all of course, can identify with.

Of more than 144,000 Iraq and Afghanistan veterans who have sought medical assistance from the VA after returning from the war on terror, more than 40,000 have complained of mental health-related problems. Of those, about 20,000 have received diagnoses of possible post-traumatic stress.

According to the Web site of the National Center for PTSD, a part of the U.S. Department of Veterans Affairs, feelings of anxiety, nightmares and depression are often reported by soldiers who have undergone combat-related stress.

Even the passage of time does not necessarily dull the pain. Some World War II veterans interviewed by The Sun Chronicle said they still experience nightmares 60 years after the fighting stopped. ...

[T]o the casual observer back home, the long-term effects of stress on a recent veteran are, for the most part, invisible. Many who suffer from the after-shocks of combat say members of the public often don't believe them or can't grasp the effects the war has had on them. "There's certainly a lack of understanding that these feelings and these symptoms are real," said David Autry, deputy national commander for public affairs of Disabled American Veterans. In addition, Autry says many affected veterans are subjected to prejudice because of stereotypes equating post traumatic stress with violent or erratic behavior.

Anderson, who continues to receive medication and counseling, said he struggled with his decision to go public, although he has received a number of supportive e-mails as a result of the documentary. He still wonders whether he made the right choice for himself. "There's a lot of stigma attached to this," he said.

Troops who come forward in this brave way, sharing their uncomfortable and personal struggles, are doing a great public service; although others may wish them to tone it down, keep these things private, raising public awareness on this issue helps to relate to us what some of the needs are of our returning troops.

Only weeks after [his] unit arrived in camp near Tikrit, a mortar round exploded near one of Anderson's men, blowing off his foot. Despite being subjected to incessant attacks, Anderson managed to bring all of his soldiers home alive.

While it felt great to get back home, Anderson, who works for the Federal Deposit Insurance Corp., found that he had not entirely left the war behind. Bad dreams, hostility and other symptoms made themselves felt. Before long, they began to interfere with family relationships. Anderson's girlfriend, Cathy Coln, said Anderson seemed troubled, and at times seemed to treat her "like one of his soldiers."

The turning point came one day when Anderson began to feel severe tightness in his chest -- so strong that he was convinced he was having a heart attack. After being rushed to the hospital, however, doctors could find nothing physically wrong.

Based on Anderson's combat history, physicians suggested that he look into getting help with possible combat-induced stress. The incident was more than enough for Coln. "She gave me an ultimatum," Anderson said. Anderson was referred to the VA through a veterans outreach center, one of thousands across the U.S. designed to deal with a variety of service-related problems.

Anderson said initially he wasn't scheduled to receive counseling for three months -- until a Veterans Administration nurse pulled strings. Lack of resources for veterans health care is an increasing complaint among veterans' advocates, particularly in the area of mental health. "The Congress last year spent $27 billion on veterans' health care," said the DAV's Autry. "But it spent $29 million on pork barrel projects."

Autry said veterans' mental health care appears to have a low priority in comparison with treating physical injuries and that his organization routinely hears from veterans complaining about delays in getting appointments. With thousands of new cases adding to existing patients' needs for continuing care, Autry said veterans groups worry that the Veterans Administration will be unable to keep up with the demand for services.

The more citizens who become interested and involved in advocating for better VA funding, the better it will be for our veterans, their families, and society as a whole.

Documentaries like Hidden Wounds aim to see that more people at least hear the PTSD coping veteran's side of the story. The show is scheduled to be telecast 11 a.m. and 8 p.m. on Memorial Day on New England Cable News.

Tags:

• local
• Iraq
• ptsd
• stories
• documentary

Poppy Days: Remembering Our Veterans' Sacrifices

Today, PTSD Combat is 'pinning a poppy on' in order to pay tribute to our veterans. The Concord Monitor:

The distribution of the bright red memorial flower is one of the oldest and most widely recognized programs of the [American Legion and] Auxiliary. From the battlefields of World War I, weary soldiers brought home the memory of a barren landscape transformed by wild poppies.

To honor their sacrifice, communities and veterans organizations across the nation (and world) kick up programs and events geared towards helping our current crop of veterans throughout May's Poppy Days. I'll share more history, a short listing of local dates (drives vary throughout the month of May), and poetry to pay tribute to those who served in The Great War -- and beyond.

Also see the companion piece, Poppy Days: Dates, Drives, and Donations, at ePluribus Media for creative ways to help our veterans and their dependents this month of remembrance.

Click on 'Article Link' below tags for more...

From the the TCPalm:

May, more than any other month, is a time to set aside our petty neighborhood squabbles and reflect on the sacrifices so many men and women of this country have made to keep us free.

Included among the notable days of reflection are Armed Forces Day and Memorial Day, not to mention Mother's Day. Symbolic of these somber times is the poppy flower, which the American Legion and the Veterans of Foreign Wars have for many years adopted as their fundraising figure.

The red poppy became associated with war after the publication of a poem written by Col. John McCrae of Canada during World War I, says the Web site of the VFW. The poem, "In Flanders Fields," describes blowing red fields among the battleground of the fallen.

In Flanders Fields
by John McCrae

In Flanders Fields the poppies blow,
Between the crosses, row on row,
That mark our place; and in the sky,
The larks, still bravely singing, fly,
Scarce heard amid the guns below.

We are the dead. Short days ago,
We lived, felt dawn, saw sunset glow,
Loved and were loved and now we lie,
In Flanders Fields.

Take up our quarrel with the foe
To you, from failing hands, we throw,
The torch, be yours to hold it high.
If ye break faith with us, who die,
We shall not sleep, though poppies grow,
In Flanders Fields.

For more than 80 years, both the American Legion and the VFW's Poppy and Buddy Poppy programs, respectively, have raised millions of dollars in support of veterans' welfare and the well being of their dependents. Those red poppies are still assembled by disabled and needy veterans in VA Hospitals.

The poppy was not chosen at random; its symbolism is both powerful and compelling. The petals of red stand for the vast outpouring of blood; The yellow and black center, the mud and desolation of all battlefields; the green of the stem is symbolic of the forests, meadows and fields where generations of Americans have perished to make generations free.

The stem represents the courage and determination of our fallen warriors. The assembled product, a flower, is a symbol of Resurrection, which is sure to follow.

And this from the Great Poems of the World War: Electronic Edition, W. D. Eaton:

POPPIES:

CAPT. JOHN MILLS HANSON, F.A.
IN The Stars And Stripes, A.E.F., France

POPPIES in the wheat fields on the pleasant hills of France,
Reddening in the summer breeze that bids them nod and dance;
Over them the skylark sings his lilting, liquid tune--
Poppies in the wheat fields, and all the world in June.

Poppies in the wheat fields on the road to Monthiers--
Hark, the spiteful rattle where the masked machine guns play!
Over them the shrapnel's song greets the summer morn--
Poppies in the wheat fields--but, ah, the fields are torn.

See the stalwart Yankee lads, never ones to blench,
Poppies in their helmets as they clear the shallow trench,
Leaping down the furrows with eager, boyish tread
Through the poppied wheat field to the flaming woods ahead.

Poppies in the wheat fields as sinks the summer sun,
Broken, bruised and trampled--but the bitter day is won;
Yonder in the woodland where the flashing rifles shine,
With their poppies in their helmets, the front files hold the line,

Poppies in the wheat fields; how' still beside them lie
Scattered forms that stir not when the star shells burst on high;
Gently bending o'er them beneath the moon's soft glance,
Poppies of the wheat fields on the ransomed hills of France

Poppy Days Events

• Nevada County, CA: Grass Valley Mayor Gerard Tassone has proclaimed May 5 and 6 as Poppy Days. Wilma Meyers told me that veterans and auxiliary members will be offering poppies at various businesses in Nevada County. These poppies are made by veterans at the Yountville Veterans Home. This is one way that they make spending money.
  
  
• Clarion, PA: The Clarion American Legion Ladies Auxiliary is sponsoring its annual “Poppy Days,” Friday, May 5 and Saturday, May 6. Volunteers will be located throughout the community collecting contributions. Please help the legion help local veterans and their families.
  
  
• Jupiter, FL: Members of the Auxiliary of American Legion Post No. 271 will be distributing red, handcrafted poppies, in honor of America's war dead, on Friday, May 12, and Saturday, May 13, at three locations in Jupiter.
  
  
• Tehachapi, CA: The Tehachapi American Legion Auxiliary, Unit 221, has received notice that the official 2006 Poppy Days will be May 14 through May 20. Members of the American Legion and the Auxiliary will be on hand to offer the hand-made poppies and explain the meaning of them.
  
  
• Lansing and Menominee, MI: American Legion Auxiliary Dept of Michigan holds its Poppy Days on May 18-20, 2006.
  
  
• Hastings, MN: The Buddy Poppy will be in Hastings businesses by the end of this week. Hastings Veterans of Foreign Wars Post 1210 and its auxiliary are sponsoring the annual drive, which will conclude with annual Poppy Days May 19 in Hastings.
  
  
• Fort Pierce, FL: Sebastian's American Legion Post 189 and Auxiliary Members and Legionnaires will be stationed throughout the community May 19-20 for the annual distribution of these precious remembrances, says Shirley Thornton. Alice Leclerc is Poppy chairman. The VFW also distributes poppies before Memorial Day. In Barefoot Bay, VFW Post and Auxiliary 4425 will be out in force at Barefoot Bay locations, Winn- Dixie, from May 22-27 and Wachovia Bank, May 22-26, according to Joe Walker, post commander and Poppy chairman.
  
  
• Warrenville, IL: Buddy Poppy Days May 19-20, 2006
  
  
• Ellwood City, PA: May 20-21, 2006 Poppy Days throughout Ellwood City. Support Disabled Vets. Buy a poppy during Poppy Days.
  
  
• Western Springs, IL: Poppy Days will be Wednesday, May 24, and Thursday, May 25, when the Veterans of Foreign Wars Western Springs Memorial Post 10778 collects donations for the Veterans Relief Fund. Since 1990, the post has donated several thousand dollars per year to meet the needs of patients and families at the Department of Veterans Affairs Edward Hines Jr. Hospital and the VFW National Home for Widows and Children in Eaton Rapids, Mich. The post welcomes donations, (708) 246-5759.

Please share your own local Poppy Days events in comments. You may wish to find your local American Legion office and ask when this event will take place in your own neighborhood.

I'll close the list on what may be the perfect little poem, written by one of the poppy makers at Yountville's [CA] Veterans Home:

A scrap of blood red paper,
A twist of green and black:
We make these poppies in memory,
Of the men who never came back

Far from home and loved ones,
They sleep in foreign lands;
So wear this poppy proudly,
Remembering for whom it stands.

Buy a poppy and wear it in remembrance this May.

Congress Expected to Fund Waco VA PTSD Study

While full Veterans Administration funding for '07 still awaits approval in the House and Senate, yesterday brought good news for one veterans hospital that has for 3 years fought against possible closure. A congressional subcommittee has approved the continued funding (2nd year price tag: $3.5 million) of a PTSD study slated to get underway later this year at the Waco VA Hospital and Fort Hood.

Click on 'Article Link' below tags for more...

From the Waco Tribune-Herald:

Congress is preparing to spend $3.5 million next year funding a post-traumatic stress disorder study planned at the Waco Veterans Affairs Hospital and Fort Hood.

U.S. Rep. Chet Edwards said the project provides another reason to keep the embattled Waco VA Hospital operating and could help determine why the disorder devastates some soldiers and does not affect others. “This is one more arrow in our quiver to save the Waco VA,” Edwards said. “(VA Secretary Jim Nicholson) will still make the final decision, but he doesn’t make that decision in a vacuum. I’ve been very careful not to suggest that any one step would be the key, but it’s clear we’re making a very strong case.” ...

Because close to 20 percent of Iraq war combat veterans are reporting PTSD symptoms, Dr. Paul B. Hicks, with the Central Texas Veterans Health Care System, said the research is timely and pivotal.

If doctors find clues in genetics, brain imaging and psychological analysis of returning soldiers, they could improve treatment and prevention measures, said Hicks, the VA region’s acting medical director for mental health and behavioral medicine. “We don’t really know about all the biological and psychological underpinnings of PTSD, and if we can truly make some strides in understanding that, we have the potential to dramatically affect the outcome of soldiers who go through this,” he said. Fort Hood and the Central Texas Veterans Health Care System still are awaiting the initial funding for the project but have teamed up in other ways, Hicks said.

Veterans and community advocates who have fought efforts to close or downsize the Waco VA Hospital over the past three years hailed the proposed funding. “I really trust that this is yet one more good sign that perhaps the secretary will in short order be making a very positive announcement for Waco,” said Robert Gamboa, a veteran who has rallied support for the hospital.

Nicholson is evaluating the hospital and 16 others as part of a nationwide review and is expected to determine its fate later this year. The VA has considered downsizing or closing expensive older facilities in overserved communities, including the Waco VA Hospital, while increasing resources in cities where growing veterans’ populations are far from the nearest VA hospitals.

Last year U.S. Sen. Kay Bailey Hutchison, [R-TX], designated the Waco VA Hospital a mental health “center of excellence.”

Tags:

• va
• funding
• legislation
• clinical
• ptsd
• studies

National Military Appreciation Month Resource

Looking for ways to show your appreciation of our military families? Please visit the National Military Appreciation Month website where you'll find a calendar of events, actions and drives to participate in, and more. "NMAM, as designated by Congress, ... gives the nation a time and place on which to focus and draw attention to our many expressions of appreciation and recognition of our armed services. National Military Appreciation Month (May) includes Loyalty Day (1st), VE Day(8th), Military Spouse Day (12th), Armed Forces Day (20th), and Memorial Day (29th)." A grand tip of the hat to our military families. Thank you for all you do...

Tags:

• military
• tributes
• events
• actions
• individual

Civil War-era Legal Pay Limit for Vet Claim Help May Be Lifted

This just up at Army Times:

The chairman of the Senate Veterans’ Affairs Committee says it is time to drop a Civil War-era rule that prohibits lawyers from being paid more than $10 to help veterans with benefits claims. Other lawmakers have made similar attempts over the years, but the May 4 announcement by Sen. Larry Craig, R-Idaho, that he was introducing a bill to drop the prohibition marked the first time a veterans’ affairs committee chairman supported the proposal.

Click on 'Article Link' below tags for more...

The current law places a limit of $10 on fees that can be paid for legal help given to a veteran filing a VA benefits claim "as long as a claim is handled administratively." Once a claim has been heard by the court and ruled upon (which may occur as much as 3-5 years after the initial filing), only then can a lawyer receive fees in excess of $10. I have to admit, not being a veteran myself, I had no idea this rule even existed!

Additional details:

Today, 85 percent of veterans appealing their initial benefits decision get help from veterans’ service organizations or other nonprofit groups, Craig aides said. Craig is joined in the effort by Sen. Lindsey O. Graham, R-S.C., an Air Force reserve judge who is a member of the veterans’ committee and chairman of military personnel subcommittee of the Senate Armed Services Committee. “This overdue change will significantly improve veterans’ access to the VA and expedite just outcomes,” Graham said in a statement.

Their bill, S 2694, is called the Veterans’ Choice of Representation Act. It would repeal a ban that Craig aides said began when it was possible to become a lawyer without attending law school.

Although discussions have taken place over the years to allow paid legal representation, the federal government and many veterans’ groups have resisted changing what has been viewed as a generally nonadversarial process for filing claims in which benefit of the doubt is supposed to go to a veteran.

Opinion has changed, though, among veterans groups in recent years. Many associations now provide legal representation for members or recommend lawyers when a veteran is dissatisfied with the administrative handling of a case and requests judicial review. “I suppose that some would still warn that lawyers are not to be trusted, but the reality is that the laws are complex and I want veterans to have the option of hiring an attorney to help navigate the system, if they choose,” Craig said.

This bill was also introduced in the House on March 9, 2006 as HR 4914 by Rep. Lane Evans [D-IL] (who recently announced his retirement and will be sorely, sorely missed).


 Related Posts

• New VA Rule Would Require Vet Lawyers to Pass Test
  
• Lead Ft. Lewis Army Lawyer: Military Stacks Deck Against PTSD, TBI-injured Troops
  
• When Time Isn't on Your Side: The Veterans' Medical Disability Claim System Backlog
  
• 86,000+ OEF/OIF Vets Granted Disability; 30,000 Claims Pending
  
• Local Angle on National Story: Veterans Claim Processing Nightmare
  
• House Bill Introduced to Allow Vets Legal Rep for VA Claims
  
• House Reps, Dems Push Bush Admin to Increase VA Staffing
  
• Veteran Filing a PTSD Claim? Here's Help...

Minnesota Continues to Excel in Troop Reintegration

The good news just keeps pouring in for troops based in the fine state of Minnesota. Just a couple of days ago I posted an update on a ground-breaking community troop reintegration program offered for its Duluth National Guard members.

Now a recently returned Iraq veteran from Clay County's Army National Guard is delivering public education forums seeking the community's help in easing troop return to civilian life. Completing this trilogy of wonderful news and action, today kicks off the 87th annual Convention of the Minnesota Chapter of Disabled American Veterans -- held in Duluth for the first time since 1987.

Click on 'Article Link' below tags for more...

From The Forum:

When Capt. Aaron Krenz of Fargo returned to the Red River Valley after a deployment to Iraq, he found a different world from the home he left 15 months earlier. The 9-month-old daughter who couldn’t talk or walk in September 2004 had grown into a toddling bundle of energy with a mind of her own. His wife, Monica, having learned to live as a single mom for a year, had developed a system of running the household, and Krenz wondered where he fit into the equation.

Simply put, after the flag-waving and cheers that accompanied Krenz’s return to the U.S. in November faded away, he faced a new set of challenges: adjusting back to civilian life. For Krenz, 32, the transition from company commander of 152 field artillery men to husband and father of a 2-year-old hasn’t been easy. It’s been a day-by-day process for the veteran whose job was to train Iraqi police forces in southeast Baghdad. “Certain sounds or smells will take me back mentally to Iraq,” said Krenz, who still jumps when a door slams before realizing it’s not a roadside bomb.

“My focus has been on trying to get back with my family, trying to integrate with my wife and my daughter, Ellie. I also want to help educate the public on things they may not know about.” That’s one reason Krenz is working with Clay County to offer community training on how to ease veterans’ re-entry into daily life.

A series of public forums sponsored by the Minnesota Army National Guard is addressing how neighbors can help newly returned soldiers. Veterans such as Krenz will speak about their experiences. Veterans hope the initiative will help the community to better understand issues such as what it’s like for a combat veteran to return home, how combat stress affects a veteran’s daily life and how employers, clergy, school personnel, law enforcement and other community members can assist in the re-entry process.

The soldier was to present at a forum held at a local high school yesterday; there's also a community seminar slated for May 23, 2006 in Moorhead. All indications are that there will be a great need, in the near future, for a wide variety of support services as troops return from serving in combat overseas. Krenz to his great credit is trying to prepare his neighbors ahead of time.

Krenz and Clay County Veterans Service Officer Tom Figliuzzi told the Clay County Commission on Tuesday the community needs to prepare for what will likely be the largest influx of new combat veterans in the state’s history. In March, about 2,600 Minnesota National Guard members were part of a 4,000 multi-state brigade that left for a 12-month stint in Iraq. The 1st Brigade Combat Team, 34th Infantry Division, has several members from the Fargo-Moorhead area.

Come spring 2007, those veterans will be grappling with the same re-entry issues that sometimes perplex Krenz.

Krenz relates a story on how, while his wife left him alone with their daughter for the first time, he struggled with feelings of fear at not knowing what to do in the situation -- toddler care was foreign to him. And a bit unnerving.

Other soldiers struggle with different situations.

Krenz said some drive excessively fast, swerving through traffic as they were ordered to in Baghdad. Many soldiers get depressed moving from high-tension situations to more mundane tasks, he said. “You’ve got an 18-or 19-year-old kid up in the turret of a humvee making life or death decisions everyday, whether to pull the trigger or not to pull the trigger,” Krenz said. “Now they come back and they may be flipping burgers at McDonald’s. To have that amount of control and power taken away and to make sure the hamburgers aren’t burning – that’s a difficult transition for some people.

Figliuzzi said National Guard members in particular need support because they find themselves immersed in civilian life outside the environment of a military base that many veterans return to. While National Guard members’ main role used to be disaster assistance at home, their duties have shifted to active military participation abroad, he said.

Commissioners were receptive to the idea and complimented the National Guard’s efforts. “Whether you support the war or not, it’s important that soldiers have support,” said Commissioner Mike McCarthy.

A big Woo Hoo! goes out for this effort. And also to the Minnesota Chapter of Disabled American Veterans convention:

As many as 300 disabled Minnesota veterans will participate in a four-day convention starting today in Duluth. The 87th annual Convention of the Minnesota Chapter of Disabled American Veterans is the first to be held in Duluth since 1987, said Jerry Uecker, commander of the Minnesota DAV's Sixth Chapter. The chapter includes a geographic region covering the northern half of Minnesota. Part of the convention will focus on the issues facing America's newest disabled veterans -- those returning from combat duty in Iraq and Afghanistan.

Send your thanks to the Forum and the Duluth News Tribune and let them know you appreciate their covering these great strides in true troop support. Way to go, Minnesota!


 Related Posts

• House, Senate Pass Defense Bill Nationalizing Minnesota's 'Beyond the Yellow Ribbon' Reintegration Program
  
• Minnesota Holds Its First-Ever Combat Stress Conference; Warrior to Citizen Campaign Editorial
  
• As Another Suicide Occurs, Minnesota Leaders Urge DoD to Revise Post-Deployment Contact Rules
  
• Alternative Sentencing Considered for Minnesota's OEF/OIF Veteran First-Time Offenders
  
• Opinion: Proactive Community Needed to Help Troops Reconnect, Reintegrate
  
• Ed Schultz Show: Reintegration Program Discussion Wednesday
  
• Advice for OEF/OIF Vet Employers and Co-Workers
  
• Cloquet, MN: Troop Reintegration Program Update, Advice
  
• MN Community Reaches Out to its Troops
  
• Small Town Learns How to Support Returning Troops

Buried Sacrifice: Inside the Military Family

Many of you who visit this site are military family members; others are students or researchers looking for information on the military family experience. If you're a civilian like me interested in gaining a better understanding of these Americans who sacrifice for us all in big and small ways every day, please take a jump over to ePluribus Media and my latest commentary. You'll gain insight into something called 'anticipatory grief', get a couple of book suggestions, and view stats on the subject that I've collected.

I welcome further insight from our military family members; please consider sharing any of yours in comments. Thank you!

Tags:

• family
• grief
• deployment
• stats
• commentaries

Coping Tips Following a Traumatic Loss

The DOD's Deployment Health and Clinical Center website makes information available to help troops deal with what they call 'operational stress'. Their Stress and Trauma factsheet lists possible reactions to stress, what to expect as recovery continues, suggested post-trauma do's and don'ts, and what to do about flashbacks. Today I'll share the closing topic with you: coping with bereavement.

Click on 'Article Link' below tags for more...

From the DOD's Stress and Trauma factsheet:

Coping With Bereavement

The loss of someone close, especially as a casualty during deployment or war, is one of life's most stressful events. It can leave you so numb that you have difficulty recognizing the reality of death or coping with its impact on your life.

Even so, you're forced to deal with ideas that cause a great deal of pain. We know, for example, that a refusal to acknowledge "the facts of death" is a disservice to the dying and the living alike, but doing so forces the acknowledgment of how real this situation is, and it hurts.

This fact sheet was not created to make the pain go away--unfortunately, nothing can do that for you--but to help you understand the intense emotions you're experiencing or are going to soon feel.

Background
Bereavement literally means "being deprived by death." It describes a process all people go through when someone close dies. Each person experiences this process differently, but there are some characteristics common to most instances of bereavement:

It doesn't progress in an orderly fashion.
You probably won't find yourself moving systematically from one well-defined stage to another. Instead, you'll probably drift back and forth from what might best be described as overlapping, fluid phases of anger, denial and acceptance.

It involves emotions and behavior that wouldn't be described as normal under other circumstances.
While some people benefit from professional help to cope with their grief, you shouldn't automatically interpret emotions or acts as a sign that you're losing your sanity.

It's frequently complicated.
The initial numbness makes the later physical and emotional upheaval all the more frightening, or seem a sign of weakness but it is not. Grieving is a healthy, necessary process, and refusing to grieve may postpone inevitable reactions that build up into later crises.

By design, bereavement is self-centered.
You need all your energy to cope with your emotions. Resist the inclination to put your own needs aside in an effort to meet those of your family; a healthier idea would be to secure outside support and guidance from a mental health professional.


The Experience Of Normal Grief

Feelings - sadness, anger, guilt, anxiety, loneliness, helplessness, hopelessness, shock, yearning, relief, and numbness.

Physical Sensations - hollowness in stomach, tightness in the chest, tightness in the throat, oversensitivity to noise, a sense of depersonalization, feeling short of breath, weakness in the muscles, lack of energy, dry mouth, and fatigue.

Cognitions - disbelief, confusion, preoccupation, sense of presence, hallucinations, and dreams about the deceased.

Behavior - sleep disturbance, appetite disturbance, social withdrawal, absent-minded behavior, avoiding or seeking out reminders of the deceased, sighing, restlessness, crying, and visiting places or carrying objects that remind the survivor of the deceased.


Phases

1. Numbness
2. Yearning
3. Disorganization and Despair
4. Reorganized Behavior


What Helps?

Effective coping with bereavement really depends on your ability to mourn properly. When a loved one dies, there are many things which will help you cope better with the pain. Some examples include:

People who care.
Family, friends, neighbors, colleagues, and strangers in a mutual support group who have "been there" can all offer support. A lifetime habit of close, caring relationships is the best possible preparation for bereavement.

Understand the "facts of death."
This is a particularly important in time of war. Knowing what to expect and knowing your options helps. Express your feelings--talk, be angry, weep. You are not alone; all grieving people need such outlets.

Reach out for help.
Others cannot always make the first move. They may be afraid of intruding on your privacy. Make your needs known. Seeking out a mutual support group in your community is a great first step.

Keep in touch with your physician.
Following your physician's advice can help you deal with physical side effects.

Accept the inevitable.
Some things in life, and certainly in war, have no basis in logic; they just happen. Accepting this can prevent much bitterness and self-blame.

Don't rush into major life changes.
Moving, changing jobs, or remarrying are too important to rush. This is no time to make major decisions. Your judgement may be poor and the changes are only likely to add to your stress. Wait a year. Make big decisions then. Introduce new relationships gradually and carefully--let them grow.

If you find yourself in need of more assistance than friends and family can provide, contact your clergyperson or your physician. Your local Mental Health Association can also help you find the support you need.


How To Help Those You Care About

• Understand that emotional consequences follow a traumatic experience
  
  
• Don't expect that the person you care about will "get better" in a certain amount or time or in a certain way. Sometimes recovery is a long and difficult process. If the person requires more time than you expected, you may feel frustrated or even angry.
  
  
• Tell the survivor how you feel: that you are sorry they have been hurt.
  
  
• Encourage the survivor to talk to you about how they feel. When they do, listen without interrupting or making judgements about what you hear. All survivor's feelings are ok even if you might not feel the same way.
  
  
• Remind the survivor that their confusing emotions are normal.
  
  
• DO NOT attempt to impose your explanation on why this has happened to the survivor. It probably won't be the explanation the survivor believes and imposing your view might hurt your relationship with them.
  
  
• DO NOT tell the survivor, "I know how you feel" or "Everything will be all right." Often, these statements are really efforts to relieve your own anxiety about how you feel about what has happened to the survivor. Survivors say that when they hear these statements they thing that people do not care about or understand them.
  
  
• Go to any court hearings, community meetings or other appointments that relate to the trauma. This is an important way to provide support to the survivor.
  
  
• Be willing to say nothing. Just being there is often all that you can do to help.
  
  
• Don't be afraid to encourage a survivor to ask for help in the form of post-trauma counseling. You might even go to the first appointment to show your support and concern.

Take a look at the entire factsheet; lots of good information contained in it.

Tags:

• trauma
• grief
• psychology
• losses
• flashbacks

Tri-Service Combat Stress Conference Continues

The 14th Annual Tri-Service Combat Stress Conference kicked off this past Saturday (and runs through May 4, 2006) at Camp Pendleton, CA. It's the largest and oldest gathering of its kind, bringing together leading military mental health professionals and chaplains to share their knowledge of the latest techniques in combat stress treatment. The San Diego Union-Tribune interviews Bart Billings, the event's co-founder, and the results are informative and quite illuminating.

Click on 'Article Link' below tags for more...

From the San Diego Union-Tribune:

Bart Billings and Richard Lynch started a combat stress conference in 1993 after watching the toll the Persian Gulf War took on their military friends and colleagues. Accounts of bankruptcy, divorce and suicide compelled them to bring together top researchers and counselors to help service members and their families.

Vietnam vets – and to a lesser degree those from the Gulf War – had slipped through the federal government's mental-health net, Billings and Lynch said. They were determined not to let that happen to the next generation of U.S. combat troops.

Thirteen years later, they and some of the nation's foremost experts in the field contend that the military's mental-health care remains hobbled by anemic budgets, poor and often inexperienced staffing and an overreliance on prescription drugs at the expense of holistic care.

In short, they see another lost generation in the making. “I would give the Pentagon a less than adequate grade for its mental health efforts,” said Lynch, a retired brigadier general and a radiologist at the Brooke Army Medical Center in San Antonio. His criticism is shared by psychiatrists, social workers and specialists in integrated medicine.

The event's co-director is less than satisfied with the current veterans healthcare landscape.

“I don't think we are OK where we are,” said William Marshal, a primary care doctor for the Veterans Affairs system in West Los Angeles and co-director of the conference with Billings. “I am concerned that we aren't cranking up to care for (the newest veterans') needs. If we don't provide the necessary support, we could lose a large number of these veterans to homelessness, drugs and joblessness.”

Marshal, a retired Army colonel, estimated that a third more doctors, nurses, psychological technicians and social workers are needed to handle the military's growing mental-health needs as more and more veterans come back from Iraq and Afghanistan. Twenty percent to 40 percent of such troops suffer mental illness, several studies in the past year and a half have documented.

That percentage is roughly what Vietnam veterans reported long before the Pentagon officially recognized post-traumatic stress disorder, or PTSD, and other forms of combat stress.

The article continues to offer up a rich selection of statististics: the VA has been underfunded over the past 3 years to the tune of $1.2 billion to $2.6 billion yearly. The reasons given include the increasing burden placed on the system by our returning OEF/OIF veterans, as well as higher-than-expected costs associated with caring for both World War II and Korean War vets.

Money aside, assembling and keeping a mental-health staff are challenging because the pool of qualified people is relatively small and in high demand, said Col. Bob Ireland, program director for mental health policy at the Pentagon. “There has been a joke around for years that . . . we are always 100 percent manned if you keep dropping the number of what 100 percent is,” Ireland acknowledged.

Mental-health care ranges from an A+ to a D-on bases nationwide, Ireland said. But overall, he argued, the military has improved its services. He noted that innovative mental-health programs promising greater access and confidentiality are coming, though he didn't elaborate.

Ireland also said the military has recently improved its mental-health screening of troops before and after they deploy. For example, the Pentagon has encouraged military health providers to use a detailed questionnaire on mental conditions for interviewing troops up to 18 months after they return home.

Billings wonders if the efforts will be backed with enough funding. In 1997, he pitched his Human Assistance Rapid Response Team program to Pentagon officials as a way of assessing spiritual, mental and economic needs that could become distractions in combat.

The Pentagon incorporated it into a Defense Department directive on combat stress prevention but never funded it, Billings said. “No one picked it up because there was no money, but they have money for other things,” said Billings, a clinical psychologist in La Costa, a retired military medical officer with 33 years of service and a psychologist for the California Department of Rehabilitation.

The issue of prescribing anti-despressant medication to returning troops coping with posttraumatic stress disorder symptoms is also examined.

Some doctors believe strongly in using antidepressants and other medications to treat conditions like PTSD, said C. Scott Saunders, director of the Trauma Psychiatry Service at the University of California Los Angeles. However, Saunders doesn't advocate the practice because, “You can't medicate it away. It is a way to lessen the symptoms . . . but I don't think medications go to the heart of the problem.”

Billings, Lynch and Saunders, among others, believe an interdisciplinary strategy is the most effective way to heal the mind, body and soul of people suffering from mental illness. This broader approach can pretty much restore patients' conditions to the way they were before a traumatic event, but the recovery process is often long, expensive and mentally taxing, Saunders said.

A lack of experienced health providers, including a shortage of counselors, makes it more likely that physicians will resort to prescribing medications instead of using multiple therapies, the experts agreed. “A doctor can see four or five patients an hour if all he or she does is write prescriptions (for drugs), which don't work about 50 percent of the time,” Billings said. “You need large numbers of trained counselors to handle those problems.”

Billings urged veterans and active-duty service members to demand more or better counseling if their mental illness doesn't improve, and to seek help outside of the military if necessary.

Great advice. You bet we have to agitate and demand for better funding, more attention, and real progress re: veterans healthcare. Please consider contacting your elected officials and asking them where they stand and what they're doing on this issue.

And join me in thanking the San Diego Union-Tribune for this informative and important piece of reporting.

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Opinion: Wedge Issue Trumps Vets Health Funding Debate

While the Senate carries on its debate on the issue of flag-burning (in the face of other more pressing problems facing our nation including meeting the health needs of our returning veterans) I came across an opinion piece on the matter running in today's Asbury Park Press.

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From New Jersey's Asbury Park Press, this op-ed is written by Janet Walsh, a former Vietnam veteran and current member of Veterans Defending the Bill of Rights:

Once again, the U.S. Senate is debating a constitutional amendment to ban desecration of the American flag. I cannot help but feel weary as policy-makers brace for yet another fight over the extent of freedom of expression. ... Proponents tout the amendment as a show of support for our troops overseas and our veterans here at home. I see it as meaningless rhetoric that distracts attention from far more critical issues affecting the quality of life for service members and veterans.

I have dedicated my life to providing quality health care for all Americans, especially for our soldiers. What I see is a looming crisis, one far more deserving of congressional attention than a constitutional ban on flag desecration.

Let me be perfectly clear: I do not in any way support flag burning. When I served at the 2nd General Army Hospital in Landstuhl, Germany, during the Vietnam War, it broke my heart to see the American flag burning back home. But as a first lieutenant in the Army Nurse Corps, I had an important job to do: to make sure that American soldiers received the best medical care available. And now, 40 years later, I fear those same men and women are no longer being properly cared for.

What I see are policy-makers who are more interested in making headlines with a wedge issue than addressing the needs of those who put their lives on the line to defend this country and the principles it stands for.

The author points out a couple of ways veterans are getting left behind: the decades-long under-funding of the VA, and the Base Realignment and Closure plan which will leave more veterans without access to health care services in their area.

As a new generation of American veterans returns home from combat overseas, we should be grateful for their commitment to our country. We should be showing our appreciation, not using their considerable risks and sacrifices as a platform to advance an empty agenda.

Sen. Robert Menendez, D-N.J., has always been a strong supporter of our nation's — and especially New Jersey's — veterans. I hope as the debate over the flag-burning amendment comes to a head, he will reject this frivolous bickering and instead use the power of his seat to generate bipartisan support for adequate health care for veterans. If there is one thing that can be agreed upon in this age of partisan politics, it is that we owe a great debt to our veterans. The very least our policy-makers can do is band together to repay them with their promised care. ...

If the Senate truly supports America's veterans, I would rather see them make a real difference and turn their attention to the ongoing struggle for quality health care for veterans instead of this damaging attempt to restrict our rights.

If you have any feedback to offer on this piece, please contact the Asbury Park Press.

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Cloquet, MN: Troop Reintegration Program Update, Advice

An update and some advice from a Minnesota small town which came together in February to begin the work of offering 120 of their returning soldiers from the Duluth Guard unit a ground-breaking reintegration program. [See the following posts to get up to speed on this incredible story: 1 | 2] The first wave of troops have now gone through the Minnesota National Guard's program, and the Pioneer Press provides an update. Closing things out: advice by the program's director on how to improve your own community's support of its returning troops.

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From the Pioneer Press:

The 120 soldiers with the Cloquet-based E-Battery of the 216th Air Defense Artillery, of which Madrinich is a member, are among the first in the state to complete the Minnesota National Guard's pioneering program to ease the transition from war to home.

Since they returned, soldiers and family members have met every 30 days for briefings on military benefits and how to maintain mental health. Most local soldiers who have returned from an overseas deployment are able to transition smoothly into civilian life.

For a few, joy gives way to anxiety. "At first they are so glad to be back, they don't think they have any problems. And 98 percent of them don't," said Lt. Col. Susan Whiteaker, a member of the Army Reserves Combat Stress Team. "After two weeks to six months, though, things start to hit them."

Military experts estimate that 7 percent to 30 percent of returning soldiers will have trouble readjusting to civilian life.

We all know that hearing or reading something once is never enough to get you to change your habits. It's better to revisit a topic more than once -- only then will you have a good chance of incorporating that knowledge into your daily routines. That's the beauty of these types of reintegration programs. Teach positive skills early-on, and keep the negative ones from cropping up.

During a mid-March reintegration session at the Cloquet Armory, about 60 days after the unit's return, Whiteaker talked about anger management. Soldiers in the audience were busy whispering back and forth among themselves. "Hello. Can I have your attention, please?" Whiteaker's shouts echoed in the armory. "This is important. I may not be important, but this information is important to you."

Most soldiers quickly become so used to the chronic stress of a battlefield that they can go on working through just about anything, even, as Madrinich knows, if car bombs are exploding nearby. The military wants and needs soldiers to ignore that kind of stress and to use their anger as a fuel to fight the enemy, Whiteaker said. "But this is not a good adaptation when you come home again," Whiteaker said.

She offered tips and techniques to deal with overwhelming anger, from deep breathing to meditation. "It's hard to get this information across, but it's not impossible," said Maj. Cindy Rassmusen, also a member of the combat stress team. "People need to hear this more than once. Each person will pick out what's important to them," she said.

As the community began ratcheting up its program, Cloquet's Pine Journal pitched in by running an incredibly informative 4-part public awareness series starting in February. They are well worth taking a look at if your local community is interested in basing a reintegration program on their model:

• Community Learns Key Role it Plays in Reinstating Returning Soldiers
  
• The Long Road Home - Soldier
  
• The Long Road Home - Community
  
• The Long Road Home - Resources

Are you considering starting up a supportive reintegration program in your own community? If so, you might find the following advice (culled from the third article above) of great help:


Community Advice for Supporting Troop Reintegration

The process of readjusting to civilian life for returning combat soldiers is basically an eight-part process, according to National Guard Chaplain John Morris. Morris told community members at a special seminar at the National Guard Armory in Cloquet recently that the way ahead for returning soldiers must include: awareness, acceptance, education, healing and forgiveness, joining the community, growth, productive living and contributing to others. ...

[In Minnesota,] Guard units returning from combat now receive two days of initial reintegration training immediately following their return home. The unit is then reassembled after 30 days for reassessment and again after 60 days to address such issues as anger management, gambling, dealing with law enforcement issues and other situations that may be a reaction to combat stress.

Ninety days after their return, the soldiers are reassembled once again for a thorough physical and mental health assessment. Morris said the state believes it is imperative to remain vigilant in assessing how the soldiers are doing on both the short- and long-term aftermath.

Further, he said soldiers must learn what triggers their fears and how to adapt, even if they can’t get over the combat stress they might be experiencing. That, he said, requires the help and support of the entire community, and he offered some specific suggestions for various community members regarding how they can best contribute.

Law Enforcement
“Don’t lie to me when I get in trouble,” he stated. “Don’t tell me it will be all right. And don’t talk down to me. Instead, we need to work through things together. You might be able to identify me as a combat vet because chances are, I am going to talk tersely. If that is the case, call me by my last name [as they do in the military] and that will help diffuse the situation. “I need clear and defined guidance from you.”

Social Service Providers
“Don’t feel you have to ‘fix’ us. You don’t have to handle our problems alone. You already have training in dealing with trauma, so try to treat us with respect no matter what we may be going through and validate what we perceive ‘normal’ people should be like.”

Pastors/Clergy
[T]here is one thing that is key in getting returning combat soldiers “back into the fold” of the church. “If you tracked with my family while I was gone, I will give the church a great deal of respect. If not, you will not see me again. Also, before announcing my return in church, ask me first if I’m feeling confident enough to deal with it. Otherwise, let me keep a low profile. Create a safe place for me and offer me hope of forgiveness, and please don’t talk about the politics of war.”

Employers
[Consider offering] on-the-job sensitivity training for fellow employees of the returning soldier to help rebuild the bond of trust. “Remember we are severely handicapped by what we’ve missed while we were gone,” he said, “and help us pole vault that18 months.”

Bartenders
“Be sympathetic when you hear my story, but don’t buy me another drink. Instead, start slowing me down. What I really need is a ride home.”

Applause, again, for this program!

Please send your thanks to the Pioneer Press for their coverage of this issue. Also, consider emailing the Pine Journal a quick thank you, too; being a small paper, they'll probably really appreciate hearing that their efforts are being recognized. Perhaps consider contacting your local officials to ask if your community has any plans to organize something like this, too (especially if you live near a base).


 Related Posts

• House, Senate Pass Defense Bill Nationalizing Minnesota's 'Beyond the Yellow Ribbon' Reintegration Program
  
• Minnesota Holds Its First-Ever Combat Stress Conference; Warrior to Citizen Campaign Editorial
  
• As Another Suicide Occurs, Minnesota Leaders Urge DoD to Revise Post-Deployment Contact Rules
  
• Alternative Sentencing Considered for Minnesota's OEF/OIF Veteran First-Time Offenders
  
• Opinion: Proactive Community Needed to Help Troops Reconnect, Reintegrate
  
• Ed Schultz Show: Reintegration Program Discussion Wednesday
  
• Advice for OEF/OIF Vet Employers and Co-Workers
  
• Minnesota Continues to Excel in Troop Reintegration
  
• MN Community Reaches Out to its Troops
  
• Small Town Learns How to Support Returning Troops

SFO Giants: 3rd Annual Salute to Our Military Game

The San Francisco Giants and Operation Care and Comfort are hosting their 3rd Annual Salute to Our Military Game on May 26 at 7:15 pm in San Francisco, CA. From the website: "Celebrate the start of Memorial Day weekend and our Armed Forces for our annual Salute to the Military Day complete with post-game fireworks. Thousands of uniformed service men and women will be in attendance and the Giants will be celebrating the night with plenty of pageantry.” You’ll also get a one-of-a-kind Giants Salute to the Military Night desert camouflage Giants military bucket cap. Details | Donations

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New Combat PTSD Cases May Total 15,000 in 2006

From yesterday's Kansas City Star:

The number of troops back this year from Iraq and Afghanistan with post-traumatic stress disorder could be five times higher than the Department of Veterans Affairs predicted. Instead of 2,900 new cases that it reported in February to a veterans advocate in Congress, the increase could be 15,000 or more, according to the VA. [emphasis mine]

Just as this figure suggests, the article continues with more sobering information for us to examine, digest -- and act on.

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Continuing from the Kansas City Star:

At the Kansas City VA Medical Center, only nine vets from current combat were diagnosed with PTSD in 2004. Last year, it was 58. In just the first three months of fiscal 2006, the hospital saw 72. “It’s absolutely incredible,” said Kathy Lee, at the Missouri Veterans of Foreign Wars.

A former Army nurse in Vietnam who works at the hospital, Lee said, “Every single Iraq vet who comes in, I give them a list and say, ‘How many of these (PTSD) symptoms do you have?’ It’s almost nine out of 10.”

Compared to the Vietnam era, the VA is doing a better job in treating the natural psychological wounds some of our veterans return home with. Yesterday, AP reported:

The VA says it is more prepared to deal with returning veterans than it was after Vietnam, when an estimated 17.5 percent of veterans returned with mental or emotional problems. The agency has more than 160 programs for the treatment of PTSD and a $29 million dollar budget to provide services for military men and women returning from Iraq and Afghanistan. "If we don't get intervention within the first five years, the veteran is set up for a lifetime of problems," John Wilson, a psychology professor at Cleveland State University, told The (Cleveland) Plain Dealer for story published Sunday.

Wilson helped the VA design its first counseling program in the late 1970s. Now all veterans undergo a required post-deployment screening program, including a mental health assessment.

Although these programs are a step in the right direction, they are far from the magic bullet to cure all reintegration ills.

Despite expanded services and better post-deployment screening, some critics still wonder if the VA is prepared to deal with an influx of veterans coming home after multiple deployments in the Middle East. Larry Scott, who founded a Web site scrutinizing the VA, said that while the system has improved greatly, he worries the VA is still too understaffed and underfunded.

Wilson agreed there is cause for concern since repeated deployments can take an even greater mental toll on soldiers. "Iraq is a nonstop, 24-seven, hostile environment, so what happens is that these guys are incredibly wired all the time," he said. "One of the things we learned from Vietnam is that once that hyper arousal response develops, it doesn't go off."

Back to the Kansas City Star piece, we find a cautionary warning:

John Baugh, who attends a PTSD support group at the Kansas City VA Medical Center, said many soldiers still in combat zones are suffering from the disorder. “They think that the numbers are high right now,” said Baugh, 31, a former driver for an Army construction battalion in Iraq. “Wait until those guys get out and try to start functioning in the civilian world. There’s going to be hell to pay.”

The miscalculation on PTSD echoes last year’s underestimation by the Bush administration of how many Iraq and Afghanistan veterans would need medical treatment. It had underfunded VA health care by $1 billion, despite assurances to Congress that the department had enough money. Congress subsequently added $1.5 billion to the VA’s budget, but money problems still loom.

“They’re going to be short and they’re going to be playing catch-up,” Cathy Wiblemo, deputy director for health care at the American Legion, said of the VA’s PTSD treatment. “They’re not going to have the money, and the waiting list will grow.”

As the VA budget last year needed an infusion of $1.5 billion to meet its needs, many say the President's 2007 VA budget as it currently stands is insufficient to meet the needs of our returning veterans.

The White House asked for $80.6 billion in 2007 for the VA, including $3.2 billion for mental health programs. But Rep. Michael Michaud, a Maine Democrat on the House Committee on Veterans Affairs, said the VA would need more, sooner. “What’s going to happen is unless we give added resources, they’re going to have to start rationing care,” Michaud said. “It’s going to have to start pitting veterans against veterans.”

Jeff Schrade, a spokesman for Sen. Larry Craig, an Idaho Republican and chairman of the Senate Veterans Affairs Committee, said Craig was unhappy over the VA’s botched estimates on health care last year. Congress now requires quarterly budget reports, which Schrade said show that VA’s budgeting appears to be on track. “What concerns us is they’re seeing a lot more patients than they anticipated,” he said.

The VA’s contradictory estimates on PTSD surfaced in February. Prior to a Capitol Hill budget hearing, the agency replied to written questions from Rep. Lane Evans of Illinois, ranking Democrat on the House VA panel.

Asked about the need for mental health services, the VA told Evans that it expected to see 2,900 new cases in fiscal 2006, which began Oct. 1 and ends Sept. 30. A week later, the agency issued its latest quarterly report on use of the VA by Iraq and Afghanistan veterans. The numbers indicated it had diagnosed 4,711 possible cases just from October through December — more in the first three months than it told Evans to expect over the entire fiscal year.

VA spokesman Jim Benson said the estimate of 2,900 cases was based on earlier data. The latest quarterly numbers were still in the draft stage at the time of the hearing, he said, and VA officials stuck with the earlier data because trying to explain “would be more challenging and perhaps more confusing.”

The unnerving news continues:

VA officials also had at the time of the February budget hearing a report from the department’s Special Committee on Post-Traumatic Stress Disorder. It warned that the VA was unable handle services to new combat veterans as well as survivors of past wars, saying: “We can’t do both jobs at once within current resources.” Most of the PTSD cases the VA sees involve veterans from earlier conflicts, primarily Vietnam.

Baugh of Kansas City won’t talk much about his Iraq deployment because it triggers bad memories. But when he returned home in 2004, he couldn’t escape them. “I was jumpy, angry, irritated, sleeping one-two hours a night,” Baugh said. “I was totally worn out. I’d drink and drink and drink just to shut the memories down and the nightmares.” His wife pushed him to get help. Baugh said he’ll “jump through the ceiling” if she drops a frying pan. The clattering of kids skateboarding down his street sounds just like “gunfire in the distance: kack-kack-kack-kack.”

Joshua Lansdale knows about nightmares and noises, too. A 23-year-old veteran from Kansas City, North, he spent 11 months in the Sunni Triangle as a firefighter and emergency medical technician with the Army Reserve’s 487th Engineer Detachment. “It was a pretty hot zone,” he said. “We took a lot of mortar fire, IEDs, car bombs, saw a lot of helicopter crashes and worked the UN embassy bombing. I dragged a lot of people out of burning buildings, cars, motorcycle wrecks and explosions.” Back home, Lansdale was diagnosed with PTSD and joined a support group at the VA hospital. He predicted that returning troops would overrun the VA.

“A third of all soldiers are seeking help,” he said. “Do we have the capability of treating all those soldiers? I don’t think we do.”

The better informed we are, the more we can achieve.

As halting as these figures and assessments may be, we mustn't let them paralyze us; rather, we must use this data to energize us and our fight to get our returning troops and their families the support they need. They -- and our nation -- deserve nothing less.


 Related Posts

• Obama, Bond Demand DoD Provide PTSD Data
  
• OEF/OIF Vets Seeking PTSD Care from VA Jumps 70%, Mental Health Counseling Tops 100,000
  
• Returning OEF/OIF Troops with PTSD
  
• Returning Vets' Stress Help Rate Doubles
  
• Combat Stress: A Look Back at the New England Medical Journal Study

Delaware Vet Claim Denied? Free Legal Help Available

If you're a Delaware veteran "subsisting at 125% of poverty level [and have] been denied benefits by the Regional Office and the Board of Veterans Appeals and wish to take an appeal to Court of Veterans Appeals (COVA)," Widener University School of Law's Veterans Assistance Program may be just what you're looking for. Started by Professor Thomas J. Reed in 1997, the complimentary legal service has "helped about 80 veterans collect nearly $1 million in benefits." Be sure to explore both links above to learn more.

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