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Sunday, November 18, 2007

Combat PTSD Positions: Edwards, Obama, and Clinton

Last week, Sen. John Edwards unveiled a $400 million five-point plan to help returning troops and their families cope with post traumatic stress. While not the only presidential candidate to set his sights on this issue, the Edwards plan is the first to be prominently unveiled as the presidential race heats up. From AP:

Under Edwards' plan, veterans could seek counseling for post-traumatic stress disorder outside the Veterans Health Administration system; the number of counselors would increase; and family members would be employed to identify cases of PTSD. ...

"I strongly believe we must restore the sacred contract we have with our veterans and their families, and that we must begin by reforming our system for treating PTSD. We also must act to remove the stigma from this disorder," Edwards said in prepared remarks his campaign provided to The Associated Press. "Warriors should never be ashamed to deal with the personal consequences of war."

Let's take a deeper look at these points, as well as what fellow presidential candidates Barack Obama and Hillary Clinton are doing -- or planning to do -- on this issue.

John Edwards
From the Edwards campaign website:

Senator John Edwards strongly believes we must restore the sacred contract we have with our veterans and their families, and that we must begin by reforming our system for treating PTSD. As president, Edwards will enact the following five-point plan for PTSD:

Give service members more time at home
The ideal "dwell-time" between deployments is twice as much time at home as on tour. Inadequate dwell time leads to higher levels of PTSD, as soldiers have too little time to recuperate, aggravating any mental stress from service in the field. The Bush Administration has extended tours to 15 months, with troops given too little time at home in between deployments. Troops have also been redeployed with PTSD—a problem even the Bush Administration has described as "daunting and growing." As president, Senator Edwards will avoid deployment patterns likely to lead to higher levels of PTSD. He will also avoid reckless military decisions like a so-called "preventive war" with Iran that could hurt our troops and their families. [Veterans for America 2007; DOD Task Force on Mental Health, 2007].

Improve resources, training, and outreach
We must refocus our attention on PTSD and remove the stigma that too long has been associated with the disorder. A warrior should not be ashamed to get treatment for the personal consequences of the experience of war. Too often, however, veterans have a difficult time getting counseling because there are not enough trained counselors in the TRICARE and VA networks. Veterans also sometimes avoid getting care within the networks because of the stigma associated with PTSD. Edwards will act to remove the stigma from PTSD, increase counseling resources within the TRICARE and VA networks and will permit veterans to access counseling outside of the networks. Edwards will also improve training for health personnel to recognize and treat PTSD and establish uniform standards for mental health care. Finally, he will ensure outreach is extended to family members, who can help recognize symptoms of PTSD and help their loved ones get the help they need.

Aggressively resolve the claim backlog
The VA currently has a backlog between 400,000 and 600,000 claims, and wait times for initial determinations of up to 6 months. This means that veterans with PTSD have to suffer longer. Edwards will adopt an aggressive, goal-oriented approach to processing the backlog. As president, he will process the entire backlog that exists when he takes office by Memorial Day 2009, and will cut the average processing time in half. [CNN 2007].

Provide a comprehensive medical examination
Too often, veterans receive their first medical examination months or even years after they leave the service, which makes it difficult to ascertain whether an injury is service-related, creating difficulties and inefficiencies later. As president, Edwards will create a new system providing each service member with a comprehensive, standardized medical examination immediately upon leaving the service, and will link that examination with the disability rating. Both will be included in a new "Homefront Redeployment Plan" every veteran will receive.

A national chain of care
Once our service members become veterans, we have to make sure the system doesn't fail them. As president, Edwards will create a new national chain of care to ensure that no veteran again falls through the cracks. Because many veterans receive treatment outside the VA system, this chain will coordinate treatment and benefits in outreach centers and clinics in every county where a veteran resides, both within and outside the VA network.

Edwards on other veteran-specific issues.

Barack Obama
From the Obama campaign website:

As a member of the Senate Veterans' Affairs Committee, Senator Obama is committed to helping the heroes who defend our nation today and the veterans who fought in years past. A grandson of a World War II veteran who went to college on the G.I. Bill, Senator Obama has reached out to Republicans and Democrats in order to honor our commitment to America's veterans. ...

In 2005, the Department of Veterans Affairs announced it would contact veterans with severe PTSD and ask them to prove that they deserved their disability payments. This review of disability claims was highly disruptive to veterans still suffering serious health effects from their military service. Senator Obama fought this review. He and Senator Dick Durbin (D-IL) passed legislation to limit it and helped publicly pressure the agency to finally abandon the effort in November of 2005.

Senator Obama also worked with Senator Bill Frist (R-TN) to pass an amendment ensuring that all service members returning from Iraq are properly screened for Traumatic Brain Injury (TBI). TBI is being called the signature injury of the Iraq war. The blast from improvised explosive devices can jar the brain, causing bruising or permanent damage. Concussions can have huge health effects including slowed thinking, headaches, memory loss, sleep disturbance, attention and concentration deficits, and irritability.

Obama actually has a better track record on PTSD than his campaign website seems to reflect. For example:

U.S. Senators Barack Obama (D-IL) and Christopher Bond (R-MO) sent the following letter to Secretary of Defense Robert Gates, requesting a full accounting of service members’ psychological injuries, including Post-Traumatic Stress Disorder (PTSD), since October 2001. The senators also requested a detailed report on how the military monitors other psychological injuries. Recent media accounts indicate that the number of service members seeking care for PTSD from the Veterans Administration (VA) increased 70% over a 12-month period, or an increase of some 20,000 cases. In addition, reports of the total number of cases of PTSD treatment at the VA since 2001 – 50,000 cases – far exceed the number of wounded documented by the Pentagon.

In the letter, Obama and Bond request information including the total number of PTSD among active duty service members; the total number of other reported psychological injuries; the procedures and referral mechanisms for service members to seek counseling while in combat; the number of mental health staff deployed in Iraq and Afghanistan; the number of mental health staff for each major mobilization and demobilization site; the incentives in place to attract additional behavioral health specialists; and the total annual expenditure on mental health care for active duty service members.

In addition:

Six senators have requested an investigation into what they call “upsetting allegations” that the Army gave personality-disorder discharges to 18 Fort Carson, Colo., soldiers diagnosed with post-traumatic stress disorder or traumatic brain injuries.

“There are allegations of commanders at Fort Carson, Colo., denying soldiers access to mental health care and instead ordering them redeployed for additional tours in Iraq,” states a letter to the Government Accountability Office. “We have also heard of cases in which service members with PTSD are diagnosed as having ‘personality disorders’ that the Army considers ‘pre-existing,’ thus depriving otherwise eligible combat veterans of disability benefits and much-needed mental health care.”

The letter, dated April 19, is signed by Senators Barack Obama, D-Ill.; Barbara Boxer, D-Calif.; Christopher Bond, R-Mo.; Joe Lieberman, I-Conn; Tom Harkin. D-Iowa; and Claire McCaskill, D-Mo. It was also sent to Deputy Defense Secretary Gordon England and Acting Secretary of the Army Pete Geren.

“I’m especially troubled by reports of some DoD commanders downplaying the serious mental health conditions confronting service members returning home from Iraq,” Obama said in a statement, “and then redeploying those troops without proper treatment. It’s time for a full accounting of how many of our troops are affected by post-traumatic stress disorder, other service-connected mental health conditions and traumatic brain injuries.”

Additional Obama-related posts (impressively, there are many).

Hillary Clinton
From the Clinton campaign website:

As a member of the Senate Armed Services Committee, Hillary has championed legislation to improve the lives of our veterans and their families. She worked to provide access to TRICARE for National Guard and Reserve members. She authored the Heroes at Home Act that will begin to help service members struggling with post traumatic stress disorder and traumatic brain injury. She worked with others in the Senate to pass legislation to increase the military survivor benefit from $12,000 to $100,000.

As president, she will honor three fundamental commitments: First, every member of our armed forces will receive a fair shot at the American dream when their service is over. Second, every veteran in America will have health care. Third, every veteran will receive the benefits they have earned and the assistance they need - right from the start.

Details on her Heroes at Home legislation, introduced June 15, 2006:

Senator Clinton’s bill proposes four key initiatives to assist military service members of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) with readjustment to work, the problems of posttraumatic stress disorder (PTSD) and other mental health issues, and traumatic brain injury (TBI). The bill, which is supported by the National Military Family Association and the Wounded Warrior Project, also provides support to their family members. ...

The Heroes at Home Act, which Senator Clinton plans to offer as an amendment to the Department of Defense Authorization bill currently on the Senate floor, centers around Department of Defense (DOD) and Department of Veterans Affairs (VA) partnerships with employers and community organizations in acknowledgement of the fact that despite more services and resources being offered at DOD facilities, VA hospitals, and Vet Centers, returning service members are often reluctant to go to traditional mental health clinics due to stigma and concerns about confidentiality and their military careers. ...

Specifically, the Senator’s legislation would require the Secretary of Defense to build upon an existing Mental Health Task Force by partnering representatives from the public and private sectors to identify the readjustment and mental health needs of returning National Guard and Reserve members in their transition to the civilian workforce after deployment. The bill would also establish an Assistance Center for employers, employee assistance programs, and other organizations to provide them with best practices and education for ensuring the success of Guard and Reserve members in resuming civilian work.

Under the legislation, demonstration grants would be awarded to organizations in community setting for providing PTSD and other mental health education and assistance to National Guard and Reserve members and their families, since many of these troops return to local communities scattered across the country far away from military bases and VA hospitals.

The legislation also calls for a study on the long-term physical and mental health consequences and rehabilitation needs of traumatic brain injured service members. To further assist the mushrooming number of traumatic brain injured service members and their families, this legislation would establish a TBI Family Caregiver Training Curricula for health professionals at DOD and VA hospitals, who would use the curricula to teach family members important skills for caring for their loved ones suffering from TBI when they go home.

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