PTSD Combat : Winning the War Within: October 2007

Tuesday, October 30, 2007

President Nominates New VA Chief: Former Army Surgeon General James Peake

President Bush nominated retired Army General James Peake to the position of Veterans Administration Secretary today. Early reaction, but first from Bush's announcement:

BUSH: Caring for our military veterans is a solemn responsibility of the federal government. It is our enduring pledge to every man and woman who puts on our nation's uniform. And it is the daily work of the Department of Veterans Affairs. I am pleased to announce my nomination of an Army doctor and combat veteran who will be a strong new leader for this department: Lieutenant General James Peake. ...

Dr. Peake grew up in a home where service to country was a way of life. His father started out as an enlisted man in the Army, and became an officer who spent most of his 30-year career in the Medical Service Corps. Dr. Peake's mom was an Army nurse. His brother was a naval aviator. And as a young man of 18, he set upon his own lifetime of service when he arrived at the United States Military Academy.

After graduating from West Point in 1966, Second Lieutenant James Peake was sent to Vietnam with the 101st Airborne. There he served as a platoon leader, he led men in combat, and earned several medals for his courage _including the Silver Star. One of those who knows him best describes his leadership this way: End of a chow-line officer _everyone else first.

In Vietnam, he also earned two Purple Hearts. While in the hospital recovering from his second wound, he learned that he had been accepted to medical school. And after completing his medical studies at Cornell University, he devoted his career as an Army doctor to improving care for our wounded servicemen and women. Long before the global war on terror began, Dr. Peake was changing the way we deliver medical care to our troops. As a result of his reforms, many who once might have died on the battlefield _now they come home to be productive and having fulfilling lives.

As a medical officer and combat vet who was wounded in action, Dr. Peake understands the view from both sides of the hospital bed _the doctor's, and the patient's. He brought that understanding to many jobs. These jobs include command surgeon in the Army hospitals, commanding general of the largest medical training facility in the world, and Army Surgeon General _where he commanded more than 50,000 medical personnel, oversaw 16 hospitals across the world, and managed an operating budget of nearly $5 billion.

Since leaving the Army, he has served as Executive Vice President and Chief Operating Officer of Project Hope. There he helped one Navy hospital ship respond to the victims of the Asian tsunami and another that was sent to care for those hit by Hurricane Katrina. Most recently, he has served as Chief Medical Director and Chief Operating Officer with QTC Management, which provides military veterans with timely medical examinations, as well as electronic medical record services.

When confirmed by the Senate, Dr. Peake will bring his unique set of skills and experiences to the Department of Veterans Affairs. He will be the first physician and the first general to serve as Secretary. He will apply his decades of expertise in combat medicine and health care management to improve the veterans' health system. He will insist on the highest level of care for every American veteran.

[UPDATE Oct 31, 2007]: Bush's announcement.

Click on 'Article Link' below tags for nomination reaction...

In the interest of education, article quoted from extensively.

Continuing:

BUSH: One of Dr. Peake's first tasks as Secretary will be to continue to implement the recommendations of the Dole-Shalala Commission on Wounded Warriors. And Senator, thank you for joining us. Some of their recommendations are the responsibility of the executive branch, and Dr. Peake will be a leader in carrying them out. Others require the approval of United States Congress, and that's why this month I sent a bill to Capitol Hill that will make those recommendations the law of the land.

As Secretary of Veterans Affairs, Doctor Peake will be a powerful advocate for the prompt enactment and implementation of this vital legislation. And he will work tirelessly to eliminate backlogs and ensure that our veterans receive the benefits they need to lead lives of dignity and purpose. ...

I want to thank Acting Secretary Gordon Mansfield for leading the department these last few weeks. He's done a fine job. He's earned the respect of all those who've worked under him. He's earned the gratitude of our nation's vets.

I appreciate Dr. Peake's willingness to step forward at this important time for the department. He' a man who' been tested in battle; he has proved himself as a soldier, as a physician, as a leader and as a good family man. He will be a superb Secretary of Veterans Affairs, and the United States Senate should promptly confirm him.

Doctor, I appreciate you stepping up again. On behalf of the United States of America, congratulations.

PEAKE: Mr. President, Secretary Mansfield, Secretary Principi, Senator Dole, ladies and gentlemen, thank you very much for being here. And sir, thank you for this opportunity to come back in service. Fundamentally, I'm a soldier. I've been taking care of soldiers essentially all of my adult life. And to have that chance again, especially at this time _at a time when the American people and you, Mr. President, have so clearly committed to the well-being of those who have served — well, it's a high honor indeed.

I do understand that though it's an honor, this is not an honorary position, and there's a lot of work to be done as we move forward on implementing the Dole-Shalala commission recommendations. The disability system is largely a 1945 product _1945 processes around a 1945 family unit. About everybody that has studied it recently said it is time to do some revisions.

I am really proud of the military medics who have done such remarkable things, in terms of bringing wounded soldiers back home _soldiers that in other conflicts would never have made it off the battlefield. I think each of these men and women deserves the right to lead as full and productive a life as is possible. This great VA system of ours reaches across the nation into every community and touches veterans and their families in so many ways, committed to the principle that I just talked about.

Well, I'm committed to that principle as well, and that's why I'm here. I know personally many of those who lead in the VA. It is a great team. If confirmed, I look forward to working with them. I look forward to working with Congress. I look forward to working with the veterans' service organizations, and particularly with the Department of Defense as we move forward to do the right thing _not just for the short-term, but for the longer-term _to set the future so that we can continue to meet our commitment to those who deserve our care.

Janice, thank you so much for allowing me to come on this journey, and coming with me. Mr. President, thank you so much for the confidence and the opportunity, and I'll see you on the high ground.

BUSH: Thank you all.

END

Nomination details and early response

From the LA Times:

White House Press Secretary Dana Perino said of Peake: "He has experience on both sides of the hospital bed, both as a patient for sustaining wounds ... in Vietnam, and also as a doctor for over four decades."

She said his experience in the Pentagon would help Veterans Affairs meet the recommendations of the Dole-Shalala task force to better integrate the work of the two agencies as it applies to wounded troops.

From The Hill:

Senate Majority Leader Harry Reid (D-Nev.) said he looks forward to the confirmation process.

“The agency needs strong, stable leadership to reverse a series of major missteps by the Bush administration,” Reid said. “From the enormous task of streamlining and improving the military and veterans’ disability systems, to implementing a joint electronic medical record, to caring for the large number of returning veterans with Post Traumatic Stress Disorder and Traumatic Brain Injury, we hope Gen. Peake will demonstrate to Congress that he can provide the VA with the strong leadership to make the monumental changes that our veterans deserve.”

From FCW:

Lawmakers from both sides of the aisle praised Peake’s selection. His nomination is the first step in bringing strong leadership to VA, said Rep. Bob Filner (D-Calif.), chairman of the Veterans Affairs Committee.

“It is my hope that Dr. Peake’s role as the senior physician in the Army, his experience as a highly decorated and wounded veteran, and his recent work with the medical, disability and health communities in the private sector will equip him to address the unresolved problems plaguing the VA,” Filner said.

Rep. Steve Buyer (R-Ind.), ranking member of the committee, called Peake an outstanding candidate to modernize VA and establish a seamless transition process.

“Peake possesses a wealth of knowledge and experience required to institute these necessary changes,” Buyer said.

From the Washington Post:

Former senator Robert J. Dole (R-Kan.), who co-chaired the commission to improve health care for wounded troops, said Peake seems to be a good choice.

"He's been on both sides," Dole said. "He was a patient after he was wounded in Vietnam, and he spent much of his career as a caregiver." ...

"We'd feel more comfortable having somebody with much more intimate knowledge of the VA than someone from outside," said David W. Gorman, executive director of Disabled American Veterans. "He's a gentleman, a professional, and he has dedicated his professional career to caring for active-duty military. But there is a line drawn between them and veterans, and there needs to be an understanding of that difference."

From CNN:

The Department of Veterans Affairs had a budget of more than $69 billion for fiscal year 2005 and employs about 230,000 people. Peake retired from his last post -- as Army surgeon general -- in September 2004.

The nomination elicited concern from Sen. Patty Murray, D-Washington, a senior member of the Senate Committee on Veterans Affairs and a critic of the Bush administration's handling of veterans issues.

"Given Dr. Peake's past posts running the Army health care system, he will have serious and significant questions to answer about failed preparations for our returning wounded warriors," Murray said in a statement. "For months we've been hearing horror stories from Walter Reed and other military care centers, and I will want to know what role, if any, Dr. Peake played in the failures of the system."

But Sen. Larry Craig, R-Idaho, also a member of the Veterans Affairs Committee, disagreed that Peake's position as Army surgeon general would weigh against his approval.

"We should view that as experience and not as a take-away," he said. "What you need in that position is someone with a very broad base because of the incredible spread of service they provide through the VA, so I don't see that as a disqualification."

Veterans groups had complained that Bush's failure to name a replacement for [former VA Secretary James] Nicholson quickly was a sign his administration does not place a high priority on veterans issues. ...The veterans agency was also criticized after the revelation in 2006 that a laptop computer containing data on 26.5 million veterans had been stolen. The laptop was later recovered.

At the White House ceremony where his selection was announced, Peake acknowledged continued flaws with some of the services provided to veterans and pledged to overhaul them.

"The disability system is largely a 1945 product, 1945 processes, around a 1945 family unit. About everybody that has studied it recently said it is time to do some revisions," Peake said.

Peake was nominated by President Bill Clinton as Army surgeon general and served in that role from 2000-2004. After leaving that post, he worked for Project Hope, a nonprofit international health organization.

Most recently, Peake was chief medical director for QTC Management Inc., a private firm that provides medical exams and electronic medical records services for veterans ...

Sen. Barack Obama, an Illinois Democrat who is running for president, said he hoped Peake would bring a "new era of leadership" to the veterans agency. But Obama said budget shortfalls, inadequate care and other problems had marked the Bush administration's oversight of the agency.

From the San Antonio Express-News:

“Dr. Peake's first-hand experience as a former surgeon general of the Army and commander of U.S. Army Medical Command based at Fort Sam Houston in San Antonio will be invaluable at the VA,” said Sen. Kay Bailey Hutchison, R-Texas.

Peake's nomination comes just months after the Department of Veterans Affairs was rocked by allegations of shoddy medical care for veterans at Walter Reed Army Medical Center in Washington.

Politicians have been flooded with complaints from veterans about delays in providing health care at facilities across the country.

Hutchison said she would discuss with Peake the “urgent health care needs of Texas veterans.”

From KTVK-Phoenix:

Former Maricopa County Attorney Richard Romley had been recommended to head the Department of Veterans Affairs by members of Arizona's congressional delegation. Romley is a decorated Marine Corps veteran who lost portions of both legs in a mine explosion in 1969. He says he's disappointed that he wasn't nominated, but says he will be supportive of Peake and wishes him the very best.

From VA press release:

Statement by Acting Secretary of Veterans Affairs Gordon H. Mansfield On the Nomination of Retired Lt. Gen. James Peake to be VA Secretary: "The President has nominated a decorated combat veteran and accomplished surgeon to lead the Department of Veterans Affairs. We await his confirmation in the Senate and stand ready to work with Dr. Jim Peake to serve our nation's veterans with the finest health care services and benefits."

Speaker Pelosi press release:

Speaker of the House Nancy Pelosi issued the following statement today after President Bush nominated retired Army Lieutenant General James B. Peake to be the new Secretary of Veterans Affairs:

"The Bush Administration is overdue in appointing someone to lead the Department of Veterans Affairs who will ensure that all veterans receive the quality, timely health care they deserve - particularly our brave men and women returning from Iraq and Afghanistan.

"This is a time for independent, forceful leadership at the VA that is accountable to America's veterans and committed to the highest quality VA care.

"I am hopeful that Dr. James Peake is the right man to the lead the VA and will work with Congress to persuade President Bush to sign our legislation providing the largest increase for veterans' health care in history."

DNC press release:

DNC Chairman Howard Dean: "If confirmed, Peake will take over a highly criticized Bush Veterans Affairs Department which has failed to provide promised services, properly care for our wounded veterans at medical centers like Walter Reed, and left the personal financial information of America's 26.5 million veterans vulnerable.

Democrats have kept their promise to make improving health care and benefits for veterans a top priority, passing the largest increase in veterans' health care funding in our nation's history.

"Lt. General Peake has a tremendous responsibility ahead of him if he's confirmed. The Bush Administration has failed America's veterans, asking them to risk their lives for a disastrous Iraq policy and then neglecting them after their brave service. This must change. Democrats will continue to stand up to President Bush, fighting to fully fund veterans' health care services and to fix the VA. Lt. General Peake must stand with America's veterans and military families, not the partisan politics of the Bush Administration. We owe our troops and veterans better."

Also, an early editorial in the Wheeling [WV] News Register.

Labels: army, bush, buyer, craig, dole, filner, hutchison, murray, obama, oversight, peake, pelosi, politics, shalala, va, video

Monday, October 29, 2007

Montana Working to Destigmatize PTSD, Holds Its Largest Combat PTSD Conference in November

From the Helena Independent:

When Carroll Jenkins looks back over the past six years, he can’t help but credit the Sept. 11 terrorist attacks for creating a broader understanding of post traumatic stress disorder. For a psychotherapist specializing in PTSD, that’s a good thing.

“It seems like our society has to get hit right upside the head, pretty hard, to get it,” Jenkins said Friday. “I think we’ve got it this time. I’ve been battling this sucker for years. To see people sit around talking about PTSD the way they are now — we’re destigmatizing it.”

Jenkins was recently contracted by the Montana National Guard to help train therapists across the state in recognizing and dealing with PTSD.

Now, nearly a month later, he’ll help the Montana Chapter of the National Association of Social Workers in a related conference to be held in Helena next month.

John Wilkinson, executive director of NASW-MT, said the organization will host what’s believed to be the largest conference ever held in the state dedicated entirely to post-combat stress and veteran care.

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

In the interest of education, article quoted from extensively.

Continuing:

One finding by the state PTSD task force, created by the Montana National Guard earlier this year, recommended building stronger support across the community in tackling the issue, which some fear could be one of the current war’s lasting legacies.

It’s a recommendation Wilkinson has taken to heart in organizing next month’s conference.

“We’re still too distant — we’re all still doing our own thing,” he said. “We’re doing it with extraordinary commitment and focus but the players, by and large, aren’t talking with one another.”

The two-day conference hopes to unite professionals who serve in the clinical community across Montana and educate them on the needs of veterans and their families. Wilkinson hopes the conference creates a clinical dialogue across a wider spectrum of providers while improving access to care for veterans.

Montana, he noted, has more than 100,000 veterans, or nearly one person in every 10. Per capita, the state also had the highest recruitment into the U.S. Army when compared to other states in 2004 and 2005.

More details on the conference:

The conference itself notes a long list of experts in various fields, including Dr. Rosa Merino, the state’s chief of behavioral health, who will lecture on combat stress related disorders.

The two-day event also includes Beeta Homaifer, a postdoctoral fellow in advanced psychology at the Denver Veterans Affairs Medical Center, who will talk on traumatic brain injury; and India Bower, a clinical social worker who will discuss therapeutic approaches for treating combat related stress.

“They’re coming to understand that this is a traumatic experience that happens to this 3-pound thing called the brain,” said Jenkins. “They understand that this is a wound of war. We have destigmatized mental illness to the degree that PTSD is now just something else that happens to you.”

Last month, with the help of Jim Smith and Kristin Best, Jenkins trained 35 therapists at Fort Harrison in response to the National Guard’s task force recommendations.

After the session, the team selected 15 of those therapists to cover the state, holding workshops on the topic with Montana National Guard soldiers.

“Every National Guard soldier in Montana has been trained in PTSD,” Jenkins said. “We put in place 44 military one-source providers. There are now almost 80 providers trained or (who) know something about combat PTSD.”

More conference info online (includes links to register online or download a registration form [pdf] or brochure [pdf]) or phone NASW at 406-449-6208.

Labels: caregivers, clinical, combat, conferences, counseling, events, psychology, reintegration

Saturday, October 27, 2007

Plan to Attend Colorado's Fall Veterans Reintegration Workshops

I had the pleasure of meeting Elizabeth Hawkins and Steve Robinson with ONE Freedom at my Boulder stop on this past summer's Moving a Nation to Care tour.

ONE Freedom is a Colorado Springs, Colo., nonprofit that offers free reintegration programs for returning veterans and their families. They've got two new workshops coming up on November 17 and December 1. Highly-recommended participating if you can.

From ONE Freedom:

ONE Freedom, Inc., is offering its Fall 2007 reintegration workshops for Operation Iraqi Freedom and Operation Enduring Freedom veterans and their family members, ages 18 and over, in Colorado Springs on November 17 or December 1, 2007.

The 1-day workshop “Strength after Service” provides returning Colorado veterans and families education and training on how prolonged stress changes the brain and body, and how specific, scientifically-based skills can improve the impacts. ONE Freedom’s training model re-frames the way warriors and their family members understand stress; and provides a normalizing look at how we are changed by experiences and what can be done to positively impact negative effects.

“Service members and their families are trained up for war,” said Elizabeth Hawkins, executive director of ONE Freedom, “and they need a vehicle for training down once they return home. ONE Freedom approaches reintegration from a bio-physical standpoint which is a non-stigmatizing and non-therapeutic way for them to better understand and take charge of the reintegration process.”

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

Continuing:

Local Nonprofit Offers Reintegration Workshops for Returning Veterans and Their Families in Colorado Springs on November 17 and December 1.

The 1-day workshops have been well-received by young veterans and family members, active duty and National Guard, with over 1,000 Colorado veterans and families having attended workshops since the spring of 2007. 1st SGT Shields of the Colorado Air National Guard reported, “I spoke to everyone in our unit, and they told me it was the best post-brief they’ve had on stress management.”

Taught by a team of military and civilian trainers, these 1-day sessions offer a new approach to issues of reentry into home, community and work.

Dates: November 17, 2007, 10:00 a.m. - 5:00 p.m.
December 1, 2007, 10:00 a.m. - 5:00 p.m.

Location: La Foret Retreat and Conference Center
6145 Shoup Road, Colorado Springs, CO

Participation, meals and childcare are free of charge to veterans and family members with registration. Space is limited to 30 people. To register, e-mail register@onefreedom.org or call (303) 444-1221 or toll-free (888) 334-VETS.

ONE Freedom's mission is to teach audiences a ‘101 version’ of the neurophysiology of stress and to promote skills that elevate the ability to manage adverse life experiences.

For more information, visit www.onefreedom.org.

Labels: events, family, freebies, local, mind_and_body, reintegration, resources, workshops

Thursday, October 25, 2007

Obama, Bond Demand DoD Provide PTSD Data

Press release from Senator Barack Obama's office:

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.

Click on 'Article Link' below tags for full text of letter...

In the interest of education, article quoted from extensively.

Continuing:

October 23, 2007

The Honorable Robert M. Gates
Secretary of Defense
The Pentagon
Washington, D.C. 20301-1000

Dear Secretary Gates:

We are writing to request a full accounting from the Department of Defense on the number of psychological injuries sustained by service members since October 2001 and how the military reports on and invests in treating these less visible psychological injuries. Recent media accounts indicate that the number of service members seeking care for Post-Traumatic Stress Disorder (PTSD) from the Veterans Administration (VA) jumped 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.

While the literature suggests that symptoms of psychological injuries such as PTSD often surface after the initial trauma, these reported numbers not only underscore the increase in demand for mental health resources among our veterans, but suggest that many of our brave active duty service members are sustaining less visible psychological injuries at a time when the military faces a severe shortage of behavioral health personnel. As a result, many of our warriors may lack access to care just at a time when early treatment could be beneficial.

In light of the fact that mental health care is now the second largest area of VA treatment sought by Iraq and Afghanistan veterans, it is incumbent on the military to ensure it is providing adequate treatment before our warriors ever separate from service. Especially in combat theaters, where recent reports also suggest a spike in suicides, we must ensure service members facing the stress of combat operations have access to resources and care for psychological injuries.

For these reasons, we ask that you provide the following information:

* What is the total number of cases of PTSD among active duty service members documented by each military department since October 2001? Please distinguish between those cases that were diagnosed in and out of a combat theater. Is this number reported in the Pentagon’s regular compilation of wounded/injured figures, whether or not cases require a medical evacuation? Of this number, how many received treatment from a mental health professional?

* What is the total number of other reported psychological injuries documented by each military department since October 2001? Please distinguish between those cases that were diagnosed in and out of a combat theater. Is this number reported in the Pentagon’s regular compilation of wounded/injured figures, whether or not cases require a medical evacuation? Of this number, how many received treatment from a mental health professional?

* What procedures and referral mechanisms are in place in each military department for a service member who may want to seek counseling in a combat theater? How are service members currently trained to identify symptoms of combat stress?

* What is the approximate number of mental health staff, differentiated by specialty, deployed in Iraq and Afghanistan, by calendar quarter and military department, since October 2001? Of this number, on average how many are embedded with units in forward operating areas?

* What is the number of mental health staff, differentiated by specialty, for each major mobilization and demobilization Army and Marine Corps site? Please provide the number of military personnel assigned to each of these installations.

* What incentives are in place, or being considered, to attract additional behavioral health specialists, differentiated by specialty?

* For Fiscal Year 2002 through 2007, what has been the total annual expenditure, by quarter and military department, on mental health care for active duty service members? Of these totals, how much was expended for staffing, both for military personnel and private contractors?

Caring for the mental health of our service members should be as important as caring for their physical wounds. Thank you for providing this information to our offices by November 13, 2007.

Sincerely,

Barack Obama
United States Senator

Christopher S. Bond
United States Senator

Check out the related links below to see how team Obama/Kit has been doing on the issue of PTSD. Amazing work, guys.

Labels: bond, caregivers, dodd, gates, obama, outreach, oversight, psychology, senate, shortfalls, stats, wounded

Wednesday, October 24, 2007

More than 50% of Army's 948 Suicide Attempts in 2006 Sought Help First

The Hartford Courant recently ran a piece, "Suicides - A Treatment Issue," by Lisa Chedekel (who has done incredible reporting on combat PTSD issues). Noteworthy information.

From the Courant piece (via VFCS):

A recently released, first-ever analysis of Army suicides shows that more than half the 948 soldiers who attempted suicide in 2006 had been seen by mental health providers before the attempt - 36 percent within just 30 days of the event. Of those who committed suicide in 2006, a third had an outpatient mental health visit within three months of killing themselves, and 42 percent had been seen at a military medical facility within three months.

Among soldiers who were deployed to Iraq or Afghanistan when they attempted suicide in 2005 and 2006, a full 60 percent had been seen by outpatient mental health workers before the attempts. Forty-three percent of the deployed troops who attempted suicide had been prescribed psychotropic medications, the report shows.

The report offers no details on the type or duration of mental health care that troops received before they tried to kill themselves. But it is prompting calls from some soldiers' advocates for better training of medical and behavioral health specialists in recognizing and treating service members in distress.

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

In the interest of education, article quoted from extensively.

Continuing:

Like soldiers' advocates, some family members of troops who have committed suicide question the quality of care being provided.

Yania Padilla of Bridgeport said her brother, Walter Padilla, was diagnosed with PTSD after he returned from Iraq in 2004. But she believes he never received adequate treatment from either the Army or the Department of Veterans Affairs.

"He saw someone at Fort Carson" in Colorado, where he was stationed, she said. "They told him he was not to be assigned to duties where he had access to a firearm. I don't know what else they did, [but] he wasn't getting better."

Yania Padilla said her brother, a tank gunner who suffered from nightmares, flashbacks and stomach problems, received a medical discharge from the Army in December 2005. He then sought treatment from the Colorado VA. The outgoing, artistic young man who had followed his father into the Army became edgy and distant, his sister said.

On April 1 of this year, while living and working in Colorado Springs, Walter Padilla pressed his Glock pistol to his head and ended his life. He was 28.

After he died, the family found a bag full of prescription antidepressants in his apartment, said Yania, 31, a schoolteacher. "He never received the kind of help he needed," she said. "I just don't want to see the same thing happen to someone else."

A series in The Courant last year detailed a number of cases in which troops who committed suicide in Iraq in 2004 and 2005 had been seen by mental health workers and placed on powerful psychotropic drugs, with little to no counseling or monitoring. The military in August 2006 adopted detailed guidelines for dispensing psychiatric drugs to combat troops, calling on mental health providers to have weekly contact with patients, during the first weeks of treatment, and to ensure that troops receive psychotherapy.

Walter Padilla is not counted in the Army's suicide numbers, because he had been discharged before he died. The Army does not officially track veterans' suicides.

But suicides among active-duty soldiers have climbed in the last few years. In 2006, soldiers killed themselves at the highest rate in 26 years, with the number of suicides among those serving in Iraq exceeding the record level of 2005. At least 120 soldiers tried to kill themselves while deployed to Iraq or Afghanistan in 2005 and 2006.

In addition to these details, the Sacramento Bee reports:

In 2006, 30 soldiers and Marines committed suicide while serving in the war in Iraq, the most in any year since it began in 2003, according to information released by the Defense Manpower Data Center in response to a Freedom of Information Act request by The Bee. This year is on track to meet or surpass that number with at least 27 suicides so far in 2007.

Soldiers and Marines are being required to serve on the front lines for longer than any time in U.S. military history, according to a report on mental health by the Army's Office of the Surgeon General.

During World War II and Vietnam, service members were regularly and routinely withdrawn from war zones for rest, something that's not happening in this war, the report says.

The report also deemed the military's suicide prevention training not applicable in a combat environment. And with only one behavioral health specialist per 1,000 service members – one per 700 soldiers and 2,000 Marines – the question is whether service members would be able to access help even if they overcame the military stigmas surrounding mental health issues.

[UPDATE Nov 12, 2007]: WCVBtv Channel 5 report on troops returned to combat zone suffering with PTSD

Labels: army, counseling, incidents, marines, medication, outreach, stats, studies, suicidal

A Link and a Nod

I'm sure many of you who subscribe to PTSD Combat (and those who pop in from time-to-time) feel the same way that I do: There's just never enough time in a day to catch up on all the latest on combat PTSD. That's probably one of the reasons why you've subscribed in the first place.

The news on this issue increasingly comes on hot and quick these days as more and more people want to learn about the issue, and more and more media outlets bring us the coverage we need (at long last). I find it hard to keep up with it all, too.

And so, I've recently added three outside blog feeds to PTSD Combat (they're in the right-hand column, here): IAVA, Wounded Times and Healing Combat Trauma. The latter two blogs, edited by Kathie Costos and Lily G. Casura, are especially fine complements to PTSD Combat. If we lived in a perfect world, rather than simply providing a link and a nod to their great work, you'd see the three of us posting together on one site to make it easy for you to get your combat PTSD news fix all in one place.

Then again, if we lived in a perfect world there wouldn't even be a need for blogs like ours, would there? I hope the feeds provide another avenue for you to educate yourself on an issue that is not only a hot topic right now, but of great importance to our society and our returning troops and their families.

Labels: linklists, reading

Tuesday, October 23, 2007

Joshua Omvig Veterans Suicide Prevention Act Passes House and Senate, Ready for President's Signature

From the Des Moines Register:

A young Iowa reservist who killed himself after returning from Iraq, and his parents' crusade to prevent more suicides, took center stage on the floor of the U.S. House today.

Lawmakers voted 417-0 to grant final approval today to the Joshua Omvig Veterans Suicide Prevention Act. It is named in honor of an Army veteran from Grundy Center who took his own life following an 11-month deployment.

In emotional remarks, Iowans and others vowed the nation must do better when it comes to veterans who suffer from post-traumatic stress disorder.

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

In the interest of education, article quoted from extensively.

Continuing:

The bill already has been approved by the Senate, following a squabble over whether veterans should receive mental health screening, and now goes to the president for his signature.

Under the bill, the Veterans Administration is directed to develop and carry out a comprehensive program aimed at reducing suicide among veterans. Mandatory training for staff would be put in place, and veterans would be offered mental health screening and referrals, at their request, for counseling and treatment.

Mental health care would be available on a 24-hour basis, including a toll-free hotline, and additional research conducted into suicide prevention among veterans, including for those who experienced sexual trauma in the service.

Family outreach and peer counseling is encouraged under the legislation, with a special emphasis on removing the stigma associated with mental illness and promoting skills for veterans in dealing with mental illness.

Christian Science Monitor Brings OEF/OIF Veteran Care Numbers Together

A piece by the Christian Science Monitor yesterday gathers some of the numbers concerning the health care of our returning troops:

•Of the more than 1.4 million service men and women who have served in the two war zones, nearly 700,000 have become eligible for Department of Veterans Affairs (VA) medical care, of whom about 230,000 have sought such care since 2002.

• Depending on future force deployments, VA medical costs associated with Iraq and Afghanistan could total between $7 billion and $9 billion over the next decade, according to Congressional Budget Office (CBO) projections. Disability compensation and survivors' benefits could add another $3 billion to $4 billion.

• A total of about 30,000 troops have been wounded in action. The survival rate of those wounded is higher than it was in Vietnam and much higher than World War II, due to body armor, advances in battlefield medical procedures, and more rapid evacuation.

Put another way, this means the number of those killed is a relatively smaller portion of overall casualties. It also means concern is growing about injuries and ailments that have come to mark this war: amputations, traumatic brain injuries (TBI), and the mental and emotional shock of combat.

"Of the [Iraq/Afghanistan] veterans who sought care from VA, about 38 percent have received at least a preliminary diagnosis of a mental health condition, and 18 percent have received a preliminary diagnosis for PTSD [post-traumatic stress disorder], making it the most common, but by no means, the only mental health condition related to the stress of deployment," Michael Kussman, undersecretary of the Veterans Health Administration, told a House Committee on Veterans' Affairs hearing last week.

According to the Congressional Research Service, between 2003 and 2007 about 60,000 troops were diagnosed with either PTSD or TBI.

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

In the interest of education, article quoted from extensively.

One more snippet:

In recent congressional testimony, Joseph Wilson of the American Legion cited federal studies showing that by 2020, projected retirements will create a shortage of about 24,000 physicians and almost 1 million nurses nationwide.

"Another challenge [is] acquiring staff trained in certain specialty fields … physical medicine and rehabilitation, blind rehabilitation, speech and language pathology, physical therapy, and certified rehabilitation nursing," warned Mr. Wilson. "Given the special rehabilitative and long-term care needs of combat wounded veterans returning from Iraq and Afghanistan – especially those residing in rural areas – shortages in these specialty fields will have a lasting impact on these veterans as they attempt to resume independent functioning."

More OEF/OIF stats as of March 2007 (will be updated in the coming weeks). And don't forget to click on the 'stats' label below for more.

Labels: caregivers, shortfalls, stats, tbi, va, wounded

Monday, October 22, 2007

Editorial: Troops Deserve Sustained Care

From The Tennessean editorial board:

Once again, the nation has some fundamental decisions to make about supporting the troops who fight for this country.

Are people really going to support the troops and their families, including a follow-through support system as veterans cope with disabilities that include serious mental-health issues? Or is supporting the troops going to mean nothing more than writing checks for the Pentagon to carry out a flawed war policy? And does supporting the troops mean little more than engaging in cheerleading during missions of shock and awe? ...

Much of the way this nation has handled the war in Iraq and Afghanistan will be debated for years. One aspect of the debate should be on how the nation cared for the Americans it sent into battle. The war might someday be history. But the effects of it on a soldier can last the soldier's lifetime. The support must be there for the troops long after they return home.

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

Labels: benefits, disillusion, dod, editorial, injustice, media, society, wounded

Washington Post Reporters Update on Medical Care for Returning Troops Story

Well worth a listen [real : windows], last week NPR's Diane Rehm Show touched base again on the quality of health care -- and aftercare -- our returning troops are receiving:

Medical Care for Soldiers and Veterans

An update on the ongoing care and benefit challenges faced by wounded soldiers, veterans, and their families.

Guests
Anne Hull, reporter, "The Washington Post"
Dana Priest, intelligence correspondent for "The Washington Post" and author of "The Mission: Waging War and Keeping Peace with America's Military"

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

Labels: audio, benefits, injustice, wounded, wramc

Thursday, October 18, 2007

OEF/OIF Vets Seeking PTSD Care from VA Jumps 70%, Mental Health Counseling Tops 100,000

From tomorrow's USA Today:

The number of Iraq and Afghanistan war veterans seeking treatment for post-traumatic stress disorder from the Department of Veterans Affairs jumped by nearly 20,000 — almost 70% — in the 12 months ending June 30, VA records show.

More than 100,000 combat veterans sought help for mental illness since the start of the war in Afghanistan in 2001, about one in seven of those who have left active duty since then, according to VA records collected through June. Almost half of those were PTSD cases.

The numbers do not include thousands treated at storefront Vet Centers operated by the department across the country. Nor do they include active-duty personnel diagnosed with the disorder or former servicemembers who have not sought VA treatment.

About 1.5 million U.S. troops have served in Iraq or Afghanistan. Of those, 750,000 have left the military and are eligible for VA health care. The nearly 50,000 VA-documented PTSD cases far exceed the 30,000 military personnel that the Pentagon officially classifies as wounded in the conflicts.

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

In the interest of education, article quoted from extensively.

Continuing:

The total of mental health cases among war veterans grew by 58% from 63,767 on June 30, 2006, to 100,580 on June 30, 2007, VA records show. The mental health issues include PTSD, drug and alcohol dependency and depression. They involve troops who left the military and sought health care from the veterans department.

Mental health is the second-largest area of illness for which Iraq and Afghanistan veterans seek treatment at VA hospitals and clinics. It follows orthopedic problems and is increasing at a faster rate, the VA says.

The reality of troubled veterans is finally hitting the department, says Sen. Jack Reed, D-R.I., a former soldier and member of the Senate subcommittee that oversees VA spending. "They're trying to catch up with a moving train because before … they weren't getting the resources they needed," Reed says.

The department says it began responding in 2005 to war-related needs, gradually increasing by 4,000 to nearly 11,000 the number of mental health specialists, spokeswoman Alison Aikele says.

"We are seeing the increase (in mental health cases), and we are preparing to deal with it," says Antonette Zeiss, the VA's deputy chief of mental health services.

The VA's challenge is to provide PTSD care, which is complicated and expensive, where veterans need it, says Joy Ilem, a Disabled American Veterans health specialist. Delays in treatment, she says, put veterans at risk for drug or alcohol abuse or even suicide.

Labels: counseling, psychology, stats, va, wounded

A Workshop for Caregivers: Helping Children Cope with War

Coming this Saturday:

Supporting Children Affected by the Iraqi War: What Responders Need to Know [pdf flyer]

Betsy McAlister Groves, LICSW
Director, Child Witness to Violence Project, Boston Medical Center, Associate Professor of Pediatrics, Boston University School of Medicine.

Major Molinda Chartrand, MD
Division of Developmental and Behavioral Pediatrics, Boston Medical Center, Assistant Professor of Pediatrics, Uniformed Services University of Health Sciences

Brandeis University, Schwartz Auditorium [directions]
October 20, 2007
9:30 - Registration
10:00 – 1:00 Presentation

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

Program details:

Wartime operations in Iraq and Afghanistan have a significant impact on the children and families of deployed soldiers, now numbering more than 1.5 million persons. Many families and children are able to cope in healthy ways with the stresses of deployment and parental absence.

However, for some families, especially those in which the soldier is injured, killed or psychologically debilitated, the experience may have a traumatic effect on all family members.

The goal of this workshop is to present a framework for understanding the range of children’s responses to the stressors of having a parent deployed to a war front and to identify strategies to support those children who may be more vulnerable.

Drawing upon research findings from studies of military families, and the clinical experiences with traumatized children seen in the Child Witness to Violence Project at Boston Medical Center, the presenters will give an overview of childhood traumatic stress and its effects on social and emotional development.

Guidelines for identifying children who are at risk and for providing support that builds on family and community strengths will be presented.

Educational Objectives
* To increase knowledge of child traumatic stress and its effects on child development.
* To increase knowledge about the stresses of deployment and typical family reactions to deployment.
* To gain skills at identifying children who may be at risk.
* To become familiar with principles of intervention and support for children and families.

Co-sponsored by SOFAR, National Association of Social Workers, Massachusetts Chapter; Mass Chapter of the American Academy of Pediatrics Brandeis University, Lemberg Children’s Center PCFINE and MAPP

Continuing Education Information
The Massachusetts Association for Psychoanalytic Psychology (MAPP) offers continuing education for psychologists and social workers. MAPP is approved by the American Psychological Association to sponsor continuing education for psychologists. MAPP maintains responsibility for this program and its content. Please contact Alice Rapkin at 781-433-0906 for the number of continuing education credits available and the authorization number.

The Lemberg Children’s Center, Education Program, Brandeis University will issue certificates of participation for educators.

SOFAR is a program of PCFINE

Labels: deployment, events, family, local, self care, stress, trauma

White House Begins Move to Implement Dole-Shalala Commission Recommendations

This week, President Bush began moving forward on the recommendations of his post-Walter Reed scandal appointed Commission On Care For America's Returning Wounded Warriors, also known as the Dole-Shalala Commission.

From Stars and Stripes:

President Bush’s plan to reform the disability compensation system, which he sent to Congress on Tuesday, includes a four-part payment scheme targeted exclusively at a newer generation of servicemembers and veterans.

The plan is ambitious in scope and more generous than the current disability system. As proposed by the White House, it would be applied automatically only to future disabled veterans. It would be offered as an alternative to current disability benefits only for veterans separated or retired from service since Oct. 7, 2001, the day of the U.S. invasion of Afghanistan. ...

As described by Donna Shalala, Dole’s co-chair and a former cabinet member under President Clinton, the Bush plan would totally restructure how disability compensation levels are set.

The military’s role would be reduced to conducting a thorough physical and, from that, determining if an ill or injured servicemember is unfit for duty. Those found unfit would be retired with a lifetime annuity based on final rank and time in service. Annuities would set at 2.5 percent of basic pay multiplied by years served.

The VA then would award a disability rating based on any service-related injury or ailment found. In addition to the military annuity, veterans would get a three-part VA payment: (1) transition money to help adjust to civilian life; (2) a monthly payment for loss in earnings capacity, the same rationale for current disability pay; (3) a new quality-of-life payment to compensate for limits on day-to-day activities resulting from the disabilities.

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

The changes, however, will not be extended to veterans of former eras, and that has created a bit of a sticking point. Continuing from Stars and Stripes:

Former Sen. Robert Dole, an architect of the plan as co-chairman of the President’s Commission on Care of America’s Returning Wounded Warriors, said he is getting “push back” from veterans’ service organizations. Lawmakers will feel it too, he said, but it shouldn’t deter them from giving newly-disabled vets and the current force a better disability package.

“I think we passed the baton to this generation” as being “the greatest,” Dole told the Senate Veterans’ Affairs Committee on Wednesday. “If they do a little better than we did, that’s OK. These are the grandsons and sons of Vietnam veterans and World War II veterans.” Improving their benefits, he said, “shows we’re making progress” and honoring their sacrifice.

More details from the Associated Press:

[T]here would be a single medical exam to evaluate injuries; the military and VA now do separate exams. Wounded service members and their families would receive lifetime health care coverage. Those with post-traumatic stress disorder would be eligible for lifetime treatment. Relatives could take up to 12 months off from their jobs to help with care. ...

Terry Scott, chairman of the Veterans' Disability Benefits Commission, an independent panel appointed by Congress and the president, said any overhaul of the disability evaluation and payment system could take up to five years to complete.

The prospect of a long wait frustrated some senators. "We don't have any choice, we have to do it and we have to do it quick," said Sen. Richard Burr, R-N.C. The Dole-Shalala commission has not given a cost estimate for the changes in benefits, and Dole said cost was not a factor in the recommendations.

Among the new benefits would be transition payments for service members who leave due to injuries and compensation for changes in quality of life caused by an injury.

"Maybe you won't be able to dance, maybe you won't be able to play the piano. Things you can't do that really affect your quality of life," said Dole, who was seriously injured while serving in Italy during World War II.

The Los Angeles Times adds:

[The commission] proposed potentially far-reaching changes in a system established more than 50 years ago to meet the needs of veterans of World War II and the Korean conflict.

"It's an old system, it's an antiquated system, it's an outdated system that needs to be changed," Bush said during a session with reporters in the White House Rose Garden after he met with the commission. He praised the care provided at Walter Reed but said "serious problems" had caused "bureaucratic delays and administrative failures."

He said the need for legislative action was "urgent."

Dole agreed, describing the regulations of the current system as 600 pages of "Band-Aids and amendments." The military personnel needing care now, he said, are of "a different generation than my generation, than the Vietnam generation. And the treatments are different."

When the commission issued its report, Shalala estimated that its recommendations would cost $1 billion over 10 years.

Karl Zinsmeister, assistant to the president for domestic policy, said that before costs could be assessed, officials would have to redraw what is known as the injury schedule -- the amount that service members receive for permanent wounds, such as below-the-knee leg amputation.

In a conference call with reporters, Zinsmeister said the current military disability system, which covers 3 million wounded veterans, cost the government about $30 billion a year. The new system, he said, would probably "cost a little more than the old system."

The White House also said that the Veterans Affairs department would establish "recovery coordinator" positions -- patient advocates assigned to oversee the management of individual veterans' care, help them handle paperwork and other requirements of the federal bureaucracy, and ease their transition to civilian life. Creation of such a position was a key recommendation of the commission. ...

Veterans would be reassessed every three years, and the rating system would be adjusted to reflect "modern concepts of medicine and disability," the White House said, describing the plan. ...

Severely wounded service members would be eligible for up to 40 hours of weekly in-home assistance, easing the burden on their families, the president said.

Paul Rieckhoff, Iraq veteran and founder of Iraq and Afghanistan Veterans of America, applauds the President's move on the commission's recommendations, but reminds us today:

While the intentions of the Commission’s recommendations should be applauded, there are outstanding problems that will undoubtedly impede their accomplishment. With the Secretary of Veterans Affairs’ post filled by a temporary appointment, and a VA budget that is more than two weeks late, implementation will be a challenge.

One of the Dole-Shalala Commission’s major recommendations is already doomed. The Commission suggested that coverage be provided for family members of wounded troops under the Family Medical Leave Act. Earlier this month, this protection was denied not due to bureaucratic hurdles or funding shortfalls, but because of the President’s decision to veto SCHIP, the State Children’s Health Insurance Program reauthorization.

Today, Congress had an opportunity to override the President’s SCHIP veto-and should have voted to do so. Two largely overlooked provisions of SCHIP would address the urgent issue of protecting military families as outlined by the Dole-Shalala Commission. Sections 621 and 622, under Subtitle C, provide one year of employment discrimination protection to family members caring for grievously wounded troops, and extend permitted work leave for these caretakers from three to six months.

Right now, when a service member is critically wounded, friends and family members put their lives on hold to be at their loved ones’ bedside during the weeks and months of recuperation. Annette McLeod is one such family member. When her husband, Specialist Wendell McLeod, was injured while serving in Iraq, she rushed from her Chesterfield, South Carolina home to be with him at Walter Reed in Washington, D.C. Caring for her husband, who sustained multiple injuries to the back and head, became her full time job. After three months at Walter Reed, the human resources department at the factory where she had worked for 20 years told her she had exhausted her time off. She was forced to give up her job and all of her benefits.

Annette’s story is all too common. Thanks to improved battlefield medicine, thousands of troops are surviving catastrophic injuries, but they face long and painful recoveries at home. This puts enormous financial and emotional strain on their loved ones. According to the Dole-Shalala Commission, one in five severely wounded troops says a family member or friend has had to give up a job to provide care. Unfortunately, current law offers caregivers few employment protections. All too often, they lose their jobs, pushing their families to the brink of financial ruin.

Today, Congress had the opportunity to defend the family caregivers of wounded heroes by overriding the President’s SCHIP veto. Unfortunately, the legislation that would have given these families much-needed breathing room failed. So now, instead of focusing on recuperating, many of our injured service members will have to worry about where their family’s next paycheck will come from.

Any member of Congress who claims to support the troops should have voted to override the President’s SCHIP veto today. When this vote failed, so did a critical protection for families of our most grievously wounded troops. And now, more family members like Annette will face unfair and unnecessary financial burdens during what is already a more difficult time than most of us can imagine. Our wounded heroes and their families deserve better.

Outline of the President's plan from the White House Fact Sheet, Ensuring Our Wounded Warriors Get the Best Possible Care:

To the extent that the Administration can move forward without legislative action, we are working to implement the Commission's recommendations; however, some reforms require Congressional action:

Modernizing And Improving The Disability And Compensation Systems

Commission Recommendations

1. Change DoD Disability Entitlement for those deemed unfit for duty for combat-related reasons by providing an annuity based solely on rank and service, rather than percent disability.
2. Expand TRICARE Coverage to those unfit for duty for combat-related reasons, not just those who are at least 30 percent disabled or who have 20 years of service, as in the current system.
3. Restructure VA disability entitlement such that, for new entrants retired from service for fitness, VA benefits would include transition payments to cover living expenses equal to either three months of base pay (if no rehabilitation is needed) or family living expenses for longer-term rehab patients. The new VA disability benefits would also include "earnings-loss payments" and "quality-of-life payments."
4. Reassess all disability rating schedules to ensure they reflect modern medicine and modern concepts of the impact of disability. VA would reassess disability status every three years and adjust compensation accordingly.
5. Increase vocational rehabilitation benefits such that VA would pay a bonus equal to 10 percent of transition pay after year one, 5 percent after year two, and 10 percent after year three of training completion.

Legislation

* DoD disability payments should be replaced by DoD annuity payment for all eligible service members separated or retired after the implementation date of this provision. Those separated or retired since the beginning of the Operation Enduring Freedom/Operation Iraqi Freedom will be able to choose between the existing system and the new system.
* TRICARE benefits should be extended for those seriously injured in combat or combat-related activities.
* The VA disability system should be strengthened and improved to provide for an immediate transition payment, loss of earnings, and quality of life payment.
* Individuals and their conditions will be reassessed every three years.
* The disability rating schedule should be updated to reflect modern concepts of medicine and disability.
* The disability system restructure will take effect upon conclusion of the seven-month disability compensation study, legislation implementing VA disability payment rates, and regulations updating VA's disability rating schedules.

Administrative Actions

* Beginning in November 2007, DoD and VA will pilot a replacement to the cumbersome previous system of two entirely separate disability determinations by each Department with a single, comprehensive medical exam to be administered by DoD.
* Rulemaking is underway to update the VA Schedule for Rating Disabilities to include Traumatic Brain Injury (TBI) and severe burns.

Aggressively Preventing And Treating Post-Traumatic Stress Disorder And Traumatic Brain Injury

Commission Recommendations

1. Expand VA health coverage to ensure that all veterans of Operation Enduring Freedom and Operation Iraqi Freedom with post-traumatic stress disorder (PTSD) receive care related to this condition.
2. Address DoD shortage of mental health clinicians.
3. Conduct awareness training and provide clinical guidelines for PTSD and traumatic brain injury (TBI).

Legislation

* All Operation Enduring Freedom and Operation Iraqi Freedom veterans should be allowed to receive PTSD care from the VA without first showing service connection.

Administrative Actions

* Secretaries of the military departments have begun using existing authorities such as incentive pay and bonuses to recruit and retain sufficient experts in mental health fields.
* DoD and HHS are working on an MOU to provide additional mental health professionals to meet short term needs.
* By November 30, 2007, DoD and VA will establish a National Center of Excellence to conduct training and research, deliver care, and disseminate clinical best practices with regard to TBI, PTSD, and other mental health conditions.
* DoD has expanded mental health and TBI training programs for deploying service members.
* VA is working to screen all patients for PTSD as part of their initial treatment.

Significantly Strengthening Support For Families

Commission Recommendations

1. Expand TRICARE respite care and aide and personal attendant benefits to service members seriously injured in combat.
2. Provide training and counseling to family members to support them as caregivers. DoD and VA should standardize and assure universal access to family services early in the treatment process. This package should include education about the service member's injuries and expected progress, caregiver training and counseling, and psychological services.
3. Amend the Family Medical Leave Act (FMLA) to allow up to six months of unpaid leave for family members of combat-injured service members, and allow combinations of unpaid and paid leave, when available.

Legislation

* TRICARE respite care and aide and personal attendant benefits should be provided to service members seriously wounded in combat under Extended Care Health Option (ECHO).
* Many family members of service members with combat-related serious injuries should be eligible to receive 26 weeks of unpaid leave within the first 24 months following the injury or diagnosis of the injury.

Administrative Actions

* DoD and VA have implemented family caregiver training.
* DoD and VA are developing a package of employment options and health care options for caregivers of seriously injured service members.

The Administration Is Acting Now To Implement Recommendations That Do Not Require Legislative Action

Immediately Creating Comprehensive Recovery Plans To Provide The Right Care And Support At The Right Time In The Right Place

Commission Recommendations

1. Those seriously injured in combat will receive an individual Recovery Plan that leads them back to duty or public life seamlessly guiding and supporting them through medical, rehabilitation, and disability programs.
2. A Recovery Coordinator will be assigned to service members seriously injured in combat to serve as their ultimate resource in the recovery process. The Public Health Service (PHS) Commissioned Corps will help develop this cadre of well-trained and highly skilled advocates.

Administrative Actions

* On September 19, 2007, DoD, VA, and the Department of Health and Human Services (HHS) signed a joint Memorandum of Understanding (MOU) for the creation of a joint Recovery Coordinator Program for service members seriously injured in combat or combat-related activity.
* By December 1, 2007, DoD and VA will develop the Recovery "Life" Plan to be used by the Federal Recovery Coordinators for seriously injured service members with combat-related injuries.
* VA will take the lead on creating the organizational structure for the Federal Recovery Coordinators. The PHS Commissioned Corps will serve as consultants for program development and care management.

Rapidly Transferring Patient Information Between The Departments Of Defense And Veterans Affairs

Commission Recommendations

1. DoD and VA must continue the work under way towards a fully interoperable IT system that will meet long-term administrative and clinical needs.
2. DoD and VA must, within the next 12 months, have all patient information viewable by any clinician, health professional, or administrator who needs it within either department.
3. DoD and VA must develop a plan for a user-friendly health and benefits portal for service members, veterans, and family members.

Administration Actions

* No later than October 31, 2008, DoD and VA will make available and viewable all essential health and administrative data.
* By March 31, 2008, DoD and VA will have the ability to share all essential health images.
* DoD and VA are creating a single Web portal to provide for the care and support needs of veterans and their families.

Strongly Supporting Walter Reed By Recruiting And Retaining First-Rate Professionals Through Closure In 2011

Commission Recommendations

1. DoD must ensure that Walter Reed (WRAMC) has the resources it needs in outpatient and inpatient care.
2. DoD must implement tailored incentive packages to encourage civilian personnel to continue working at Walter Reed, and enable recruitment of new professionals as needed.

Administrative Actions

* The Secretary of the Army will ensure that WRAMC has a sufficient budget to fund recruitment and retention bonuses.
* The Secretary of the Army is pursuing additional recruitment authorities to hire and assign health care practitioners and support personnel.
* DoD sent a request to the Office of Personnel Management to authorize DoD's use of retention bonuses to retain high-quality personnel.
* DoD is creating a "guaranteed placement program" to ensure that critical employees at Walter Reed will have placement at the new National Military Medical Center if they stay in place until WRAMC closure.

Labels: benefits, bush, disabled, dod, dole, family, funding, iava, injustice, legislation, shalala, va, wounded, wramc

CBO Stats on OEF/OIF Casualties and Costs

Deputy Assistant Director for National Security Matthew S. Goldberg's written statement given to the Congressional Budget Office yesterday offers an analysis of the costs of taking care of returning troops returning home from our wars in Afghanistan and Iraq. Extended has the summary stats. The full document is available online [pdf].

A few other stats reported previously by the CBO included.

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

From the summary:

Source: Congressional Budget Office

+ As of December 2006, more than 1 million active-duty military personnel and over 400,000 reservists had deployed to combat operations in the Iraq and Afghanistan theaters. Of those, 690,000 have either separated from the active component or become eligible for VA health care as reservists. In turn, one third of those personnel (numbering 229,000) have sought VA medical care since 2002.

+ About 3,800 U.S. troops have died while serving in OIF, and over 400 have died in OEF. A total of almost 30,000 troops have been wounded in action during those two operations.

+ The survival rate among all wounded troops has averaged 90.2 percent during OIF and OEF combined. By comparison, the survival rate during the Vietnam conflict was 86.5 percent. Among seriously wounded troops, the survival rate was lower—76.4 percent—during the Vietnam conflict and has also been lower—80.6 percent—for OIF and OEF combined. Higher survival rates during OIF and OEF reflect the widespread use of body armor, as well as advances in battlefield medical procedures and aeromedical evacuation. A census conducted by the Department of Defense (DoD) indicates 749 amputations from OIF and 42 amputations from OEF through January 2007. The amputation rate is 3.3 percent among all wounded troops.

+ Through December 2006, DoD physicians had diagnosed a total of 1,950 traumatic brain injuries (TBIs), of which over two-thirds were classified as mild. The rate of TBI diagnosis is 8.2 percent among all wounded troops. Some TBIs, however, are difficult to diagnose and may go unrecognized unless screening is performed after a soldier returns to the United States from deployment.

+ Post-traumatic stress disorder (PTSD) is also difficult to diagnose. Among OIF and OEF veterans who have received VA medical care, about 37 percent have received at least a preliminary diagnosis of mental health problems, and about half of those (17 percent) have received a preliminary diagnosis of PTSD. The overall mental health incidence rate may be lower to the extent that OIF and OEF veterans who have not sought VA medical care do not suffer from those conditions. On the other hand, some veterans with PTSD or other mental health problems may not seek care because they fear being stigmatized.

+ Of the total 229,000 OIF/OEF patients seen by the VA, 3 percent (fewer than 8,000) have been hospitalized in a VA facility at least once since 2002; the other 97 percent were seen on an outpatient basis only. Not all of those patients visit VA medical facilities in any single year; in 2006, for example, 155,000 OIF/OEF patients were treated by VA, accounting for 3 percent of the total veteran patient load. VA estimates an average annual cost of $2,610 per OIF/OEF veteran who used VA health care in 2006, versus an overall average of $5,765 per year for all VA patients.

+ VA’s medical budget is discretionary (that is, lawmakers appropriate funds on an annual basis); it is not possible to project definitively VA’s future medical appropriations because they depend on future acts of the Congress. However, depending on the future force levels deployed to OIF and OEF, if the Congress chooses to fully fund medical care for veterans of those operations, VA medical costs explicitly associated with those operations could total between $7 billion and $9 billion over the 10-year period 2008 through 2017, CBO projects. The costs of disability compensation and survivors’ benefits could add another roughly $3 billion to $4 billion over the same period.

Meanwhile, from Reuters last month:

A long-term U.S. military presence in Iraq, as President George W. Bush has alluded to, would cost around $10 billion to $25 billion a year, depending on how often troops are engaged in combat, the Congressional Budget Office said on Thursday.

CBO, a nonpartisan budget analyst for Congress, based its estimates on a 55,000-troop presence in Iraq, far smaller than the approximately 169,000 U.S. soldiers now fighting a war that is in its fifth year.

"The analysis addresses the potential costs of a U.S. presence that might last for several decades, as it has in Korea, and would not necessarily apply to operations over the next several years," CBO said.

On July 31, CBO said the Iraq war has already cost U.S. taxpayers about $421 billion. Bush could soon ask Congress for another $200 billion to cover Iraq and Afghanistan war costs next year.

The budget office prepared the latest report [pdf] at the request of Senate Budget Committee Chairman Kent Conrad, a North Dakota Democrat who opposed the war in Iraq.

Conrad, noting that CBO previously estimated a possible $1 trillion cost for maintaining troops in Iraq from 2009 to 2017, said the CBO estimate of costs for an additional 40 years would bring the tab to around $2 trillion. ...

The CBO report estimated that 55,000 U.S. troops engaged in long-term combat would cost around $25 billion a year, but could exceed $30 billion annually, in part depending on whether equipment wears out at a faster pace.

CBO said this would be in addition to one-time costs of $4 billion to $8 billion.

For a long-term noncombat mission, as U.S. forces have performed in the Korean peninsula or Germany, the $10 billion-a-year cost assumes the Pentagon would have to supply food, electricity, sewage and other utilities. But "costs would fall over time" if the Baghdad government improved the country's economy and infrastructure, CBO said.

CBO noted that it costs less than $1 billion annually to support about 80,000 U.S. personnel watching over the Korean border.

More CBO Afghanistan and Iraq reports.

Labels: benefits, funding, kia, stats, studies, tbi, wounded

Wednesday, October 17, 2007

Fort Campbell: 9 Suicides in 2007, 3 in Last 2 Weeks Moves Commanding General to Act

From the Army Times:

Fort Campbell’s commanding general is making suicide prevention a priority as he cites the ninth soldier this year taking his own life as enough. The latest death was Tuesday, making it the third soldier suicide within the last two weeks.

“This is unacceptable and it must stop,” wrote 101st Airborne Division commander Maj. Gen. Jeffrey J. Schloesser in a letter to the post community. “I want everyone associated with Fort Campbell to take pause, and to focus on what we can do as a community to reverse this trend.”

Schloesser wrote in the letter that with the stresses that go along with multiple deployments, everyone needs to be extra vigilant about looking after each other.

More than 10,000 division soldiers have already deployed to the Middle East, with about 5,000 more to leave for Afghanistan early next year. Both tours are expected to last up to 15 months. For many of these soldiers it’s their third or fourth deployment within the last six years.

“In stressful times such as these, with so many pushed to the breaking point, it is vital that we ALL understand that we are not alone, and that EVERYONE has a role to play when it comes to suicide prevention,” he wrote.

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

Last month, from IPS News:

Dane and April Somdahl own the Alien Art tattoo parlor on Camp Lejeune Boulevard -- just outside the sprawling Marine Corps base of the same name in Jacksonville, North Carolina. In an interview from the back of her shop, April talked about how her customers' tastes have changed since George W. Bush ordered the invasion of Iraq in March 2003.

As the war approached, she said, "The most popular tattoos were eagles and United States flags. Those were coming in so often and, you know, everybody was like 'I gotta get my flag.'"

Then, a year into the war, the Somdahls noticed a new wave of Marines coming in to get information from their military dog tags tattooed onto their bodies. Most said they wanted so called "meat tags" so their bodies could be identified when they die.

"We went through over a year of meat tags, but then that passed too," she said. "Now we are seeing a lot of memorial tattoos. Even the wives are getting memorial tattoos -- moms and dads in their fifties too. And in a lot of cases they're getting their first tattoos. And they're saying 'We didn't think we would ever get a tattoo, but this one is to remember my son.'"

Because of the changing needs of their clientele, the Somdahls no longer blast rock and roll music inside the shop. Instead, the artists work in silence.

"The mood has died," April told IPS.

"For our employees to do tattoos of photos of fallen heroes, fallen friends, it plays hard on them," she said. "It makes it so our artists are depressed. The tattoo isn't done just for decoration or just for fun anymore. The tattoo has become a solid symbol of their feelings and a lot of it dealing with the war."

The mood is particularly heavy because the Somdahls have had a death in their own family. On Feb. 20, April's younger brother, Sergeant Brian Jason Rand, shot himself under the Cumberland River Centre Pavilion in Clarksville outside Fort Campbell, Kentucky.

Officials at Fort Campbell refused to comment on Brian Rand's suicide, saying they don't discuss individual soldier's deaths. But the military brass has been investigating what seems like an increasing trend of soldiers taking their own lives.

From another report by the same journalist:

After two tours in Iraq, Brian Rand told his sister April Somdahl: "I can see everything April. It all makes perfect sense now. I know what I have to do and it makes so much sense. I have to die. I have to leave the physical realm and leave earth and go up in heaven and be part of the Army of God and I've got to stop this war and save my guys here. And the best way I can do that is to do it up in heaven 'cause I can't do anything while I'm down here.'"

On February 20, 2007, the Clarksville, Tennessee police department found his body lying facedown under an entertainment pavilion on the banks of the Cumberland River, with a shotgun beside it.

Another Fort Campbell soldier among the nine to have committed suicide this year is Derek Henderson. From the Louisville Courier-Journal:

Derek Henderson's hands shook as he held the railing on the Clark Memorial Bridge and stared down at the dark waters of the Ohio River.

A few feet away stood Aisha "Nikki" McGuire and her boyfriend, Patrick Craig, who had spotted Henderson while driving by. They begged him not to jump -- "It's not worth it," they said. Henderson wouldn't say what brought him there. "I don't want to talk about it," he told Craig, before climbing over the railing and hanging for a moment off the other side.

McGuire looked at his face and saw fear. She ran to police officers who were just pulling up, as the big clock on the Colgate plant across the river in Indiana showed a few minutes before midnight.

Craig kept pleading with Henderson: "God is with you, man. Come on."

"Thank you, brother," Henderson said.

Then he let go.

On that night in mid-June, Henderson, a 27-year-old Louisville resident who'd served with the Army in Iraq and Afghanistan, surrendered to an enemy that has tormented thousands of veterans.

Like nearly one out of every five Americans who have served in the conflicts, Henderson suffered from Post Traumatic Stress Disorder. And like many of them, he had made the rounds of veterans' hospitals and psychiatric wards but still was unable to defeat his demons.

Although it's unclear exactly when he was diagnosed, his PTSD is noted at least five times in medical records, obtained by his family and supplied to The Courier-Journal, that cover a period that begins shortly after his Army discharge in October 2003.

Henderson's family believes the Louisville Veterans Affairs Medical Center could have done more to ease his pain, by keeping him in the hospital for longer stays, for example.

VA officials wouldn't discuss the case for privacy reasons but expressed condolences to the family.

Henderson's story is, in many ways, a familiar one. A study published in June showed that men who served in the military are twice as likely to kill themselves as men who haven't, and the federal government estimates that 5,000 veterans, including those who have not seen combat, commit suicide every year.

Experts worry that the numbers will grow as more soldiers come home with mental wounds. Dr. Bentson McFarland, an Oregon psychiatry and public health professor and an author of the recent suicide study, said veterans of the wars in Iraq and Afghanistan face many risk factors, such as repeated tours and the constant stress of urban warfare.

"I hate to say it," McFarland said, "but I think it's going to be worse than Vietnam."

After a look at Henderson's childhood, the piece describes what he was like when he returned from Iraq:

When he returned home after an honorable discharge in October 2003, Henderson was edgy and quick-tempered, his family said. He began to carry a footlong knife in his car.

One night, when his mother stopped at his apartment, he seemed agitated as he took her hand, forcefully pulled her to her knees and demanded she pray. "Derek," she told him, "you've got to get help." She petitioned to have him committed to the VA Medical Center in November, and a judge agreed, calling for a 60-day involuntary hospitalization.

In medical records provided by Henderson's family, a psychiatric exam done at University Hospital before the commitment said he "has a hard time with transformation from military life to civilian life," that he was asking for a gun to protect himself "on the battlefield."

Despite the judge's recommendation, VA doctors released him after a week with an anti-anxiety medication called BuSpar, which is sometimes used to treated "hyperarousal" or irritability in PTSD, medical records say. Henderson's mother said she pleaded with doctors to keep him longer or give him stronger medication.

A month later, Crumes Henderson said, she was working at Norton Audubon Hospital as a night shift nursing assistant when her son confronted her. Agitated and angry, he accused her of interfering with his attempts to get a job as a contractor in Afghanistan -- which she said she didn't do.

Before she could calm him, he sped off, but he returned later in the night. Swearing at her, he again accused her of interfering with his job plans.

"What's wrong with you?" she asked. Outside, he drove his car toward his mother and two co-workers; the car brushed her hip. He then backed up the car and struck a stairwell. Employees scattered.

Henderson got out of his car, looked up at the sky and yelled: "Oh God! What did I do?" Then he took the knife from his car and hacked at his left wrist.

Crumes Henderson and her co-workers were treated for minor injuries at Audubon, while an ambulance took her son to University Hospital for emergency surgery to repair nerves, tendons and an artery.

A record of the trip, provided by the family, says doctors and nurses told ambulance workers that PTSD, combined with anger, prompted the violence.

A 2001 study in the journal Military Medicine showed far more aggression among veterans with PTSD than those without. And the VA's National Center for PTSD says: "Many symptoms of PTSD can lead to a lifestyle that is likely to result in … sudden outbursts of violence."

University Hospital medical records describe Henderson's PTSD and his difficulties with "adjustment to civilian life." They say he "talked at length about time served in Iraq" and told doctors, nurses and therapists that he was "looking for peace."

Medical records also say Henderson suffered from psychosis, a loss of contact with reality that sometimes co-exists with PTSD. One chart listed schizoaffective disorder, a mental illness characterized by delusions and mood problems.

Nurses and therapists also noted that he spent hours in prayer. Pointing at his Bible, he told one hospital worker, "I just need to read more."

After about two weeks, doctors transferred him to Central State Hospital, a psychiatric care facility in eastern Jefferson County.

After that, he made the rounds of the VA, University Hospital and Central State. His family can't remember how many stays there were, but said they were frequent. Most were short, although Central once kept him more than a month, and his family believed the long-term care served him best.

Another of far too many incidents that will be added to the PTSD Timeline in the coming months as I return to that project.

Labels: army, disillusion, incidents, reintegration, society, stats, suicidal

Shortfall of Chaplains Another Military Strain

From last night's ABC World News, a report on the spiritual comfort provided injured soldiers by our nation's military chaplains. Unfortunately, there is a severe shortage of these important personnel in the military today, with each deployed spiritual caregiver responsible for up to 1,000 soldiers the report says.

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

In March, MSNBC reported on the problem as well:

Some Army National Guard units may have to deploy overseas without a chaplain if recruitment incentives, including $10,000 signing bonuses, don’t work to fill hundreds of vacant positions.

Some chaplains have served repeated overseas tours to help take up the slack.

“We’re all concerned that we don’t wear the guys out — there is a limit,” said Chaplain Lt. Col. Randall Dolinger, a spokesman for the Army Chief of Chaplains Office in Arlington, Va.

The Army National Guard has 310 chaplain vacancies. That’s 40 percent of its authorized level, but so far the Guard has not been forced to deploy units without a chaplain, Dolinger said.

Vacancies soared after 2001, when many chaplains moved to active duty in the Army. Filling the openings has been difficult because faith leaders have been deterred by the likelihood of long and repeated deployments to Iraq and Afghanistan, Dolinger said. ...

The shortage is largely an Army National Guard problem, with the Air National Guard at 85 percent of its quota. Army National Guard officials said they have a tougher challenge because unlike the Air National Guard, their units are scattered and demand more chaplains. Active duty services also have managed to fill most of their chaplain slots, Dolinger said.

Labels: caregivers, shortfalls, spirituality, video

A Thank You to Amherst

This is a quick thank you to everyone who attended last night's Amherst stop of the Moving a Nation to Care book tour. (Especially, a big thank you to Cho, my ePluribus Media PTSD Timeline colleague who snapped these photos; my camera, which has been hit or miss since I dropped it on my hotel bathroom's hard tile floor the night of my very first book stop in Waltham in May, decided to sit this event out. Shrug.)

I'm planning a book tour recap in the coming days.

For now, these photos will have to suffice. While in Massachusetts, Kevin and Joyce Lucey were kind enough to arrange a live New England Cable News interview (thank you Liz and Leslie) for me [view video]. They also came out in support of my stop, and I'd like to thank them immensely, along with everyone else who attended.

It was a night I'll never forget, hosted by the wonderful people at Food For Thought Books. Thank you one, and all.

Labels: advocacy, authors, events, moving_a_nation

Sunday, October 14, 2007

Moving a Nation to Care Tour Returns to Massachusetts Tuesday in Amherst

Since May, I've been fortunate enough to have had the chance to meet a great many incredible people on my Moving a Nation to Care book tour. With no fancy limos and author's handlers whisking me to and fro between airports and book stores and fancy hotels and cocktail receptions (that's how it is for other authors out there, isn't it? :o), I've had to rely on angels on the ground who have made each stay a success.

Back in May, my first stop was just outside of Boston at Waltham's Back Pages Books. Tuesday I return to that great state, my events bookending a very fine run, this time to Food For Thought Books in Amherst. It will be my final 2007 tour stop.

Long neglected as I researched, wrote and promoted Moving a Nation to Care these past 18 months, in November I return my focus to working on the PTSD Timeline with my ePluribus Media colleagues. Sadly, the incidents continue unabated.

If you are in the Amherst area, I do hope you can join us in wrapping up what has been a really incredible journey for me.

Although I am what one might consider an accidental author (due to the fact that Ig Publishing proposed I write a book when I hadn't considered such a thing even within my realm of possibilities), I have enjoyed the process and have been honored to join with those already actively advocating for our returning troops and their families. Thank you, Ig.

And for everyone else out there: Thank you for embracing me, my (which I really consider our) work, and most especially thank you for your help in moving a nation to care.

I am so proud of us...

Details:

Moving a Nation to Care reading and book signing

Date: Tuesday, October 16, 2007
Time: 7:00 PM
Place: Food for Thought Books Collective
106 N.Pleasant Street
Amherst, MA 01002

Contact: Tel: 413-253-5432 :: Fax: 413-256-8329 :: Email

Labels: authors, events, local, moving_a_nation

As Combat PTSD Stigma Fades Somewhat, Funding Fight and Political Disillusionment Come Into Focus

Today's New York Daily News quotes two highly-decorated veterans appointed to the House Veterans Disability Benefits Commission.

They've spent over two years studying the problems of the Veterans Administration health care system. In discussing their 113 recommendations (released earlier in the month), comments by one of its distinguished members, retired Marine Maj. Gen. James Livingston, brought to focus how far we've come in our work to destigmatize combat PTSD:

They were an unlikely bunch of soldiers to be making the case for the "talking cure" before Congress last week. They once dismissed it as a copout for shirkers and wimps.

"Absolutely, we've gone through a transition" over the years, said retired Marine Maj. Gen. James Livingston, who wears the Medal of Honor from Vietnam. "Now I'm a believer in early intervention" by therapists in the treatment of post-traumatic stress disorder, the diagnosis for what was called battle fatigue or shell shock in wars gone by, Livingston said.

While we've made great inroads (especially when considering that a rough, tough guy like Livingston has come around full-circle in his attitude towards the psychological wounds of war), the truth is that our changed attitudes are worthless if we don't follow up with the proper response.

Proper response means we make sure that we not only learn from all of these time- and resource-consuming studies, but also that we act on what we've learned. That means putting informed recommendations into action. That means funding these valuable recommendations fully and not being insincere about how we as a nation say we support our military families.

But as we move forward in destigmatizing the way many of us think about combat PTSD, we haven't even begun to move forward in dealing with another very real stigma against those vets who dare to say that part of their combat PTSD is related to disillusionment with the war that they participated in.

From the Department of Veterans Affairs Iraq War Clinician Guide:

Over time, soldiers develop a belief system about themselves, their role in the military, the military culture, etc. War can be traumatizing not only because of the specific terrorizing or grotesque war-zone experiences but also due to dashed or painfully shattered expectations and beliefs about perceived coping capabilities, military identity, and so forth."

'So forth' can include becoming disillusioned with the war itself.

And that 'so forth' can include disillusionment with the way they're treated once they get back home.

If we learned nothing else from the experience of Viet Nam veterans, it is this: Disillusionment with the reality of war and its aftermath and the role individual soldiers play in it is as much a part of combat PTSD for some as are flashbacks or nightmares of blood and gore, or grief and guilt over the loss of battle buddies and admired leaders.

Let's take a look at these two issues, 1) putting our money where are mouths are when it comes to funding and acting on what we've learned and 2) allowing returning troops the nonjudgmental space to process their experience candidly without stigmatizing those who have returned disillusioned and perhaps even bitter about the war they fought in.

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

In the interest of education, article quoted from extensively.

Continuing from the Daily News:

The VA system is overloaded. Waiting periods for appointments at VA regional centers now average 177 days. At Veterans Benefits Administration offices, which assign disability ratings, the waits stretch to more than two years.

But they were told that money was tight for what they proposed. "We must deal with funding issues," insisted Rep. Stephen Buyer (R-Ind.).

Livingston said the money must be found, the PTSD programs must be funded, or the nation will risk decimating the all-volunteer force.

"People have to know they're going to be taken care of," Livingston said, or "moms and pops are not going to allow their kids to join the military."

He reflects on lessons learned:

"Well, you remember what it was like" for Vietnam veterans, Livingston said to this reporter, who served with him in the 2nd Battalion, Fourth Marines, before the battle of Dai Do on May 2, 1968, where he earned the Medal of Honor.

Leading Echo Company, then-Capt. Livingston attacked the fortified village with 180 Marines. He was wounded three times and there were 35 Marines standing after Echo took the village and fought off a ferocious counterattack.

"I always thought after Dai Do it would've been good if we could've sat down and talked about it," Livingston said. "But in those days it was all macho," he said. "You didn't want to admit anything. If you did, you were a battlefield wimp. Well, been there, done that.

"I'd like to think we're a lot more mature in our thinking. Bottom line, somebody's got to give a damn."

Showing our military families that we care about them means that we have to deliver on the promises made to them.

So far, that response has been a hollow, underfunded one.

In addition, society can often place added burdens on its returning troops by expecting them to think and act a certain way. Pro-war soldiers are given the spotlight while anti-war soldiers are often stigmatized and shunned. They make us uncomfortable.

But here's the question: Do returning veterans who have uncomfortable-to-some political arguments against the war deserve the space to share their feelings with us without our condemnation? Or should they be expected to go away or even shut up so that the rest of us don't have to grapple with their issues and concerns?

So far, we have had a relentless two-faced approach towards matters concerning our troops. We say we support them, yet we've allowed them to serve in combat zones without proper equipment. And we've stood by and watched as they return home with insufficient periods of rest between deployments and to underfunded programs they and their families need.

Might any of this further anger or disillusion them?

The fact is that combat PTSD is not merely a reaction to the sight of blood or the grief of losing a comrade.

What they've witnessed and seen and experienced when they were away plays a starring role, of course. But their inner turmoil can't help but be exacerbated by frustration with a system that makes them wait years to get a claim heard or months to get an appointment for care when they come home.

Let's give our veterans the funding they deserve.

And let's give them the freedom they need to express themselves, no matter what direction their views take. They're the ones with real skin -- and heart and soul -- in the game.

Labels: disillusion, funding, politics, shortfalls, society, stigma, vietnam

Saturday, October 13, 2007

First 'Veterans Village' Set to Open in California in November

This is wonderful news to share, and an update of a June 2006 post. It shows the power of one, boosted by the power of many.

From the Stockton Record:

An unexpected donation of land and a four-story building in Sonoma County has ramped up a Tracy woman's plans for a retreat center to segue soldiers from the battlefield to civilian life.

The building, in final phases of construction on a wooded hillside outside idyllic Guerneville, and 2 acres of farmland will serve as a pilot location for Nadia McCaffrey's Veterans' Village, a self-sustaining counseling and job-training center for armed forces members returning from Iraq and Afghanistan.

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

Continuing:

A World War II veteran, who wants to remain anonymous, made the donation late last month after hearing McCaffrey speak in Petaluma two months ago about her vision for the Veterans' Village program.

"He is a veteran himself. He understands what they are going through when they come home," McCaffrey said.

McCaffrey's son, Sgt. Patrick McCaffrey, a National Guard soldier, was killed by the Iraqi troops he was training in 2004. A nonprofit organization McCaffrey founded and named for her son is heading up the project and expects it to be serving as many as 16 veterans by the end of November. ...

A soldier who served in the National Guard with McCaffrey's son volunteered to redeploy to Iraq in July rather than cope with the transition to civilian life, said McCaffrey, who has kept in touch with soldiers who served with her son. The soldier, whom McCaffrey did not name, had taken to heavy drinking and risky behavior as he attempted to settle back into civilian life, McCaffrey said.

McCaffrey continues to pursue plans for a $25 million main Veterans' Village campus in North Carolina, where she has been working with local veterans groups, and she envisions satellite villages around the country to offer aid to the hundreds of thousands of veterans returning from war.

Since 2002, 686,306 veterans of the Iraq and Afghanistan wars have left active duty and are eligible for health benefits from the U.S. Department of Veterans Affairs, according to the agency. One-third of those veterans - 229,015 - have been evaluated by Veterans Affairs, and slightly more than a third of them were diagnosed with mental disorders, such as post-traumatic stress disorder.

[UPDATE Oct 22, 2007]: Related report from San Francisco ABC News:

Growing Military Family Movement Helps Returning Troops

Labels: advocacy, community, reintegration, resources, video

Friday, October 12, 2007

Studies, Reports, Promises and Reality: Another Deplorable Case of Veteran Neglect

Years of studies, and endless reports showing that the veteran health care system is broken in America. Endless promises made by politicians and overseers of the system. And yet another unbelievable, maddening, saddening, deplorable case of neglect has led to the stateside death of a veteran injured in an Iraqi roadside bomb attack.

From the Associated Press:

An Indiana National Guardsman who died while in the care of an Army unit for wounded soldiers was alone, in excruciating pain and had not been seen by doctors for days, his family said.

Sgt. Gerald Cassidy, 32, of Westfield, died in a chair on the third floor of a renovated barracks at Fort Knox, Ky., in September – five months after arriving at the post with what his family said was brain damage suffered in a roadside explosion in Iraq.

Cassidy’s mother, Kay McMullen, of Carmel, said Tuesday that the manner of his death – and inconsistent treatment that included the Army denying him pain medication – cast doubt on the quality of care for service members if the severely wounded are being left to fend for themselves.

“He died because the Army didn’t care for him,” she said tearfully. “He came back from Iraq, and they killed him.”

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

In the interest of education, article quoted from extensively.

Continuing:

A military autopsy had not been fully completed Tuesday, but results of an independent examination performed at the request of the family could not determine a cause of death. That autopsy, however, found Cassidy had been dead for hours before being found and may have been unconscious for days.

Cassidy’s body was found in his room Sept. 21.

Military officials checked on Cassidy only after his wife made repeated calls to the post begging for help, McMullen said.

His family said a review of voice-mail messages left on Cassidy’s cell phone indicate he had not been checked on for at least two days despite an Army requirement that each soldier be accounted for twice daily. McMullen also said the Army declined to let an Indianapolis doctor treat him until weeks before his death.

Connie Shaffery, spokeswoman for the Army post outside Louisville, Ky., declined to comment. “This is something that is very important to us, and we want to have a conclusive answer,” she said.

Cassidy arrived at Fort Knox in April with blinding headaches, memory and hearing loss and post-traumatic stress disorder. He was assigned to a “warrior transition unit,” which the Pentagon created for wounded service members after problems were discovered at Walter Reed Army Medical Hospital.

Under the Army units, each injured service member is to be assigned a doctor, a nurse care manager and a squad leader to manage treatment. A Government Accountability Office report last month, however, found that more than half the 35 new medical units were not fully staffed.

Shaffery said the transition unit at Fort Knox also had not been fully staffed, but that the nearly 250 injured soldiers there get adequate care.

As early as 2003, Fort Knox was the target of criticism for putting injured soldiers in unsuitable living conditions, including outdated wooden barracks unfit for medical care. Wounded soldiers that year were moved to newer, more accommodating buildings, but similar problems were reported at posts including Fort Stewart, Ga.

McMullen questions whether that care was adequate. She said Cassidy was often left in lines waiting to see doctors and would forget whether he took his medications due to memory problems.

On one occasion, Cassidy told family he passed out in his room and woke in a pool of blood coming from his nose and mouth. “He should have had a buddy. He should never have been put in a room by himself,” McMullen said. “He would still be alive if they had let him do that.”

While Congress and the President find themselves incapable of moving quickly to remedy the funding problem, I guess our military families can only expect more of the same.

Labels: army, disillusion, guard, incidents, injustice, shortfalls, tbi, wounded

College Students: Mental Health Care Field Needs You

From my Northern Star column today:

There is a need for health care professionals in our military. Don’t know what to do after college? Maybe you can answer the call.

Leo J. Shapiro & Associates is a premier Chicago-based market research firm. Every month, the 50-year-old company surveys Americans on how they feel about a variety of issues, such as spending and saving, consumer prices and the stock market, and income and job security.

In August, they reported that nearly 40 percent of us are worried about losing our income because of a job layoff or cut in work hours.

It was the fourth month in a row that Americans were so downbeat. Clearly, a lot of us are anxious about our future. And college students are no different. If anything, their anxieties are compounded: College students not only worry about their future job security, they also worry about choosing the right major.

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

In the interest of education, article quoted from extensively.

Continuing with one more snippet:

Last month the Pentagon reported that hundreds of social workers, nurses and health care specialists are needed in the fields of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD).

Specifically, the need for psychiatrists and psychologists is so great that the military is proposing shortened two-year recruitments and richer retention bonuses for these positions. They’re even offering to pay down outstanding college loans for this essential group.

For those leery of enlisting, the Veterans Administration gives civilians a chance to “serve” without having to sign up for a tour of duty in a combat zone. And by donating their services through groups like Operation Comfort and Give an Hour, even private therapists are lending a hand to returning troops and their families who need reintegration help.

As the operations in Afghanistan and Iraq continue, and with troops continuing to return home with TBI and PTSD, a career specializing in either of these fields is sure to provide the job security most of us crave. Added bonus? A health care career would serve the needs of the country, too.

Labels: caregivers, jobs, opinion, shortfalls, stats

Thursday, October 11, 2007

Action Item: Tell Congress to Approve Veterans' Budget Now

Iraq and Afghanistan Veterans of America is spearheading a campaign directed at moving our congressional leaders to approve the delayed veterans' budget. They've collected funds to air a television commercial and are collecting signatures for a petition. It's not too late to donate or to add your name if you feel you'd like to support this worthy cause.

The commercial is below, and more details below the fold.

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

For educational purposes, article(s) quoted from extensively.

Yesterday, IAVA founder Paul Rieckhoff wrote on the issue over at the Huffington Post:

In the spring, as the scandal at Walter Reed Army Medical Center dominated the headlines, the President promised to fix the problems facing returning veterans. Congress proposed the best veterans' budget we've ever seen, including the biggest increase in funding for vets' health care in 77 years.

But more than six months later, little action has been taken. A new GAO report confirms that the problems at Walter Reed aren't solved. Furthermore, the VA budget is officially late, so veterans' hospitals are making do with temporary funding at last year's low levels. ...

Apparently, Congress is too busy fighting about Rush Limbaugh's comments or MoveOn's latest ad to solve the problems facing veterans. When there's real work to be done, they'd rather take a stand against name-calling. Lately, they've been like the Miss Manners of legislative assemblies.

We hope you'll watch the ad, and join us in reminding Congress that the troops still have real problems to worry about. The politicians need to put aside the partisan game-playing and provide some real solutions.

Clarksville Online introduces two people featured in the IAVA ad:

Annette L. McLeod is the wife of Army Specialist Wendell W. McLeod, Jr. On July 6, 2005, at the end of a ten-month deployment, Spc. McLeod sustained multiple injuries while serving near the Iraqi border in Kuwait.

On August 8, 2005, Wendell arrived at Walter Reed Army Medical Center. During his stay, Spc. McLeod experienced sporadic appointments, was often denied the necessary tests and treatment, and had his identity stolen. Furthermore, though Wendell suffered from traumatic brain injury, the doctors concluded that his cognitive impairments were the result of a pre-existing learning disability.

In hopes of sparing other military families from having to go through a similar ordeal, Mrs. McLeod testified before the House Government Reform and Oversight Committee on March 5, 2007. In her testimony, Mrs. McLeod called attention to the bureaucratic hurdles and poor care that her husband and other soldiers faced at Walter Reed. Her full testimony can be found here [pdf].

Today, Wendell continues to suffer from migraines, Post-Traumatic Stress Disorder (PTSD), and chronic pain. He also has behavioral and short-term memory problems. As a result, Annette has assumed the role of almost full-time caretaker for her husband.

Staff Sgt. John Daniel Shannon was wounded in Iraq on Nov. 13, 2004, during a gunfight in the town of Habaniya. He suffered a gunshot wound to the head that resulted in the loss of his left eye and a traumatic brain injury.

At Walter Reed Army Medical Center, SSG Shannon endured bureaucratic neglect and was continually denied proper benefits. Largely as a result of lost paperwork and delayed treatment, it took Shannon over two years to secure medical retirement through the Medical Evaluation Board and Physical Evaluation Board.

On March 5, 2007, SSG Shannon spoke out about the problems at Walter Reed during his testimony before the Government Reform and Oversight Committee. His testimony revealed that injured troops encountering obstacles to receiving their proper treatment often give up their benefits in order to move on with their lives. His full testimony can be found here [pdf].

Analysis from the Gloucester County Times (because it hits all the pertinent points, I am sharing a great length of it):

The veterans' health issue may be a case study in how the regular budget process does not work. House and Senate lawmakers have passed bills to significantly increase funding for the health care system run by the U.S. Department of Veterans Affairs.

But members of Congress haven't managed to find a way to negotiate a final House-Senate compromise, or a final deal with the White House, even though officials in both parties want to pump more cash into the stressed veterans' health care system.

The House legislation would provide $43.2 billion for the U.S. Department of Veterans Affairs in fiscal 2008, an unheard-of increase of $6.7 billion over last year. The Senate draft would provide $43 billion for the VA, a $6.5 billion boost. The House bill passed in mid-June, 409-2. The Senate vote occurred in early September, 92-1. But there are problems, as there have been for eight years running.

The White House Office budget office has issued policy statements to blast both the House and Senate bills for "an excessive level of spending and other objectionable provisions." President Bush, perhaps wary of vetoing a bill for veterans' health care during the war on terrorism, did not threaten to nix either bill.

Instead, Bush demanded that lawmakers cut the added money they were targeting towards veterans' health care from other programs. And he urged them to stay within his budget cap of $933 billion for discretionary programs. ...

Bush had sought $39.4 billion for the VA for next year. That would be a significant increase, but $3.8 billion less than provided by the House bill and $3.6 billion less than appropriated in the Senate measure. ...

Democrats want to spend up to $22 billion more on discretionary programs including education, children's health care, job training, farm programs, water projects, roads and bridges, homeland security initiatives, and scientific research than President Bush has proposed for fiscal 2008.

Democrats claim that $22 billion is not a huge amount of money, at least not in comparison to an estimated $12 billion per month that the government is spending in Iraq and Afghanistan.

White House officials and lawmakers have not even begun talks to bridge the discretionary spending gap. Instead, Members of Congress have passed a bill to keep the government running through Nov. 16.

And so the delay in funding veterans' programs persists for roughly 1,400 VA health care facilities and 7.9 million enrolled veterans around the country.

Let's tell Congress this is unacceptable.

Labels: benefits, bush, funding, house, iava, injustice, legislation, politics, senate, shortfalls, stats, va, wramc

Today is National Depression Screening Day

As part of Mental Illness Awareness Week every October, one day is set aside by clinicians throughout the country to offer free screenings and educational programs. Today is that day (apologies this post is so late). Details from About.com:

What Should I Expect During a Screening?

Screenings are free and completely confidential. The screening is an opportunity to learn more about anxiety and mood disorders, complete a brief screening questionnaire, and speak one-on-one with a mental health professional. If appropriate, you may be referred for a complete evaluation.

As part of the screening, you will have the opportunity to:

* Complete a written screening questionnaire,
* Discuss your results with a health professional,
* Get a list of clinicians and treatment facilities in your area,
* Watch an educational video,
* Pick up some pamphlets and brochures, and
* Fill out a "friends and family questionnaire" for a loved one.

To find a site near you, visit www.mentalhealthscreening.org.

If you can't get out today in time for a free consultation, About.com has a list of online depression screening tools.

Labels: events, freebies, psychology, screening

Wednesday, October 10, 2007

South Dakota VA Hosts Retreat for Female Veterans and Military Family Members

From the Rapid City Journal:

The specialized Post Traumatic Stress Disorder Outpatient Treatment Program of the Department of Veterans Affairs Black Hills Health Care System is hosting a women's retreat Friday through Sunday, Oct. 19-21, at Fort Meade VA Medical Center.

The semiannual weekend retreat, beginning at noon Oct. 19, is for women veterans of all eras and family members (wives, significant others, mothers, adult daughters, etc.) of male combat veterans. The major objectives of the retreat are to help provide participants a better understanding of PTSD and an opportunity to develop new perspectives in relationships.

Participants must be screened and preregister by calling the SUPT Program at 720-7449 or 1-800-743-1070, Ext. 7449.

More upcoming veteran-focused events.

Labels: events, family, reintegration, va, women

Are PTSD Veterans Slated to Lose Their Right to Possess Firearms?

I haven't peered deeply enough into this issue, but I've been hearing bits and pieces of this story for the past couple of months. The following explanation of this hot button issue is from a Military.com column by VAWatchdog.org editor Larry Scott:

There is no such thing as the “Veterans Disarmament Act.” There is no pending legislation that would take firearms away from veterans. There is no pending legislation that would prevent a person with post-traumatic stress disorder (PTSD), veteran or not, from purchasing a firearm or ammo.

But, there is a huge campaign of misinformation and scare tactics being forwarded by a small gun owners group who view themselves to be in competition with the National Rifle Association (NRA).

Let’s use some common sense instead of nonsense. If veterans were to lose the right to own firearms, you’d have a lot of unemployed cops. If those who have PTSD were to lose that right, there’d be even more unemployed cops and other first responders, as well. The arguments about a “Veterans Disarmament Act” are, quite simply, ridiculous and illogical.

The piece of legislation is question is H.R. 2640, the NICS Improvement Amendments Act of 2007. H.R. 2640 was carefully-crafted by the NRA and Members of Congress to protect the rights of gun owners, especially those who may have mental health issues such as PTSD.

Alert: Tell your public officials how you feel about this legislation.

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

In the interest of education, article quoted from extensively.

Continuing:

The NICS is the National Instant Criminal Background Check System, the database that contains the names of those not allowed to buy firearms and ammo. There are nine specific groups of persons who are included in the database.

Included is anyone "has been adjudicated as a mental defective or has been committed to any mental institution." "Any mental institution" would, obviously, include a VA hospital mental ward. And, the government's definition of a "mental defective" is: “A determination by a court, board, commission, or other lawful authority that a person, as a result of marked subnormal intelligence, or mental illness, incompetency, condition, or disease: (1) Is a danger to himself or to others; or (2) Lacks the mental capacity to contract or manage his own affairs. The term shall include a finding of insanity by a court in a criminal case.”

The confusion over H.R. 2640 and veterans, especially veterans with PTSD, began in 2000 when the VA gave the names of between 83,000 and 89,000 veterans to the NICS database. The names were of veterans who had been committed to VA psychiatric wards or who had been adjudicated as a “mental defective.” This was required of all government agencies.

Some thought that any veteran with a mental health issue ended up on the NICS list. That is an absurd assumption. If a veteran tries to quit smoking and goes to VA smoking cessation classes, they are in a mental health program because nicotine is considered an addictive substance. The same applies for those seeking treatment for alcohol or drug abuse. And, we know, these veterans did not end up in the NICS database.

Neither current law nor H.R. 2640 would put any person, including veterans, who have sought psychiatric treatment or voluntarily checked themselves into a psychiatric unit on the NICS list. This includes those with PTSD, those seeking treatment for alcohol or drug abuse and those who have voluntarily sought help and been admitted for observation, sometimes termed a “voluntary commitment.”

So, why all the noise about H.R. 2640? Some feel the small gun owners group is just looking for members. Others feel they have some kind of beef with the NRA. Whatever the reason, the misinformation and scare tactics should be considered for exactly what they are.

The NRA (which supports H.R. 2640), in the wake of the Virginia Tech shootings that killed over 30 students, realized that current firearms legislation had some real problems. People who should be in the NICS database, like the Virginia Tech shooter, were left out. And, just as important, the NRA knew that some people who shouldn’t be in the database had been included and there was no way for them to get their names of the NICS list. Also, some believe there is wiggle-room in the current regulations that can allow government agencies to “interpret” them incorrectly. The NRA set out to solve those problems, and they did. ...

The bottom line for veterans concerned about H.R. 2640 is to just use some common sense. Read the legislation. You may not agree with it. But, if you’re a veteran or you have been diagnosed with PTSD, don’t worry, they aren’t coming for your firearms. The NRA put it correctly when they said, “H.R. 2640 is NOT gun control legislation.” It is legislation designed to end inequities in the current laws that have unfairly prevented many from purchasing firearms and ammo.

Please read the rest of the piece.

Protections built into H.R. 2640:

(1) IN GENERAL- No department or agency of the Federal Government may provide to the Attorney General any record of an adjudication or determination related to the mental health of a person, or any commitment of a person to a mental institution if--

(A) the adjudication, determination, or commitment, respectively, has been set aside or expunged, or the person has otherwise been fully released or discharged from all mandatory treatment, supervision, or monitoring;

(B) the person has been found by a court, board, commission, or other lawful authority to no longer suffer from the mental health condition that was the basis of the adjudication, determination, or commitment, respectively, or has otherwise been found to be rehabilitated through any procedure available under law; or

(C) the adjudication, determination, or commitment, respectively, is based solely on a medical finding of disability, without a finding that the person is a danger to himself or to others or that the person lacks the mental capacity to manage his own affairs.

Please note again that a person cannot be put on the NICS list solely for a "medical finding of disability,” and that would include PTSD.

Also, H.R. 2640 will provide a means for a person to take their name off the NICS list if they should not be on it, something they cannot do at this time. That provision reads:

(A) PROGRAM FOR RELIEF FROM DISABILITIES- Each department or agency of the United States that makes any adjudication or determination related to the mental health of a person or imposes any commitment to a mental institution, as described in subsection (d)(4) and (g)(4) of section 922 of title 18, United States Code, shall establish a program that permits such a person to apply for relief from the disabilities imposed by such subsections. Relief and judicial review shall be available according to the standards prescribed in section 925(c) of title 18, United States Code.

Labels: house, legal, legislation, opinion

Tuesday, October 09, 2007

Minnesota Holds Its First-Ever Combat Stress Conference; Warrior to Citizen Campaign Editorial

Over the past two years, I've been following Minnesota's top notch efforts on behalf of its military families and returning troops (see related posts below). The state and its communities have been proactive to the nth degree in offering these important members of society the support that they need to deal with deployments -- and the readjustment period that follows.

With all the good work coming out of Minnesota, it's not surprising to see their latest move. On October 17th they will be convening a conference featuring Lt. Col. Dave Grossman, author of the indispensable book, On Killing: The Psychological Costs of Learning to Kill in War and Society.

Details:

To address the behavioral health care needs of the thousands of Minnesota National Guard members throughout the state, Blue Cross and Blue Shield of Minnesota (Blue Cross), along with TriWest Healthcare Alliance and the Minneapolis VA Medical Center (VAMC), is hosting the first-ever Combat Stress Conference.

The Minnesota National Guard consists of more than 13,000 members who live in nearly every corner of the state. Since 2001, more than 80 percent of the members have been mobilized for active duty, serving in 33 different countries. In addition, nearly 2,600 Minnesota National Guard members completed their deployments to Iraq and returned home in August.

Nearly 350 community-based physicians, nurses, psychiatrists and other health care professionals that care for the troops have been invited to attend the conference on Oct. 17, 2007 at the Earle Brown Heritage Center from 7:30 a.m. to 5 p.m. It is intended to help providers identify deployment-related symptoms such as combat stress, anxiety, depression, post-traumatic stress disorder (PTSD) and traumatic brain injury, as well as providing treatment methods.

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

Continuing:

"Health care professionals need to understand the unique health care needs a veteran brings to them," said Chaplain Lt. Col. John J. Morris, Minnesota National Guard. "For example, a veteran may be depressed, experiencing nightmares and flashbacks, or have difficulty concentrating. We are asking providers to learn how to recognize the signs of combat stress and address those issues when they are treating a combat veteran."

"The onset of emotional or mental health symptoms is unpredictable. Symptoms can manifest immediately or take months or years," said Dr. Melissa Polusny, psychologist with the post-traumatic stress disorder recovery program at the Minneapolis VAMC. "Giving providers information about clinical combat stress is vital to addressing the mental health needs of our troops and their families throughout the deployment cycle. If providers don't know what to look for, they may miss a crucial clue of the kind of treatment a patient really needs."

Key conference presenter is retired Lt. Col. Dave Grossman, author of On Killing: The Psychological Costs of Learning to Kill in War and Society. Grossman's book explores the reactions of healthy people in killing circumstances (such as police and military in combat) and the factors that enable and restrain killing in these situations.

Additional sponsors include the Minnesota Psychological Association, University of Minnesota and the University of North Texas Health Science Center.

In related Minnesota veteran news, an editorial from the Minneapolis-St. Paul Star Tribune:

Minnesota communities and civic institutions can do much to help returning veterans make a healthy transition to civilian life. The Warrior to Citizen campaign promotes a variety of such activities, from simply offering thanks or a listening ear to veterans, to hosting job fairs and convening support groups.

That aspect of the new campaign is not unique. Many groups are offering a helping hand to returning vets. Indeed, the Minnesota Guard's own reintegration program, Beyond the Yellow Ribbon, is receiving national acclaim for its systematic 30-, 60- and 90-day support seminars for Iraq war Guard veterans and their families.

But Warrior to Citizen is making a special contribution, highlighted last week by the Citizens League as part of its Civic Minds series. Its emphasis is not only on communities helping veterans, but also on veterans helping communities. It takes seriously a message Ahlness said needs saying just now: "We can expect great things of these veterans."

Warrior to Citizen maintains that a citizen's public work ought not end when a military uniform is packed away. It invites veterans who think the skills they acquired in Iraq aren't relevant to life in Minnesota to think again. Veterans' appreciation of group dynamics alone has wide application in civilian life -- not to mention the specialized skills many of them acquired in water quality improvement, construction, supply management and the like. Their stories of public service also have great value.

"All of our communities stand to benefit from the tremendous leadership skills these folks come back with," said Jessie Ostlund, a campaign developer. That idea should catch on. It can expand the way Minnesotans see returning vets -- and maybe the way they see themselves.

For more information, see www.publicwork.org, or call 612-625-0142.

Kudos to the great state of Minnesota.

Labels: authors, caregivers, community, editorial, events, guard, local, psychology, reintegration, society, va

Saturday, October 06, 2007

Deep Breathing Techniques for Stress Release

YouTube is not only a great source of news and entertainment clips, it's also got some wonderful instructional videos. I've collected a few here that focus on better breathing techniques to aid in stress release.

Yoga Chicago recently reported on the usefulness of deep breathing and meditation exercises for those coping with PTSD:

The U.S. Department of Defense has not yet fully embraced yoga, but the Walter Reed Army Medical Center in Washington, D.C. is seeing impressive results from it. A recent feasibility study conducted there indicated that a particular approach of yoga had a positive effect on military personnel suffering from post-traumatic stress disorder (PTSD).

The study, funded by the Samueli Foundation, a private grant-making institution dedicated to facilitating positive change and enabling individuals to achieve their potential, used a protocol of Yoga Nidra meditation to examine its healing effect on US active-duty soldiers who were experiencing PTSD from their experiences in the Afghanistan and Iraq war zones. Yoga Nidra uses deep relaxation, deep breathing and meditation to systematically reduce physical, emotional, mental and even subconscious tension.

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

#1
First, a 5-minute relaxation meditation of nature scenes and sounds.

The most important part of yoga practice is the ability to breathe deeply and fully. Proper breathing is vital to our health, mental focus and sense of calm.

In this free, introductory class, Kavita guides you through simple techniques to bring fullness to your breath; these techniques are useful both on and off the yoga mat. Bring the Yoga of the Breath with you wherever you go Duration: 7 min

Ancient yogis discovered that we don't breathe through both nostrils at the same time and that each of our nostrils share characteristics of brain hemisphere dominance: for instance, when we breathe through the left nostril, the right side of the brain (creativity) is dominant and when we breathe through the right nostril our left brain (logic) is dominant

Do this for 3-5 minutes when you awake, anytime during the day, and/or before you turn in for the night.

Butterfly Breathing is a great way to start you day or any work out. It's a good cold remedy, too! It gets you well oxygenated, helps you eliminate toxins, gets your cardio vascular system revved up and bumps up your metabolism. It's a great way to perk yourself up when you're mentally fatigued. And, just about anybody can do it safely.

#5
A good 7-minute basic yoga breathing session.

This is an example for paced breathing with the characteristics of slowed respiration (10 seconds interval) and prolonged exhalation (4 seconds inhalation : 6 seconds exhalation). This could be helpful for relaxation. Begin with the higher pitched tone. Perhaps it is better with only audio or only visual pacing. Of course you can use first both audio and video information and after that only one of them.

The 10 seconds interval was found in the so-called "Mayer waves", which is a cardiovascular rhythm. If this rhythm is enhanced, it can lead to increases in parasympathetic and decreases in sympathetic activity.

Adjust the volume so that it is pleasant to you.

Labels: mind_and_body, relaxation, self care, video

Friday, October 05, 2007

A Look at the Unease of Transitioning to Homefront Living Following Combat

Last week, the New York Times examined concerns some of the 3,300 soldiers of the 10th Mountain Division’s Second Brigade have after winding up their 15-month combat tour. It's a good window into the anxious feelings many troops have at homecoming.

On bases big and small south of Baghdad, the scrambled reality of war has become routine: an unending loop of anxious driving in armored Humvees, gallons of Gatorade, laughter at the absurd and 4 a.m. raids into intimate Iraqi bedrooms.

This is Iraq for the 3,300 soldiers of the 10th Mountain Division’s Second Brigade, and many have come to the unfortunate realization that it now feels more like home than home.

No brigade in the Army has spent more days deployed since Sept. 11, 2001, and with only a few weeks to go before ending their 15-month tour, the soldiers here are eager to go. But they are also nervous about what their minds will carry back, given the psychic toll of war day after day and the prospect of additional tours.

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

In the interest of education, article quoted from extensively.

Continuing:

[G]oing home often creates another cycle of grief, said Lt. Col. Reagon P. Carr, the behavioral health officer for the Second Brigade. Many soldiers return feeling not just down but also guilty for having survived, Colonel Carr said.

The Army screens returning soldiers for post-traumatic stress disorder and other signs of trouble, but for many, the struggle has already begun. During one recent week, Colonel Carr said, he met with 3 soldiers contemplating suicide, 12 who could not sleep, 5 who feared returning to a dysfunctional marriage and 16 who said they were disgruntled about their leadership.

“A lot of soldiers here, from what they’ve seen or witnessed, will go back very on edge,” he said. “It is a cumulative effect, especially when you have a short time between deployments.”

The challenge for most consists of figuring out “how to keep Iraq in Iraq and how to keep home at home,” said Capt. Rich West, the chaplain in Mahmudiya.

Several soldiers said they feared free time at home and the thoughts that might arise. Few have told their families the details of what they have seen, or how accustomed they have become to a surreal routine with no 9 to 5, no errands, no bills, no diapers — just a series of moments that snap from frightening to odd, and then back again.

On one recent patrol near Abu Ghraib, for instance, a group of Second Brigade soldiers received wet kisses from a barefoot old woman with tattoos as they searched her backyard for nitric acid that could be used in explosives. ...

[T]he war here, as it continues on and on, can be banal, a groove well worn by a shared sense of humor and knowing glances that say “only in Iraq, only in Iraq.”

Detachment comes and goes. As Colonel Carr said, his treatment in the field must be limited; soldiers are taught to cope so they can go out and do their jobs.

Many bring that need to detach home with them.

With their tolerance for war increased, many soldiers say they feel stronger, having faced a test and passed. Their families may ultimately be the ones left out, as they try to connect with loved ones forever changed.

This is exactly what many soldiers fear. For Sergeant Ray, who has spent a total of about 30 months in Iraq with the Second Brigade and other units, this deployment has been particularly tough. He and his wife have been deployed since last summer; he patrols south of Baghdad, she works in Mosul, in the north. As a result, his 7-year-old stepson and 2-year-old daughter now live with their grandparents in New Jersey.

He still loves the Army, valuing the work, the brotherhood of his platoon and the military’s promise of financial stability, he said. His wife will get out soon, however, and he cannot help wondering about the war’s effect on his daughter.

“I think she’s just confused,” he said, as the sun set on the date palms south of Baghdad. “She’s right at that age. She turned 2 in August, so she’s just starting to talk and realize what’s going on. And neither one of us is there.”

Labels: avoidance, family, fear, grief, homecoming, iraq, reintegration

Wednesday, October 03, 2007

Veterans Disability Benefits Commission Releases Report, Recommends Sweeping System Overhaul

From the Associated Press:

Veterans disability payments should be increased immediately by up to 25 percent as part of a sweeping overhaul designed to compensate for a wounded warrior's lost "quality of life," a special commission recommended Wednesday.

The 2 1/2-year study [full report :: executive summary]...by the Veterans' Disability Benefits Commission offers the most comprehensive look yet at the ailing government benefits system that provides millions of injured veterans with about $30 billion a year in payments.

Tracking the findings of recent reports that detailed flaws in veterans care, the 13-member congressional commission concluded in its 544-page report that both the Pentagon and Veterans Affairs Department fall woefully short in providing adequate mental health care as well as timely and fair disability payments.

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

Military Times reflects on the report:

Most of the recommendations, including the proposed 25 percent benefits boost, would require congressional action before they could take effect.

With the Bush administration already balking at the $4 billion increase in veterans’ health care and benefits programs being pushed by Congress, it is unlikely that administration officials would support further increases.

However, an overhaul of the veterans’ disability rating system, streamlined claims processing and an easier transition from military to veterans programs are all issues under consideration by Congress, and could end up included in the Wounded Warrior Assistance Act that lawmakers expect to pass later this year. An overhaul of the military’s complicated disability retirement and physical evaluation process is expected to be part of that bill. ...

The VA ratings schedule that sets disability levels has not been changed in 62 years, and needs to be updated, the commission says, with top priority going to revising the ratings for PTSD, traumatic brain injury and other mental health and neurological body systems. This could be done quickly, in time to help Iraq and Afghanistan war veterans, while leaving a review of the rest of the ratings to roll out over five years.

Continuing with AP:

[R]etired Lt. Gen. James Terry Scott, the commission's chairman, said the disability system needed to be revamped, expressing his belief that the Army might be seeking to lowball veterans' disability ratings to avoid paying more benefits. ...

"We have come up with 113 recommendations — some of them are cheap. Some are easy. Some are extremely hard and complex. Some of them, there is a significant bill attached to it," Scott said. "But what we're hoping is that the Congress carefully looks at all 113."

Among the findings:

_Veterans with post-traumatic stress disorder are in danger of slipping through the cracks because there is little coordination among agencies to ensure they get the full range of services from needed medical treatment to proper compensation and vocational rehabilitation so they can return to work.

_After initial screenings, the VA often does not follow up soon enough with re-examinations of veterans with suspected PTSD. The report blamed in part the VA's struggles to reduce its backlog of disability claims, which it said was diverting the agency's attention and resources away from needed PTSD care. The commission called for mandatory re-examinations for PTSD to gauge treatment and other issues every two to three years.

_Benefits should be awarded to veterans for any service-related injury, regardless of whether it was incurred during combat.

_The VA must make better use of technology as a way to reduce its overwhelming delay of 177 days, on average, in handing out disability payments.

Sen. Daniel Akaka, D-Hawaii, who chairs the Senate Veterans Affairs Committee, said his panel will closely review the recommendations in the coming weeks.

"Many of these changes may prove costly," he said. "However, as I have stated time and time again, caring for veterans must be viewed as a continuing cost of war."

The commission report comes after the Government Accountability Office last week found that the Bush administration has yet to find clear answers to some of the worst problems afflicting wounded warriors, such as personalized medical care and reducing backlogs in disability pay.

Labels: akaka, benefits, disabled, dod, oversight, senate, shortfalls, studies, va

Blackwater Employee PTSD Care Questioned

From ABC News:

Along with congressional hearings on allegations of recklessness against Blackwater USA security forces in Iraq, questions are also being raised about the way military contractors deal with traumatic stress while overseas and upon returning home.

The House began hearings Tuesday on the military contractor Blackwater following reports about the company's employees in Iraq who were linked to the killings of 11 Iraqi civilians in September...In light of the high-profile incidents, possible explanations for the company's actions are emerging, including psychological harm such as post-traumatic stress that led to erratic behavior by some contractors.

"I have never heard of a company offering psychological counseling," a military contractor who works for another company said on the condition of anonymity because of his firm's involvement with the Blackwater investigation.

In February we looked at the mental health care given to private government contractors returning from work in combat zones like Iraq. While the focus at that time was on insurance coverage denial, related questions are rising from the current Blackwater story.

One problem area is the responsibility private companies have -- or do not have -- for providing returning employees access to sufficient health care resources (to treat PTSD, for example, if necessary). And how proactive do these private companies need to be in designing and delivering such a health care system?

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

In February, NPR Day to Day looked at the experience of recently-returned contractors, including those coping with PTSD. The San Francisco Chronicle introduced us to a private contractor who'd worked in Iraq:

No one knows how many of them have been injured and killed. No one keeps track of how many contractors there are in Iraq. And when they come back, many find themselves abandoned. "Nobody ain't doing nothing for us," said [Steven] Thompson, 43, who for six months in 2004 drove a supply truck in Iraq for Halliburton subsidiary KBR, the largest corporate contractor in Iraq.

Thompson was paid $1,850 a week while he was there -- far more than he had been earning before the war. "And I'll tell you right now, it wasn't worth it," he said. Thompson said he survived several roadside bombs, mortar and rocket attacks, and countless small-arms firefights as he transported supplies for U.S. troops along Iraq's perilous roads. He returned from Iraq without physical injuries.

But his war wounds are evident in the cocktail of prescription medications he takes every day -- for hostile behavior, hallucinations, depression, insomnia, anxiety, anxiety-related tics and spasms, and hypertension, all symptoms he says he developed during his time in Iraq.

Two doctors in North Carolina have independently diagnosed Thompson with post-traumatic stress disorder, a psychological ailment with symptoms that typically include anxiety, loss of sleep and flashbacks. The government has acknowledged that he is disabled, and he receives a $1,224 monthly Social Security payment.

But Thompson says his claim for treatment for post-traumatic stress disorder was denied by American International Group Inc., or AIG, the insurance company for KBR, on the grounds that there was not enough medical evidence of his trauma.

In the case of Blackwater, the company has stated that their employee insurance covers contractors who return with PTSD:

Chris Taylor, a former Blackwater vice president now studying at Harvard University's Kennedy School, said the State Department -- with which Blackwater has an exclusive security contract to protect diplomats -- requires the company to screen all its personnel for mental health problems before deployment.

He said employees in the field are regularly reviewed by their peers and leaders and the company had recently hired a former Marine chaplain to provide counseling services. He also said Blackwater employees' insurance covers post-traumatic stress treatments once they return home.

Later in the article Taylor added, "Blackwater has a good safety net for dealing with PTSD type disorders." So that is good news.

ABC News, however, says the problem is not one of insurance coverage in this case, but of being proactive enough about getting the tools employees might need to deal with the expected stresses of having worked in a combat environment:

Unlike soldiers, however, who can access resources through the military and the Department of Veterans Affairs, companies typically provide contractors little in the way of counseling on the ground or treatment once they return home.

"There are thousands of guys coming home untreated," said Paul Brand, a psychologist who consults for DynCorp, one of the few companies that offer post-traumatic stress screening and in-country counseling to its employees. "These are private businesses out to make a profit. Most companies make money by not putting systems in place to take care of their employees' mental health… Frankly, it is a travesty that not enough has been done to give contractors the support they need."

Psychologists who treat contractors say the lack of immediate resources for employees in Iraq augment the effects of post-traumatic stress disorder and can lead to erratic and dangerous behavior.

The earlier you move to counteract PTSD in its early stages, the more successful your overall efforts will be.

By not having a proactive system in place, the article goes on to say, Blackwater is missing a great opportunity to protect the mental health of its workforce.

After being introduced to a few (non-Blackwater) contractors having a hard time getting the care they need because their insurance companies are denying their claims, one employee raves about the PTSD care she got from her employer, DynCorp.

Alece Davis, a 30-year-old police officer who went to train Iraqi police in April 2006, said the constant stress of living in a war zone led her to become increasingly stressed and ultimately set off a series of seizures.

"Just being over there was traumatic and stressful. Period. Seeing friends not come home, watching IEDs explode in front of my eyes, seeing kids without limbs or kids walking by dead bodies in street. It got to me."

Davis said she left Iraq and through her company, DynCorp, received treatment first in Germany and then followed up with her when she arrived at home.

Unlike most companies, DynCorp has its own experts in place to screen contractors for post-traumatic stress and recommend they seek treatment. But she said she had met with resistance from her insurance company, which has been reluctant to fully fund her treatment.

So, while Davis' employer was supportive, her insurance company was somewhat adversarial. Similar stories played out in a July New York Times piece on contractors coping with PTSD:

Contractors who have worked in Iraq are returning home with the same kinds of combat-related mental health problems that afflict United States military personnel, according to contractors, industry officials and mental health experts.

But, they say, the private workers are largely left on their own to find care, and their problems often go ignored or are inadequately treated.

A vast second army, one of contractors — up to 126,000 Americans, Iraqis and other foreigners — is working for the United States government in Iraq. Many work side-by-side with soldiers and are exposed to the same dangers, but they mostly must fend for themselves in navigating the civilian health care system when they come back to the United States.

Lack of experience in treating the aftereffects of military combat in the civilian health care world is problematic as well. Paul Brand, a psychologist and chief executive of Mission Critical Psychological Services, a Chicago firm hired by Dyncorp International, estimates that "thousands, maybe tens of thousands" of returning contractors may need reintegration help:

“Many are going undiagnosed. These guys are fighting demons, and they don’t know how to cope,” [Brand says.]

Jana Crowder, who runs a Web site for contractors seeking help, says she gets new evidence of that every day in phone calls from desperate workers.

“In the first few years of the war, we were seeing a few trickle in,” said Ms. Crowder, of Knoxville, Tenn. “Now, as contractors start coming home, you are starting to see a lot more.”

Workers tell haunting tales of their psychological torment. Tate Mallory, a police officer from South Dakota who worked as a Dyncorp police trainer, was grievously wounded by a rocket-powered grenade last fall. After returning home, he was so mentally scarred, he said, that he begged his brother to kill him.

Kenneth Allen, a 70-year-old truck driver from Georgia whose convoy was ambushed in Iraq, says he endures mood swings and jittery nerves and is often awake all night. And Nathaniel Anderson, a Texan whose truck was hit by rockets while hauling jet fuel, lost a contractor friend to suicide. Though suffering from stress-related symptoms himself, he has yet to see a doctor.

The Times delved into the insurance coverage problems:

Federal law requires employers to provide medical insurance for workers in a war zone. Workers have filed about 205 claims for treatment of post-traumatic stress disorder, or P.T.S.D., according to the Department of Labor, which monitors the data. Industry officials say that number significantly underrepresents the problem because many troubled people do not file claims.

Of those who do, many have been denied coverage and have filed lawsuits. Gary Pitts, a Houston lawyer, says insurers have challenged almost every claim filed by about 50 clients, even though the insurance companies paid for medical care involving their physical injuries.

“The contrast between the way the military and the civilian contractors are handled on P.T.S.D. is like night and day,” Mr. Pitts said. “The contractors have to figure it out on their own, and they often have to litigate it with the insurance company.”

Some other stats (from November 2006):

The toll of the war on contractors has largely been hidden from public view. About 1,000 have died since the conflict began, and nearly 13,000 have been injured. While some are well compensated for their work in Iraq, many more collect modest wages and provide support services vital to the military. ...

Although no U.S. agency keeps track of how many civilians are employed by U.S. contractor companies in Iraq, some reports estimate the number to be in the tens of thousands of Americans, Iraqis and citizens of other countries. Mann said KBR has 50,000 workers in the Middle East.

Between March 1, 2003, and Nov. 16, 2006, at least 673 civilian contractors -- Americans and foreigners -- were killed in Iraq, according to Labor Department spokesman David James. The number is based on the amount of death claims filed by relatives and may not represent all contractor fatalities.

By February 2007 it was being reported that 800 contractors employed by the Pentagon had been killed while working in Iraq, and another 3,300 were injured.

DynCorp's proactive reintegration efforts again stood out:

Dyncorp, a firm based in Texas that has a State Department contract to train the Iraqi police, is sponsoring its first conference Friday and Saturday on post-traumatic stress for former employees. The company is also treating workers in Iraq after bringing in Mr. Brand’s firm to determine the extent of problems.

Twenty-four percent of the Dyncorp police trainers showed symptoms of post-traumatic stress disorder after their deployment, Mr. Brand said. He and others said they knew of no other studies that formally assessed the problem among private workers in Iraq.

Those findings parallel an Army study earlier this year that about 17 percent of personnel in Army combat units in Iraq showed symptoms of P.T.S.D. one year after their deployment, said Dr. Charles W. Hoge, chief of psychiatry at the Army’s Walter Reed Institute for Research.

If marital problems, alcohol abuse and other adjustment problems are counted, the number rises to 30 percent to 35 percent, said Col. Elspeth C. Ritchie, a psychiatric consultant to the Army surgeon general.

The Chicago Sun-Times editorial board chimed in :

While getting help and benefits to war veterans suffering from post-traumatic stress disorder can still be hit or miss, the federal government has become more sensitive and responsive to vets suffering from this problem. Since PTSD entered the public consciousness during the Vietnam era, a diagnosis of it has been accepted as the basis of an indemnity claim by a returning soldier. Troops back from the war in Iraq, a psychological and emotional pressure cooker with its constant threat of suicide and roadside bombings, have access to a network of specialists to screen them for combat-related stress and assign them treatment.

But as reported in the New York Times, thousands of American contractors who worked in Iraq, often alongside troops and exposed to the same dangers, have a much more difficult time getting treated for the same disorders after they return home. With no access to the military or VA health system, in which returning soldiers are routinely screened for mental or stress problems, they have to cope with a civilian health system that lacks experience and expertise in this field. Left untreated, an increasing number of these workers have trouble coping. ...

With many people viewing companies like Halliburton as opportunists using clout to make quick money in Iraq, contractors there have to contend with an unsympathetic image. And some people consider the individuals working for the contractors to be hired guns, so to speak. Had the contractors and their employees been able to help rebuild the infrastructure of Baghdad and set up basic services -- impossible tasks in the absence of proper security -- their efforts in Iraq might have been viewed more favorably. Sympathetic or not, contractor employees are at great risk, doing the jobs they were hired to do, and deserve the same attention and treatment as returning soldiers. Their employers owe it to them to make that a reality -- and not ask the government for more money to get that job done.

If you'd like to dig into the contractor issue more deeply, check out Susie Dow's incredible writing at ePluribus Media and blogging at The Missing Man.

Labels: civilian, contractors, dod, stats

Monday, October 01, 2007

Real Time Interview with Ken Burns

Bill Maher had director Ken Burns ("The War") on his show this past weekend; well worth a viewing.

Labels: 911, history, society, video, wwii

Archives
2009: Jan Feb Mar Apr May Jun Jul Oct Nov
2008: Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
2007: Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
2006: Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
2005: Sept Oct Nov Dec

Tuesday, October 30, 2007

President Nominates New VA Chief: Former Army Surgeon General James Peake

Monday, October 29, 2007

Montana Working to Destigmatize PTSD, Holds Its Largest Combat PTSD Conference in November

Saturday, October 27, 2007

Plan to Attend Colorado's Fall Veterans Reintegration Workshops

Thursday, October 25, 2007

Obama, Bond Demand DoD Provide PTSD Data

Wednesday, October 24, 2007

More than 50% of Army's 948 Suicide Attempts in 2006 Sought Help First

A Link and a Nod

Tuesday, October 23, 2007

Joshua Omvig Veterans Suicide Prevention Act Passes House and Senate, Ready for President's Signature

Christian Science Monitor Brings OEF/OIF Veteran Care Numbers Together

Monday, October 22, 2007

Editorial: Troops Deserve Sustained Care

Washington Post Reporters Update on Medical Care for Returning Troops Story

Thursday, October 18, 2007

OEF/OIF Vets Seeking PTSD Care from VA Jumps 70%, Mental Health Counseling Tops 100,000

A Workshop for Caregivers: Helping Children Cope with War

White House Begins Move to Implement Dole-Shalala Commission Recommendations

CBO Stats on OEF/OIF Casualties and Costs

Wednesday, October 17, 2007

Fort Campbell: 9 Suicides in 2007, 3 in Last 2 Weeks Moves Commanding General to Act

Shortfall of Chaplains Another Military Strain

A Thank You to Amherst

Sunday, October 14, 2007

Moving a Nation to Care Tour Returns to Massachusetts Tuesday in Amherst

As Combat PTSD Stigma Fades Somewhat, Funding Fight and Political Disillusionment Come Into Focus

Saturday, October 13, 2007

First 'Veterans Village' Set to Open in California in November

Friday, October 12, 2007

Studies, Reports, Promises and Reality: Another Deplorable Case of Veteran Neglect

College Students: Mental Health Care Field Needs You

Thursday, October 11, 2007

Action Item: Tell Congress to Approve Veterans' Budget Now

Today is National Depression Screening Day

Wednesday, October 10, 2007

South Dakota VA Hosts Retreat for Female Veterans and Military Family Members

Are PTSD Veterans Slated to Lose Their Right to Possess Firearms?

Tuesday, October 09, 2007

Minnesota Holds Its First-Ever Combat Stress Conference; Warrior to Citizen Campaign Editorial

Saturday, October 06, 2007

Deep Breathing Techniques for Stress Release

Friday, October 05, 2007

A Look at the Unease of Transitioning to Homefront Living Following Combat

Wednesday, October 03, 2007

Veterans Disability Benefits Commission Releases Report, Recommends Sweeping System Overhaul

Blackwater Employee PTSD Care Questioned

Monday, October 01, 2007

Real Time Interview with Ken Burns

About the Editor

Discussing Combat Stress

Contact Congress/Media

Latest Postings

Outside Feeds

Legal Notice