After Afghanistan, House Webcasts, Vietnam Homecoming, Military Handbooks

A few items to share:

• Stars and Stripes today offers an in-depth look at the return home of one Fort Drum, N.Y., soldier following a 17-month deployment to Afghanistan.
  
  
• The House Veterans Affairs Committee goes high tech this Tuesday when the April 1, 2008 Subcommittee on Health “PTSD Treatment and Research: Moving Ahead Toward Recovery” hearing is webcast at 10 a.m. EST.
  
  
• Cumberland County, Tenn., officially welcomes home its Vietnam veterans this weekend proving that it's never too late to thank those who serve in uniform.
  
  
• Military Handbooks' 2008 crop of pdf offerings have arrived -- and they're free for the asking.

Stop-Loss in Theaters Today

Stop-Loss, the latest film revolving around the subject of our wars in the Middle East, arrived in theaters today. Peter Rainer gives a good introduction in the Christian Science Monitor:

Stop-loss, colloquially referred to as the "Back Door Draft," refers to the controversial policy, authorized by Congress when the draft ended but not utilized by the military until the Gulf War, of retaining soldiers beyond their expected terms and sending them back to war zones for second and even third tours of duty. According to this film, an estimated 81,000 soldiers have thus far been stop-lossed in Iraq.

In "Stop-Loss," Sgt. Brandon King (a stronger-than-usual Ryan Phillippe) is one such soldier. Returning to Brazos, Texas, where he and his fellow hometown combatants receive heroes' welcomes, he discovers he has been stop-lossed. Raging against the system, he goes AWOL – accompanied by Michelle (Abbie Cornish), the girlfriend of his war buddy Steve – in hopes of winning over the senator (Josef Sommer) who awarded him the Purple Heart and Silver Star in Washington, D.C. We already know, even if Brandon does not, that his quest is futile.

This is director Kimberly Peirce's first feature since her debut "Boys Don't Cry" nine years ago. She deserved a less clichéd script (which she wrote with Mark Richard). To an even greater extent than was true of such films as "In the Valley of Elah" and "Grace Is Gone," "Stop-Loss" dramatizes the Iraq war and its home-front losses in ways that summon up Vietnam-era movies as disparate as "Coming Home" and "The Deer Hunter."

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

In educational interest, article(s) quoted from extensively.

A.O. Scott, New York Times:

For many viewers (and some critics as well), the prospect of another Iraq movie, like so much else about the war, is likely to be more wearying than galvanizing. The commercial failure of last autumn’s crop of high-profile Iraq-themed movies — Paul Haggis’s “In the Valley of Elah” and Brian De Palma’s “Redacted” among them — has hardened into conventional wisdom about the moviegoing public’s reluctance to engage the war on screen. But those movies did not necessarily deserve their fate, and it would be a shame if “Stop-Loss” were to follow them into oblivion.

I say this partly because Ms. Peirce’s movie, which she wrote with Mark Richard, is not only an earnest, issue-driven narrative, but also a feverish entertainment, a passionate, at times overwrought melodrama gaudy with violent actions and emotions. The sober, mournful piety that has characterized a lot of the other fictional features about Iraq — documentaries are another matter — is almost entirely missing from “Stop-Loss,” which is being distributed by Paramount’s youth-friendly label MTV Films. Not that the movie is unsentimental — far from it — but its messy, chaotic welter of feeling has a tang of authenticity. Instead of high-minded indignation or sorrow, it runs on earthier fuel: sweat, blood, beer, testosterone, loud music and an ideologically indeterminate, freewheeling sense of rage.

Most of these elements are present in the very first scenes, which show mock-amateur video of young soldiers at rest and on duty. Their teasing is raucous and rude, and it is clear from the start that they are neither saints nor monsters, but rather the impure products of American pop culture. With exaggerated bravado, they sing “Courtesy of the Red, White and Blue (The Angry American),” Toby Keith’s anthem of 9/11 payback, which threatens righteous whuppings for America’s enemies: “And it feels like the whole wide world is raining down on you.”

Instead, the world comes crashing down on the soldiers.

David Edelstein, NPR:

The movie centers on three Texas soldiers, good ol' boys, who return from Iraq right after an ambush that left some of their buddies dead and maimed, and another grimly stoic after inadvertently killing women and children.

That's the opening sequence, and Peirce makes you understand the adrenaline-fueled hyperawareness of these men at a checkpoint as they almost fire on a family speeding toward them, then the unreality of the moment when insurgents in another speeding car suddenly open fire on them. They make split-second and not-too-wise decisions as the insurgents melt into civilian crowds.

And when it's all over and they roll into Texas on a bus, ready to be discharged, you get a palpable sense of how wound up they are—how they're itching to get very, very drunk and have crazy sex and court oblivion. They barely make it through the parade and the welcome speech of a U.S. senator before they're throwing back shots and retching and punching people out.

The first night home, Tommy, played by Joseph Gordon-Levitt, gets thrown out by his wife. Steve, played by Channing Tatum, backhands his fiancée, and begins to dig a trench in the yard while screaming he's under fire. Brandon, played by Ryan Phillippe, seems the most stable until he goes back on base to get his discharge papers — only to discover he's going to be sent back to the war zone, courtesy of a policy the military calls "stop-loss."

Nicole Reino, San Diego Union-Tribune:

"Stop-Loss," the film, began as a documentary about soldiers -- why they joined, what they experienced while at war and what they felt when they returned. But this project took a personal turn when director Kimberly Pierce ("Boys Don't Cry") watched her own 18-year-old brother enlist in the Army after Sept. 11. He entered the war in 2003. While in Iraq, he text-messaged Pierce a true story about a decorated soldier who was Stop-Lossed -- he was being sent back to the combat zone against his will. Upon hearing this story, Pierce turned her research to Stop-Loss and, instead of making a documentary, she decided to make a feature film about one man's experience with this policy.

This is not a true story, but it's certainly inspired by the stories of the 80,000-plus men and women in uniform who have experienced this firsthand. ...This film will wake you up at 3 a.m., and it may make you consider and reconsider everything you may or may not have thought about the concept of patriotism.

Sean P. Means, Salt Lake City Tribune:

"Iraq fatigue" has set in with the American public and, in particular, its news media. Americans don't want to hear about the war, we're told by news outlets who busy themselves with repetitious chatter about Barack Obama's pastor or Eliot Spitzer's hooker bills. That "Iraq fatigue" set in deeply last fall at the multiplex as major movies that dealt with Iraq, Afghanistan or the "War on Terror" - titles like "In the Valley of Elah," "Lions for Lambs," "Rendition" and "Grace Is Gone" - went unwatched.

Two movies opening today, "Stop-Loss" and "Taxi to the Dark Side," are in danger of falling into that chasm of apathy. That would be a shame, since both movies are excellent, stellar examples of art illuminating the human faces behind war and politics. ...Peirce and her co-writer, Mark Richard, ably perform the difficult trick of crystallizing the war's horrors and the bureaucratic cruelty of the "stop-loss" policy within this group of soldiers. Their lives, from their Texas roots to their wartime baptism of fire, are grounded in authentic details and in the tough-minded performances of a uniformly great cast.

"Stop-Loss" also is one of the few movies that understand the complexity of choosing military service and don't stereotype soldiers (as some movies have) as violence-prone brutes or flag-waving chumps. It shows them as real people who have been betrayed by their government and ignored by a war-weary public.

If "Stop-Loss" shows the wrongs this war and this administration have done to our soldiers, Alex Gibney's Oscar-winning documentary "Taxi to the Dark Side" shows the evils committed to random strangers in Iraq and Afghanistan.

Framing the film with the story of an Afghan cabdriver named Dilawar, who was detained at Bagram Air Base in 2002 and died five days later from injuries suffered at the hands of U.S. military personnel, Gibney traces the link from Bagram to the torture - there is no other word for it - of terror suspects at two infamous sites: the U.S. base at Guantánamo Bay in Cuba and the Abu Ghraib prison in Iraq.

And Gibney follows that link, as no government investigation ever did, up the chain of command to the possibly illegal policy decisions of then-Defense Secretary Donald Rumsfeld, White House counsel (and later Attorney General) Alberto Gonzalez, Vice President Richard Cheney and President Bush. (How do we know the decisions might be illegal? Because these officials wrote themselves a law giving themselves immunity for "crimes against humanity.")

Through dozens of interviews and a ton of documentation, Gibney (who exposed corporate corruption in "Enron: The Smartest Guys in the Room") gets the sad details of Dilawar's death, the brutality inflicted by U.S. military police, and the tacit approval of intelligence officers and their bosses in the Executive Branch. He also raises an alarm to America's conscience, angrily asking why we the people have allowed our values - and even our safety - to be compromised by such secret policies.

Nell Minow, Chicago Sun-Times:

No matter how respectfully made and deeply felt, no feature film about the experience of American soldiers in the era of the Iraq war can approach the visceral power of the films made by and with the troops themselves. No studio film with actors can have the impact of any of hundreds of clips uploaded to YouTube or the superb documentaries that let the soldiers tell their own stories like "Gunner Palace," "My War My Story," and "The War Tapes."

Despite the sincerity of its aspirations, "Stop- Loss" is hampered by awkward construction, its characters' inarticulate attempts to describe and discuss what is going on, and the handsome Hollywood gloss that cannot come close to the power of real-life soldiers telling their own stories.

Related Posts

• 'In the Valley of Elah' Coming September 21
  
• At the Movies: Film and PTSD
  
• Forced Individual Ready Reserve Call-ups a Special Stress for Troops

Virginia Heroes, Marlboro Marine, Vet Unemployment, DoD Study

Notable quick stops well worth a visit:

• On Wednesday, 200 social service workers gathered at the Virginia is for Heroes regional conference held at Fort Monroe. A few helpful articles over there, especially "Tune In to Special Needs of Military Families [pdf] ," by Barbara J. Howard, M.D.
  
  
• Jenny Eliscu offers a heart-tugging update on James Blake Miller, 'The Marlboro Marine,' in the latest Rolling Stone.
  
  
• Following-up on yesterday's post, the Topeka Capital-Journal editorial board chimes in on news that unemployment in the younger veterans set had shot up to 23 percent in 2005 from 2000's 10 percent rate.
  
  
• From last week: A University of Texas Health Science Center at San Antonio research consortium has been awarded $33 million from the DoD to study post-traumatic stress disorder (PTSD) in returning troops. Their main objective will be to "develop and evaluate the most effective early-interventions for detecting, preventing and treating combat-related PTSD."

Time Mag and Minnesota's Warrior to Citizen Campaign: Something to Think About, Then Do

My work on the PTSD Timeline has gone on hiatus again for the past few months as I juggle four NIU classes and all other things (dropping so much along the way -- including far too many wonderful emails from PTSD Combat visitors, I'm afraid; I apologize to those that have gone unanswered).

Yet, the press-reported incidents of a wide variety of reintegration problems awaiting our returning troops continue to scream out from all corners of our county. Collection of these incidents continues behind-the-scenes, too.

While I save them for a time when I can go about the work of submitting them to my colleagues over at ePluribus Media, I rarely point these individual cases out here at PTSD Combat (except when writing about the occasional incident or when sharing news of a batch of our latest timeline entries).

I'm not sure I ever set about explaining why I don't, as a rule, share these difficult stories with you as I find them. The reasons are many-fold, the main one being simply that I don't want the incidents themselves to be the sensational driver of my work here. I think most of the readers that visit this online journal already know that these incidents are taking place; they don't need further proof.

[I, however, can't say enough how greatly I appreciate the work of those who do keep a running tally of such published articles. Kathie Costos at Wounded Times and Paul Sullivan at Veterans for Common Sense come to mind immediately; often their efforts are the only thing standing in the way of lost articles, lost information important for us to catalog, once public but now tucked out of our reach in archives or even wiped completely from servers to make room for the latest news.]

Most Americans by now also realize that we have deep and serious problems with the state of our stateside combat aftercare. They have heard the stories, they've seen the reports. And most know we will continue to hear of more tragedies as the years pound onward with no sign of relief for our volunteer military force tasked with doing so much for so long.

But the time for 'making the case' is over.

It's time now for us to really begin to tackle the heart of the problem. And, in certain spots, an article published by Time magazine today and written by Washington correspondent Mark Thompson does just that.

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

In educational interest, article(s) quoted from extensively.

From Time:

A Maryland murder trial is being turned into a debate on the lingering traumatic impact of the wars in Afghanistan and Iraq on the psyche of the Americans who served there. The prosecution is trying to prove that Gary Smith, a one-time Army Ranger, murdered his roommate of 20 days and fellow Ranger Michael McQueen, 22, by putting a .38-caliber revolver to his right temple and pulling the trigger. Smith's attorney, however, notes that the 25-year-old former sergeant has been diagnosed with post-traumatic stress disorder following repeated combat tours, and insists that McQueen committed suicide, drunk, despondent and unemployed.

Whether McQueen's death was a murder or a suicide, the tale offers a rare window into the grim realities of post-war mental trauma. As the odometer of war clicks past 4,000 killed in Iraq, and approaches 500 in Afghanistan, it's stories like those about the Ranger roommates that often fall below the nation's radar screen. The Army introduced these two men to one another — McQueen was African-American; Smith is white — and dispatched them to Afghanistan together twice, in 2004 and 2005. There, it seems one or both became unhinged by the experience. But in a country that rescues Wall Street banks from ruin while down-on-their-luck homeowners find themselves suddenly homeless, the prosecution would prefer to keep the focus of the trial in the Rockville, Maryland, courthouse away from the war.

"This is a homicide — Gary Smith is the person that did it," prosecutor John Maloney said in his opening argument March 18 in what is expected to be a two-week trial. "The most important thing you'll bring to your deliberations is your common sense." But Smith's attorney, Andrew Jezic, said McQueen was unemployed, not in school and drinking heavily when he killed himself. Smith, upset at the death of a war buddy, tried to hide how he died to preserve McQueen's dignity — and to avoid being implicated — according to police files. "There is no motive in this case," Jezic said. "Zero." ...

Military leaders have acknowledged that the service was unprepared for the flood of mentally wounded caused by the wars. Given the lack of resources to handle the thousands of Gary Smiths and Mike McQueens returning from Afghanistan and Iraq, such collateral damage may be inevitable. "Treatment is a struggle," the Pentagon's top doctor, Ward Casscells, said at a March 14 congressional hearing.

Read the rest.

And then ask yourself what more you can personally do to change the dynamics laid out plainly above. Have you extended yourself, given even one day a month of your time, to reaching out to returning veterans? If not, here are a few ideas from Minnesota's Warrior to Citizen program that can be retrofitted or used as a springboard for your inspirations.

The Challenge – Veterans need valuable outlets for their new skills and experience and Minnesota needs the insights and expertise our veterans can offer – but we’re not making the connection.

* We need to build on our rich history of veterans as returning citizens. For instance, after World War II, public policies like the GI Bill recognized that veterans would be mainstays of their communities and, as a result, Minnesota and American civic life was immensely strengthened.

* Today, many of us are aware of challenges that some veterans face when they return home. As a society, we are increasingly aware of things like post traumatic stress disorder, traumatic brain injury. and other lasting effects of wartime service. We are continuing to develop services to meet the needs of soldiers struggling with these and other serious issues.

* But despite the challenges some veterans can face, we must remember that they do not see themselves as victims. They are not fragile or broken. In fact, most are just the opposite – stronger and more accomplished than ever before.

* They have new skills and experiences in addressing a range of practical issues – far more than combat – such as water purification and distribution projects, conflict resolution, and infrastructure development as a result of their service. Unfortunately, after the fanfare of their arrival dies down and life returns to “normal,” many of our returning veterans will struggle to find valuable, productive outlets for those new talents within their families, workplaces, neighborhoods and broader communities.

* This is a frustrating experience for our soldiers – and a potentially tragic loss for Minnesota. We are failing to tap the civic leadership, skills and passions of our veterans. We may be reaching out to lend a helping hand if we see a need, but we aren’t asking our veterans how they can use their new skills to contribute to our organizations, our civic groups, our businesses, our schools, and our communities.

* With 2,600 Guard members returning this summer, Minnesota citizens have an historic opportunity to help our warriors become active, engaged, valuable citizens by asking them to help build communities here at home – if we’re up to the challenge.


Warrior to Citizen Campaign – A citizen-led campaign to help returning veterans re-engage as citizens.

* The Warrior to Citizen campaign is a broad but simple statewide effort to encourage ALL Minnesotans to think about the ways that veterans are especially qualified to contribute to the strength and growth of our communities.

* The Warrior to Citizen campaign is a growing coalition of individuals and organizations throughout the state, including National Guard members, legislators, faith-based leaders, health care professionals, local government officials, social services providers, students and many, many more. It is being organized by the University of Minnesota’s Center for Democracy and Citizenship.

* The Warrior to Citizen campaign is NOT an effort for only those who are directly connected in some way (through a family member, colleague, church, etc.) to a returning soldier. In fact, the Warrior to Citizen campaign is meant to speak directly to people who may not think they have a specific role to play. Those are the people who can open up creative new networks and new opportunities for returning veterans to engage with their communities.

Call to Action – You can lead or help with the Warrior to Citizen campaign in your community in many ways.

* By asking veterans to share their stories, skills and expertise, we continue to honor their service while providing a valuable outlet for their new ideas and abilities.

* Here are some starter ideas for what individuals, organizations, and entire communities can do to lead the Warrior to Citizen campaign:

• If you are an employer, consider holding job fairs designed to leverage the special skills many returning veterans have. Or, invite a veteran to provide advanced training for your existing workforce, if expertise is appropriate.
• If you are an employer or community organization, consider hosting a brown-bag lunch event featuring a local veteran who is interested in telling his/her story and answering questions about their experience as a warrior.
• If you are a member or leader of a church or a faith-based organization, consider dedicating a service or social gathering to promoting the Warrior to Citizen concept; encourage community members to tap the skills and experience of your local veterans.
• If you have a neighborhood association or live in a close-knit community where block parties and social gatherings take place, invite local veterans to discuss their experiences.
• If you run a youth group or are a teacher, invite a veteran to train young people in a certain skill.
• The list goes on and on.
  

Closing, Next Steps and Resources

* Encourage the group to commit to at least one specific goal or effort related to the Warrior to Citizen campaign. Identify a small group that wants to continue working on this issue.

Please visit the Warrior to Citizen website for more ideas and resources. Last month's Minnesota Journal [pdf] offered up a full 12 pages to cover the call of citizens to the project; I'd highly recommend reading Sean Kershaw's article, "Our challenge isn’t warrior-to-citizen, it’s citizen-to-warrior," found on page 3.

Whatever you do, just do.



Related Posts

• House, Senate Pass Defense Bill Nationalizing Minnesota's 'Beyond the Yellow Ribbon' Reintegration Program
  
• Minnesota Holds Its First-Ever Combat Stress Conference; Warrior to Citizen Campaign Editorial
  
• Opinion: Proactive Community Needed to Help Troops Reconnect, Reintegrate

VA Report: 23% of Young Vets Unemployed, Up from 10% in 2000

From Yochi J. Dreazen at the Wall Street Journal:

A new government report paints a dire picture of the employment prospects of returning military veterans, concluding that young veterans earn less and have a harder time finding work than do civilians in the same age group.

The report prepared for the Veterans Affairs Department found that the percentage of veterans not in the labor force -- because they couldn't find jobs, stopped looking for work, or went back to school -- jumped to 23% in 2005 from 10% in 2000. Half of the young veterans -- ages 20 to 24 -- with steady employment earned less than $25,000 per year, it found.

Young veterans "face career challenges when transitioning from the military service to the civilian workforce," and suffer from higher unemployment than their civilian peers, the report said. "Transitioning into civilian life and the workforce requires help and guidance," the report concluded. "The federal government might consider reevaluating or refining how it serves...these returning young service members to ensure a successful transition process."

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

In educational interest, article(s) quoted from extensively.

Continuing:

The new government report, which hasn't been publicly released, highlights some of the challenges facing veterans seeking stable employment in the civilian world. The Army has long pitched military service as a way for recruits to gain valuable work experience, but the report found that most of the returning veterans were unable to find civilian jobs that matched their previous military occupations.

The only exceptions were the veterans working for private-security firms such as Blackwater or in the maintenance and repair fields, and the report suggested that the government steer veterans to those types of jobs. "Perhaps it would be helpful to promote jobs...that match their military skills and in which their military skills can be applied," the report said.

Many of the government's efforts to help returning veterans find work appear to be falling short, the report found. The Veterans Affairs Department offers educational-assistance programs for young veterans, but the report said the initiatives had little impact on the employment status or salaries of the former military personnel.

Mark Zdechlik of Minnesota Public Radio filed an informative report on the problem of veterans' unemployment last week:

[Iraq veteran Dustin] Shugren now lives with his older brother north of the Twin Cities in a basement apartment of St. Francis home. He said even after a year and a half, it's still weird being back home.

"It's different because you come back, they put you in general public and you have no control over nothing," he said. "People look different. There ain't no uniforms. There ain't nothing. When I got home with my best friends, it's like wow, dude, you really need to get a haircut."

Shugren's hair is buzz-cut military short. He is tall and thin.

At a veterans job fair in November of 2007, he was optimistic about finding a full time job. He said then he was looking for something more stable than the seasonal lawn care he'd been doing. "It's kind of like shooting fish in a barrel," he said. "You're almost guaranteed to get one. So hopefully I'll find a good job."

But Shugren's military experience welding and repairing weapons has not caught the interest of potential employers in Minnesota. He has not found a job. And he's well aware now is a difficult time to be out looking.

"Everybody asks for experience. Well, I didn't really have much experience in being a machinist," he said. "I don't really have much experience doing this or doing that. Well, I know how to work on guns, but it's hard to get that job because they want you to be gunsmith certified. So I'd have to go back to school and redo all of that. I could go to a welding job. I do have experience in that. I've applied at CAT, and I didn't get that job. But that's alright."

Shugren said he's really not even looking for a job right now. His seasonal lawn work picks up in April. He said he will restart his job search in the fall.

The most recent U.S. Department of Labor statistics show the unemployment rate among veterans is slightly lower than that of the general population, a little less than 4 percent last year. But for young vets, like Shugren, the rate is nearly 12 percent, well above non-veterans in the same age 20 to 24 age group. The labor department says it's concerned about the high unemployment rate among young vets and that it's working to bring it down.

The director of veterans employment programs in Minnesota, Jim Finley, said more job placement services are available to veterans in Minnesota than to non-veterans. But Finley said not all of the vets who need help know that.

"One of my biggest concerns is the fact that there are people out there that don't know that we exist," he said. "There are people out there, I talk to them all the time, who tell me I didn't even know about you guys. And because of the fact that we're a government agency we don't spent a lot of money on marketing. So we worry about that." ...

"It almost seems like nobody really support the military or even the soldier alone," he said. "If more companies can just try working for the soldier, doing stuff for the soldier, it would be a lot better. Nobody really cares any more these days and it's kind of bad I think."

Shugren plans to move back into his parents' home so he can save some money. He said his unit could be deployed again as soon as next year. He said wouldn't mind going back to Iraq.

Computerworld's Jaikumar Vijayan spoke with Oliver North regarding the issue of employing returning veterans in the IT sector:

In a tight job market, U.S. companies might want to consider Iraq war veterans for information security jobs, retired Lt. Col. Oliver North said today in a keynote address at the Infosec World 2008 security conference and trade show being held here this week.

North, a former member of the National Security Council during the Reagan administration, noted the rising unemployment rate in general and the jobless rate among returning Iraqi war veterans in particular. One way to address the situation is to consider giving employment in the technology sector to returning veterans because they embody many of the core values and skills that companies need to compete in a rapidly changing global marketplace, North said.

"There are 225,000 young Americans with combat experience looking for good jobs," North said. "These are the brightest and the best of this generation," North said. "They certainly deserve to be employed by companies like yours," he said to conference attendees.

Now, I was never much of an Ollie North fan, but I can't argue with him here. But it's not just the veterans who are having a difficult time finding work. Many military wives struggle with unique problems stunningly spelled out by military wife Laura Dempsey in a special Washington Post op-ed. It is so rich with information and insight that I will quote heavily from it:

The U.S. Army recently announced that it would pay captains up to $35,000 in retention bonuses to stem the tide of junior officers leaving the Army, in part because of the conflicts in Afghanistan and Iraq. Bonuses may temporarily retain a few captains, but the problem will continue well into the future unless policymakers address a more fundamental issue: A military lifestyle makes the pursuit of a career nearly untenable for military wives.

I know the challenges that Army wives face. I've been a lawyer and an Army wife for 10 years. In that period, I've moved seven times. I've taken four different bar exams and held five different jobs. My income has been taxed in at least five states. I think it's safe to say that military wives like me face career obstacles that few civilian wives could appreciate.

Wives attending college when service members transfer must choose between paying exorbitant out-of-state tuition if they stay behind or losing a substantial number of credits if they move. Although many smaller and online universities admirably volunteer to accept transferred credits for military wives, most of the country's larger public universities and almost none of the top-tier private schools do.

Working wives face long waiting lists for child care and a lack of well-paying jobs. If they find well-paying jobs, their income is taxed unfairly at the state and local level. Entrepreneurial wives must adapt to different state and local laws with each move. In some cases, they must dissolve and reincorporate their businesses (and pay the requisite fees).

Professionally licensed wives such as teachers (yes, and lawyers) are hit hard. Most licensed professions are regulated by states. Therefore, wives must test for, and pay for, new licenses with each move. In many professions, spouses get no credit for experience in other states, yet they must continue to pay annual fees to each state in which they are licensed.

The process gets prohibitively expensive, forcing spouses to either pay hundreds of dollars per year to maintain licenses in multiple states (which is desirable, since the family may eventually be assigned back to that state) or relinquish the licenses they worked so hard to obtain.

Preparation for licensure exams can cost thousands of dollars, but because many military families don't own homes and therefore don't itemize deductions on their tax returns, they get no money back for their efforts. As a result, families that would be upwardly mobile are repeatedly handicapped.

Unemployment among military wives is nearly four times the national average. There is a $12,000 wage gap between college-educated civilian and military wives. A military wife with a postgraduate degree has 20 percent less chance of finding full-time employment than a civilian wife.

A few targeted efforts by the federal government would make a great difference. Lawmakers should pursue regulatory and licensure exemptions and tax incentives to ease the burden on entrepreneurial and working wives, or, better yet, exempt military families from local and state taxes; improve child-care options for military families; allow family members to pay in-state tuition regardless of the service member's duty station; require public universities to accept more transferred credits from spouses who choose to move with service members; and allocate more positions on military installations to spouses so that they can pursue careers wherever they are stationed.

Simply allowing spouses to claim a permanent state of residence, as members of the military do, would alleviate some of the bureaucratic hassles of frequent moves. There is no doubt that Americans, liberal and conservative alike, place a high value on the service that the military provides. American policy should reflect this and modernize, removing the barriers placed between military families and a higher quality of life.

In a related piece:

Noting that military officers really don’t mean it when they ask for volunteers, a Colorado Springs lawmaker wants to change state law and allow spouses of members in the military to collect unemployment insurance when they are forced to relocate.

Rep. Amy Stephens, R-Monument, said those spouses and their employers are forced to pay for unemployment insurance, but can’t collect it if they are transferred. She said in the military, rejecting a transfer because of financial hardship isn’t an option. “They’re forced to relocate. They’re forced to realize that once you’re in the military, they own you,” Stephens said.

The measure (House Bill 1180) removes a limitation that a transfer must be during time of war or armed conflict and for medical-related purposes in order for an individual who relocates with an active-duty military spouse to be eligible for unemployment insurance benefits after paying into the system for a year or more.

The bill is expected to be heard in the Senate State, Veterans, & Military Affairs Committee on Wednesday.

A few resources can be found at the U.S. Department of Labor veterans resources page and the USA.gov Training, Education and Career Transition page. MilitarySpouse.org has a fabulous collection of links that will direct you to just about every available veterans employment resource out there.


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Connecticut Works to Understand and Support its Returning Troops

The always informative Lisa Chedekel filed another statistic-rich report for the Hartford Courant earlier this month that I've been wanting to share with you. In it, she lists the results of a recent study, a 205-question survey developed by Drs. Marc Goldstien and James Malley, conducted by the state of Connecticut examining the health and reintegration needs of their 11,000 returning troops:

A first-ever survey of returning state troops shows that at least one-quarter of them meet the diagnostic criteria for post-traumatic stress disorder, while many cite problems with a spouse or partner and difficulties "connecting emotionally with family" as major concerns.

A state mental health hot line [866-251-2913] has fielded more than 300 calls for assistance from Iraq and Afghanistan veterans and their family members in the past nine months. Recently, the state veterans' affairs commissioner has begun working with the courts to ensure that increasing numbers of recently returned troops who are arrested for domestic violence, drunken driving or other offenses are flagged and referred to counseling programs.

"There's a lot of real high risks here — not only for the military members themselves, but for their families," said Linda Schwartz, commissioner of the state Department of Veterans' Affairs. "We have people in almost every town in our state who have served deployments, and the VA is just not going to be able to get to them all. We have to do more to reach out to them … to catch them when they fall."

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

In educational interest, article(s) quoted from extensively.

Small clip from WWLP:



In September, Gov. M. Jodi Rell announced the study, saying:

“This is a different type of warfare that is creating new issues and stresses on our veterans and their families,” said Governor Rell. “We cannot wait ten or twenty years to begin planning how best to take care of this latest generation of heroes. We must be proactive in determining their needs now. This study is an important step forward in that effort.” ...

“We waited too long during the Vietnam-era to prepare for the extensive needs of those who served their country. We cannot make that mistake again,” said Dr. Linda S. Schwartz, commissioner of the Department of Veterans Affairs and a Vietnam veteran. “I strongly encourage all those veterans who have received this needs assessment to take the time to register their voice by completing and returning this survey. You can help make a difference in your future.”

“Your experience – and the experience of your family – is important to help us develop meaningful legislation, services and programs,” Governor Rell wrote in a letter to all veterans who received the needs assessment. “It is important we hear from you in order to accurately understand your problems, issues and needs in order to put in place the programs and support you may need in the future. It is critical to identify potential gaps in the support systems for veterans early on – so Connecticut will provide the best for you and future generations of service members.”

Continuing with the Courant:

Preliminary findings of a survey sent to 1,000 Connecticut troops who served in Iraq and Afghanistan — more than half in the National Guard or reserves — found that about 19 percent met criteria indicating they are at risk of traumatic brain injury, while at least 24 percent met the diagnostic criteria for PTSD. Schwartz said the percentage of troops who are experiencing symptoms of PTSD is likely higher than the rate captured in the survey, which used strict criteria.

The study also suggests that troops are reluctant to seek counseling from mental health professionals, with a large proportion of respondents saying they have sought psychological help from primary care doctors or emergency rooms. About half reported that their general health was "much worse" or "somewhat worse" than before they were deployed to war.

The state-funded study — conducted by Central Connecticut State University's Center for Public Policy and Social Research, with assistance from the Yale School of Medicine — identified several key areas of concern among the returning troops, among them: a sense of being disconnected from their community; trouble communicating with everyone except fellow veterans; feelings of being "tightly wound" or "aggressive"; and a reluctance to seek psychological help, for fear of being stigmatized or perceived as weak.

Last October, Central Connecticut hosted an all-day summit on veterans issues convened by Gov. Rell and Wesley Strong wrote of the gathering in the university's paper:

The event, which took place last Friday, included two sessions where about 300 participants broke into focus groups to work on specific issues from healthcare to women veterans’ issues. Each group consisted of several experts from the Department of Veteran’s Affairs and veteran community, and was geared towards discussing the problems in each one’s topic.

Recommendations compiled by the groups included proactive education of benefits to the soldiers, more communication between the Department of Defense and Veteran’s Affairs, and greater access to services during times that would not interfere with work. ...

The summit also included a report of preliminary findings from a study run by veterans from Operation Enduring Freedom and Operation Iraqi Freedom. The study conducted by Dr. Marc Goldstien and Dr. James Malley in coalition with the CCSU Center for Social Research and Public Policy compiled data from focus groups and over 200 surveys.

The data found that many veterans were reluctant to get help. Over 60 percent of those who had shown signs of PTSD had not sought help. Dr. Malley said that in the focus groups some troops had found it easier to stay in combat than to come home.

Emily Beaver at the Waterbury Republican-American introduces us to one veteran who participated in the summit:

When Sgt. Matt Talbot returned to Connecticut in 2006 after serving in Iraq with the Marine Corps, he had tension in his shoulder, bone chips in his ankle and anxiety. But Talbot, now a full-time business student at Northwestern Connecticut State University, has to travel 50 minutes from his home in Torrington to receive the care he needs at a VA hospital in Newington. Sometimes, he has to miss class to attend doctor's appointments, a choice 23-year-old Talbot said he doesn't want to make.

On Friday, he went to a summit at Central Connecticut State University to ask state officials how they plan to accommodate veterans like himself, who return from conflicts in Iraq and Afghanistan to face a health care system that can be difficult to navigate, benefits buried beneath mounds of paperwork and a community they don't seem to fit into anymore.

"I haven't had a negative experience, but there's room for improvement," Talbot said.

The Courant's Ann Marie Somma also covered the summit:

As an active duty soldier returning home from Iraqi [sic] in 2004, Joel Patrick Leger faced an experience shared by many veterans. He felt isolated, in need of someone to help him make the transition back to civilian life.

"I wish there was some type of peer support system, someone who I could have talked to from the same war theater," said Leger, 27, of East Windsor, who fought with the Army's 101st Airborne Division. ...

Participants found that heath care access differs in each branch of service, that a traumatic brain injury is often confused with post traumatic stress syndrome, that families of veterans need outside help and support, and that educational benefits are lacking for certain branches of the service. The groups all agreed on the need for better communication among veterans and state agencies and service providers.

Gary Knight, an Army veteran from Operation Iraqi Freedom who participated in the employment focus group, said that when he returned home in 2005 he didn't know that as a veteran he could get his driver's license renewed free of charge.

"I learned things word of mouth. There needs to be a better system, a briefing when you return," said Knight, 46, of Waterbury.

One more chunk of important information from the Chedekel piece:

Last spring, state agencies and the Connecticut National Guard launched a hot line [866-251-2913] and referral program that links returning troops and their family members with a network of trained community mental health providers. The program — funded with $1.3 million in state money — has received more than 315 calls and made 180 referrals.

State officials, concerned that troops with PTSD and other psychological problems are not seeking care, say they are hoping to draw more people to the program in the next year through outreach and advertising.

The survey findings indicate some adjustment problems for troops returning to jobs or enrolling in colleges. Almost 20 percent of respondents said that after being deployed, their civilian jobs were not as satisfying to them. Some who returned to colleges said they felt like outsiders on campus.

Schwartz said she has begun asking state colleges to establish "drop-in centers" where veterans can go to socialize with other veterans, to help ease the sense of isolation. ...

Some private sector efforts to help returning troops also are underway. The Hartford Financial Services Group, in collaboration with the Disability Management Employer Coalition, has produced a free guide [pdf] for employers that contains recommendations on helping returning troops re-integrate into the workplace. The recommendations include providing sensitivity training to managers about issues faced by civilian soldiers during and after deployments and providing mentoring programs to link returning troops with other veterans.

Read the rest of Chedekel's piece. On the Hartford's guide:

Employers can help America's heroes succeed in the workplace by offering employee assistance and mentoring programs, advised the Workplace Warrior Think Tank - the first-of-its-kind group launched by the Disability Management Employer Coalition (DMEC), the leading developer of employee health and productivity strategies, and three of the nation's leading disability insurers - The Hartford Financial Services Group, Inc. (NYSE: HIG), MetLife and Unum.

Today, the think tank is providing its recommendations to employers in a free guide, "Workplace Warrior: The Corporate Response to Deployment and Reintegration [pdf]." ...

"The U.S. military involvement in Iraq and Afghanistan has created long-term medical and disability issues for returning veterans. To retain these valuable employees and benefit from their knowledge, abilities and experience, a comprehensive response is needed by employers," said Marcia Carruthers, chief executive officer of DMEC and think tank co-chair.

"One effective way that employers can assist veterans is employing an Employee Assistance Program to tackle the major health, work and family challenges resulting from a lengthy overseas assignment in a combat zone," said Carol Harnett, vice president and national disability and life practice leader for The Hartford and co-chair of the Workplace Warrior Think Tank.

Another highly effective tool to support the successful reintegration of civilian soldiers is a mentoring program that links them with veterans within the workforce. The commonality of military experience may forge bonds among colleagues. "Virtually any employer can provide mentoring by other veterans - at any level and for very little cost," said think tank participant Andrew R. Gilbert, a military veteran who founded a forum at his employer Booz Allen Hamilton.

This kind of community-wide response is impressive.


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New Age Treatments for a New Age of Warfare: Army Seeking Alternative, Holistic Therapy Research Proposals

Noah Shachtman at Wired (and cheers back to you, Noah, for the 'special thanks' mention and link to PTSD Combat) looks at the Army's obviously necessity-inspired opening-up of minds and pocketbooks regarding the use and exploration of alternative treatment options for wounded returning troops:

The military is scrambling for new ways to treat the brain injuries and post-traumatic stress of troops returning home from war. And every kind of therapy -- no matter how far outside the accepted medical form -- is being considered. The Army just unveiled a $4 million program to investigate everything from "spiritual ministry, transcendental meditation, [and] yoga" to "bioenergies such as Qi gong, Reiki, [and] distant healing" to mend the psyches of wounded troops. ...

The Defense Department "is dedicated to supporting evidence-based approaches to medical treatment and wants to support the use of alternative therapies if they are proven efficacious," notes a recently-issued request for proposals.

But many of these treatments haven't been held up to much rigorous scientific scrutiny before. So the Army is looking to hand out $4 million in "seedling grants" to "conduc[t] rigorous clinical studies" into all sorts of "novel approaches." Projects "containing preliminary data" will be eligible for up to $1 million. But even "innovative but testable hypotheses without preliminary data" could get as much as $300,000. Proposals are due May 15.

Full Defense Center of Excellence for Psychological Health (PH) and Traumatic Brain Injury (TBI) program announcement for the Military Psychological Health Research – Complementary and Alternative Strategies grant is available online as an MS Word doc. Grant instructions and application forms are available, too.

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

In educational interest, article(s) quoted from extensively.

Abstract of the Army's grant proposal:

Funding Opportunity Number: W81XWH-08-PH-TBI
Opportunity Category: Discretionary
Current Closing Date for Applications: May 15, 2008
Funding Instrument Type: Grant Cooperative Agreement
Category of Funding Activity: Science and Technology and other Research and Development
Expected Number of Awards: 10
Estimated Total Program Funding: $4,000,000
Award Ceiling: $1,000,000
CFDA Number: 12.420 -- Military Medical Research and Development
Cost Sharing or Matching Requirement: No

Eligible Applicants
Unrestricted (i.e., open to any type of entity above), subject to any clarification in text field entitled "Additional Information on Eligibility"


Agency Name
Dept. of the Army -- USAMRAA

Description
The Defense Center of Excellence (DCoE) for Psychological Health (PH) and Traumatic Brain Injury (TBI) is soliciting proposals for studies on Complementary and Alternative Medicine (CAM) in service members dealing with sustainment and treatment for psychological health and promoting healing for traumatic brain injuries in service-members.

The high prevalence of psychoneurological and other brain injuries associated with the current OEF/OIF war effort make it especially important to understand current use of CAM therapies by service-members, and to explore approaches that may be particularly effective in both protecting and treating the injured service-member. The DoD is dedicated to supporting evidence-based approaches to medical treatment and wants to support the use of alternative therapies if they are proven efficacious.

Specific aims of this call for proposals focus on a holistic approach for trauma spectrum disorders, including patients with TBI and/or post traumatic stress disorder (PTSD), depression, anxiety, and/or substance dependence/abuse. With the focus on a holistic approach for trauma spectrum disorders, including patients with TBI and/or post traumatic stress disorder (PTSD), depression, anxiety, and/or substance dependence/abuse, the following delineate several of the areas of interest:

1. Conducting rigorous clinical studies to determine the efficacy of alternative therapies for treating psychological health injuries using techniques such as music, animal-facilitated therapy, art, dance/movement, massage therapy, EMDR program evaluation, virtual reality, acupuncture, spiritual ministry, transcendental meditation, yoga and other novel approaches.

2. Identification of patterns of use of CAM therapies to build resilience in military populations.

3. Identification of factors and perceptions associated with use of alternative and complementary therapies by service-members.

4. Studies of mechanisms and efficacy of biologically-based treatments, botanicals, and nutritional supplements for enhancing cognitive function and mood in patients with trauma spectrum disorders, including TBI and/or PTSD, depression, anxiety, and/or substance dependence/abuse.

5. Studies that examine gender-specific implications and issues related to the use of CAM therapies.

6. Biological mechanisms and efficacy underlying acupuncture for trauma spectrum disorders, including TBI and/or PTSD, depression, anxiety, and/or substance dependence/abuse, including neuroimaging studies.

7. Identification of the use and efficacy of therapies using bioenergies such as Qi gong, Reiki, distant healing, and acupuncture, especially new biophysical approaches involving instrumentation.

Proposals must provide a clear justification and military relevance for the choice of therapies selected for study. Collaboration with DoD medical researchers at the Defense and Veterans Brain Injury Center (DVBIC), clinical research laboratories at military medical centers and VA centers are encouraged and will be considered in the selection of awards.

Studies should be designed to test pragmatic and theoretical components at once; thus, they need to include sham control to separate specific from non-specific effects. Rationale should include why the intervention should have effects across trauma spectrum and evaluate putative mechanisms. Use of primary care and community sites should be accessed and networked into participate.

Two types of proposals will be considered. Individual research proposals containing preliminary data are expected to average $200,000 per year for up to four years of support; no proposal award will exceed $1M in total funding (including indirect costs). Seedling grants proposing innovative but testable hypotheses without preliminary data, will be considered for $300,000 in total funding (including indirect costs), with research to be completed within 18 months. A total of approximately $4,000,000 is available for the portfolio of projects to be funded.

This is great news. Good luck to those who apply!


Related Posts

• Deep Breathing Techniques for Stress Release
  
• Arizona's Merritt Center Treats Returning Troops to Peaceful Retreat
  
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Full Trial Moves Ahead in Lawsuit Against VA, OEF/OIF Veterans with PTSD Sought

Latest updates on this and related VA/Army lawsuits posted in "As Second Legal Attempt Fails to Force VA Hand on Disability Claims Processing, Army Sued Over Discharged Veteran PTSD Disability Ratings." -- Ilona Meagher, 12/17/08

If you're a long-time reader, you're probably aware of the class action lawsuit filed last July against the Veterans Administration by two veterans groups. One of them, Veterans for Common Sense, is helmed by tireless former VA employee and veterans advocate Paul Sullivan. His important update and call for help:

Dear VCS members,

I am writing to update you about our class action lawsuit, Veterans for Common Sense and Veterans United for Truth v. U.S. Department of Veterans Affairs. We are challenging the VA's failure to provide prompt mental health care to veterans with Post Traumatic Stress Disorder (PTSD) and VA’s failure to promptly and accurately process disability compensation claims for PTSD.

The week of March 3, the judge held a hearing about the quality and timeliness of mental health care given to suicidal veterans. After four days of testimony, the judge ordered a full trial on all of our issues to start on April 21, 2008. This is a very quick timeline, and we hope this means that we will receive a final decision from the judge in the next few months.

In order to put on our strongest case, VCS and our attorneys need your help in the next few days. The attorneys for VA challenged our right as a group to sue VA. We need our VCS veteran members to contact us if they have either of these two problems:

• You are diagnosed with PTSD and have experienced problems getting timely VA mental health care for their PTSD or for potential suicide.


• You filed a VA claim for PTSD and have problems getting your PTSD disability compensation claim approved by VA.

If you are a veteran with either of these specific types of problems, then please send VCS a new email with your contact information in the next several days, even if you already sent one in the past. VCS will then forward your information to our attorneys.

If you are willing to talk to our attorneys about your problems with the VA, then I strongly encourage you to contact our attorneys directly in the next few days. Our attorneys need to show the judge that the problems we are complaining about are system-wide problems and not just isolated to a few veterans.

This call went out last week, actually, so if you are one who would wish to make contact with them with your story, email Paul as soon as possible. Additional contact info in extended.

Click on 'Article Link' below tags for contact information...

Continuing:

Our attorneys have been working on this case for more than a year. I have met them all, and they are friendly and understanding when it comes to speaking with veterans and families about confidential issues. Your participation now could make a huge difference in the lives of the hundreds of thousands of veterans fighting with the VA for many years.

Danny Brome, dbrome@dralegal.org
Kasey Corbit, kcorbit@dralegal.org
Disability Rights Advocates
Phone: (510) 665-8644
Fax: (510) 665-8511
TTY: (510) 665-8716
www.dralegal.org

For information about our class lawsuit, please go to this web site: www.veteransPTSDclassaction.org

Thank you for your continued support of our important lawsuit.

Paul.
Paul Sullivan
Executive Director
Veterans for Common Sense
Post Office Box 15514
Washington, DC 20003
(202) 558-4553
Paul@VeteransForCommonSense.org
www.VeteransForCommonSense.org

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Study: Traumatic Injuries Hurt Even One Year Out

From ScienceDaily:

Most patients have moderately severe pain resulting from their injuries one year after sustaining major trauma, according to a new article. "Pain is a natural accompaniment of acute injury to tissues and is expected in the setting of acute trauma," according to background information in the [JAMA Archives of Surgery] article.

Recent studies have shown that most patients with pelvic fractures and lower extremity injuries continue to experience chronic pain five to seven years after injury. Pain after injury can lead to disability, post-traumatic stress disorder and depression.

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

In educational interest, article(s) quoted from extensively.

Continuing:

Frederick P. Rivara, M.D., M.P.H., of the University of Washington, Seattle, and colleagues analyzed information from 3,047 patients (age 18 to 84) who were admitted to the hospital and survived to one year after experiencing acute trauma. Pain 12 months after injury was measured on a 10-point scale. Personal, injury and treatment factors that may predict chronic pain in these patients were also noted.

"At 12 months after injury, 62.7 percent of patients reported injury-related pain. Most patients had pain in more than one body region, and the mean [average] severity of pain in the last month was 5.5 on a 10-point scale," the authors write. The occurrence of pain one year after injury was most common in those age 35 to 44 and least common in those 75 to 84. "The most common painful areas were joints and extremities (44.3 percent), back (26.2 percent), head (11.5 percent), neck (6.9 percent), abdomen (4.4 percent), chest (3.8 percent) and face (2.8 percent)." ...

"The reported presence of pain varied with age and was more common in women and those who had untreated depression before injury," the authors write. "Pain at three months was predictive of both the presence and higher severity of pain at 12 months. Lower pain severity was reported by patients with a college education and those with no previous functional limitations."

"The findings of this study suggest that interventions to decrease chronic pain in trauma patients are needed," the authors conclude. "The high prevalence of pain, its severity and its effect on functioning warrant such interventions. This may consist of interventions during the acute phase of hospitalization to aggressively treat early pain and better manage neuropathic pain."

General information on trauma and pain from BBC News:

In the Archives of Surgery journal, the University of Washington team called for more intervention to control pain as swiftly as possible. UK patients face the same problems, said one specialist physiotherapist. A report published in 2004 suggested that the quality of chronic pain management in primary care, and the amount offered to patients, was "highly variable".

Only one in 25 of those primary care trusts which replied said that they were even trying to record how many patients they had suffering from chronic pain. The US finding clearly sets out the burden of long-term pain on those suffering traumatic injuries.

The patients in their survey were aged between 18 and 84, who had all survived at least one year after their accident. After 12 months, they were asked to rate their pain on a 10-point scale, and almost two-thirds said they were still in pain, often in more than one part of the body. The average level of pain was not excruciating, but still severe - a rating of 5.5 on the scale. Three or more painful areas were reported by 59% of those with injury-related pain.

The researchers wrote: "The presence of pain varied with age, and was more common in women and those who had untreated depression before injury. "Pain at three months was predictive of both the presence and higher severity of pain at 12 months. "The findings of this study suggest that interventions to decrease chronic pain in trauma patients are needed."

Striking early

They suggested that more work at the time of the injury to deal with "early pain" might be effective. Peter Gladwell, a specialist physiotherapist with an interest in pain management, and a member of the Physiotherapy Pain Association, said that research findings were consistent with his experiences with patients.

"Chronic pain can have a devastating effect on patients, on all kinds of areas of their lives. "It's pretty well understood now that any delay in getting specialist opinion on pain management is unhelpful, and our waiting times are nowhere near as long as they were. "There is plenty of evidence that early, good quality, pain relief can improve the outcome for patients."

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4,000 and 488

Together with the news that 25 fuel trucks transporting fuel to our forces in Afghanistan were bombed today, it is a sad Easter as we reach our 4,000th fatal casualty in the Iraq War (not confirmed yet in the media, but I have received word of it via email by a knowledgeable source and ICasualties.org is showing the same) alongside our 488th fatal loss in Afghanistan, Pakistan and Uzbekistan under the Operation Enduring Freedom umbrella.

My thoughts and prayers to our military families.

[UPDATE] From AP:

A roadside bomb killed four U.S. soldiers in Baghdad on Sunday, the military said, pushing the overall American death toll in the five-year war to at least 4,000. The grim milestone came on the same day that rockets and mortars pounded the U.S.-protected Green Zone, underscoring the fragile security situation and the resilience of both Sunni and Shiite extremist groups despite an overall lull in violence.

Click on 'Article Link' below tags for reflections on our losses...

In educational interest, article(s) quoted from extensively.

Continuing:

Military deaths rose above 100 for three consecutive months for the first time during the war: April 2007, 104; May, 126 and June at 101. The death toll has seesawed since, with 2007 ending as the deadliest year for American troops at 901 deaths. That was 51 more deaths than 2004, the second deadliest year for U.S. soldiers.

The milestones for each 1,000 deaths — while an arbitrary marker — serve to rivet attention on the war and have come during a range of pivotal moments. When the 1,000th American died in September 2004, the insurgency was gaining steam. The 2,000-death mark came in October 2005 as Iraq voted on a new constitution. The Pentagon announced its 3,000th loss on the last day of 2006 — a day after Saddam Hussein was hanged and closing a year marked by rampant sectarian violence.

The deaths taken by U.S. soldiers in Iraq, however, are far less than in other modern American wars. In Vietnam, the U.S. lost on average about 4,850 soldiers a year from 1963-75. In the Korean war, from 1950-53, the U.S. lost about 12,300 soldiers a year.

But a hallmark of the Iraq war is the high wounded-to-killed ratio, partly because of advances in battlefield medicine, enhanced protective gear worn by soldiers and reinforced armored vehicles. There have been about 15 soldiers wounded for every fatality in Iraq, compared with 2.6 per death in Vietnam and 2.8 in Korea.

The deadliest month for American troops was November 2004, with 137 deaths. April 2004 was the next with 135 U.S. military deaths. May 2007 saw the third-highest toll. Last December was the lowest monthly death toll, when 23 soldiers were killed — one less than February 2004.

Easter message from President Bush to the troops:

President Bush said, at Easter, Americans are thinking about U.S. troops on the front lines who will spend this holiday far from home. "I deeply appreciate the sacrifices that they and their families are making," he said. "America is blessed with the world's greatest military, made up of men and women who fulfill their responsibilities with dignity, humility, and honor."

In his weekly radio address, President Bush said Americans remember those who have given their lives. "These brave individuals have lived out the words of the Gospel: 'Greater love has no man than this, that a man lay down his life for his friends.' And our nation's fallen heroes live on in the memory of the nation they helped defend," he added.

The war in Iraq entered its sixth year this past week. Nearly 4,000 American troops have been killed. The latest public opinion poll by CBS News says nearly two-thirds of Americans disapprove of how President Bush is handling the war. Mr. Bush said earlier this week the conflict is noble and just and the world is better off without Saddam Hussein in power.

Anthony H. Cordesman via ABC News:

The 4,000-dead mark will symbolize the real cost of the U.S. participation in the war in Iraq, and the courage and sacrifice of our men and women in uniform. It will also inevitably trigger another wave of polarized debate. Those who oppose the war will see the 4,000 dead as further reason to end it. Those who support the war will point to military progress and say that future casualties will be much lower.

There is likely to be something of a saturation effect in this debate. There already are a host of Iraq-related issues to deal with. We will reach the 4,000 mark at a time when the fifth anniversary has already triggered a new wave of debate on its own, and Gen. David Petraeus and Ambassador Ryan Crocker's testimony before Congress on Iraq progress will come in early April. It will interact with the $3 trillion war cost debate, the bitter exchanges between Democratic Party candidates, Iraqi debates over political accommodation, and al Qaeda's ongoing suicide attacks and atrocities.

This makes it likely that the level of debate over just how much a round number of killed matters may be less intense than it might be otherwise. No one will be able to avoid mentioning the number, but it will be one statistic among many.

New York Newsday editorial:

The lessons of Iraq are clear. The numbers are simple. The solution and the outlook, sadly, are neither. And, unless voters and presidential candidates focus a lot more attention on this issue than they have in recent weeks, clarity will continue to elude us. The woes of the economy, the tactics of the presidential horse race, and the sexual behavior of two New York governors are just a few of the stories that have helped push Iraq off the front page.

Right now, there's a brief surge - to use an overworked word - of attention on Iraq: Last week saw the fifth anniversary of the invasion on March 19, 2003. But we must pay continued attention to Iraq - and to the deteriorating situation in Pakistan and Afghanistan, from which Iraq has too long distracted us. If we don't, we'll squander a precious chance to use the searing heat of a presidential election cycle to generate the light we need to see Iraq more clearly.

But before we discuss what's next, we should reflect on what has gone before.
Let's start with 4,000 - the impending landmark of young Americans killed. Hundreds of thousands of Iraqi civilians have died. Estimates vary, but each civilian death, tragic in itself, carries the seeds of possible future violence by bereaved family members.

30,000. Nearly that many service members have been wounded. Medical science has saved their lives, but they and their families face decades of coping with crushing physical disabilities. And thousands will suffer for years from the crippling psychological disability of post-traumatic stress disorder.

Five years. This war has now lasted longer than the Civil War, longer than World War I, longer than World War II. 100. That's the number of years that Sen. John McCain once said he wouldn't mind seeing America spend in Iraq. 4.5 million Iraqis have been driven from their homes - roughly half are displaced inside the country and half are refugees in other nations.

$3 trillion. That's one estimate of the war's price tag, including caring for veterans and other costs. So say Nobel Prize-winning economist Joseph Stiglitz and Linda Bilmes in their new book, "The Three Trillion Dollar War." Compare that with $50 to $60 billion - the original Bush administration forecast of the war's cost.

Another editorial in today's Hartford Courant:

No weapons of mass destruction to be found in Iraq. No operational link between al-Qaida and Saddam Hussein's regime. One by one, many of the pillars of President Bush's reasoning for invading Iraq have fallen, along with Americans' support for the war. But, as Vice President Dick Cheney would say: So? Mr. Cheney, his boss and other supporters of this misbegotten conflict aren't about to be "blown off course" by the facts.

As the Iraq war marks its fifth anniversary, they are as stubbornly insistent as ever that the war is a righteous cause and, as Mr. Bush said last week, has made the world better and the United States safer. The world arguably is a better place because a cruel dictator was toppled, captured and hanged. But most Americans understandably think the price is too dear.

Earlier this week, the Arizona Republic editorial board wrote:

Five years after the March 19, 2003, invasion of Iraq, recalling the "shock and awe" of that fateful night seems something far and distant. Of another time. And that it was. As New York Times reporter John F. Burns stood with other Western reporters on the roof of their Baghdad hotel, he watched the violent, cataclysmic end to the rule of a terrible totalitarian, Saddam Hussein. The explosions, the power of the attack that night, were "more like an act of God than man."

"But the larger part, the one that seems surreal now in the light of all that has followed, was the sense that, with the beginning of the end of Saddam Hussein's evil, the suffering of millions of ordinary Iraqis that we had chronicled and pitied was ending."

Such was the view on the far side of March 19, 2003. Something evil had ended. But at the same time, something wrenching and difficult - something almost catastrophic, for a time - had begun. The coalition forces unleashed by President Bush and former British Prime Minister Tony Blair had extricated Iraq from Saddam. But in the same sweeping onslaught, we entrenched ourselves in a long and bloody aftermath that, for several difficult years, threatened to engulf not just Iraq but the U.S., as well.

Without dispute, the Iraq war has changed this nation. In some ways, yes, for the worse. Bush, who campaigned in 2000 as a domestic-oriented, anti-interventionist, stood almost alone for a time in pressing the war forward. Our home-front battles over Iraq have been epochal. And they continue.

But whatever the ultimate outcome of the conflict, one important observation must be noted at this five-year juncture: With but a few (pathetic) exceptions, Americans have stood with their soldiers this time. And those soldiers have served us with valor beyond measure. Tough as the Iraq war has been, pride in the accomplishment of our soldiers has been the least of our worries there. Weary as we may be of war, the nation remains in awe of them.

Indeed.


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VA Patient Suicide Attempts Rise Dramatically

On Thursday, CBS Evening News with Katie Couric ran an important story on the rapid rise of veteran suicide attempts currently receiving Veterans Administration care. Newly-released VA records show there were 462 system-wide suicide attempts by their patients in 2000. That number rose to 790 suicide attempts by VA patients in 2007, a 44 percent increase over seven years.

Certain age groups found their numbers increase more than others. For example, 20- to 24-year olds attempted suicide 11 times in 2000; by 2007, that figure rose to 47. Meanwhile, patients attempting suicide in the 55 to 59 age category rose from 19 in 2000 to 117 in 2007.

Video courtesy of VAWatchdog.org:



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

In educational interest, article(s) quoted from extensively.

Armen Keteyian's findings at CBS News:

CBS News has obtained never-before seen patient data from the Department of Veterans Affairs, detailing the growing number of suicide attempts among vets recently treated by the VA. The data reveals a marked overall increase - from 462 attempts in 2000 to 790 in 2007.

"This is highly statistically significant," said Dr. Bruce Levin, head of the biostatistics department at Columbia University. Levin is one of three experts who analyzed the data for CBS News. ...In addition, this VA study, also obtained exclusively by CBS News, reveals the increasing number of veterans who recently received VA services ... and still succeeded in committing suicide: rising from 1,403 suicides in 2001 to 1,784 in 2005 - figures the VA has never made public.

Rep. Bob Filner is chairman of the House Committee on Veterans Affairs. He's been critical of the VA's unwillingness to provide a full accounting of veteran suicides.

"These are incredible figures," he said.

"Does it surprise you that a study like that even exists?" Keteyian asked.

"Well, given the fact that we keep asking for data and they say, 'we don't have any,' yes, it surprises me," Filner said. It angers Filner. "If we can't get the correct information, we can't do our job. We can't prevent every suicide but you can prevent a whole lot of them and it's our duty as a nation to do that."

The VA declined to speak on-camera about this story, but in an e-mail, said it "takes the issue of veteran suicide very seriously" and "has been doing a thorough data investigation to document the number of patient suicide attempts…"

It insists the patient suicides are "...consistent with national trends," despite recent studies that show veteran suicide rates are substantially higher than those of non-veterans.

If you are a veteran who needs help, call the VA's hotline, 1-800-273-TALK, or seek out other resources (in right hand column) available for the taking.


Related Posts

• A Thank You to the House Veterans Affairs Committee From a Concerned Citizen
  
• Upcoming House Veterans' Affairs Committee Hearing on Veteran Suicide and Homelessness
  
• CBS Evening News Veteran Suicide Investigation Follow-up
  
• Groundbreaking CBS News Investigation Into Veteran Suicide 'Epidemic'

Reflecting on the 5th Anniversary of the Iraq War

From my Northern Star column, which runs today:

This week ushers in the 5th anniversary of the start of the war in Iraq. While war markers rarely bring a smile to the face as other anniversaries do, and while numbers are cold and sterile and harbor nothing of the humanity or gravity of such losses, they serve a useful purpose.

They ask that we observe, if only briefly, the sacrifices made for us half a world away.

Quick: Do you know how many troops have deployed, become injured, or even died so far? If you said 1.6 million (this first figure includes Afghanistan) have deployed you’d be on target. Toss in nearly 30,000 injured and nearly 4,000 killed in action in Iraq alone, and you’re totally engaged.

You’re lonely, too.

According to a Pew Research News IQ survey released last week, only 28 percent of us currently know how many U.S. troops have died in Iraq. This figure is down from 54 percent in August 2007. The indifference or even boredom reflects what’s going on in the media, too. War coverage made up only 3 percent of last month’s overall “newshole,” down from July 2007’s more generous 15 percent slice of the news pie.

IAVA is asking us to join together in signing an open letter to the media asking that they increase coverage of the Iraq war. They've made it easy for us to send via this handy online form.

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

In educational interest, article(s) quoted from extensively.

Text of IAVA's media petition letter:

Dear ABC, CBS, NBC, MSNBC, Fox News and CNN,

In February, your network devoted an average of 3% of the coverage to the war in Iraq. Because of that appallingly low number, fewer people than ever before know how many American soldiers have died in Iraq, while a majority of the public knows Oprah Winfrey endorsed Senator Barack Obama for president.

Our troops are still serving in hazardous conditions and encountering daily violence. We owe it to those who have served in the past five years and those who are still serving to keep the Iraq war and veterans' issues in the public eye.

Make sure the Iraq war is getting the coverage it deserves.

Thank you.

Another graf or two from my column:

The latest numbers offer one glimpse at the experience of our soldiers, sailors, airmen and Marines.

During the World War II era, about 12 percent of the U.S. population fought in the war. Today, only half a percent of us are
serving overseas. Over 500,000 have been deployed twice or more.

Nearly 37 percent (299,585) of our returning Iraq and Afghanistan veterans have received one form of medical treatment or another from their local Veterans Administration. About 40 percent of those patients (120,049) have been diagnosed with a mental health condition, 23 percent (67,717) with post-traumatic stress disorder. Studies show PTSD risk increases with multiple deployments.

Meanwhile, 663,000 veterans of all wars are waiting for their disability claims to be processed, the highest backlog on record. Hearing damage is the number one disability for today’s vets, with nearly 70,000 suffering from ringing in the ears and another 58,000 from hearing loss.

Read the rest. More stats can be found in The War List that I've been compiling since last year. I'll be updating it as best I can throughout the week.


Related Posts

• 4,000 and 488
  
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As 5th Anniversary Approaches, Iraq War Mistakes a Heavy Burden for Its Veterans

A sobering piece by St. Louis Post-Dispatch reporter Philip Dine reflects on some of the problems encountered, and later literally shouldered, by the Iraq War's returning veterans. First a summary of the government's missteps, followed by a look ahead:

Three factors are generally viewed as having combined to produce problems in care for U.S. veterans of Iraq:

— Strategic mistakes that made the war longer and more lethal, including sending too few troops, not sealing Iraq's borders or arms depots, failing to recognize the insurgency early on and not planning how to secure the peace.

— The nature of the war. The lack of front lines made everyone vulnerable at any time, increasing the danger and stress. The insurgents' use of improvised explosive devices has produced devastating injuries. Multiple deployments and the unprecedented use of the National Guard and Reserves increased the risks, especially of stress-related problems.

— A lack of preparedness for the volume of casualties, which overwhelmed the system. Additionally, the military missed many cases of post-traumatic stress disorder or traumatic brain injury by relying on soldiers to come forward. Of the 1.7 million service members with recent combat experience, some 800,000 are now veterans entitled to VA health care and benefits. Of those, 300,000 have had treatment; 40 percent were diagnosed with a mental health problem, more than half with PTSD, according to Veterans Affairs figures released as a result of a lawsuit by Veterans for Common Sense, a nonpartisan veterans advocacy group.

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

In educational interest, article(s) quoted from extensively.

Continuing:

After what many experts describe as a chaotic few years marked by too few resources — though Walter Reed and other institutions have done remarkable work in areas such as prosthetics — the past year or so has seen some progress. Congressional legislation, pressure from veterans advocacy groups, continued efforts by veterans services groups and greater urgency by officials in the VA and Pentagon have moved things along.

Since August, military officials have encouraged soldiers who were near an explosion to get checked for traumatic brain injury, and Illinois and some other states have filled gaps for their own veterans. The transition between the Pentagon and VA is smoother, with record transfers being done electronically, and VA care has been extended for combat veterans.

A handful of key bills passed last year. They include efforts to prevent suicides, give wounded veterans cost-of-living adjustments, unify the disability rating system between the Pentagon and the VA and compel the military to examine personality-disorder discharges.

Much remains to be done to get mental health treatment to rural veterans or provide home care for disabled veterans, [Matthew Cary, president of Veterans & Military Families for Progress] says. More generally, what's needed is a comprehensive approach to treating veterans and families, as well as better funding mechanisms. One idea, he says, would be to sell war bonds to fund care, so the public could help. ... [He] worries that financial concerns could impede the current progress, given the mounting war costs and the looming recession.

More via AP:

How much longer?

Most likely, the war will go on for years, say many commanders and military analysts. In fact, it's possible to consider this just the midpoint. The U.S. combat role in Iraq could have another half decade ahead - or maybe more, depending on the resilience of the insurgency and the U.S. political will to maintain the fight.

Iraq, experts say, is no longer a young war. Nor it is entering an endgame. It may still be in sturdy middle age. "Four years, optimistically" before the Pentagon can begin a significant troop withdrawal from Iraq, predicted Eric Rosenbach, executive director of the Center for International Affairs at Harvard's Kennedy School, "and more like seven or eight years" until Iraqi forces can handle the bulk of their own security.

What that means depends largely on your vantage point.

For the Pentagon, it's about trying to build up a credible Iraqi security force while struggling to support its own troop levels in a military strained by nonstop warfare since 2001. During a trip through the Persian Gulf last year, Adm. William Fallon, then head of U.S. Central Command, was peppered with as many questions about resources as about strategies moving ahead.

For many Americans, it's about a rising toll - nearly 4,000 U.S. military deaths and more than 60,000 wounded - with no end in sight. Iraqis count their dead and injured in much higher figures - hundreds of thousands at least - and see entire neighborhoods changed by the millions who have fled for safer havens.

For others, it's about an ever-mounting loss of goodwill overseas: "We've squandered our good name," says 29-year-old Ryan Meehan, sitting in a St. Louis coffee shop.

You can also frame the war in terms of the cost to the treasury: $12 billion a month by some estimates, $500 billion all together, and the prospect of hundreds of billions more. But then there's other measures of the war as it enters its sixth year.

These are more difficult to weigh - yet are just as real and profound - and are found in places such as Jim Durham's home in Evansville, Ind. He tries to fight off a sense of dread as he watches his 29-year-old son prepare for his second tour in Iraq with the Indiana National Guard.

Read Durham's story and much, much more.


Related Posts

• 4th Anniversary of Start of Iraq War Winds Down, 5th Year Begins
  
• 3 Years On, Combat PTSD Comes Out of the Closet
  
• 15 Year Anniversary of Start of first Gulf War, Desert Storm

PTSD Sculpture Therapy: One Woman's Clay Journal

Recently, a sculptor pointed me in the direction of her series of figurative pieces created while she was in therapy for PTSD. At the Tri State Sculptors website, Kim Marchesseault (who blogs at Spackel) says of her work:

My work is about relationships among people, with self, with the universe. It’s a study of why we are here, what makes us who we are and how each one of us affect everyone and everything around us. I move shapes and lines until they work together to soothe and heal.

Kim, who in the past has practiced a wide variety of art expression including bronze casting and mural painting, was kind enough to answer a few of my questions regarding her ethereal ceramic sculptures. I believe her creations and answers offer us a glimpse into the heart of someone processing their PTSD. Her impressions are deep, funny at times, and always thought-provoking.

A heartfelt thanks to Kim for sharing so much with us.

Click on 'Article Link' below tags for my interview with Kim...

Ed note: The accompanying images are used with permission and have been artistically rendered. Additional pieces and clearer examples of Ms. Marchesseault's work, along with dimension and medium descriptions, are found at her Tri State Sculptors page.

Ilona Meagher: Your pieces tell an incredible tale of the soul finding strength in adversity. How difficult were those first pieces to produce?

Kim Marchesseault: Thank you.

I made the first piece, "The Pawn", in a sculpting class at NC State Craft Center and it was all I could do to make myself go.

I didn't know what was wrong with me, but I was scared enough to start seeing a therapist. I was having flashbacks and nightmares. I was terrified of even the most normal, commonplace interactions.

I was afraid someone was going to hurt me if they saw my sculpture. I tried my best to pretend everything was alright. I didn't want anyone to know. I just kept sculpting.

--

IM: Your clay journal, as you describe it, moves from 'The Pawn' to 'Free Diver' -- can you offer up any insight into the personal meaning each piece (or the meaning of the overall collection) holds for you? Which expressions are most transferable to the wider world today in your opinion?

KM: I see universal patterns in almost everything in life.

"The Pawn" represents being in situations that are beyond our control. Her eyes are closed. She has no arms. No hands to fix things with. The woman who modeled for us was crying the last night I worked on this piece because her cat was dying of a terrible illness. I thought if I made a change to the sculpture, she wouldn't have to be sad so I divided her hair/head into three parts.
I think this represents dissociation -- the thing we use to get us through the crisis. It is the separation of intellect from emotion and physical pain.


"Agony" is hurting. People might not realize just how much pain we're in. They don't believe us. We look like we're not really that bad off, but just acting, being dramatic. They reject us, discredit us. We're alone.

"River's Dawn" is a bit of hope. Hair (former living cells of our body -- our past) becomes water (cleansing, tears).

"Why?" Why did you do this to me? Expresses anger with God. Something that is taboo.

Waves crash against his legs.

"The Truth" is the most philosophically universal piece of art I have ever made. Jim Fatata and I shared a model, but I completed it later, alone. I changed the position of the head and the hand he's looking at. A lot of what happens in my work is intuitive. I usually experience things in my life that I see echoed throughout the universe on many different levels. I know that sounds silly.

Truth is elusive and I believe absolute truth is perfection of knowledge, which we as human beings cannot ever obtain full understanding of. So in his hand he believes he's holding the truth, but has he ever really seen it before. Is he hiding it? Preserving it? Protecting someone from it? Will he destroy it? Is he actually grasping the real truth? Or is it in his other hand? (the one behind him).

I thought about making a version of this piece that is not nude, but I don't know if I should cover up "The Truth"!! :P~ This is us trying to make sense -- to understand the memories and flashbacks. It's always a challenge to separate popular opinion -- what people in control want us to believe and what we want to believe -- from what is actually true.

"Letting in the Light" is exposing, revealing or demanding the truth. Pulling the facade off -- removing the minimalization; eliminating wrongful justification; peeling away the denial -- facing things head on.

It was at this point I was having the worst flashbacks. This was the most daring, most dramatically empowering and painful part of my therapy, a turning point.

"A New Direction" represents choosing a new path. It took me a long time to finish this one. I didn't think I was a good enough sculptor to complete it.

Around this time I eliminated destructive relationships from my life, realized I am worth protecting, that I need protection and learned how to protect myself in a healthier, more acceptable way.

Here I differentiated between what is and what is not a real obstacle. I was finding a safer way around the the real obstacles to reach my goal.

"Reverie" represents reflection, quiet contemplation. At this stage I pictured how I want the people around me to feel, visualized what I want my life, the lives of family members and friends to be like and how to achieve happiness.

"Free Diver" represents freedom. Flashbacks are gone. It is safe to simply exist and to be ourselves without fear.

---

IM: Do you express yourself artisticly in other ways, too (write, paint, compose music, etc)?

KM: I enjoy writing. Sometimes I'm chained to reality. Other times I head off in abstract, comedic, off-the-wall directions with my writing. Music is just for fun, sheer improv when I'm singing or beating out a rhythm or goofing around on the piano. My best instrument is probably the kitchen countertops. Is that an instrument? I have a few paintings that came from my dreams. They are meaningful to me.

---

IM: How do those art therapy forms differ from what you get out of sculpting?

Writing/words are more of a commitment. They have meanings you can look up in the dictionary. I don't always want to commit. I want the freedom to interpret, feel and evolve that comes with visual art and music. Of course words enter in visual art as titles and descriptions, in music as lyrics. And I do find new meaning in old books I haven't read in a while. I believe the various forms of art enhance each other and overlap at times.

---

IM: What have you found are the benefits of using art to process trauma?

KM: Art quietly invites you to reflect on your life, your world, your relationships while at the same time offering comfort. Good sculpture allows you to see what you need to see -- to project onto it the things you need to work out. The forms can be soothing and can communicate gracefully and directly without intruding, without a word. You choose to look or not.

There is no right or wrong.

Creating your own art causes more trauma when you are hard on yourself, perfectionistic, judge every mistake you make with cruelty. Eventually you learn to relax and know in your heart that nothing is wrong in art. You are improving with each piece, you begin to work quickly, finish, let it go and do better on your next piece of art -- then it becomes a growing, wonderful experience. You suddenly find you are being productive instead of beating yourself up.

Every work you do expresses your ideas, your emotion, your experiences. You see that you have some paintings or sculptures you like and others you're not as crazy about, but you know you can do better next time. Ideas for more art begin to flow. You discover you've become resilient and this manifests in other parts of your life.

---

IM: Had you been an artist before your trauma incident? If so, how was your work changed?

KM: I had Complex Post Traumatic Stress Disorder with trauma beginning when I was an infant. I've always excelled in art classes and dance when receiving instruction, but I was afraid whatever I created on my own would be stolen, ridiculed, broken and that I would be attacked for it. I didn't feel safe enough to truly express myself in art until recently in my life.

---

IM: How might your artwork help veterans returning from the combat zone?

KM: It would make me happy if our veterans going through the flashbacks and emotions of PTSD see with their own eyes in these sculptures that we can beat this thing.

There is hope.



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Senate Amendment Aims to Decrease Veterans Disability Claims Backlog

From Rick Maze via Navy Times:

The Senate moved Thursday to add $50 million to the fiscal 2009 Department of Veterans Affairs budget specifically to speed the processing of disability claims. By voice vote and with no opposition, the Senate revised the 2009 federal budget to include an amendment sponsored by Sen. Blanche Lincoln, D-Ark., adding the money for VA claims processing.

The Senate’s budget resolution, S. Con. Res. 70, which lays out guidelines for federal spending for the fiscal year that begins Oct. 1, already included a $3.2 billion increase in veterans’ funding over the Bush administration request.

In total, the budget resolution would give the VA $93.6 billion in budget authority for 2009, $5.2 billion more than this year’s VA budget. Lincoln, who sponsored similar legislation last year, said the money is needed “to help veterans receive the benefits they have earned. Veterans are not getting the benefits they need and are not getting them in a timely way.”

The $50 million increase would apply to the general administration account for the Veterans Benefits Administration, which processes benefits claims. The money is earmarked for pilot programs to find ways to cut the average waiting time for a ruling on a claim, currently six months for initial claims. Lincoln thinks working the problem from that direction could have a bigger long-term effect than continuing to hire more people to try to whittle down the huge backlog of claims.

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

In educational interest, article(s) quoted from extensively.

Meanwhile, the search for a new VA Benefits Chief has begun:

A 10-member commission was appointed [last] Thursday to screen candidates to become the next undersecretary of veterans affairs for benefits. Retired Navy Vice Adm. Daniel Cooper, the Veterans Affairs Department’s current benefits chief, has announced he will step down April 1. ...

There is no firm timetable for the commission to complete its work, and a successor to Cooper is unlikely to be named by April 1, according to a senior VA official who asked not to be identified. “This is not the kind of position where you should rush into naming a replacement,” the official said. ...

The benefits chief runs an arm of VA that has about 15,000 employees and pays out $45 billion a year in disability and survivor payments and education benefits, and also oversees VA’s insurance and home loan programs.

Cooper held the job for six years, the longest tenure in that position in VA history. He inherited a large backlog of pending benefits claims that he battled to reduce through a variety of changes, including hiring more people and assigning so-called “tiger teams” of benefits experts to tackle more complex claims so that less experienced people could process the simpler claims.

Despite his efforts, the claims backlog is larger today than at any time in VA history, with about 600,000 pending at any one time. Average processing time for an initial claim is about 180 days. Congress has been pressing for improvements. In a Feb. 28 report on the White House’s proposed VA budget for 2009, Democrats on the House Veterans’ Affairs Committee said the current claims backlog stands at 663,000, about 37,000 more than a year ago.

“We believe the VA must vigorously explore alternative methods of addressing, once and for all this, intolerable backlog,” the report said. Secretary of Veterans Affairs Dr. James Peake said finding the right person for the top benefits job is important.

“With a new generation of combat veterans returning from Iraq and Afghanistan, the search commission must ensure we fill the undersecretary’s job with a person having the right skills, experience, vision and commitment to our nation’s veterans,” Peake said in a statement.

 Related Posts

• Experts, Advocacy Groups, Officials: VA Disability System Fixable
  
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Winter Soldier Gathering to Hold Crisis in Veterans' Healthcare Panel on Friday

The Winter Soldier: Iraq and Afghanistan testimonies begin at the National Labor College near Washington, D.C., today and continue through Sunday. The event title hearkens back to the 1776 writings of Thomas Paine: "These are the times that try men's souls. The summer soldier and sunshine patriot will, in this crisis, shrink from the service of his country; but he that stands by it now, deserves the love and thanks of man and woman."

Tomorrow, Friday March 14, 2008, The Crisis in Veterans' Heathcare panel will be convened from 11:00AM – 12:30PM EST. From the event schedule:

This panel will look at neglect and abuse of veterans and service members with regards to their mental and physical health. Testimonies will include accounts about the impact of an under-funded Veterans Administration, injured soldiers being forced back into combat without fully recovering from their wounds, cases of the military’s denial of mental healthcare for those suffering from post traumatic stress syndrome and exposure of service members to depleted uranium munitions and other hazardous materials.

(Speakers: Martin Smith; Adrienne Kinne, IVAW member and worker in Veterans Administration; Eugene Martin, national organizer with American Federation of Government Employees, AFL-CIO; Joyce & Kevin Lucey, parents of a son who committed suicide after being denied treatment for post traumatic stress syndrome; Zollie Goodman; Tod Ensign)

Listen in via online stream or check other viewing options.

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

In educational interest, article(s) quoted from extensively.

Details from The Nation:

From [today] through Saturday the Winter Soldier: Iraq and Afghanistan hearings in Washington, DC will feature testimony from US veterans detailing what's really happening on the ground in these occupations.

They'll present photographs and videos, recorded with mobile phones and digital cameras, to back up their allegations of brutality, torture and murder. The event is inspired by the Winter Solider tribunal held in 1971 by Vietnam War vets, including, famously, John Kerry.

Winter Soldiers, according to Thomas Paine, are patriots who stand up for the soul of their country, even in its darkest hours. With this spirit in mind, the current generation of Winter Soldiers are standing up to make their experiences available to all who are concerned about the direction of our country.

Some Americans may not agree with the desire for war veterans to come forward to speak plainly about their experiences -- especially while war still rages. And one quick Google News search using the keyword 'Winter Soldier' will show how little the mainstream media wishes or cares to cover the event.* But, if any group has earned the right to be heard on issues having to do with war and peace, it would be those that have worn the uniform in battle.

*Indeed, a new Pew poll shows an overall waning of media coverage of the Iraq War.


Related Posts

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Returning Vets and Hearing Loss

In addition to the expected physical drawbacks of suffering combat-zone hearing injuries (now being called the "the silent epidemic"), I wonder what, if any, psychological effects these persistent wounds have on our soldiers.

Are returning vets with ringing or buzzing ears, also known as tinnitus, at a disadvantage when it comes to putting the war behind them? What effect does the constant reminder of the IED blast or RPG attack they survived have on them?

From AP:

Large numbers of soldiers and Marines caught in roadside bombings and firefights in Iraq and Afghanistan are coming home with permanent hearing loss and ringing in their ears, prompting the military to redouble its efforts to protect the troops from noise.

Hearing damage is the No. 1 disability in the war on terror, according to the Department of Veterans Affairs, and some experts say the true toll could take decades to become clear. Nearly 70,000 of the more than 1.3 million troops who have served in the two war zones are collecting disability for tinnitus, a potentially debilitating ringing in the ears, and more than 58,000 are on disability for hearing loss, the VA said. ...

For former Staff Sgt. Ryan Kelly, 27, of Austin, Texas, the noise of war is still with him more than four years after the simultaneous explosion of three roadside bombs near Baghdad.

"It's funny, you know. When it happened, I didn't feel my leg gone. What I remember was my ears ringing," said Kelly, whose leg was blown off below the knee in 2003. Today, his leg has been replaced with a prosthetic, but his ears are still ringing.

"It is constantly there," he said. "It constantly reminds me of getting hit. I don't want to sit here and think about getting blown up all the time. But that's what it does."

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

In educational interest, article(s) quoted from extensively.

Continuing:

"They can't say, `Wait a minute, let me put my earplugs in,'" said Dr. Michael E. Hoffer, a Navy captain and one of the country's leading inner-ear specialists. "They are in the fight of their lives."

In addition, some servicemen on patrol refuse to wear earplugs for fear of dulling their senses and missing sounds that can make the difference between life and death, Hoffer and others said. Others were not given earplugs or did not take them along when they were sent into the war zone. And some Marines weren't told how to use their specialized earplugs and inserted them incorrectly. ...

Sixty percent of U.S. personnel exposed to blasts suffer from permanent hearing loss, and 49 percent also suffer from tinnitus, according to military audiology reports. The hearing damage ranges from mild, such as an inability to hear whispers or low pitches, to severe, including total deafness or a constant loud ringing that destroys the ability to concentrate. There is no known cure for tinnitus or hearing loss.

The number of servicemen and servicewomen on disability because of hearing damage is expected to grow 18 percent a year, with payments totaling $1.1 billion annually by 2011, according to an analysis of VA data by the American Tinnitus Association. Anyone with at least a 10 percent loss in hearing qualifies for disability.

In 2005, Congress mandated the Institute of Medicine to assess "noise-induced hearing loss and tinnitus associated with military service from World War II to the present, the effects of noise on hearing, and the availability of audiometric testing data for active duty personnel." Their full report, Noise and Military Service: Implications for Hearing Loss and Tinnitus, found:

For this congressionally mandated and VA-funded study, an IOM committee reviewed evidence on the following concerns:

• Sources of hazardous noise exposure during military service

• Levels of noise exposure necessary to cause hearing loss or tinnitus

• Available data on hearing loss that could be expected among members of the armed forces

• Course of hearing loss following noise exposure, including whether onset can be delayed

• Risk factors for noise-induced hearing loss and tinnitus

• Adequacy of the services’ hearing conservation programs to protect the hearing of servicemembers

• Compliance by the military services with requirements for audiometric testing

... Many sources of potentially damaging noise exist in military settings, including weapons systems, wheeled and tracked vehicles, fixed- and rotary-wing aircraft, ships, and communications devices. Servicemembers encounter noise through training, standard military operations and combat, and exposure to combat-related noise may be unpredictable in onset and duration. Servicemembers may also be exposed to hazardous noise through activities that are not unique to military service, including engineering, industrial, construction and maintenance tasks.

... It is well established that individuals vary in their responses to noise exposure, but the factors that account for this variability are still poorly understood. Evidence from studies in humans was not sufficient to determine whether noise exposure combined with specific endogenous or exogenous factors was associated with additional risk for noise-induced hearing loss or tinnitus. Endogenous factors that have been studied include older age, gender, race, eye color and prior hearing loss. Among the exogenous risk factors that have been studied are aminoglycoside antibiotics, cisplatin, diuretics, salicylates, solvents, carbon disulfide, carbon monoxide, cigarette smoking, whole-body vibration, body temperature, exercise and electromagnetic fields. Some of these exogenous factors, primarily the medications and chemicals, may induce hearing loss in and of themselves.

... From its analysis of available data, the committee concluded that military hearing conservation programs dating from the late 1970s forward were not adequate to protect the hearing of servicemembers. Hearing conservation activities from World War II through the 1970s would have been even less adequate because only early hearing protection devices of limited effectiveness were available and mandatory hearing conservation measures were in place only in the Air Force.

Use of hearing protection devices is often the primary defense against noise-induced hearing loss for military personnel, and the effectiveness of these devices depends, in large measure, on how well and how often they are used. Data are limited, but a handful of reports over the past 30 years suggests that in some settings, only about half of those who should have been using hearing protection devices were doing so.

Although the services’ hearing conservation programs require annual audiometric testing for enrollees, some personnel may not be receiving the required tests and some test results may not be reaching the data registry. Where test records are available, the percentage of servicemembers who have a significant shift in their hearing thresholds currently ranges from about 10 to 18 percent, a level two to five times higher than is considered appropriate in industrial hearing conservation programs.

... The current irreversibility of noise-induced hearing loss and tinnitus means that preventing these problems, or limiting their progression, is important. The committee recommended that the military services implement several practices to enhance hearing protection for servicemembers and improve the effectiveness of military hearing conservation programs. Some of these include:

• Work to achieve more extensive and consistent use of hearing protection

• Include questions about the presence and severity of tinnitus on all audiometric records

• Enforce requirements for audiograms prior to noise exposure for all new military servicemembers at all basic training sites

• Enforce (or establish) requirements for audiograms at the completion of military service

• Enforce hearing conservation requirements for annual monitoring audiograms and for follow-up audiograms if a significant threshold shift is detected

• Improve the reporting capabilities of the Defense Occupational and Environmental Health Readiness System (DOEHRS), including adding the ability to track reports of tinnitus.

The full 342-page report is available on Google Books. The American Tinnitus Association has some helpful general information for anyone interested in learning more on this injury.

If you're a veteran suffering from hearing loss, here's some helpful advice on filing a claim for your injury:

Claims for bilateral hearing loss and bilateral tinnitus must be well supported by current medical evidence. There must be a pertinent military service history which indicates that the veteran was exposed to prolonged loud noises while on active duty, there must be medical evidence of a current hearing loss with or without tinnitus and, most importantly, there must be a documented medical opinion from a state licensed audiologist that the current hearing loss or tinnitus was more likely than not to have been caused by his/her exposure to environmental and/or combat related noise while on active duty.

All veterans who are contemplating filing a claim for bilateral hearing loss and bilateral tinnitus are advised to request an audiologist exam from the VA Medical Center [in your area]. The audiologists at that facility know exactly what the VA regional office needs for a service connected hearing claim. The amount of disability granted for service connected hearing loss depends on the degree of loss.

What we need from you to assist with the preparation of your claim.

If you are enrolled with VA Health and are being seen at a local VA Clinic, when you see your VA primary care provider at your next appointment please remember to tell your provider that you have hearing loss and ringing in your ears. Ask them to make you an appointment with the audiologist clinic at the nearest VA facility for an audiologist evaluation.

When you see the audiologist tell him:

1. You have a hearing loss.
2. You have continuous ringing/buzzing in your ears .
3. You were exposed to loud environmental noise while you were on active duty.

After your examination go to the “release of information office” and ask them to send a copy of your audiologist evaluation results to your home. When you receive the results bring them in to our office. We will submit the results as medical evidence to the VA Regional Office along with your claim.

Medical evidence is critical to the approval of your claim. Medical evidence establishes the verification needed by the VA to confirm that the disability you are claiming actually exists.

The audiologist may or may not further document an opinion in the report as to whether or not the possible cause of the hearing disability is a result of your earlier exposure to environmental and/or combat related noises while on active duty.

The sample letter is a copy of the type of letter that the VA will accept as medical evidence of a “link” between your current hearing loss with tinnitus and the loud noise that you were exposed to while on active duty.

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DoD/VA to Implement 'A Life Map for Recovery' for Returning Veterans

From Government Executive:

Top officials from the departments of Veterans Affairs and Defense said on Tuesday that they plan to improve the health care for troops wounded in Iraq and Afghanistan by providing them with "a life map for recovery" that integrates all their heath records into one package and lays out a listing of follow-up services.

In a joint statement submitted to a hearing of the Senate Veterans Affairs Committee, Dr. Lynda Davis, deputy assistant secretary of the Navy for Military Personnel Policy, and Kristin Day, chief consultant for care management and social work at VA, said Defense and VA partnered in October to establish the Joint VA/Defense Federal Recovery Coordinator Program.

Program coordination officials will develop several Web-based applications, including a Federal Individual Recovery Plan and a National Resource Directory, they said. They will team with military health care personnel to use the recovery plan to create in one set of documents a so-called life map for recovery for wounded, ill or injured service members, as well as veterans and their families.

The recovery plan will provide a complete menu of care (integrated documents that include all health services and health organizations, including longitudinal records, and clinical and nonclinical services) to service members headed back to duty or retirement, Davis and Day said. The plan will include information on support services and resources for health care providers and the wounded service members and veterans, they added.

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In educational interest, article(s) quoted from extensively.

Continuing:

VA and Defense developed the application based on recommendations from the President's Commission on Care for America's Returning Wounded Warriors, which President Bush formed in response to critical reports of military health institutions such as Walter Reed Medical Center in Washington, providing poor health care services to wounded soldiers returning from Iraq and Afghanistan. Last August, the commission, headed by former Sen. Bob Dole, R-Kan., and Donna Shalala, secretary of the Health and Human Services Department in the Clinton administration, recommended that Defense and VA develop within a year a Web-based portal to provide patients with health care and benefits information from the two departments.

Deputy Secretary of Defense Gordon England and Veterans Affairs Deputy Secretary Gordon Mansfield told the Senate Veterans Affairs Committee in February that they planned to set up an eBenefits Web portal that will meet the commission's mandate, but they did not provide a timeline.

The commission also said the Web portal should provide patient records to recovery coordinators, who work directly with wounded soldiers in military clinics and hospitals, to clinicians and other health care professionals in both departments.

Davis and Day also described the National Resource Directory, developed in collaboration with the Labor Department, that wounded service members, veterans and families will use will use to find health services offered by federal, state and local agencies and veterans services organizations. Health care providers and the general public will be able to use the directory as well, Davis and Day said.

But for the time being, care for wounded soldiers still remains in disarray, says retired Air Force Col. Peter Bunce, whose son Justin, a Marine corporal, was severely wounded by an improvised explosive device in Iraq in March 2004. Peter Bunce, who testified before the committee, says families still must battle a disorganized, paper-based system on their own to obtain needed care.

Peter Bunce said his son lost an eye as a result of an IED blast and also sustained traumatic injury from a piece of shrapnel that penetrated the frontal lobe of his brain. Peter Bunce said he considers the brain injuries the "signature wound" of combat operations in Iraq and said the effects of those injuries are felt not only by the wounded soldiers but also by their families, who as caregivers are often left to manage much of the wounded soldiers' daily lives.

The burden that they bear in dealing with traumatic brain injuries is compounded by what Peter Bunce described as "the multitude of bureaucratic hoops that families are expected to jump through for services [which] can be the breaking point for that veteran's support system."

Case management at the VA Medical Center in Washington, where Justin Bunce receives treatment, only schedules appointments, Bunce told the panel. "Case management has been the sole responsibility of my family," he said. "We have had to navigate ourselves through the stovepiped departmental nature of care at the VA.

"We have been the ones, not VA personnel, to make trips to other VA hospitals in Tampa, [Fla.], and Milwaukee to bring back best practices for ... therapeutic care to our local VA hospital that is ironically located in the heart of our nation's capital just a few miles from the Veterans Administration [sic] headquarters," he added.

Poor case management at the VA Medical Center is the cause of Peter Bunce's inability to obtain a review of the medications prescribed to Justin Bunce by various medical departments and evaluate the dosages and how the medications may be interacting, Peter Bunce told the committee. He said the only way he can keep track of clinicians providing care to Justin was with "a fistful of business cards, [which] does not suffice when families are overwhelmed with day-to-day recovery, therapeutic, medical and emotional issues."

Peter Bunce gave the committee his own recommendations for care at VA, which reflect those made by the wounded warriors commission and which appear to be the goal of the new eBenefits Web portal:

* A wiring diagram detailing the responsibilities of the different VA team members in the various medical departments that delineates their respective roles in rehabilitation, therapy and medical care.
* One document for each family listing the names and phone numbers of the entire member on a patient's health care team and department extensions.
* A flow chart allowing a family to track the process for making appointments, referrals, contacts for financial services, and insurance and legal assistance, and explaining how to access free outside medical and therapeutic services.

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Atlanta's Shepherd Center Picks Up Where TRICARE Leaves Off to Improve TBI Care of OEF/OIF Troops

Up to 20% of soldiers serving in Iraq and Afghanistan get TBI according to an Army report [pdf] released in January. In addition to the 1-in-5 figure, some returning soldiers with the milder form of TBI (aka concussions) don't even know they have the injury most associated with IED attacks.

The military had been flat-footed in the opening years of the war when it came to treating TBI; their limitations in care are still apparent. Fortunately, some private health care providers are providing relief to military families trying to recover from the more devastating of TBI injuries.

On Sunday, CBS Evening News sat down with Brig. Gen. Donald Bradshaw who heads up the military's TBI Task Force, to discuss these issues:



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In educational interest, article(s) quoted from extensively.

From BusinessWire:

Humana Military Healthcare Services (HMHS) and the Shepherd Center, an Atlanta-based hospital specializing in the medical care and rehabilitation of people with spinal cord and brain injuries, announced a partnership with Home Depot co-founder Bernie Marcus. This partnership will assist military service members wounded during their service in Operation Iraqi Freedom and Operation Enduring Freedom, as well as their families, in obtaining additional care that will aid in their recovery from combat related injuries.

The SHARE Initiative, began in January 2008, and will primarily focus on wounded service members in the Southeast, subsequently expanding to encompass a larger population. SHARE'S vision is to enrich the hope and recovery for wounded men and women of the military. The partnership with Shepherd Center (one of the nation's leading rehabilitation hospitals) will complement the healthcare that may not be covered by TRICARE or other health insurance. Services may include specialized rehabilitation and community reintegration for spinal cord or traumatic brain injuries (TBI) survivors who sustained injuries while serving in Iraq and Afghanistan.

"Humana Military is pleased to be a part of this initiative," said Dave Baker, president and CEO of HMHS. "The courageous men and women of the military deserve the finest of care when they return home with injuries. I am happy that HMHS is partnering with Mr. Marcus and the Shepherd Center to complement the quality care they are already receiving."

Marcus will sponsor wounded warriors needing assistance in paying for essential medical rehabilitation, post-acute rehabilitation, as well as community and family support services at the center that may not be covered under TRICARE or other health insurance.

The types of services that Marcus will take financial responsibility for could include: neuropsychological evaluation to assess for TBI and post-traumatic stress disorder (PTSD), cognitive therapy, counseling, activity- and community-based rehabilitation, residential services and respite care for family members, and housing while services are being delivered. Services also could include assistive technology devices, cognitive prosthetics, and home health care equipment, such as bathroom equipment and canes.

For more information, please contact Susan Johnson at the Shepherd Center, 404-352-2020.

Coverage on the Army's TBI report released in January, first from AP:

Up to 20 percent of U.S. troops returning from Iraq and Afghanistan may have suffered mild concussions but were unaware of them and did not get treatment...Concussions, which the military calls traumatic brain injuries (TBIs), are among the most common injuries troops suffer during combat tours. But the Army has a hard time identifying and treating affected troops because the soldiers and Marines don't recognize the symptoms and don't report them.

"The Army is challenged to understand, diagnose and treat military personnel who suffer with mild TBI," said Brig. Gen. Donald Bradshaw, who leads the Army's TBI task force. Traumatic brain injuries are caused by powerful blasts, such as ones created by improvised explosive devices, or other severe trauma that shakes the brain inside the skull. The result can be bruising of the brain or greater damage.

The Army began looking at the TBI issue and care in January 2007 by talking to soldiers, family members and caregivers to find out how such injuries were identified and treated, Army officials said. The Army now checks soldiers before and after deployment to identify and treat as many TBI-affected troops as possible.

Less than half who suffered from a mild traumatic brain injury in combat have persistent symptoms associated with it, Col. Robert Labutta, a neurosurgeon with the Army surgeon general's, office told The Associated Press. But symptoms from the injury such as irritability affect a soldier's interaction with family and fellow soldiers, said Col. Jonathan Jaffin, deputy commander of the U.S. Army Medical Research and Materiel Command.

"By identifying them, giving them a diagnosis so they don't think they're just going crazy ... we think that helps them deal with it," Jaffin told the AP.

From Armed Forces Press Service:

The report contains some 47 recommendations to help the Army better prevent, screen, diagnose, treat and research traumatic brain injury, said Brig. Gen. Donald Bradshaw, who led the task force charged with investigating TBI. Bradshaw is commander of Southeast Regional Medical Command and Eisenhower Regional Medical Center, at Fort Gordon, Ga.

"Our report indicates that, like our civilian counterparts, the Army has done well in the identifying and treatment of severe or penetrating traumatic brain injury, but is challenged to understand, diagnose and treat personnel who have suffered short-term or persistent symptoms of mild TBI," he said. "The task force identified opportunities for improvement as well as best-practice guidelines." ...

Today, eight of the recommendations made by the task force have already been implemented, said Col. Judith Ruiz, deputy director for rehabilitation and reintegration with the Office of the Surgeon General. "We have made significant progress to take care of soldiers and to standardize practices across the Army medical department," she said.

Some of the recommendations that have already been implemented include:

-- Working with interagency and civilian groups to better define TBI;

-- Implementing in-theater TBI screening and documentation for all soldiers exposed to brain injury-inducing trauma;

-- Adding TBI-specific questions to deployment-related health assessments;

-- Developing a proposal on the appropriate functions of a "TBI center of excellence";

-- Proposing the Defense and Veterans Brain Injury Center as the core of the new center of excellence;

-- Optimizing the positioning of clinical, educational and research activities;

-- Centralizing the evaluation of the scientific merit, clinical utility, and priority of new treatment strategies, devices or interventions; and

-- Adapting the Military Acute Concussion Evaluation overprint as an approved Department of the Army form to document mild TBI closest to the point of injury.

Ruiz said 31 additional recommendations are in progress, four are planned, and four are in the process of being transferred to other agencies. ...

The Army launched the post-traumatic stress disorder/mild traumatic brain injury chain teaching program in 2007 to help soldiers better identify signs and symptoms of these conditions and to reinforce the collective responsibility to take care of each other.

The Army is also working to educate the civilian medical community about mild TBI so that soldiers in the reserve components, who may not have full-time access to military medical care, also can be identified, said Col. (Dr.) Jonathan Jaffin, deputy commander of the U.S. Army Medical Research and Material Command.

"One of the things we are concerned with and … one of the points behind the whole chain teaching was trying to get the message out to the country, not just the active-duty force, Guard and reserve," he said. "(We wanted) the country, including providers throughout the country, to be aware of mild TBI and concussions and the long-term symptoms that some people may be having."

Bradshaw said Army leaders at all levels are committed to the good health and well-being of all soldiers and are proactively addressing the issue of TBI. "Continued research in this area can only help us more clearly understand the medical impacts of the war and the best ways to prevent, recognize and treat soldiers with TBI," he said.

Report details from U.S. Army Medical Command:

The Army has aggressively sought to prevent, diagnose and treat traumatic brain injuries (TBI), but much remains to be done to understand and respond to these injuries commonly associated with the conflicts in Iraq and Afghanistan.

So concluded the Traumatic Brain Injury Task Force, a group of experts chartered by the Army Surgeon General to analyze and make recommendations to improve the clinical, administrative and research processes involved with providing medical care and services to Soldiers and other service members.

The group was chaired by Brig. Gen. Donald Bradshaw, commander of the Army's Southeast Regional Medical Command, and included representatives from all the military services and the Department of Veterans Affairs (DVA). They studied the issue from January to May last year, and their report now has been released. ...

"We wanted to bring together the best practices, policies and resources to treat and manage Soldiers and Marines diagnosed with TBI," Brig. Gen. Bradshaw said. "We also want to identify any gaps in their medical care as they reintegrate back to their civilian lives or continue their military careers. Furthermore, we wanted to make recommendations for areas of additional research. The task force completed its work in May 2007 and since that time DoD and DVA have made vast improvements in the identification, treatment, screening and education for TBI as well as establishing research processes and priorities. The task force findings are one contribution to this ongoing improvement in care."

The task force visited military, DVA and civilian facilities caring for injured service members; interviewed Soldiers, Family members, caregivers and subject matter experts; and reviewed documents.

TBI is classified as mild, moderate, severe or penetrating, depending on the severity and nature of the injury. Mild TBI, commonly known as a concussion, may affect 10 to 20 percent of Soldiers and Marines redeploying from combat in Iraq and Afghanistan. It is not the same as Post Traumatic Stress Disorder, although the two conditions may produce similar symptoms, such as sleep problems, memory problems, confusion and irritability. Other mild TBI symptoms include headache, dizziness, nausea and light-sensitivity. More than 80 percent of patients treated for mild TBI recover completely.

"Our findings demonstrate that, like our civilian counterparts, the Army has a good handle on treatment of moderate to severe TBI but is challenged to understand, diagnose and treat military personnel who suffer with mild TBI. The task force identified opportunities for improvement as well as best practices and areas for additional research," Brig. Gen. Bradshaw said. ...

Some of the challenges identified included coordination and policy; recording of incident data; inconsistent treatment and documentation; and education for Soldiers, units, leaders, Families, providers and communities. From the provider perspective, the task force found inconsistent specialty staffing. They also found that the Army Physical Disability Evaluation system contained no specific standards for the use of neuropsychological testing and that the complexity of dysfunction after TBI is not easily captured by the Veterans Administration Schedule for Rating Disabilities.

Many best practices however, were also identified by the task force.

"Fort Carson, Colo., Soldier Readiness Processing is a model that is being emulated across the Army. All redeploying Soldiers are surveyed by a health-care provider for symptoms of possible mild TBI. Fort Carson providers noted that survey responses indicate approximately 17 percent of redeploying Soldiers could have TBI. Their careful screening methods and prompt, multi-disciplinary treatment are a "best practice" of early and appropriate treatment," Brig. Gen. Bradshaw said.

"Walter Reed Army Medical Center had a 100 percent screening of all patients from theater (now all military treatment facilities and the DVA do the same) and a multi-disciplinary approach to treatment and education of patients and families," he added. Brig. Gen. Bradshaw said he wants Soldiers and their Families to know that traumatic brain injury is a treatable condition with marked improvement in most cases—especially in concussion—and that Army leadership is proactively addressing the issue.

"We are committed to continued research in this area to help us more clearly understand the medical impacts of the war and the best ways to prevent, recognize and treat Soldiers with TBI," he said.

Read the report in full [pdf].


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Vietnam Veteran Believed to Have Found Missing Iraq Vet Suffering with PTSD

Sad conclusion to the latest missing Iraq veteran case.

Condolences to Eric Hall's family and a great debt of gratitude to the volunteer Vietnam veteran, Charles Shaughnessy, who would not leave a fellow battle brother behind until he was found.

From the WINK News [Ft. Myers]:

The father of Missing Marine Eric Hall says he believes the body found this weekend in Deep Creek is his son's. Kevin Hall says the body found in a drainage pipe by a volunteer had a titanium hip like Eric's and had on the same clothes Eric was wearing the night he disappeared.

Hall has been missing since February 3rd when a witness told wink news he saw Hall jump off his motorcycle and run into the woods. His family says Eric suffered from Post Traumatic Stress Syndrome after a tour of duty in Iraq. The Medical Examiner's Office is still awaiting dental records for an identification of the body.

The family has scheduled a memorial service for Eric Hall. It will be held this Thursday, March 13th at noon at the Faith Lutheran Church in Punta Gorda. The family says Eric will be buried at home in Indiana.

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In educational interest, article(s) quoted from extensively.

From the Charlotte Sun-Herald:

Charles Shaughnessy had been inside the drainage ditch twice, but something felt different this time. The morning air was thick with an unmistakable stench. It was coming from the pipe, a manhole-sized cylinder hidden beneath thick brush in Harbour Heights.

Shaughnessy and other volunteers had spent weeks searching for Eric Hall, the 24-year-old Iraq veteran who went missing Feb. 3. Their efforts led back to the pipe. This time, Shaughnessy would crawl 50 yards through rotten sediment and bugs to discover decomposed human remains. Authorities have not identified the body, but people close to the search suspect it could be Hall.

"My heart goes out to that family," said Shaughnessy, a decorated Vietnam veteran who specialized in tunnel searches during the war.

Shaughnessy was spearheading a search Sunday with Eric's mother, Becky Hall, and another Marine when he detected a terrible odor coming from the drainage pipe. The 60-year-old Gulf Cove man had recovered sneakers from the pipe several weeks earlier, and even camped near the site to monitor movement.

Shaughnessy had entered the pipe again last Thursday, but found nothing. This time, he would venture further.

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Philadelphia Inquirer Alpha Company Series: Nearly 50% of Returning Troops Treated for PTSD

The Philadelphia Inquirer spent nearly a year reaching out to the Pennsylvania National Guard's Alpha Company following their return from Iraq. They lost six troops while overseas; the Inquirer spoke with almost all of the 131 who made it home alive. The paper's coverage, packaged in a four-part series, began yesterday.

First, Alpha Company's stunning PTSD figure:

Of all the things that Alpha Company has had to struggle with since it came home from Iraq, the most pervasive may be post-traumatic stress disorder, or PTSD. Of the 126 veterans interviewed or surveyed by The Inquirer, almost half - 46 percent - said they had been treated for PTSD, most at VA hospitals and clinics in the region.

Alpha's rate of PTSD is higher than that of most U.S. troops who served in Iraq or Afghanistan - partly, no doubt, as a result of its being a frontline combat unit that lost six men. Shelley M. MacDermid, a Purdue University professor who served on a Defense Department mental-health task force last year, said typical PTSD rates among returning veterans were about 14 percent.

"Those are big numbers," she said of The Inquirer's Alpha findings.

National Guard and Reserve units, in general, have shown slightly higher PTSD rates than have regular Army units, she said. The Defense Department task force said this might be in part because civilian-soldiers were separated after they returned home, rather than staying together as units in which the members could support one another.

Ira Katz, director of mental-health services for the Department of Veterans Affairs, said that among the 300,000 or so veterans who have been seen by the VA, about 20 percent have been diagnosed with PTSD. But he said that twice that number - about 40 percent - have had some "mental condition."

"That's not all that different from your [46] percent," he said.

Both MacDermid and Katz said that PTSD had become a popular shorthand for all sorts of emotional symptoms that veterans experience. These may include depression and anxiety disorders, but not rise to the level of PTSD.

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In educational interest, article(s) quoted from extensively.

From yesterday's opener:

More than two years after coming home, and on the eve of the Iraq war's fifth anniversary, the 131 survivors of Alpha Company are still trying to sort out the meaning of their sacrifice. These were citizen-soldiers, many of them family men, drawn from across the Philadelphia region. They are, today, police officers and prison guards, construction workers and drugstore clerks. One is an airport screener, one carries mail, and one digs graves.

The Inquirer set out almost a year ago to track down every Alpha member. About a third have left the Guard, and others have transferred to units as far away as Texas and Arizona. One died in a car accident, one went to prison, one melted into the shadows of Army Special Forces. It took court records to find some. Others, although still in the Guard and in the area, were wary of talking.

The newspaper ultimately reached all but one veteran, and all but five cooperated in reporting on how they were doing.

Alpha never expected to go to war. Its members knew it was possible, but the Pennsylvania Army Guard hadn't sent units into combat since World War II. Many of the men had been in the Guard for years without ever venturing much farther than Fort Indiantown Gap on the eastern slopes of the Allegheny Mountains.

Then came 9/11. Then came the Iraq invasion. Alpha was called up in 2004 for almost six months of pre-Iraq training in Texas and Mississippi. The unit then spent nearly 11 months in the dust and danger of northern Iraq, where Alpha endured half a dozen bomb attacks and ambushes in which men were hurt. Besides the six men who were killed, 17 received the Purple Heart for getting wounded in combat.

Amid the relief and joy of coming home in late 2005, the survivors weren't fully prepared for what, to them, were unexpected difficulties of readjusting to civilian life. Some emerged from the trial of Iraq stronger and more self-confident, with high hopes for the future. But others feel derailed and don't know, yet, how to get back on track. Almost half - 46 percent - have been treated for post-traumatic stress disorder, or PTSD.

For many, the stresses of reentry - reacquainting themselves with wives and girlfriends, returning to work or school - caused levels of anger and anxiety that required psychotherapy and medication, often at a VA hospital or clinic. About a third were collecting VA disability pensions for PTSD, hearing loss, bad backs and other injuries - some while still serving in the Guard.

Almost every man said he had felt welcomed home. Sometimes strangers, seeing them in uniform, would say thank you. But many in the company saw an America bored with veterans' stories - too detached or too distressed by events in Iraq to care much about them. And that felt like an insult.

For some men, the path to recovery remains as elusive as the shadowy insurgents Alpha stalked on the plain of ancient Mesopotamia.

Read what deployment was like. Today, the bumpy road home:

At Fort Dix, where they arrived 11 weeks after the attacks that killed six of their men, Alpha Company veterans were warned that their homecomings with wives and girlfriends might not be easy.

It was October 2005. Nearly a year had passed while they were abroad. The men would need a break, a chance to do nothing. But so would the women. They had been dealing with babies and budgets and busted pipes all on their own. What's more, the veterans were apt to exhibit symptoms of post-combat stress, including fits of anger and anxiety. That was natural. But if it persisted, it could become a problem.

"You've all changed," said David R. Hulteen of the Army Career and Alumni Program, a bald Vietnam-era veteran with a flowing white beard. "And so has your family. So has everything."

The veterans of the Philadelphia-based National Guard unit looked sleepy and bored as they slumped on hard chairs in the old base chapel. Here they were in South Jersey, an hour's drive from home, maybe less. The autumn landscape beckoned, but they had to sit and listen, during days of debriefings, as one speaker after another told them how hard being a civilian again was going to be.

"It's sometimes just as tough to be back home," said Bonnie Reed of Army Community Services. Tough? No one wanted to hear it. "I just wanted to go home," said Sgt. Lorenzo Martinez. Martinez, like others, could not visualize the road ahead. He could not know that, months later, flashing back to a sniper incident in Iraq, he would find home to be a deeply threatening place.

"I dreamt of this place," Staff Sgt. David Jock said. Nine days before his first Christmas home, the Alpha Company medic was nursing a beer at a bar in tiny Oxford, Chester County. It was where Jock felt most at home since coming back.

He had survived the Aug. 9, 2005, attack in which four men had been killed, and his left shoulder still hurt where the ligaments had been torn when his humvee rolled into a bomb crater. A slight man with sinewy muscles, Jock said he was dealing with guilt - guilt that he had made it, guilt that he had felt "glad it wasn't me."

He had not felt able to return to his civilian job as a paramedic. After seeing so much blood in Iraq, he didn't think he could handle the flashbacks he was sure the work would bring. Feeling bad was weighing him down.

He and his wife, Susan, shared a twin house with her disabled grandmother up the street from the tavern. They were having a hard time. They had been married only a year before he was called up, and they had spent their first anniversary packing his uniforms and toiletries for Iraq. Then he had been away almost 18 months. Susan, now pregnant, thought Jock was drinking too much.

"We need helmets when we clash," he said.

Several other Alpha Company veterans had returned to find their marriages over. Some marriages that had been weak to start had not stood up to the stresses of the long separation.

A platoon sergeant from Philadelphia's Feltonville section came home to an empty house. His wife had moved to Georgia and taken their 8-year-old daughter. A soldier from Kutztown said his wife told him while he was still in Iraq that "she didn't want to be married anymore." He said: "I came home to a bunch of boxes on my front porch."

Jock knew he was hard to live with. He didn't sleep well and was often angry. He felt as if he was always on edge, always on guard. While Christmas shopping at a Wal-Mart in Parkesburg, he had been talking at the checkout with another war veteran. A woman complained that they were holding up the line. Jock wheeled around and cursed at her. His outburst surprised him.

"I just haven't been feeling like the old Dave," he said. "The old Dave had a good sense of humor. My patience is not what it used to be. The amount of anxiety that has built up is incredible. I have never felt this way before." ...

On the dreary afternoon of Feb. 8, 2006, three months after Alpha Company came home, more than 200 mourners were packed into Lamm & Witman Funeral Home in Wernersville, west of Reading. They were there to say goodbye to Spec. Tyler Kline, a company veteran.

Alone in his car, Kline had driven off a rural road near his parents' home at 10:49 on a Thursday night and struck a tree. A deputy Berks County coroner ruled him dead on the spot. By morning, almost all of Alpha had heard the news. The soldiers were devastated. It was as if another man had been killed in Iraq.

Ray Hildebrand, who had been Kline's roommate, said the men had known some might die in the war - but at home? Not the day after a man turned 21. Kline's birthday had been that Wednesday. Some of his friends had taken him to celebrate at the VFW hall in Myerstown and then at a bar in Robesonia. He had slept safely at Hildebrand's house.

"We all thought we would grow old together and be brothers to the end," Hildebrand said. Many in Alpha had not seen one another since coming home in October. They had felt a little lost, isolated. Sgt. Jim Murray, 31, of Phoenixville, a poker buddy of Kline's, said later that his friend's death set back his own readjustment to civilian life.

"You go through all that crap, wondering if you are going to see the next day," he said. "And then you come home and you're free and life is good - and then some car accident kills you. "What the heck is the point?"

The Alpha veterans had been on duty at Beiji, 110 miles north of Baghdad, when their six comrades killed in two August 2005 bomb attacks were buried in Pennsylvania. The guardsmen had therefore never really had a chance to mourn.

Now, six days after Kline's accident, they were turned out at Christ Lutheran Cemetery in green dress uniforms, desert camouflage and stiff civilian suits. As an honor guard fired three blank volleys and a trumpeter blew Taps, they fought back tears of pent-up grief.

Afterward, Murray and his wife silently wended their way back to Phoenixville and ended up at the home of another Alpha veteran. The one thing they didn't talk about was loss. They'd had enough of that. ...

Moments after a February sunrise, four Philadelphia police detectives and three uniformed officers banged on the door of a rowhouse on South 53d Street. They had come with a search warrant.

They were investigating a drive-by shooting that wounded three men. In a car that might have been involved, they had found a Glock semiautomatic pistol. They traced the pistol to an occupant of the house: Joseph Steven Smith, 22, a soldier in Alpha Company. Now, they wanted to see what was in the house. They found 2.2 grams of crack cocaine and a .22-caliber Beretta pistol they said Smith had bought illegally on the street.

Smith was arrested.

Word spread among Alpha Company veterans that the popular private first class, a beefy 5-foot-11 and 230 pounds, was in jail. Alpha veterans who were members of the Police Department checked on Smith's status. The rumor was that Smith had been charged in the drive-by shooting. But that was not the case. The District Attorney's Office had charged him only with drug possession and having a stolen firearm.

Staff Sgt. Anthony Kelly, among other Alpha leaders, was shocked. Smith had been an eager soldier, a man who volunteered for extra combat missions when a platoon was short a man for a patrol. In April 2006, two months after Smith's arrest, the charges were dismissed. But then came another arrest in Essington, Delaware County, in September.

The Delaware County authorities accused him of dealing drugs and arrested him on six criminal charges. Capt. Kenrick Cato, who had taken over from Anthony Callum as company commander, at one point checked with Smith's mother to make sure Smith had a good lawyer. He did. Smith, by then, had withdrawn from contact with his old Alpha comrades.

Several months after the Delaware County arrest, Smith pleaded guilty in Delaware County to one charge - criminal conspiracy - and was sentenced to a year in prison. He spent much of it at a state prison before being released. Smith declined several times to speak with The Inquirer. Cato said he thought Smith's Iraq experience might have added to his troubles by giving him the sense that, having survived a war, he was invulnerable.

Many of the men, he said, felt that way, at first.

Read more and view previous Alpha Company Inquirer articles. Tomorrow, the Inquirer will look at the flashbacks that haunt some of the returning soldiers who were generous enough to share their experiences with us.

As difficult as these issues are to face, these stories help us to better understand the consequences of war on individual, family and society. Thank you, Alpha Company, for entrusting us with them.


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Court of Inquiry Sought for Military Leader Dereliction of Duty in Providing for Wounded Soldier Welfare

From the Denver Post:

Secretary of the Army Pete Geren will be asked today to convene a panel of officers to investigate "Army policies and practices which permit the deployment of medically unfit soldiers."

Spec. Bryan Currie, 21, of Charleston, S.C., will ask Geren to convene a Court of Inquiry — a rarely used administrative fact-finding process — to investigate top generals at Fort Carson; Fort Drum, N.Y.; and Fort Hood, Texas. A Court of Inquiry is composed of at least three high-ranking military officers and can subpoena civilians. Geren can refuse the request.

"It's very important for the Army and very important for my clients. This is an investigation that is long overdue," said Louis Font, a Boston attorney who represents Currie and Spec. Alex Lotero, 21, a Fort Carson soldier from Miami. The request says the Court of Inquiry should "investigate the extent to which the (generals) have been derelict in failing to provide for the health and welfare of wounded soldiers."

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

In educational interest, article(s) quoted from extensively.

Continuing:

The request for the Court of Inquiry says the panel should be assembled on behalf of Currie and four Fort Carson soldiers. They include:

• Lotero, a soldier diagnosed with post-traumatic stress disorder "who was subjected to ridicule and threats for seeking medical attention." He said his commanders took his medications away from him, saying it was for his own safety.

• Master Sgt. Denny Nelson, who had a severe foot injury and was deployed to Kuwait. A physician in Kuwait urged in an e-mail to the brigade surgeon that Nelson be sent back to the United States: "This soldier should NOT have even left CONUS (the U.S.). . . . In his current state, he is not full-mission capable, and in his current condition is a risk to further injury to himself, others and his unit."

• An unnamed Fort Carson soldier who was deployed from Cedar Springs psychiatric hospital in Colorado Springs before he could finish a 28-day treatment program for alcoholism. An Army e-mail, dated Dec. 14, 2007, shows the soldier was taking psychiatric medications, pending a diagnosis of bipolar disorder, "but that information was not passed on" before he was discharged.

• Staff Sgt. Chad Barrett, 35, a Fort Carson soldier from Saltville, Va., who died in Iraq on Feb. 2. The Army is investigating the cause of his death. "He allegedly was found not deployable by military medical personnel, but he was deployed anyway and reportedly committed suicide in Iraq in February 2008," the request says.

Barrett's wife, Shelby, who lives in Fountain, said Thursday that she does not believe her husband killed himself. She said she believes he died of a heart-related ailment, a condition that runs in his family.

Before he was deployed on Christmas Day 2007, Chad Barrett was undergoing a medical evaluation board for issues related to post-traumatic stress disorder and traumatic brain injury from two previous tours, his wife said. He had a permanent profile — meaning he did not meet retention standards — but he asked Fort Carson to halt the medical board process so he could deploy, she said.

After an evaluation by a psychiatrist, he was sent to Iraq on the condition that he work in a light-duty job. He worked as a radio operator, she said, but was taking Klonopin for anxiety, Pamelor for severe migraines, and Lunesta and Ambien to help him sleep. Barrett said she believes her husband was under stress because five soldiers in his unit were killed days earlier and that he worried about her being alone as well as his extended family. ...

Currie said he served with the 10th Mountain Division for 10 months in Afghanistan. He was driving a vehicle that was blown up by a roadside bomb and suffered combat-related injuries, including post-traumatic stress disorder. He returned with his unit to Fort Polk, La., but he said his commanders harassed him for being injured.

"I suffer from physical injuries incurred in combat. Military medical personnel found that I am not deployable. My commanders, however, disregarded the medical findings," Currie says in the request. "Also, I sought medical attention for PTSD but was rebuffed." Currie left Fort Polk, La., and is considered to be AWOL from the Army. He plans to turn himself in today at Fort Drum, where the general who commands the 10th Mountain Division is stationed.

Lotero had received a 30 percent disability rating at Fort Carson for PTSD and traumatic brain injury. In June, three weeks before he was to leave the Army with a medical retirement, he deserted because he said harsh treatment from commanders made him feel as if he would harm himself or others. He was apprehended in Florida on Feb. 1 and spent 29 days in jail. He's now back at Fort Carson

House Passes Paul Wellstone Mental Health and Addiction Equity Act

On Wednesday, the House passed the the Paul Wellstone Mental Health and Addiction Equity Act, H.R. 1424, which strives to end discrimination against those seeking mental health care. Speaker of the House Nancy Pelosi's comments in favor of the bill:



How will this bill benefit returning veterans?

Pelosi: “This legislation will be especially relevant for our returning veterans from Iraq and Afghanistan who later become employed in the private sector. This will be potentially lifesaving for those brave men and women who served in the National Guard and Reserves, but who don’t receive VA care for their entire lives.”

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

From the Minneapolis-St. Paul Star Tribune:

Mental health advocates praised Wednesday's landmark vote by the U.S. House approving addiction and treatment legislation named for the late Sen. Paul Wellstone. The bill, which would require insurers to cover mental health in the same way as physical ailments, had long been championed by the Minnesota Democrat, who died in a 2002 plane crash.

"This is a very historic moment," said his son David Wellstone, who addressed a Capitol Hill rally that included former First Lady Rosalynn Carter and singer-turned-activist Carole King. "This legislation is very close to my heart."

The 268-148 House vote sets the stage for negotiations with the Senate, which passed a less stringent version of the bill last year. Key backers of the House bill, including Reps. Jim Ramstad, R-Minn., and Patrick Kennedy, D-R.I., say it provides greater access to treatment for people with addiction and mental health problems.

"This is not just another public policy issue," said Ram stad, a recovering alcoholic. "It's a matter of life and death for millions of Americans."

Industry groups that back the Senate version argue that the House bill would go too far in mandating expensive treatments and drive up health insurance premiums. They portray the Senate bill, which passed unanimously, as a better compromise among the business, insurance and mental health communities.

The Senate bill was sponsored by Kennedy's father, Massachusetts Democrat Edward Kennedy, along with GOP Sens. Pete Domenici of New Mexico and Mike Enzi of Wyoming. The younger Kennedy will negotiate with his father on a compromise.

Advocates of the Paul Wellstone Mental Health and Addiction Equity Act say it would end the stigma of mental illness by treating it on a par with physical maladies. "We're no longer going to allow people to languish in the shadows," said Kennedy, who has had his own bout with an addiction to painkillers.

While the congressional debate is far from over, champions of the Wellstone bill celebrated the House vote as the culmination of 12 years of activism on the issue.

Said Ramstad: "We know that Paul Wellstone is smiling down on us today."

Legislation specifics:

* Specifically, the bipartisan bill prohibits insurers and group health plans from imposing treatment or financial limitations when they offer mental health benefits that are more restrictive from those applied to medical and surgical services.

* The bill applies only to insurers and group health plans that provide mental health benefits. It also exempts businesses of 50 or fewer employees; and businesses that experience an overall premium increase of 2 percent or more in the first year and 1 percent in subsequent years.

* Over the last eight years, the Federal Employee Health Benefits Program (FEHBP) has made “parity” coverage for mental health care available to Members of Congress and 8.5 million other federal employees. Research has shown that there has been no significant cost increase attributable to this parity requirement in FEHBP.

* Furthermore, the nonpartisan Congressional Budget Office has estimated a miniscule impact on premiums for the mental health parity bill – just two-tenths of one percent.

* The two offsets in this bill were included in the CHAMP (Children’s Health and Medicare Protection) Act, which the House passed on August 1, 2007. One increases the rebate (or discount) that pharmaceutical companies are required to provide to State Medicaid programs for drugs provided to Medicaid beneficiaries. The second prohibits physicians from referring patients to hospitals in which they have an ownership interest (with a grandfather provision).

Following is an overview of some of the bill’s key provisions.

Requires equity in financial requirements. Under the bill, an insurer or group health plan must ensure that any financial requirements – such as deductibles, copayments, coinsurance, and out-of-pocket expenses – applied to mental health and addiction benefits are no more restrictive or costly than the financial requirements applied to comparable medical and surgical benefits that the plan covers.

Requires equity in treatment limits. Under the bill, a group health plan must ensure that the treatment limitations – such as frequency of treatment, number of visits, and days of coverage – applied to mental health and addiction benefits are no more restrictive than the treatment limitations applied to comparable medical and surgical benefits that the plan covers.

Does not mandate mental health benefits. The bill does not mandate insurers or group health plans to provide any mental health coverage. The bill’s provisions only apply to plans that choose to offer mental health coverage.

Exempts certain businesses. The bill exempts small businesses with 50 or fewer employees. It also exempts those businesses that experience an overall premium increase of 2 percent or more in the first year and 1 percent in subsequent years.

Covers same mental illnesses and addiction disorders as FEHBP. The bill ensures that group health plans cover the same range of mental illnesses and addiction disorders covered by the Federal Employees Health Benefits Program – i.e., the mental illnesses and addiction disorders included in the mental health practitioner’s guide, the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Does not mandate out-of-network benefits. The bill simply states that if a plan already offers out-ofnetwork benefits, it must offer out-of-network benefits on the same terms for mental health services as it does for medical and surgical services.

Does not pre-empt stronger state parity laws. The bill establishes a federal standard, a floor of protections that would apply to job-based health coverage, but allows states to be more protective of their
residents with stronger parity laws.

Explicitly permits medical management of health benefits. The bill allows the use of medical management tools that are based on valid medical evidence and pertinent to the patient’s medical condition so that specific coverage is not arbitrary in its application and more transparent to the patient.

Provides for enforcement. The bill provides remedies to protect beneficiaries’ rights and permits enforcement of the bill’s equity requirements by the Internal Revenue Service, the Department of Health and Human Services, and the Department of Labor.

More from the Wall Street Journal:

Now that Congressman Patrick Kennedy has won passage in the House for his mental health parity bill, he has to work out a compromise with the Senate, which has passed a much less restrictive version of the bill. Kennedy will be sitting across the negotiating table from one of the old lions of the Senate: his father, Ted Kennedy (pictured right), a driving force behind the Senate bill.

The Senate bill, backed by business and insurance groups, would give insurers that chose to cover mental health wide latitude in which conditions to cover. The House bill would require those that offered mental health coverage to cover all mental health and substance abuse disorders in the standard manual of mental illness, the WSJ reports. Both bills would forbid companies from charging higher copays or putting more stringent limits on mental health care than on other kinds of care.

Some Republican backers of the Senate bill have said the House version will never make it in the Senate. Kennedy the elder disagrees. “I don’t accept that,” he told the Providence Journal yesterday, just before walking over to the House to watch the debate over the bill. But he did say the differences are “something we’ll have to work on.”

Kennedy the younger, a Rhode Island Democrat, told the Boston Globe that he and his dad, a Massachusetts Dem, have been trying to figure out ways to bridge the legislation gap. “We’ve discussed strategies and ways we can try to move this,” he said.

Last year, the Diane Rehm Show had the elder Kennedy (and others) on to discuss the Mental Health Parity Act. Another piece of legislation, more specific to our troops, championed by the younger Kennedy is the Psychological Kevlar Act.

Personal note: I was honored to be questioned by Rep. Kennedy in a December House Veterans Affairs Committee hearing.


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Army Report: Civilian Psychologists Needed on OEF/OIF Battlefronts, Suicides Up, Stigma of Seeking Help Down

The Army's Mental Health Advisory Team V report arrived today chock-full of updated data on how our troops are fairing. From AP:

U.S. troops on the battlefield found it harder to get the mental health care they needed last year, when violence rose in Afghanistan and new tactics pushed soldiers in Iraq farther from their operating bases. A report the Army released Thursday recommends sending civilian psychiatrists to the warfront, supplementing members of the uniformed mental health corps.

Surveying a force strained by its seventh year of war, officials found that more than one in four soldiers on repeat tours of duty screened positive for anxiety, depression and other mental health problems. That was comparable to the previous year.

The report found more troops reported marital problems, an increased suicide rate, higher morale in Iraq, but a greater percentage of depression among soldiers in Afghanistan. "They do show the effects of a long war," said Col. Elspeth Ritchie, psychiatry consultant to Army Surgeon General Lt. Gen. Eric Schoomaker.

Added Maj. Gen. Gale S. Pollock, a deputy surgeon general: "I think the fact that they are doing as well as they are with the demands they are under speaks to a strength and resiliency of the men and women of America."

The report was drawn from the work of a team of mental health experts who traveled to the wars last fall. The experts surveyed more than 2,200 soldiers in Iraq and nearly 900 in Afghanistan.

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

In educational interest, article(s) quoted from extensively.

Continuing:

The recommendation of civilian mental health professionals for battlefield duty is unusual. But civilian contract employees are doing many other jobs in Iraq, from security to providing food service. The report also recommended longer home time between deployments, more focused suicide-prevention training and insurance coverage for marital and family counseling.

Among other findings were:

_More than 27 percent of troops on their third or fourth combat tour suffered anxiety, depression, post-combat stress and other problems. That compared with 12 percent among those on their first tour.

_Suicide rates "remained elevated" in both Iraq and Afghanistan. There were four in Afghanistan and 34 confirmed or suspected in Iraq. If all are confirmed, it would be the highest rate since the war began.

_The percentage of soldiers reporting depression in Afghanistan was higher than that in Iraq, and mental health problems in general were higher than they had previously been in Afghanistan. The adjusted rate last year for depression in Afghanistan was 11.4 percent, compared with 7.6 percent in Iraq.

Though U.S. troops suffered their highest level of casualties in both campaigns last year, that came as violence was decreasing in the five-year-old Iraq conflict and increasing in Afghanistan, now in its seventh year.

_As fighting against Taliban and al-Qaida fighters in Afghanistan worsened, 83 percent of soldiers there reported exposure to traumatic combat events — a key factor in the risk for mental health among the troops.

_Having troops spread out and more isolated over the rugged terrain in a less developed Afghanistan occasionally made it more difficult for them to get mental health treatment.

_About 29 percent of soldiers in Iraq said it was difficult to get to mental health specialists for help. That was among troops who had moved from bases to combat outposts set up so they could be closer to the Iraq population. The number among troops not at the outposts who had trouble getting help was only 13 percent.

_Soldiers who had special "Battlemind" training reported fewer problems than those who did not. The program teaches troops and families what to expect before soldiers leave for the wars and what common problems to look for when readjusting to home life after deployment.

_Progress was made toward reducing the fear and embarrassment that keeps soldiers from asking for help with mental health problems. In 2007, 29 percent of those surveyed in Iraq said they feared seeking treatment would hurt their careers, down from 34 percent the previous year.

_Eleven percent of those surveyed in Iraq said their unit's morale was high or very high, compared with 7 percent the previous year. Individual morale was reported high or very high among 20.6 percent, compared with 18.3 percent the previous year.

_In Iraq, some 72 percent of soldiers reporting knowing someone seriously injured or killed.

_Soldiers reported an average of 5.6 hours of sleep per day in Iraq — significantly less than needed to maintain their best performance — yet officers appeared to underestimate how it could have that effect.

_Nearly one-third of troops in Afghanistan were highly concerned that they were not getting enough sleep and about a quarter reported falling asleep during convoys last year. Sixteen percent reported taking mental health medications and about half of those were sleep medications.

U.S. Army Medical Command press release:

A team of Army behavioral-health professionals found the overall risk of mental-health problems among soldiers deployed to Iraq unchanged in 2007 compared to 2006. Soldiers serving their third or fourth deployment, however, were more likely to report such problems than those on their first or second deployments. Soldiers in Afghanistan, in contrast, reported significantly higher rates of mental-health problems in 2007 than in 2005, reaching rates similar to those in Iraq.

The Army Surgeon General has dispatched five Mental Health Advisory Teams (MHAT) to southwest Asia since 2003. In October and November last year, the latest team (MHAT V) surveyed 2,279 soldiers and 350 behavioral health, primary care and unit ministry team members in Iraq. In Afghanistan, they surveyed 889 soldiers and 87 care providers. They also conducted focus groups and examined records.

The teams were led by research psychologists from Walter Reed Army Institute of Research (WRAIR) and included officers and enlisted behavioral-health specialists. Heading the project was Lt. Col. Paul D. Bliese, chief of military psychiatry at WRAIR.

Major findings include:

* The percentage of soldiers screening positive for mental-health problems is similar to previous years, and similar in Iraq and Afghanistan. Unit morale was higher in Iraq in 2007 than in 2006.
* Combat exposure is down in Iraq, but up in Afghanistan, so that it is now similar in both theaters.
* Soldiers on their third or fourth deployment have significantly lower morale, more mental-health problems and more stress-related work problems.
* Suicide rates remain elevated in both theaters and are above normal Army rates.
* Soldiers who received Battlemind training before deployment reported fewer mental-health problems.
* There are barriers preventing soldiers from obtaining mental-health care they need. In Iraq, many soldiers were moved last year to small outposts where they could maintain close contact with Iraqi civilians and security forces. This placed them farther from care providers at large bases. In Afghanistan, dispersal of troops over a large area made access difficult. Commanders in Afghanistan have responded to the report's recommendations by moving providers closer to troops.
* Reports of unethical behavior by U.S. troops were largely unchanged from 2006.

Recommendations by the team included augmenting military behavioral-health providers in theater with civilian personnel, increasing time between deployments, providing marital and family counseling as a TRICARE benefit and more focused suicide-prevention training.

Bliese said Army leaders both in theater and at the Pentagon had been receptive to the team's recommendations.

"The issues are whether the recommendations are feasible and can be implemented. That doesn't mean every recommendation will be implemented, but Army leaders certainly are receptive to the ideas," he said.

Bliese said reported shortages of behavioral-health providers in Iraq "is a good news-bad news story."

"One reason they felt short of personnel is that commanders are relying on their providers to have very active preventive outreach programs. Additional outreach missions can lead to shortages of resources," he said.

To address these shortages, he said behavioral-health assets are reallocated within the theater to areas of greatest need. Also, combat medics, while not mental-health specialists, can receive more training to help them feel comfortable as first responders. Finally, he believes some civilian care providers can be hired to supplement the military personnel.

"There's no reason we can't send contractors or (government civilian employees) to the large forward operating bases, and let active duty personnel do outreach to the units. That would really help out. My impression is there is a number of retired military and some Veterans Affairs employees who would like to do this and get a feel for what that environment is like," Bliese said.

Pre-deployment Battlemind training tells Soldiers what they are likely to see, to hear, to think and to feel while deployed. The Army also has a post-deployment module for spouses, and several post-deployment modules to help soldiers adjust when they return home.

"It is now Army policy to give Battlemind training to everyone deploying. Some of the units we surveyed were in theater before that policy, so we had a distribution of troops that had and had not received the training," Bliese said. "There is a straight-forward question on the survey asking how well prepared the troops believe they were for deployment. Those who had Battlemind training thought they were better prepared. It's encouraging."

"I think (the training) helps because it gives the soldiers a realistic preview of what they will encounter and helps them prepare," he added. "It gives soldiers some common ground to talk about things and it takes some of the mystery out of deployment."

There appears to be a small, but steady, decrease in reports of soldiers reluctant to seek care because of stigma associated with mental-health care.

"I have the feeling this is a good-news story," said Bliese. "There now have been five years of consistent messages from the Army's senior leadership about the importance of getting mental-health care if needed. We're not seeing huge changes, but a trend of steady improvement. I think that is due to emphasis by military leaders."

In the first month of deployment, about 10 percent of married junior enlisted soldiers reported they planned a marital separation or divorce. By the 15th month of deployment this increased to 30 percent. NCOs and officers had lower rates, although also increasing over the deployment.

One recommendation is for TRICARE, the military health-insurance program, to cover marital counseling, so soldiers can go outside the military system and be reimbursed for the expense. "The Army has been active in getting family life counselors on posts. Anything that can be done to help the families is important," Bliese said.

Access to the full report.


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Testimony Begins in Class Action Lawsuit Against Veterans Administration

Latest updates on this and related VA/Army lawsuits posted in "As Second Legal Attempt Fails to Force VA Hand on Disability Claims Processing, Army Sued Over Discharged Veteran PTSD Disability Ratings." -- Ilona Meagher, 12/17/08

From the San Francisco Chronicle:

The nation's foremost authority on post-traumatic stress disorder testified in federal court Monday that up to 30 percent of combat veterans of Iraq and Afghanistan are likely to be diagnosed with the ailment and that the Veteran's Health Administration is not doing enough to help them.

Dr. Arthur Blank, a psychiatrist who has worked with troops and veterans with PTSD since 1965, said the disorder is treatable, but it requires a "human connection" with a therapist, and that's something the VA is ill-prepared to support.

"With hope and with help, recovery is possible," he said.

Dr. Blank testified at a hearing in connection with a lawsuit brought by veterans advocacy groups against the VA, claiming that the federal government's health care system for troops returning from Iraq and Afghanistan illegally denies care and benefits.

The plaintiffs, Veterans for Common Sense and Veterans United for Truth, are seeking to make the case a class action on behalf of 320,000 to 800,000 veterans or their survivors. The hearing Monday concerned a request by the veterans groups that the judge issue a preliminary injunction ordering the VA to provide immediate mental health treatment for veterans who suffer from stress disorders and are at risk of suicide.

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

In educational interest, article(s) quoted from extensively.

Continuing:

In opening statements, an attorney for the veterans groups, Gordon Erspamer, offered a litany of problems with the VA, from long waits at outreach centers to a scarcity of medical facilities in rural states, especially in the West.

District Judge Samuel Conti said he was a little unclear as to what he is legally able to order in this case. "We have a lot of strictures from Congress that give me very limited jurisdiction in this case," he told attorneys for both sides. "You might need to tell me exactly what you think I can do. It's like walking through a minefield." ...The suit claims the government's failure to provide timely treatment is contributing to an epidemic of suicides among returning soldiers.

Blank said suicide is often the result of post-traumatic stress that is untreated, or poorly treated. He said combat veterans are about twice as likely to commit suicide as the general population. "Timing is of the essence," Blank said. "It's important to respond early."

Attorneys for the government argued that Blank has not worked with the VA for more than 10 years and is ill-equipped to comment on what services the VA provides its patients.

Dr. Gerald Cross, principal deputy undersecretary for health at the Veterans Health Administration, agreed that veterans who are suicidal, or suffer from PTSD, need prompt help, but said that the VA centers around the country do a good job of identifying those veterans and getting them help.

Cross said there has been no comprehensive study done by the VA on suicides by combat veterans, but one is in the works and has been submitted to the New England Journal of Medicine for review. That study should be published soon, he said. CBS News conducted its own study of suicide rates among veterans nationally, and the study showed that in 2005 approximately 120 veterans committed suicide each week of that year. Cross said CBS declined to give the VA the data it collected for its story.

The hearing will continue at the federal courthouse in San Francisco throughout the week.

From AP:

The lawsuit comes amid intense political and public scrutiny of the VA and Pentagon after reports of shoddy outpatient care of injured soldiers at Walter Reed Army Medical Center and elsewhere. Suicides and suicide attempts continue to rise, the Pentagon reports. ...

U.S. District Judge Samuel Conti is scheduled to hear from dueling mental health experts this week to determine whether he should order the VA to immediately spend about $60 million to provide care to hundreds of thousands of veterans they say have pending health claims.

"The VA has repeatedly failed to implement programs," veterans' lawyer Gordon Erspamer told the judge. "Mental health funding is not being spent on mental health."

Erspamer urged the judge to act soon to fix a health care system he says is plagued by staffing shortages, high turnover and a crushing need to treat about 56,000 patients with post-traumatic stress disorder. Erspamer argued the demand is expected to increase as more soldiers return from combat zones.

"What is going to happen to the health care system when they all return?" he asked the judge. The judge responded that he was concerned he had scant authority to tell the VA how to spend its budget, even if he does determine there are problems.

"I have very limited jurisdiction," Conti said.

U.S. Department of Justice lawyer Daniel Bensing echoed that by telling Conti that issuing such an order had the practical effect of putting the judge in charge of patient care. The veterans' demands are "unwarranted, unworkable and would do more harm than good."

The VA has made "massive changes," Bensing said, adding new resources and mental health workers since 2005 in response to veterans returning from Iraq and Afghanistan. "It is not the policy of the VA to turn away veterans when they need emergency care," he said. "They get emergency care."

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Vietnam Veterans Reach Out to Today's Returning Troops

A few recent reflections on the invaluable role Vietnam veterans play in helping those returning from Iraq and Afghanistan today. The first, from the North County Times:

In combat, the older former warrior told the young Marines, "funny things happen." Weeks, months and even years after combat, he continued, those "funny things" can re-emerge as haunting nightmares, jittery paranoia or the root of any number of abhorrent and self-destructive behaviors.

"You cannot take a normal person and put them in that environment without it affecting them," the speaker, David Pelkey, told about 25 Camp Pendleton Marines who recently returned from Iraq. Pelkey, a Mira Mesa resident and a Vietnam veteran who served in the Army's 1st Cavalry Division, is the national director of American Combat Veterans of War, a nonprofit group founded seven years ago by Carlsbad resident Bill Rider, also a Vietnam veteran.

"We try to use ourselves as an example of what not to do in terms of denying the fact that you have been impacted by the war," Rider said about the program. While theirs is not the only program about post-traumatic stress, Rider said that American Combat Veterans of War is unique in providing firsthand advice from other veterans to the troops.

"We're here because we care about you, damn it, and there's something you don't understand that we do," said retired Marine Col. Al Slater, a Navy Cross recipient who also spoke to the returning troops. "We don't want your generation to go through the hell we did."

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

In educational interest, article(s) quoted from extensively.

Continuing:

The Marine Corps diagnosed 5,174 cases of post-traumatic stress between the invasion of Iraq in March 2003 and April 2007, according to statistics provided by the service to the North County Times.

During Tuesday's gathering, five veterans shared their battle stories, both physical and mental, as part a series of required debriefings that returning troops must attend in their first week back from a combat zone.

The talk, colored with stories about firefights, helicopter crashes and lost buddies, may have been the most riveting of the debriefings. But more than just hearing chilling war stories, the troops received practical advice about how to identify signs of stress.

"When I came back from my first tour, I had similar experiences," said 1st Lt. Jake Cusack, 25, who had just returned from working on a border transition team in Iraq. "You'd hear a loud noise, and think it's an IED (improvised explosive devise)."

Cusack said it was meaningful to him to see former Marines helping today's younger troops. Also impressed was Master Sgt. Ernie Lonza, 43, who had just returned from Tikrit in Iraq's Anbar province where 11,000 locally based troops are serving this year.

"I'm humbled by listening to them," Lonza said.

Lonza, who is stationed at the Marine Air Ground Combat Center at Twentynine Palms, said it was more meaningful to hear from veterans with firsthand experience. The lectures left him alert to signs that may indicate stress in his own life.

Last month, NPR's All Things Considered showcased warrior debriefings taking place at Camp Pendleton, which now include Vietnam veterans like Rider sharing their own stories.

Another story from the [Redding] Record Searchlight:

"When I got home I thought I was fine," said Jim Tyson of Shingletown, who served in the U.S. Army from 1996 to 2003, doing tours in Kosovo, Bosnia, Macedonia and Iraq. Tyson drove an armored Caterpillar D-9 bulldozer, like those often seen at construction sites around the north state, but in wartime he used the massive tractor for destruction.

With the help of his uncle, Jim Richards of Redding, a veteran of three tours in Vietnam who suffers from PTSD himself, Tyson recognized his problem and sought help. He now regularly meets with a counselor and is on antianxiety medication. Richards said it's difficult for someone who has been hardened by military service to admit he needs help.

"Soldiers learn how to grit their teeth and bear pain," he said.

Both said they think the military should put every returning soldier and Marine through counseling to search for subtle signs of PTSD. While veterans are screened when they leave the service, the two men said that step isn't enough. They said there also should be classes about PTSD for the family and friends of veterans.

Bonded not just by blood, but by their combat experience, Tyson and Richards said veterans dealing with PTSD can get the most help from talking to other veterans. With few lines drawn between who is friend or foe in combat zones like Iraq, Tyson said the nature of fighting today adds to the stress endured by those in the military.

"Nobody plays by the rules anymore except us," he said.

The ever-present dangers of bombs hidden along roadways and suicide bombers who could be anybody cause those serving in Iraq to be tense and ready for action at all times. Once home, it's hard to turn that readiness off, Tyson said. Triggers for PTSD are ever present on the home front: The sound of a jet. Smell of gasoline. A flash of light.

From the Christian Science Monitor:

Marine Sgt. Jeremiah Workman wasn't born yet when his friend Neil Kenny received the Navy Commendation Medal for dragging dead and wounded soldiers out of combat in Vietnam. But he has a good idea what it must have been like.

In 2004, during the second battle of Fallujah in Iraq, Sergeant Workman pushed through exploding grenades and machine-gun fire to rescue 10 trapped marines. His bravery earned him the Navy Cross, the military's second-highest honor. Yet today Mr. Kenny and Workman share more than medals. They came home from war with severe psychological wounds – anxiety, anger, and depression. More than their Marine brotherhood and shared valor, it is the painful legacy of combat that has now forged a singular bond between them. "I can tell him everything," Workman says. "I don't trust anybody. He's one of the few people I can talk to."

Their relationship is symbolic of a grass-roots movement by Vietnam veterans to help soldiers returning from Iraq cope with the mental rigors of war and ease the transition to civilian life. Across the country, both groups of Vietnam veterans and individual former soldiers are pitching in to help console, counsel, or just be a voice on the other end of the phone to those who have served in the Middle East.

Throughout history, veterans of one war have always helped those of another. But rarely has the homecoming experience of two sets of veterans been so different, and the bonds between them so deep, as those from Vietnam and Iraq.

One reason is that many Vietnam-era soldiers understand the trauma that some of today's returning fighters are going through and want to help them in ways they feel they never were. Kenny is currently mentoring five Iraq war veterans. When he looks at today's young soldiers, he sees a mirror image of himself returning from Southeast Asia at 19. "That's where I was," he says. "I don't want to turn my back on them." ...

Workman has received intensive therapy and medication for PTSD since returning from Iraq. He says these remedies help, but he feels frustrated with the care he gets through the US Department of Veterans Affairs. "All these doctors that went to school for however many years – they've never been to war," he says. "They're reading about PTSD out of a book."

Though Kenny isn't a trained therapist, he gives Workman practical advice on how to deal with problems based on his own experiences. "I tell him what he shouldn't worry about – what he can let go," Kenny says. "But I don't try to run his life."

Their relationship now goes beyond counselor-confidant: They have become fast friends. The men talk several times a week on the phone. They get together whenever possible, for a family Christmas or a Broadway show. "He's like a father figure to me," Workman says, then jokes: "But it's not like we go out golfing together."

Others see the importance of old and new veterans forging bonds, too. Dennis Fetko, a behavioral psychologist and Vietnam veteran, still struggles with psychological problems from his service in Southeast Asia. As both a therapist and patient, Dr. Fetko believes that doctors who empathize with their patients can provide greater support. ...

Even soldiers who aren't struggling with clinical problems often find unusual support in their veteran predecessors. Miko Watkins, an Army nurse, talks about how lonely and disconnected she felt after returning from Iraq in 2003. On a windswept day, she stands beside the Vietnam Veterans Women's Memorial in Washington, D.C. "My commanding officer thought coming here would be cathartic," Ms. Watkins says.

Earlier, Watkins had listened to nurses from the Vietnam era share their stories and she recounted some of her own experiences in Iraq. "I don't speak about it very often, because it just brings me to tears," Watkins says, glancing at the bronze memorial – a tableau of three nurses caring for a wounded soldier. "The Vietnam veterans here understand me, even if I can't explain it fully."

She pauses. "I should have done this a long time ago."

Army Capt. Laureen Otto, who also attended the storytelling event, served as a trauma nurse coordinator in Iraq and sits on the memorial's board of directors. While Ms. Otto has always gotten along with older veterans, her connection with the Vietnam generation changed markedly after she came back from war. "It was immediate," Otto says. "And I no longer ask them what it's like in Vietnam. We both just know."

Obviously such bonds do a great deal of good for our returning troops; but, they likely do wonders for our Vietnam veterans, too. Helping each other in this way may bring them closer to making some small semblance of sense of their collective experience and the load they uniquely carry with them throughout their lives.

This two-way lifeline, a hard-wrought silver lining, might return a sense of purpose and hope in humanity to our veterans.

Thank you, Vietnam veterans, for all you do.


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Study: PTSD-Substance Abuse Link Hinders Positive Outcomes in Both

From Medical News Today:

* Up to one-half of those seeking help for substance-abuse disorders (SUDs) also have posttraumatic stress disorder (PTSD).

* New findings show that the frequency of a PTSD is greater among those dependent on drugs rather than alcohol, and that having a PTSD tends to predict a more severe course and worse outcome for an SUD.

From one-third to one-half of those seeking treatment for a substance-use disorder (SUD) can also have posttraumatic stress disorder (PTSD). The first multi-center study of PTSD among individuals seeking treatment for an SUD has found a greater prevalence of PTSD among those who were drug- rather than alcohol-dependent, and that having PTSD was associated with a more severe course and worse outcome for an SUD.

Results are published in the March issue of Alcoholism: Clinical & Experimental Research.

"We already knew that there is a quite relevant association between PTSD and SUDs," said Martin Driessen, professor of psychiatry at Ev. Hospital Bielefeld in Germany, and corresponding author for the study. "More specifically, PTSD is a risk factor for the development of an SUD, particularly a drug dependence. However, it was unclear whether this is true for both abusers and dependent subjects, or only one of these groups, which is why we studied clearly dependent subjects."

"Drug dependence has frequently been observed in war veterans who also suffer from PTSD," added Andreas Heinz, director and chair of the department of psychiatry at Charité - University Medical Center Berlin. "Both men and women often increase drug abuse and develop dependence following war and other trauma."

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

In educational interest, article(s) quoted from extensively.

Continuing:

For this study, Driessen and his colleagues interviewed 459 subjects (274 males, 185 females) seeking help in 14 German addiction-treatment centers: 39.7 percent had alcohol dependence; 33.6 percent had drug dependence; and 26.8 percent had both. Interviewers used the International Diagnostic Checklists, Posttraumatic Diagnostic Scale, Addiction Severity Index, and Brief Psychiatric Rating Scale to assess all participants. Individual characteristics and treatment outcomes were later analyzed.

Results showed the prevalence of PTSD was greater among those with drug rather than alcohol dependence. "We found a prevalence of PTSD that was roughly double, around 30 percent, in drug-dependent subjects than that found in alcohol-dependent subjects, at about 15 percent," said Driessen. "Although we expected this, based on previous research, we were somewhat surprised to find such a high difference between drug and alcohol dependence."

Having a PTSD was also associated with worse outcomes for an SUD, Driessen said, such as more family problems, less employment, and more severe psychological symptoms.

"The subjects suffering from PTSD had higher hospitalization rates, shorter periods of abstinence, and higher drug craving," added Heinz. "However, the study did not show whether PTSD was a cause or consequence of drug dependence in individual subjects."

In addition, said Driessen, the associations between an SUD and PTSD were stronger when the PTSD diagnosis was definitive - that is, based on the interview as well as the questionnaire - compared to those patients with a probable or subsyndromal PTSD. A mere trauma exposure without PTSD was not associated with an SUD, he noted.

Both Driessen and Heinz recommended that clinicians examine patients with an SUD in order to determine if PTSD is an underlying factor, and that researchers continue investigating specific treatment options.

"Women in this study showed higher PTSD rates, which is in accordance with the literature," said Heinz. "Women also more often show clinical depression, which often precedes alcohol dependence, while in men, depression seems to follow alcohol dependence in most cases. Further research on psychotrauma and its sequelae such as PTSD, anxiety and depression may point to gender differences in the course and consequences of drug and alcohol addiction. In addition, neurobiological correlates such as monoamine and stress hormone dysfunction and alterations in central processing of affective and reward-indicating stimuli should be assessed. They may predict treatment response and indicate whether specific treatment options with psychotherapy or addictive pharmacological therapy are helpful."

Study abstract:

Background: We investigated (1) the prevalence of posttraumatic stress disorder (PTSD) in treatment-seeking subjects with substance use dependence (SUD), (2) the association between comorbid PTSD and the severity and course of addiction and psychopathology, and (3) this association in patients with subsyndromal PTSD, and in trauma exposure without PTSD.

Methods: In this cross-sectional study, 459 subjects in 14 German addiction treatment centers participated with alcohol-dependence (A) in 39.7%, drug-dependence (D) in 33.6%, or both (AD) 26.8%. The diagnostic measures included the International Diagnostic Checklists (IDCL), Posttraumatic Diagnostic Scale (PDS), Addiction Severity Index (ASI), and the Brief Psychiatric Rating Scale (BPRS). Associations between independent characteristics and outcomes were analysed by univariate and multivariate statistics.

Results: 25.3% of the subjects had PTSD confirmed by both IDCL and PDS with higher rates in the AD (34.1%) and D (29.9%) groups compared with group A (15.4%, p < 0.001). In 22.8%, PTSD was subsyndromal (either IDCL or PDS positive) without significant differences between SUD groups, and 18.3% met PTSD trauma criteria A without PTSD (exposure). After controlling for SUD and gender, trauma subgroups significantly differed regarding the onset of alcohol-related symptoms (p < 0.02), numbers of previous admissions (p < 0.03), severity of SUD (p < 0.001), current craving (p < 0.02), and psychopathology (p < 0.001). We observed the worst outcome in PTSD, while trauma exposure had no effects.

Conclusions: The prevalence of PTSD is higher in drug than in alcohol dependence. The more strictly PTSD is diagnosed (by interviewer and questionnaire) the more clearly are associations with characteristics of SUD. PTSD seems to be an independent risk factor for an unfavorable outcome of SUD.

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