Study of Combat Trauma, PTSD at Fort Hood Outlined By University of Texas Researcher

A couple of weeks ago, a facebook contact drew my attention to an exciting university study tapping into Ft. Hood's returning troops and aiming to comprehensively determine their risk factors for combat PTSD. I read the article, and then filed it away, hoping to have time to pass it along to you here.

Considering last week's shooting, the study may increase in interest for some; but, the work conducted by Dr. Michael Telch's team deserves attention on its own merits. An introduction by Jeremy Schwartz, American Statesman:

Are some soldiers more likely than others to develop post-traumatic stress disorder, a malady that affects nearly one in five service members returning from Iraq and Afghanistan? Is there anything in their genetics, brain structure or ability to handle stress that might make them more or less prone to PTSD? And if researchers can pinpoint risk factors for the disorder, is it possible to "inoculate" service members before they deploy to a war zone?

A study at the University of Texas, called the Texas Combat PTSD Risk Project, is seeking to answer some of those questions using methods that researchers say haven't been tried before. The study put 183 Fort Hood soldiers through a battery of tests before and after their first yearlong deployment to Iraq and had them fill out a monthly "stress log" over the Internet while they were on the battlefield. The result is one of the more comprehensive studies to search for risk factors for the illness, which, along with traumatic brain injury, military leaders call the signature disease of the current conflicts.

Lead investigator Michael Telch, a UT professor of psychology and the director of UT's Laboratory for the Study of Anxiety Disorders, said the research could lead to prevention programs for PTSD.

"Just like with the prevention of heart disease or many other medical conditions, the first critical step in addressing the problem of combat PTSD and other combat-stress disorders is to identify the factors that increase soldiers' risk for developing them," Telch said in an e-mail. "We hope that this study will ultimately provide important new insights into the causes of combat PTSD and ways to prevent it."

Join Me at Park Ridge VFW Veterans Town Hall Meeting on TBI/PTSD Brain Scan Imaging

This Tuesday, I'll be taking part in a veterans' issues town hall meeting hosted by the Park Ridge VFW #3579 ("Illinois' Friendliest VFW Post") and State Senator Dan Kotowski. Kotowski has been a great champion of area veterans, his leadership bringing together the Northwest Suburban Veterans Advisory Council, the Illinois Department of Veterans Affairs, the federal VA, private health care and local community members in common cause.

These groups are now all working together to provide this area with a Military Support System and model PTSD diagnosis and treatment program administered by The Vet Center at Alexian Brothers Medical Center.

It's an exceptional resource for the community.

The Center's new Veterans Imaging Program [VIP] is using state-of-the-art brain imaging or mapping technology – more powerful than a standard CAT scan – called MEG to detect the neurobiological signs of PTSD. MEG promises to quickly and accurately spot these brain changes found in PTSD patients in a completely non-invasive way. And this same technology can be used to help detect traumatic brain injury.

We'll be talking about both PTSD and TBI tomorrow night, and I invite you to join us if you're in the area.

[UPDATE Sept. 28, 2008]: A surprise guest, IL Director of Veterans Affairs Tammy Duckworth, very easily and graciously upstaged all of the rest of us. A top thrill for me of the year to have the chance to share a few moments with her and to thank her for her service to us both in and out of uniform. Photos:

UA to Study Veterans Reintegration, Obama Aims to Nationalize Montana National Guard PTSD Screening Program, Vets and Intimacy

• As the new GI Bill rolls out, the University of Arizona (with ~400 veterans already on its campus) is gearing up to welcome even more onto its rolls. Their Teaching Center is "developing a transition curriculum for veterans and is training faculty on how to teach them ... [and] has begun to offer veterans classes on resilience and stress management...designed to improve memory, strengthen problem-solving skills and build a social support network." Vets attending the University of Arizona will also be able to take part in their Disability Resource Center's federal Participatory Action Research Project , which will "study veterans reintegration and transition from the military into college." UA is hosting a celebration for veterans and their sponsors on Thursday, Oct. 9, from 4-6 p.m. in the Student Union Memorial Center.
  
  
• This past Wednesday, presidential candidate Sen. Barack Obama met with Matt Kuntz, the stepbrother of Montana National Guard and Iraq vet Chris Dana. Dana "took his life in March 2007, less than two years after returning from a tour in Iraq. His family believes he was a victim of post traumatic stress disorder, brought on by his combat experience." Since then, his stepbrother has been among those pushing Montana to implement "more than a dozen changes in its policies in an effort to address PTSD and traumatic brain injuries in returning soldiers. A key initiative in the new plan is to screen all returning soldiers every six months for two years after their tour of duty." Obama has promised that he would "expand Montana's pilot program to assess the mental health of combat vets nationwide."
  
  
• Last week, the Minneapolis-St. Paul Star Tribune's Gail Rosenblum delivered an important piece on "the private scars of war," intimately introducing us to one family dealing with the most personal after-effects of war. With ~56 percent of today's troops being married, "the U.S. Defense and Veteran's Affairs departments are acknowledging that the physical and emotional scars that troops carry home present a sensitive challenge: sexual intimacy and body-image issues that most couples' therapists are ill-prepared to treat. ...The number of people returning with disabilities, is an 'enormous problem ... an astonishing problem.' ...Combined with the fact that returning vets are usually older and partnered, this is having a devastating effect on relationships."

Army's RESPECT-MIL Program Aims to Reduce Stigma by Screening All Care-Seeking Soldiers for PTSD

From Army News Service:

According to Army medical officials, the new Re-Engineering Systems for the Primary Care and Treatment of Depression and PTSD in the Military program is designed to help providers recognize warning signs and treat those disorders early while eliminating Soldiers' fears about the stigma of psychological illnesses and their treatment.

Program officials say RESPECT-MIL takes advantage of any visit Soldiers make to their assigned primary care physicians for any reason, turning those visits into opportunities to detect symptoms that could indicate that the Soldier is struggling with PTSD.

"The Army is doing a lot more as far as trying to reach out and find Soldiers who are having issues but are reluctant to seek mental health care due to the historical mental health stigma within the military," said Dr. (Maj.) David Johnson, a Schweinfurt Health Clinic psychiatrist.

2007 Another Record-Breaker for OEF/OIF Troops Identified with PTSD

From Voice of America:

The U.S. military says newly diagnosed cases of post-traumatic stress disorder [ptsd] among American troops sent to Iraq and Afghanistan climbed nearly 50 percent last year, bringing a five-year total to nearly 40,000.

Officials Tuesday released figures that showed Marines and Army soldiers were most affected. These are the forces bearing the brunt of combat in Iraq and Afghanistan. ...

Army Surgeon General Lieutenant General Eric Schoomaker says the larger number of diagnoses in recent years partly reflects greater awareness and tracking of the disorder by the U.S. military. But he says increased exposure of troops to combat is a factor. Experts have said symptoms increase as soldiers return to combat for multiple tours of duty.

Attempts to Remove PTSD Stigma Gain Steam Under Secretary Gates

From the Billings Gazette:

Defense Secretary Robert Gates recently has been urging troops to seek treatment instead of trying to ignore the problem. "You're tough and you go into the hospital when you receive a physical wound," Gates said on a visit to a Texas Army post. "That doesn't mean you're weak in some way, and so why wouldn't you when you've received a psychological wound? It's the same difference. They're all wounded."

To make it easier for soldiers to seek treatment, Gates has announced a change on the application for a government security clearance that asks: In the last seven years, have you sought mental-health counseling? That question will no longer be asked. National Public Radio reported that studies show that the fear of losing a security clearance is one of the biggest reasons that combat veterans do not seek mental-health care. Under the new policy, applicants who seek mental-health treatment could still obtain clearances if the treatment was for problems stemming from service in a combat zone.

Earlier this month, the American Forces Press Service reported that Gates is willing to consider awarding Purple Heart medals to combat veterans suffering with PTSD.

John E. Fortunato, who runs the Recovery and Resilience Center at Fort Bliss, Texas, told reporters that awarding the Purple Heart to PTSD sufferers would go a long way toward chipping away at prejudices surrounding the disease. Because PTSD affects structures in the brain, it's a physical disorder, "no different from shrapnel," Fortunato said. "This is an injury."

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."

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.

Sunday's CBS Evening News interviewed Brig. Gen. Donald Bradshaw, who heads up the military's TBI Task Force, on these issues.

Illinois Veteran PTSD Screening, Reintegration Program Gets Underway

From the Quad City Times:

Barely off the ground, Illinois' first-in-the-nation program to help returning Iraq and Afghanistan veterans deal with mental health issues is drawing intense interest from legislators who would like to see the country as a whole take similar steps.

In late January, Illinois began using state money to set up mandatory screening of all returning National Guard and Reserve troops for post-traumatic stress disorder and traumatic brain injury, and also established a 24-hour hot line for veterans having trouble readjusting.

"We should be doing it nationwide, and we should be paying for it at the federal level," says Rep. Shelley Berkley, D-Nev., who is exploring what aspects of the $8 million Illinois program can be implemented at the federal level. "These are ticking time bombs. We've got suicides, homicides, domestic violence."

Last week, Rep. Phil Hare, D-Ill., called on Congress to adopt full mandatory funding for veterans' health care - making it a legal requirement in the federal budget, like Social Security and Medicare. In so doing, Hare cited Illinois' efforts at the state level as showing the unmet needs among veterans, and as pointing the way toward the type of programs that can succeed.

Since the program was started two weeks ago, 860 veterans and family members have come forward to get help, says Jessica Woodward, spokeswoman for the Illinois Department of Veterans' Affairs.

Navy, Marines May Send Psychologists to the Front

During the Russo-Japanese War (1904-1906), the first organized military system for treating combat fatigue occurred when physicians were placed close to the front ("forward treatment"). They were sent to perform evaluations of and administer care to traumatized soldiers.

The lessons of forward treatment, that soldiers receiving immediate care close to the action and their battle buddies were more resilient, is still relevant today. From the Associated Press:

Navy Chaplain Dick Pusateri has witnessed the stress of war on the faces of troops put in harm's way daily, in the strained relationships of families facing long deployments and the confessions of men shaken by the human cost of war.

For too long, chaplains were among the few people combat Marines felt they could turn to in a crisis. The Navy and Marine Corps aim to change that by sending teams of mental health professionals to the front lines after studies showed a jump in the past five years in cases of combat-related mental health disorders, primarily post-traumatic stress disorder.

"We've got a lot of knowledge about the way combat trauma affects people, and having somebody there to guide Marines through it in Iraq means we can respond to it more quickly," Pusateri said.

While psychologists and psychiatrists have long treated military service members on bases and in field hospitals, next month's deployment of teams of psychological professionals - one per regiment - to combat zones marks a new approach in identifying and treating mental health before problems arise.

USA Today: OEF/OIF Combat Traumatic Brain Injury Tops 20,000 Cases

In early January of this year, as the time for final editing of Moving a Nation to Care was quickly coming to a close, I was doing one last quick scan of my galley copy. Opening it to the Preface's first page, first paragraph, out jumped what was at the time a glaring typo: a sentence stating that 20,000 of returning Afghanistan and Iraq veterans had been diagnosed with traumatic brain injury.

The publicly available figure at the time was around 2,000, and you can imagine how quickly I got on the horn to my publisher to ask that we make sure to correct the error. What a difference a year makes. From USA Today:

At least 20,000 U.S. troops who were not classified as wounded during combat in Iraq and Afghanistan have been found with signs of brain injuries, according to military and veterans records compiled by USA TODAY.

The data, provided by the Army, Navy and Department of Veterans Affairs, show that about five times as many troops sustained brain trauma as the 4,471 officially listed by the Pentagon through Sept. 30. These cases also are not reflected in the Pentagon's official tally of wounded, which stands at 30,327.

JAMA: Mental Health Longitudinal Assessment of Returning Iraq War Veterans Study

Last year, a March 2006 Journal of the American Medical Association article outlined the results of a study conducted for the Department of Defense by a team of Walter Reed Army Medical Center researchers. Last week, details of a follow-up study conducted by the same WRAMC team arrived once more in JAMA, shedding light on the health of our returning troops in the months following their combat deployments.

A full review of the study in extended.

Joshua Omvig Veterans Suicide Prevention Bill Signed by President

From the Associated Press:

President Bush signed the Joshua Omvig suicide prevention bill on Monday, providing improved screening and treatment for at-risk veterans. The law is named after a 22-year-old soldier from Grundy Center, Iowa, who committed suicide in December 2005 after he returned from Iraq. ...

The new law comes amid growing concerns over mental health issues borne by veterans who have seen combat in Iraq and Afghanistan. The VA Inspector General, in a report last May, said Veterans Health Administration officials estimate 1,000 suicides per year among veterans receiving care within VHA and as many as 5,000 per year among all living veterans.

Rep. Leonard Boswell, D-Iowa, who sponsored the bill, commended Omvig's parents for their sacrifice and support of the new law.

"While suffering this personal tragedy, they went on to help other veterans and their families and have advocated for improving all mental health services at the VA," Boswell said.

VA: About 6 Percent of OEF/OIF Vets Expected to be Diagnosed with TBI

Friday, the VA said that it believes about 6 percent of returning troops seeking care at its hospitals will be diagnosed with traumatic brain injury, or TBI. From Army Times:

A VA mandatory screening program that took effect in April has looked at 61,285 veterans of the wars. Of those, 19.2 percent were identified on the screening questionnaire as potentially suffering from traumatic brain injuries and were referred for more tests.

While evaluation continues, VA spokeswoman Alison Aikele said officials believe, based on a smaller sample, that the final result about 5.8 percent will be diagnosed with TBI.

Aikele said it is too soon to draw any conclusions from the screening because the program has been under way for only a few months. Until there is more screening and evaluation, VA officials do not want to jump to any sweeping conclusions about brain injuries, she said.

“We did not really know what to expect,” she said when asked if the number of confirmed TBI cases matched VA’s expectations.

However, the 5.8 percent figure appears low. The Defense and Veterans Brain Injury Center, a joint Pentagon-VA research effort, 14 percent to 20 percent of troops in previous conflicts have had traumatic brain injuries. The Center says there are reasons to expect a higher percentage among troops in the current conflicts because improved body armor has made them more likely to survive injuries that would have been fatal in previous wars, and because of the prevalence of roadside bombs and rocket-propelled grenades to attack U.S. forces. The blasts from such weapons can easily cause concussive brain injuries.

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

From the Des Moines Register:

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

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

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

National Depression Screening Day

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

What Should I Expect During a Screening?

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

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

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

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

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

DoD, GAO Reports Show Lack of Resources, Personnel Slowing Necessary Veterans Health Care Changes

Yesterday, the Pentagon released a report [pdf] to Congress:

Dr. S. Ward Casscells, assistant defense secretary for health affairs, said that the military is committed to making the changes needed "to provide the highest possible level of care and support to our military community." But the military will not rush the reforms and run the risk of "ineffective reactions," the report said.

Among the reforms that the Defense Department won't rush are improvements in the psychological screening of active-duty troops. The task force had recommended that all service members undergo an "annual psychological health needs assessment," conducted by a trained professional who would promptly refer troubled troops to mental health clinicians.

Gates' office said that the military will expand annual health screenings to ensure that troops' mental well-being is evaluated, but the report did not offer specifics, and it set a completion date of "beyond May 2008." The report said that the changes in screening would be made gradually, during a "three-year evaluation project."

Similarly, the Defense Department said that it was working to put in place psychological screening for new recruits, as the task force recommended, but that change also is months away.

Meanwhile, the Government Accountability Office released a report [pdf] today adding weight to a recent post showing even high-visibility troops continue to slip through the cracks while the DoD and VA attempt to play catch-up.

Of course, things in a large organization like the military can't change overnight. But delays in implementing the Dole-Shalala Commission recommendations translate to very real hardships for our military families who have already had to endure a lot.

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

From the Hartford Courant:

Soldiers' advocates and some members of Congress have been calling for tighter pre- and post-deployment psychological screening of troops for more than two years - before the task force was created by Congress.

Last year, a series in The Courant that detailed lapses in the screening and treatment of soldiers with psychological problems - sometimes with tragic consequences, such as suicide - prompted Congress to push for improvements in care. In response, the Defense Department issued new guidelines last winter that set standards for deciding whether service members with psychiatric problems should be deployed and kept in combat.

In the new report to Congress, the Defense Department said that efforts to improve mental health "early intervention" have been hampered by a lack of resources.

"Although we have put in place some early intervention practices, such as our deployment health assessment and education programs, most prevention and protection efforts have come at the expense of clinical care, calling on our clinicians to do `double duty,'" the report said. "In the long-term, this business practice is unsupportable and ineffective. A change is clearly needed to make psychological fitness an equal priority to psychological treatment."

In the report, the Defense Department said that it will soon hire up to 200 military mental health professionals to work on stateside bases, to begin to ease a shortage that the task force called critical. The Army also is in the process of hiring about 260 civilian behavioral-health care workers, officials said.

With the shortfalls, it's no wonder that the military is having a hard time meeting the needs of physically or psychologically wounded returning veterans.

From USA Today:

U.S. military personnel are still receiving substandard treatment from the government, according to a new report from the Government Accountability Office.

As of the middle of this month, the agency's review showed that half of the Warrior Transition Units had "significant shortfalls" of doctors, nurses and other caregivers who to treat wounded soldiers.

Stats from another USA Today article:

The Army announced in June it would hire 200 civilian psychiatrists, psychologists, psychiatric nurses and social workers. It later raised that to 265, a 23% increase in those job categories for the Army. By last week, the Army had filled 40% of the jobs. ...

The shortage in Army uniformed therapists is having an impact on the Iraq war, where Navy and Air Force counselors are helping the army treat soldiers. The number of mental health providers has not kept pace with the additional 30,000 U.S. troops sent to Iraq this year, according to Army statistics provided to USA TODAY. In addition, the Army says some mental health counselors are burned out by their war experience.

"Medical providers are fatigued by the strains of the caring for injured soldiers and soldiers suffering from the psychological effects of deployment, including PTSD," says Col. Elspeth Ritchie, psychiatric consultant to the Army surgeon general, referring to post-traumatic stress disorder. "We are planning to put additional providers at each major installation specifically to support providers."

Experienced therapists continue to leave the military for better-paying and less stressful jobs in the private sector. The Navy, for example, expects to lose a dozen of its 88 psychiatrists this fiscal year and 25 of 116 psychologists, according to data released at a Marine Corps conference in June. Incentives have been created to keep or recruit new psychiatrists and psychologists, including retention bonuses and college loan repayment offers. ...

The Army is preparing a recruiting program aimed at older physicians and mental health providers, aged 48 to 60. They would allow for enlistments of only two years, Army Col. Larry Bolton says.

Meanwhile, the level of mental health care in the Iraq war zone — as a ratio of providers to troops — is the lowest since 2004, Army statistics show. Care has dropped from one counselor per 668 troops last year to one for every 743 this year.

From the Associated Press:

Many of the current [Warrior Transition Unit] staffers, said John Pendleton, author of the report, are borrowed, presumably temporarily, from other offices. Ultimately, hundreds more nurses, social workers and mental health specialists will be needed to handle such issues as traumatic brain injuries and post traumatic stress disorder, he said.

The GAO also noted that the Pentagon and the Veterans Affairs Departments were behind schedule in starting a pilot program under which the two departments would adopt a single medical examination and a single disability rating performed by the VA.

"We are seven months into this process and we are just now getting off the ground," said Rep. John Tierney, D-Mass., chairman of the Oversight and Government Reform subcommittee on national security. "Why has it taken so long to get going on that?" ...

Retired Adm. Patrick Dunne, the VA's assistant secretary for policy and planning, told the hearing that the pilot program to set up a unified disability evaluation system should be completed by the second quarter of 2008. If successful, it will be expanded beyond the Washington capital region to become universal.

Rep. Tom Davis, R-Va., top Republican on the panel, said his office hears every week from wounded soldiers stuck in an evaluation system they don't understand and that is complicated by different ratings coming out of the Defense Department and the VA. "Having to run that double gauntlet causes additional pain and confusion, literally adding insult to injury. That has to stop."

The GAO report's summary:

While efforts are under way to respond to both Army-specific and systemic problems, challenges are emerging such as staffing new initiatives. The Army and the Senior Oversight Committee have efforts under way to improve case management--a process intended to assist returning servicemembers with management of their care from initial injury through recovery.

Case management is especially important for returning servicemembers who must often visit numerous therapists, providers, and specialists, resulting in differing treatment plans. The Army's approach for improving case management for its servicemembers includes developing a new organizational structure--a Warrior Transition Unit, in which each servicemember would be assigned to a team of three key staff--a physician care manager, a nurse case manager, and a squad leader.

As the Army has sought to staff its Warrior Transition Units, challenges to staffing critical positions are emerging. For example, as of mid-September 2007, over half the U.S. Warrior Transition Units had significant shortfalls in one or more of these critical positions. The Senior Oversight Committee's plan to provide a continuum of care focuses on establishing recovery coordinators, which would be the main contact for a returning servicemember and his or her family. This approach is intended to complement the military services' existing case management approaches and place the recovery coordinators at a level above case managers, with emphasis on ensuring a seamless transition between DOD and VA.

At the time of GAO's review, the committee was still determining how many recovery coordinators would be necessary and the population of seriously injured servicemembers they would serve.

As GAO and others have previously reported, providing timely and consistent disability decisions is a challenge for both DOD and VA. To address identified concerns, the Army has taken steps to streamline its disability evaluation process and reduce bottlenecks. The Army has also developed and conducted the first certification training for evaluation board liaisons who help servicemembers navigate the system.

To address more systemic concerns, the Senior Oversight Committee is planning to pilot a joint disability evaluation system. Pilot options may incorporate variations of three key elements: (1) a single, comprehensive medical examination; (2) a single disability rating done by VA; and (3) a DOD-level evaluation board for adjudicating servicemembers' fitness for duty. DOD and VA officials hoped to begin the pilot in August 2007, but postponed implementation in order to further review options and address open questions, including those related to proposed legislation.

Fixing these long-standing and complex problems as expeditiously as possible is critical to ensuring high-quality care for returning servicemembers, and success will ultimately depend on sustained attention, systematic oversight by DOD and VA, and sufficient resources.

Worthy of repeating the bottom line once more: Sustained attention, systemic oversight, and sufficient resources are the keys to success for our returning troops.


Related Posts

• VA Continues to Fall Behind in Claims Processing Time
  
• VA's Inspector General Audit on Service Wait Times Rebukes Congressional Testimony
  
• Even High Profile Veterans Still Struggling with Health Care Bureaucracy
  
• Army to Hire 25% More Mental Healthcare Workers, Senate Committee Votes to Increase TBI, PTSD Screening
  
• 1-in-3 Veterans' Counselors Reporting Burnout
  
• Military Funding, Mental Health Provider Shortfalls Causing Long-Term Morale Problems
  
• Military Resources Strain a Disservice to Current and Former Vets?
  
• America's 'Ready' Brigade Not So Ready Due to Deployment Stress
  
• Navy Psychologist Warns of Mental Health Provider, PTSD Training Shortfalls
  
• Surge -- And Strain
  
• Increased Deployment Tempo Strains Military Family Ties
  
• Scientific American: A Look at the Work of Combat Psychologists

VA Chief: All Vets Seeking VA Treatment Now Screened for TBI/PTSD

From AP:

All soldiers returning from Iraq or Afghanistan who seek any treatment at Veterans Affairs hospitals are now being screened for brain injuries and post-traumatic stress disorder, VA Secretary Jim Nicholson said Monday.

The initiative, which has been in place about 90 days, was created in response to veterans' needs, he said. "Whether they come to us with a toothache or a sore knee, we screen them for any form of brain injury, and we are now screening every one of them for post-traumatic stress disorder," Nicholson told The Associated Press.

He said it was not in direct response to the "Wounded Warrior Assistance Act," approved by Congress in late March after revelations of shabby treatment of wounded soldiers at Walter Reed Army Medical Center in Washington, D.C. [House debate transcript]

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

Continuing:

Nicholson said that in the screening process, VA clinicians first talk to veterans, who will be given further testing such as brain scans if they have symptoms. He said previous research has focused on traumatic brain injuries rather than mild ones, which actually may account for many injuries in the bomb-ridden war zone.

"This is one of the signature injuries of this conflict, and we have now determined that because of the presence of these blasts, the kind of combat environment that the men and women over there are enduring, there's a possibility that they've had these injuries and were not aware of it, so we're checking," Nicholson said. ...

Nicholson said the additional screening is being funded through $100 million for enhancement mental health services and $20 million for veterans centers that help returning soldiers readjust to everyday life. Both were in the supplemental spending bill.

This is very good, if long-in-coming, news.


 Related Posts

• Class Action Lawsuit Brought Against VA
  
• WaPo's Priest and Hull Take on Combat PTSD

Vet Orgs Take to Washington, Need Our Help

A number of veterans organizations are turning up the heat lately in Washington, D.C., on issues having to do with homecoming reintegration and healthcare, accountability, the escalation (or troop 'surge') in Iraq, and even a stand against entering war with Iran. Thought I'd pass along a few of their calls for action.

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

Iraq and Afghanistan Veterans of America (IAVA)
2007 Legislative Agenda

IAVA is going to Washington. IAVA is launching one of our most important projects to date - the 2007 IAVA Legislative Agenda. Our Legislative Agenda contains 31 action items for the new Congress: concrete steps lawmakers can take to get troops and veterans the support they need and deserve.

Our agenda covers all aspects of the issues facing new vets, including:

• Mandatory and confidential mental health screening for troops coming home from combat. [more on mental health and healthcare agenda]
• A better transition system to help new veterans go to college, get a job, or start their own business. [more on homecoming agenda]
• Criminal investigation of fraud and waste by contractors. [more on accountability agenda]

Read it in full online, download the PDF, or check out the MS Word version.

In the next few weeks, we'll be reaching out to legislators on both sides of the aisle to present our agenda and ask for their support, and we'll need you to get involved.

Thank you for your continued support.

Sincerely,

Paul Rieckhoff
Iraq Veteran
Executive Director/Founder
Iraq and Afghanistan Veterans of America

VoteVets.org
Meets with Democratic Leaders on Hill

Today, VoteVets.org is profiled in the Washington Post, regarding our trips to Capitol Hill and ads we've been running.

Because of our campaign against the escalation of the war in Iraq, we're seeing some serious movement. This article details that many Senators who had blocked a debate on the bipartisan resolution against escalation are now doing a quick about-face. Because of you, the proponents of escalation of the war are starting to crumble.
We're not done yet!

This week, we had meetings with a dozen Senate offices from both sides of the aisle, and a very productive meeting with House Speaker Nancy Pelosi and Majority Leader Steny Hoyer. We have their firm commitment that nothing will get in the way of the House speaking out forcefully against an escalation in Iraq. We will do everything we can to ensure quick passage of a resolution against escalation. Once a resolution passes in the House, and more Republicans in the Senate come to the conclusion that their political lives depend on them doing the right thing, we will see the Senate follow suit.

Please help us keep the heat on. Call your Representatives and Senators, and tell them that you stand with VoteVets.org's troops and veterans of the war in Iraq by opposing the escalation. The Capitol Hill switchboard number is 202-224-3121.
Thank you for supporting the Voice of the 21st Century American Patriot.

Best,

Jon Soltz
Iraq War veteran
Co-Founder and Chairman,
VoteVets.org

Veterans for America
Demand Congressional Action

We rushed into our war with Iraq without sufficient congressional involvement, and the consequences have been dire, far-reaching, and irrevocable.

Political action is the ONLY way to prevent this from happening again.

The 110th Congress campaigned with the promise to reengage in war making decisions and we empowered them accordingly. We must hold them to this promise.

Recently, Senator Robert C. Byrd (D-West Virginia) introduced a much-needed resolution [pdf] that states that Congress must approve any offensive military action taken by the United States against another country.

Veterans for America strongly supports Senator Byrd’s resolution, and we are working to rally support for it. To join our effort, please contact your Senators and urge them to co-sponsor Senate Resolution 39.

Send a message to your Senators by visiting the Veterans for America Congressional Action webpage. Together, we can make it clear that the American people will not allow our war to be expanded to include other countries without congressional authorization.

Thank you for your continued support,

Bobby Muller
President, Veterans for America

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Military's New Mental Health Assessment Hotline Arrives February 12

From AP:

A new automated phone-in assessment program is the latest effort by the military to reach out to soldiers and family members who might not otherwise seek help for post-traumatic stress or other psychological issues. The program is similar to an anonymous mental health screening effort begun online last year. About 40,000 troops or their family members - roughly 7 percent of them in Iraq - have participated.

There's much concern among those in the military that seeking help will affect someone's career, so it's good to have more anonymous options, said Dr. Jay Weiss, a former Air Force psychiatrist in private practice in Louisiana who has treated Iraq veterans.

While seeking help via telephone and Internet is not ideal, it's "certainly better than nothing," he said. ... The phone-in program was introduced Monday at the Military Health System annual conference in Washington. It is expected to begin taking calls by Feb. 12. The calls will be conducted in English and Spanish and will operate 24 hours a day.

The toll-free number for the Telephone Self-Assessment will be (877) 877-3647. A companion anonymous online Mental Health Self-Assessment test is also available.