Senate Veterans' Affairs Committee Holds Hearing on VA Gaps in Female Client Care

While most in Washington have been busily paying attention to the Sotomayor hearings this week, the Senate Veterans Affairs' Committee met Tuesday morning to consider the quality of VA care provided to our nation's 1.8 million female veterans.

Some, but certainly not all, of their concerns regarding access to their health benefits reflect the same frustrations felt by their male counterparts. Carrie Wells, McClatchy News:

The Department of Veterans Affairs often fails to provide adequate medical care to female military veterans, five of them told the Senate Veterans Affairs Committee Tuesday.

A Veterans Affairs official agreed.

"At the root is a system that has not been responsive to the needs of women veterans," said Patricia Hayes, the department's national director of women's health care.

The five veterans said women sometimes aren't properly informed upon discharge that health benefits are still available. They described how dealing with government is frustrating and confusing, and that often their unique needs, such as child care and sexual assault counseling, aren't understood by government officials.

"I looked to the VA for help when I most needed it, but never succeeded in completing my enrollment, let alone actually receiving the care I needed," said Genevieve Chase, the founder and executive director of the American Women Veterans organization.

Hayes agreed. "Women don't really know about VA services," she said.

More coverage in extended.

The proceedings, Women Veterans: Bridging the Gap, lasted about two hours and can be viewed in full at the link.

Salon Investigation: Army Doctors Pressured Not to Diagnose PTSD, Senate Armed Services Committee Refuses to Look Into Matter

And now, back to reality.

After my glowing post yesterday, nodding to the many Army generals nudging military culture into the 21st century by admitting that anyone can and does get PTSD, it doesn't take long for things to come crashing back down to reality.

Michael de Yoanna and Mark Benjamin for Salon:

For more than a year he's been seeking treatment at Fort Carson for a brain injury and post-traumatic stress disorder, the signature injuries of the Iraq war. Sgt. X is also suffering through the Army's confusing disability payment system, handled by something called a medical evaluation board. The process of negotiating the system has been made harder by his war-damaged memory. Sgt. X's wife has to go with him to doctor's appointments so he'll remember what the doctor tells him.

But what Sgt. X wants to tell a reporter about is one doctor's appointment at Fort Carson that his wife did not witness. When she couldn't accompany him to an appointment with psychologist Douglas McNinch last June, Sgt. X tucked a recording device into his pocket and set it on voice-activation so it would capture what the doctor said. Sgt. X had no idea that the little machine in his pocket was about to capture recorded evidence of something wounded soldiers and their advocates have long suspected -- that the military does not want Iraq veterans to be diagnosed with PTSD, a condition that obligates the military to provide expensive, intensive long-term care, including the possibility of lifetime disability payments.

And, as Salon will explore in a second article Thursday, after the Army became aware of the tape, the Senate Armed Services Committee declined to investigate its implications, despite prodding from a senator who is not on the committee. The Army then conducted its own internal investigation -- and cleared itself of any wrongdoing.

Fort Carson, you may recall, was the site of a major scandal in 2006-2007 when first the Colorado Springs Independent (CSIndy) and CBS News reported in July 2006 that some troops were receiving abuse rather than proper treatment for their reintegration issues and/or PTSD after returning from Iraq. In December 2006, NPR broke the story even wider; Senate investigations followed.

VA Hiring Vets for Outreach, Army's 'Warrior Resilience and Thriving' Program, TRICARE West Offers Benefit Help, Female Veteran Testifies Re: PTSD

Recently in the news:

• The Associated Press | VA hires vets to go find comrades who need help - "Graner is one of 100 former service members hired nationally by the Department of Veterans Affairs as outreach specialists to help get Iraq and Afghanistan veterans into programs aimed at easing their transition back to civilian life. They frequent job fairs, welcome-home events and other places where troops back from the wars might congregate and look for those struggling to adjust. The goal is to persuade them to visit one of 230-plus vet centers nationwide...[for] free services from job hunting assistance to marriage and mental health counseling. Experts applaud the effort to actively search for veterans who may need help, even if some advocates say the program should be much bigger."
  
  
• USA Today | Military puts focus on epidemic of suicides - "In Maj. Thomas Jarrett's stress management class ... American troops are urged ... to strive for 'post-traumatic growth.' During a 90-minute presentation entitled "Warrior Resilience and Thriving," Jarrett, a former corporate coach, offers this and other unconventional tips on how troops can stay mentally healthy once they return home. He quotes Roman Emperor Marcus Aurelius, Paradise Lost author John Milton and German philosopher Friedrich Nietzsche... Walking through the crowd of young GIs in the makeshift classroom, Jarrett urges them to fight their "internal insurgents."
  
  
• News-Leader | Videos explain health care benefits to military families - "Military families throughout TRICARE’s west region now have a new way to learn about their health care benefits through the movies. ... “TRICARE 2 You” video topics, which run an average of three minutes in a prime-time news format, include explanations of TRICARE plan options, how to access specialty care, behavioral health resources, pharmacy options and newborn enrollment, among others. “We wanted to do whatever it takes to help our beneficiaries maximize use of their TRICARE benefit and avoid out-of-pocket costs,” said David J. McIntyre, president and CEO of TriWest Healthcare Alliance. “This is especially useful for service members, particularly those in the National Guard and Reserve who live or work in rural areas without convenient access to military base resources,” he said. Produced by TriWest, in partnership with TRICARE Regional Office-West, the videos are housed in the company’s new TRICARE 2 You Online Library."
  
  
• IAVA | Iraq Veteran Testifies On Capitol Hill - "Veteran Carolyn Schapper testified at a hearing before the House Veterans Subcommittee on Disability & Memorial Affairs about the disparities in PTSD diagnosis for male and female soldiers in combat. During her deployment to Iraq from October 2005 to September 2006, Carolyn participated in over 200 combat patrols as a member of a Military Intelligence unit with the Georgia National Guard."

More PTSD Combat Diigo links.

Senate Hearing on Military Suicides Slated for Wednesday, March 18, as Army Continues to Attack Problem

Over the course of the past years, with a notable uptick in tempo over the past few months, we've been witnessing a distressing rise in military suicides. We outside observers haven't been alone in taking note. The military has as well.

The Army, for instance, has been undergoing a month long "stand down" meant to put renewed focus on suicide prevention. They now enter the "chain teaching" phase, which will run through July 15. (In 2007, a 90-day PTSD/TBI education chain teaching program was initiated.) In addition, last week Army Vice Chief of Staff Peter Chiarelli held a blogger's roundtable [audio-mp3], "assuring those on the line that the Army understands the severity of the problem, and is doing everything it can to prevent even a single suicide from happening."

"The culture of the Army is that of a team," said Chiarelli. "And anytime one of our own feels so lost that he or she sees no other option than to take their own life, then we've failed as an organization." And so, the real work begins.

The Army is also introducing a new fitness program, set to launch in May, that will combine physical and mental strength and resiliency training. Army Chief of Staff Gen. George W. Casey Jr. said it is "designed to move mental fitness up to the level we give to physical fitness" and will "give more soldiers coping skills so they can deal with the difficult challenges of combat and come back stronger."

It's good to see the Army (and other military branches) responding as they are. While a small element, kudos to their using blogger's roundtables to engage more intimately and directly with us. [I was invited to take part in one last summer, but was unavailable; I mention it, though, because it does show that they are trying to reach out to more of us in ways that they never had before.]

Many, many Americans care about this issue, and wish to ensure that our military families have the resources they need when they serve, and when they return home, too.

New VA Report Stirs Up Long-Simmering Veterans Disability Claims Processing Controversy

Just when you think that our beleaguered veterans can relax, that health care improvements are on the way or already there, the latest VA report (yes, another one) confirms we're merely treading water.

While things are all a boil, again, this week, the veterans claims processing backlog (and everything that flows from it) has been a long-simmering problem.

Sept. 16-18: VA OIF/OEF Veterans and Families Advisory Committee Set to Meet in Palo Alto, CA

Please pass this on, especially to those in the area who may wish to add their voices, experiences. Those who wish to have five minutes to speak to the committee must pre-register by September 10. Details in extended below:

The Department of Veterans Affairs (VA) gives notice under Public Law 92–463 (Federal Advisory Committee Act) that the Advisory Committee on OIF/OEF Veterans and Families will conduct a meeting and a site visit in the Palo Alto, California area on September 16–18, 2008. Committee activities will include tours and briefings at various VA facilities.

The purpose of the Committee is to advise the Secretary of Veterans Affairs on the full spectrum of health care, benefits delivery and related family support issues that confront service members during their transition from active duty to veteran status and during their post-service years.

The Committee will focus on the concerns of all men and women with active military service in Operation Iraqi Freedom and/or Operation Enduring Freedom, but will pay particular attention to severely disabled veterans and their families.

The agenda for the September 16–18 meeting will include briefings on recent site visits, discussions on proposed recommendations to the Department of Veterans Affairs (VA), and tours of the VA Medical Center. The Committee will discuss its findings and observations based on previous Committee meetings, site visits, written reports, and personal experiences.

Combat PTSD or Adjustment Disorder? Saving Money, Not Lives, Floated at One VAMC

Last year, a firestorm erupted when it was found that 24,000+ OEF/OIF veterans had been booted out of the military with Personality Disorder discharges. PD (once labeled "Section 8") discharges are a quicker and more cost-efficient way of dealing with service members who are exhibiting problematic behavior.

The problem, of course, was that some of the discharged were combat-injured Purple Heart recipients who may have instead been coping with PTSD, a fact that would allow them access to VA health care benefits to treat their condition.

This week, we've moved from the military's diagnoses of Personality Disorder over PTSD to a Texas VAMC PTSD program coordinator advising that Adjustment Disorder diagnoses should be handed out over that of PTSD. The reason given? Saving money.

Army Vice Chief of Staff General Richard Cody: Soldiers, Families 'Stretched and Stressed' to Limit

Yesterday, in morning testimony before the House Veterans Affairs Subcommittee on Health, we heard Colonel Charles W. Hoge, M.D., Director of the Division of Psychiatry and Neuroscience at Walter Reed Army Institute of Research, say studies show "longer deployments, multiple deployments, greater time away from base camps, and combat intensity all contribute to higher rates of PTSD, depression, and marital problems."

Appearing later the very same afternoon before the Senate Armed Services Committee, Army Vice Chief of Staff General Richard Cody stated [written testimony pdf]:

Today’s Army is out of balance. The current demand for our forces in Iraq and Afghanistan exceeds the sustainable supply and limits our ability to provide ready forces for other contingencies. ...Current operational requirements for forces and insufficient time between deployments require a focus on counterinsurgency training and equipping to the detriment of preparedness for the full range of military missions.

Given the current theater demand for Army forces, we are unable to provide a sustainable tempo of deployments for our Soldiers and Families. Soldiers, Families, support systems, and equipment are stretched and stressed by the demands of lengthy and repeated deployments, with insufficient recovery time. Equipment used repeatedly in harsh environments is wearing out more rapidly than programmed.

Army support systems, designed for the pre-9/11 peacetime Army, are straining under the accumulation of stress from six years at war. Overall, our readiness is being consumed as fast as we build it. If unaddressed, this lack of balance poses a significant risk to the All-Volunteer Force and degrades the Army’s ability to make a timely response to other contingencies.

House Veterans Affairs Subcommittee Hears Testimony on PTSD Treatment and Research

Yesterday, the House Veterans Affairs Subcommittee on Health convened a long-anticipated hearing on Post Traumatic Stress Disorder (PTSD) Treatment and Research: Moving Ahead Toward Recovery. The hearing was the first to be telecast live from the House committee's website and can be viewed online in full today.

From Chairman Michael H. Michaud's opening statement:

Post-traumatic stress disorder is among the most common diagnoses made by the Veterans Health Administration. Of the approximately 300,000 veterans from Operations Enduring and Iraqi Freedom who have accessed VA health care, nearly 20 percent –60,000 veterans- have received a preliminary diagnosis of PTSD. The VA also continues to treat veterans from Vietnam and other conflicts who have PTSD.

With the release of the 2007 IOM report “Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence,” we learned that we still have much work to do in our understanding of how to best treat PTSD. I hope that my colleagues will continue to work with me in supporting VA’s PTSD research programs.

I look forward to hearing testimony today from several organizations that are working to provide comprehensive and cutting edge treatment to those with PTSD. The committee recognizes that this is an important issue and one that will be with us for a long time to come. We are committed to ensuring that all veterans receive the best treatment possible.

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.

House Veterans Affairs Health Subcommittee Explores How Best to Support Military Families

Yesterday, another important hearing, Mental Health Treatment for Families: Supporting Those Who Support Our Veterans, was convened on Capitol Hill by the House Veterans Affairs health subcommittee. [Audio now online; video link not presently available]

Rick Maze, Army Times:

A House subcommittee was urged Thursday to expand the Veterans Affairs Department’s authority to provide mental health counseling for the families of veterans, including National Guard and reserve members who have returned from combat.

Current law restricts VA to providing “limited services to immediate family members,” said Kristin Day, VA’s chief consultant for care management and social work service.

“The law provides, in general, that the immediate family members of a veteran being treated for a service-connected disability may receive counseling, education and training services,” Day told the House Veterans’ Affairs health subcommittee.

That leaves a lot of gaps for people who fall outside the military health care system, some critics say.

Experts, Advocacy Groups, Officials: VA Disability System Fixable

From Kelly Kennedy via Navy Times:

Medical experts, advocacy groups and Veterans Affairs Department officials say VA’s disability rating schedule needs to be updated — continually — but they denied the system is so bad that it needs to be dumped completely.

A Tuesday hearing of the House Veterans’ Affairs subcommittee on disability assistance and memorial affairs also focused on studies conducted over the past year that point toward needed improvements not only in the ratings schedule, but in VA’s disability retirement system itself.

Rep. John Hall, D-N.Y., chairman of the subcommittee, said VA needs to remove “archaic” criteria from the rating schedule; update psychiatric criteria to better reflect symptoms of troops diagnosed with post-traumatic stress disorder; find out why so many veterans with PTSD have been rated fully disabled; and update neurological criteria to include new research on traumatic brain injuries.

“The VA needs the right tools to do the right thing,” Hall said.

VA argued that it is already doing the right thing and has been updating the rating schedule, though officials acknowledged they could do better. From 1990 through 2007, VA had updated 47 percent of the ratings schedule, but 35 percent of the codes had not been touched since 1945. However, VA said it updated the codes for TBI in January and is working on an update for PTSD.

Amidst Warrrior Transition Unit Overdoses, Army Surgeon General Schoomaker Blasts Streamlined Disability Pilot Project as 'Fast Bad Process'

From Kelly Kennedy, Army Times:

A pilot project intended to speed the process of evaluating and rating service members’ disabilities will do little more than turn a bad process into “a fast bad process,” the Army’s top medical official said Friday.

Army Surgeon General Lt. Gen. Eric Schoomaker’s comments came at a hearing at which the services’ surgeons general had their chance to brag about what they have done in the year since the outpatient scandal at Walter Reed broke — standing up units specially designed to take care of wounded troops, asking for and receiving money to house those service members, ombudsmen, internal checks and toll-free numbers for reporting problems – before the House Armed Services Subcommittee.

Schoomaker also spent some time talking about continued problems, including his view that the pilot project designed to streamline the disability system will not prove to be the answer. Under the test, taking place at three military medical facilities and one VA medical center in the Washington, D.C., area, service members will receive a single medical examination and a single disability rating issued by VA, an effort to eliminate duplication in the separate military and VA systems and speed up the process.

But Schoomaker said both the military and VA systems for dealing with service members’ disabilities is based on an “outdated” model from the 1940s, when most of the force consisted of single soldiers with no health care. “When you speed up a bad process, all you have is a fast bad process,” Schoomaker said of the ongoing pilot project.

On other issues, Schoomaker said mental health descriptors used by military medical professionals need to be updated to fit today’s ideas about post-traumatic brain injury and depression.

He also said the Army found a new “trend” as it grouped all of its wounded soldiers into one system where they could be carefully monitored: 11 deaths in that population due to suicide, accidental overdose by prescription medications, and in motor vehicle accidents. Schoomaker said the combination of multiple prescription drugs — usually pain medication — mental health issues, alcohol and no supervision on the weekends are contributing to the problem.

Upcoming Congressional Hearings on Combat PTSD

Received this head's up on two important upcoming House Veterans Affairs Committee hearings from Mike and Kim Bowman. In December as you may recall, they offered Chairman Bob Filner and the committee heartrending testimony on their son Tim's suicide. Tim was an Illinois National Guard member, one of the OEF/OIF veterans' groups most at risk for taking their own lives after returning home.

Dates to make a note of:

2/28/2008 - Mental Health Treatment for Families: Supporting Those Who Support our Veterans

4/01/2008 - Post Traumatic Stress Disorder (PTSD) Treatment and Research: Moving Ahead Toward Recovery

More on these hearings as it becomes available.

Senate Confirms James Peake to Head VA

First up, from the Kaiser Daily Health Policy Report:

The Senate Veterans' Affairs Committee on Thursday voted 15-0 to approve retired Army Lt. Gen. James Peake, President Bush's nominee for Department of Veterans Affairs secretary, CQ Today reports. [The full Senate voted today to confirm Peake].

Peake on Thursday answered several post-hearing questions from committee members. In response to a question by Sen. Richard Burr (R-N.C.) about what he wanted to achieve during his term, Peake said he will focus on improving treatment for veterans with mental health issues, adding, "The issue of (post-traumatic stress disorder) is an important one, as is the issue of (traumatic brain injury). We must get the best of science to help us with the way we deal with our veterans."

Peake also said he would consider automatic acceptance of claims for PTSD by veterans with records that prove symptoms of the disorder. In addition, he said he would launch a probe into a claim by committee Chair Daniel Akaka (D-Hawaii) that fewer than 50% of Iraq and Afghanistan veterans who have been diagnosed with PTSD receive VA disability benefits.

A Thank You to the House Veterans Affairs Committee From a Concerned Citizen

Mike and Kim Bowman, parents of local Illinois National Guardsman who committed suicide two years ago on Thanksgiving Day after having returned home from Iraq only eight months earlier, my husband, and I flew home late last night following an incredible two days in Washington, D.C. testifying before the House Veterans Affairs Committee on the issue of veterans suicide.

[Written testimony transcripts; my full testimony below.]

I have a lot going on today as a result, but wanted to share a few things quickly now and promise to return to share some of my thoughts in full as soon as I can. But I want to say how honored and moved I was to have been in that room during the two breathtaking hours of testimony the Bowmans gave.

There really was very little left to have to say after their masterful and information-rich time in front of the committee. It just makes one all the more realize the inanity of having to do study after study and call in professional after professional to analyze data and point to what needs to be done.

If the VA and the DoD really want to know what we should be doing to assist military family members through the reintegration process, here's all they need to do: ask our military families. Fortunately, these types of hearings at least offer the rest of us -- and the VA and the DoD -- the opportunity to learn straight from the source what is needed.

We must listen, and then we absolutely must act.

Mrs. Meagher Goes to Washington

Sorry, I just couldn't help myself with that title.

Actually, I'm hoping that I'll be able to get out of Chicago today and make it to DC, as the ice is coming down quick and hard and my original flight has already been canceled.

I won't be posting anything during my trip, but will pass along my thoughts on tomorrow's House Veterans' Affairs Committee hearing on Stopping Suicide: Mental Health Challenges Within the Department of Veterans Affairs when I get back.

NIU and the Northern Star have both kindly written pieces on my journey to the Capitol to testify before Congress this week. I'm humbled to have been asked, and hope that I can contribute something valuable to the discussion.

I'd like to thank everyone for their support these past two years.

Confirmation Hearings Begin for Veterans Affairs Nominee James Peake

From AP:

Pledging to "do the right thing," Veterans Affairs nominee James Peake said Wednesday he will be an independent advocate for thousands of injured veterans and will fight for the needed funding for their care.

In a 2 1/2-hour confirmation hearing, the retired Army lieutenant general also vowed to work on making significant headway in fixing gaps in care and reducing delays in disability pay.

But Peake hedged on offering specific solutions, deferring to detailed briefings he will receive later if confirmed. He indicated his greatest mark on the agency in the waning months of the Bush administration might be improved communications with the Defense Department.

"I'm not much of a legacy guy," Peake said.

Upcoming House Veterans' Affairs Committee Hearing on Veteran Suicide and Homelessness

Passing along word of an important hearing to be held by the House Committee on Veterans' Affairs at 10 a.m. on December 12, 2007.

I have been asked to testify before Congress to discuss Stopping Suicide and Ending Homelessness: Mental Health Challenges Within the Department of Veterans Affairs, and have accepted the invitation.

Will pass along further details as I have them on related Washington, D.C. events we are planning.

From the Committee's press release:

Chairman Bob Filner (D-CA) announced that the House Committee on Veterans’ Affairs will hold a hearing to examine current mental health care available to our nation’s veterans by the Department of Veterans Affairs (VA). The hearing will focus on two recent reports: a National Alliance to End Homelessness study which showed that one out of four homeless are veterans and a CBS News report that found the rate of suicide among veterans is double that of the general population.

“These two reports only highlight what we do not know about our veterans,” said Chairman Filner. “I think the report on homeless veterans underestimates the reality of the number of America’s heroes that are on the street tonight. The tragedy of homeless veterans is that we know what we need to do to prevent it, but neither the military nor the VA bureaucracy is ready to do this. What is worse is that we know the repercussions of not acting.”

The hearing will focus on recent statistical data from private sources as a platform to discuss comparative data from the VA on these issues. Witnesses invited will include members of the media, scholars from the mental health care profession and representatives from the VA. The hearing will take place in December.

DoD/VA Recovery Coordinators Now Being Sought for Military Medical Centers

From Stars and Stripes:

Defense officials plan to have new counselors, charged with guiding wounded troops through the complex military and veterans health systems, in place and working with patients early next year.

Veterans support groups called the move an important first step, but said making sure the new recovery coordinators can fight on behalf of troops and families will be key in the success of the program.

“They have to be able to bust through the bureaucracy and have the authority to manage these cases,” said Jeremy Chwat, vice president for policy at the Wounded Warrior Project. “This will only be as good as the authority they are given.”

The new posts were one of the top recommendations from the President’s Commission on Care for America’s Returning Wounded Warriors, put in place after complaints arose about the quality of troops’ care at Walter Reed Army Medical Center earlier this year.