Sept 27, 2013
Many returning service members thought surviving the “war on terror” was the toughest hurdle they faced, however, once wounded troops return home many must battle the Department of Defense or Veteran’s Affairs to receive “promised” disability benefits. Those battle-tested warriors transitioning into the private sector also find themselves competing with millions of unemployed Americans for scarce jobs.
Watch San Diego 6 News segment here: http://www.sandiego6.com/story/kimberly-dvorak-ptsd-and-bureaucracy-20130922
Even more painful was a CNN report this week of another obstacle for our troops and that is the tragedy of suicide. Based on a little noticed report published by the Department of Veterans Affairs in February, CNN reported more than 22 service veterans commit suicide every day. However, many nonprofits, dedicated to assisting veterans believe that number is much higher because death certificates don’t always include veteran status. Many veterans’ groups identify the policy and practical hurdles many wounded warriors endure. Not only is the process painstakingly lengthy (two year back log), but also in most cases the DoD/VA rely on the service members bringing boxes of medical records to prove their injuries are service connected. Not only does this ping-pong process lead to frustration, it leads to co-morbidity problems, some include drug and alcohol abuse as well as suicide.
Last week San Diego 6 News spoke to Purple Heart recipient Thor Wold about the government bureaucracy. The former Navy Corpsman earned a Purple Heart for his heroic actions caring for wounded Marines and Sailors at the Battle of Fallujah, Iraq. Despite his own injuries, Doc Wold was administratively separated by the Navy with an honorable discharge while the medical side of the Navy was preparing to submit him into the DoD disability system. The DoD program would have provided him with the temporary disability benefits Congress mandated for his injuries — nevertheless, the DoD discharge prevailed and Wold found himself separated from the Navy but in need of medical care. The bureaucratic snafu leaves him with no alternative than to file suit against the DoD to obtain his promised benefits.
Sadly, his situation is not unique within the military ranks.
Fortunately for Wold, with the help of his support system, he applied to the VA and the VA stepped-up and took care of him, guiding him through the mountains of paperwork required to continue medical treatments for the injuries he suffered during the Iraq War.
Wold explains that the DoD “lost in translation” treatment is a result of a flawed disability rating system that eventually lead to a 2011 class action lawsuit against the DoD. The lawsuit allowed service members to bring their claims for mental health related injuries to the courtroom because the DoD refused to apply federal law by denying “promised” treatment.
The class action lawsuit, Sabo v. U.S., forced the DoD to admit it improperly discharged nearly 4,500 service members. But by applying the rules for class action lawsuits (instead of making administrative corrections to their records), the DoD was able to exclude nearly half of the eligible veterans from receiving compensation and benefits. Sadly, this is the mindset wounded veterans face at the hands of the disability system.
As if that wasn’t bad enough, the DoD asked and was granted by Congress the authority to eliminate the ability of injured service members from exercising their Constitutional rights to pursue a case in federal court. Colonel O’Brien of the Institute for Combat Wounded Policy found it disingenuous that after DoD was admonished by the court for not applying federal law, that DoD would petition Congress to limit federal jurisdiction for the wounded and relegate them to the very system that had willfully deprived them of their Congressionally mandated benefits.
For many, being caught in the bureaucratic quagmire often costs more than the medical treatment they earned. Many lose their families via divorce, turn to drugs or alcohol to mask the pain or decide suicide is the only way out. While most Americans deplore shabby treatment of military veterans, the DoD continues to separate wounded troops from the services as fast as they can in an effort to avoid costly medical issues and those with disabilities are deemed unfit for active duty.
Colonel O’Brien explains the reasoning behind DoD’s decision to separate injured troops from their ranks this way. “The DoD has a limited number of personnel, so when troops are injured, others must pick up the slack in order to maintain the operational tempo.”
It’s important to keep in mind, warriors live by an oath not to leave fallen soldiers behind but they have a hard time understanding why the U.S. military goes to extraordinary lengths to bring home the dead and wounded, only to separate the wounded without regard to their benefits.
So how exactly does the DoD/VA fix this problem? For those who have navigated the DoD/VA bureaucracy, the solution is simple. Wold explains that simply blending the two department’s medical codes would ensure a smoother transition from military health to civilian health care. The disconnect comes from the stubbornness between DoD and Veterans Affairs to adopt a computer operating system for electronic medical records that would be compatible with active duty, Reserve, National Guard, and veterans requirements.
While Electronic Healthcare Records are only a part of the problem, the move toward a universal electronic healthcare records system would go a long way toward reducing the loss of records and the delays in processing disability claims. Regrettably, that likelihood seems just as remote today as it was a decade ago when DoD and VA first broached the subject since DoD and VA recently announced abandonment of the effort after spending almost $2 billion.
President Obama said that the Department of Veterans Affairs will begin the process of making it easier for veterans suffering from post-traumatic stress disorder (PTSD) to get the treatment and benefits they need.
“Just as we have a solemn responsibility to train and equip our troops before we send them into harm’s way, we have a solemn responsibility to provide our veterans and wounded warriors with the care and benefits they’ve earned when they come home,” Obama said in a weekly radio address.
“We also know that for many of today’s troops and their families, the war doesn’t end when they come home,” Obama admitted. “Too many suffer from the signature injuries of today’s wars: post traumatic stress disorder and traumatic brain injury (TBI). And, too few receive the screening and treatment they need.”
For many returning war veterans they “have been stymied in receiving benefits” because they had to produce a plethora of paperwork and prove they suffered a traumatic event that caused PTSD. The President insisted that streamlining the process would “help both the veterans of the Afghanistan and Iraq Wars, along with generations (veterans from other eras), who have served and sacrificed for the country.”
However the former Chairman of the House Veteran Affairs Committee, Rep. Bob Filner (D-CA) says soldiers shouldn’t prove they have PTSD, but they should have to prove they don’t. The Congressman has worked tirelessly on these issues and believes the military is letting down the soldiers by not decompressing these guys once they return from the battlefield.
The new PTSD regulations will relieve veterans from proving a single wartime moment that caused the hopelessness and fear. Now veterans only need to show evaluators they served in a region where there would be cause to fear the reprisal of terrorist attack.
“I don’t think our troops on the battlefield should have to take notes to keep for a claims application. And, I’ve met enough veterans to know that you don’t have to engage in a firefight to endure the trauma of war,” Obama said.
The American Legion’s Veterans Affairs and Rehabilitation Division’s Barry Searle concurs; “This requirement seems to be a step backward in an otherwise commendable move by the VA. Private healthcare providers should be given the opportunity to work with veterans and diagnose those who suffer from PTSD.”
Searle points out that if the VA has real concerns about the treatment methods of PTSD assessment standards, “it should create a certification process for private practitioners that would satisfy its requirements.”
If the government opened up returning veterans to the Tri-Care health program, which is similar to a PPO health care plan, the private sector doctors could alleviate the backlog for PTSD/TBI treatment.
“When the VA makes claims they have enough doctors on staff to take care of the PTSD cases they are wrong. I just went to the La Jolla, CA VA and they said there was a hiring freeze for psychiatrists,” Filner said. “It’s baloney; we don’t have enough psychiatrists to treat these guys and girls.”
One congressional analysis reportedly put the cost of the new changes at $5 billion
A senior department official said the price tag is “relatively small.” Under the older system bureaucrats claimed veterans eventually received the treatment they needed and hoped the new “stealthy process” would speed up the wait time. White House Senior staffers said the new process should also bring the cost of treating PTSD down.
The Veterans Affairs Department Secretary, Eric Shinseki complimented the new PTSD treatment process and said the new directive was another critical step forward in providing an easier process for combat veterans seeking health care treatment and disability compensation. The new VA regulation was published in the Federal Register last week.
“This nation has a solemn obligation to the men and women who have honorably served this country and suffer from the often devastating emotional wounds of war,” Secretary Shinseki said. “This final regulation goes a long way to ensure that veterans receive the benefits and services they need.”
By publishing a new regulation in the Federal Register it clears the way for the VA to simplify the process for a veteran to claim service connected PTSD immediately. In return the VA reduces the evidence needed if the trauma claimed by a veteran is related to fear of hostile military or terrorist activity and is consistent with the places, types, and circumstances of the veteran’s service.
Shinseki said the science-based regulation relies on evidence that concludes a veteran’s deployment into a war zone is link enough to increase the risk of developing PTSD.
Looking back at PTSD pitfalls
In the past, VA claims adjudicators were required to corroborate that a non-combat veteran actually experienced a stressor related to hostile military activity. The new rule simplifies the development that is required for these cases and will make it easier for those serving to receive the treatment they have been denied in the past.
However, it’s Rep. Filner’s view that the military “has a much deeper problem.” Filner also alludes to the stigma attached to PTSD. “The military doesn’t want to know the full extent of the problem; they just don’t want to know.”
Nevertheless the VA expects this new rule will decrease the time it takes the VA to decide access to care.
Shinseki claims there are more than 400,000 veterans currently receiving compensation benefits that are service connected for PTSD. Congressman Filner challenges this number and believes the number is much greater than anyone is willing to admit and the VA could not handle an influx in veterans coming forward.
In the private sector, PTSD has been a medically recognized anxiety disorder that can develop from seeing or experiencing an event that involves actual threatened death or serious injury to which a person responds with intense fear, helplessness or horror, and is not uncommon among war veterans.
Filner says he has been trying to encourage the military to add an eight-week decompression course for all soldiers to attend. “Right now the veterans coming home are asked two questions to self assess a PTSD problem. On top of that many of the Commanding Officers tell them to mark no on the questionnaire so they can get home faster,” Filner explained.
The program Filner describes could take place at their home base with brothers in arms, family members and trained clinicians. “This would be a good dovetail with job training classes as well,” he said.
The costs led to the new VA regulation
The process of change within the giant bureaucracy that is Washington D.C. came about in part by testimony of Barton F. Stichman, Joint Executive Director of the National Veterans Legal Services Program.
“Under current law, VA has to expend more time and resources to decide PTSD claims than almost every other type of claim. A major reason that these claims are so labor intensive is that in most cases, VA believes that the law requires it to conduct an extensive search for evidence that may corroborate the veteran’s testimony that he experienced a stressful event during military service,” Stichman testified to at the House Veterans Committee.
“According to the VA, an extensive search for corroborating evidence is necessary even when the medical evidence shows that the veteran currently suffers from PTSD, and mental health professionals attribute the PTSD to stressful events that occurred during military service.”
“Often there is no corroborative evidence that can be found – not because the in-service stressful event did not occur – but because the military did not and does not keep detailed records of every event that occurred during periods of war in combat zones,” he concluded.
Veterans’ Affairs Subcommittee on Disability Assistance and Memorial Affairs conducted the hearing to discuss the compensation owed for mental health. The hearing addressed the difficulties veterans encounter when they are required to prove stressors in order to receive service-connected compensation for PTSD that occurred as a result of their military service.
A different outcome for British soldiers with PTSD
When looking into PTSD issues in other countries, a report shows the British soldiers are far less likely to demonstrate symptoms of PTSD. Why?
While the numbers of U.S. soldiers suffering PTSD land somewhere in the 20-30 percent range, depending who you talk to, only four percent of British soldiers who served in Iraq or Afghanistan exhibit symptoms of PTSD even though both countries’ warzone veterans have seen comparable levels of violent combat, according to an English study.
“This is truly a landmark study, in its size and rigor, and the findings are surprisingly positive,” said Richard J. McNally, a psychologist at Harvard, told the New York Times. “The big mystery is why we find these cross-national differences.”
Researchers for the British study analyzed answers to mental health questionnaires given to Royal Army, Navy and Air Force members. The results showed that approximately 20 percent suffered some form of mental health issues, including moderate anxiety and depression. Another 13 percent admitted to drinking heavily. However, few were diagnosed with PTSD.
Once researchers began to dissect reasons for the PTSD discrepancies, possible reasons included the use of reservist soldiers and differences in ‘dwell time.’
The mental health study found British reservists were more likely to cope with post-traumatic stress disorder symptoms. Another factor that could determine the successful processing of PTSD may be the fact that British troops serve six-month tours and do not spend more than 12 months in combat in every 36 months.
As far as their American soldier counterparts, U.S. military personnel, depending on their service, can serve more than 12 months at a time with only a single year in between combat deployments.
Living with the aftermath of TBI and PTSD
A common thread soldiers share is their fear of losing loved ones; “Will they still want me.”
It’s a legitimate fear as many end up losing their significant others once the hard work of rehab, reality sets in and they learn their lives will never return to pre-deployment fitness.
“I was in a coma for 12 days and now I’m like a six-year-old in a man’s body,” says S. Sgt., Jay Wilkerson, U.S. Army barracks, Iraq. He suffers from a closed-wound head trauma commonly known as TBI one of the signature wounds of the Iraq/Afghanistan wars.
“Sometimes I can’t remember my own kid’s names… I feel stupid, but my brother helps me. My son’s name is Manny and my daughter is Precious,” Wilkerson tearfully repeats.
His grueling treatment schedule includes memory groups, cognitive-skills training, physical therapy as well as psychology appointments; “All these appointments are meant to build me up and get me where I used to be.”
The Army soldier acknowledges that war is war and no medals will bring him a normal life again, but at least he is making the effort and hopes to regain a sense “normalcy.”
That life of “normalcy” often includes using nonprofit groups like Help Wounded Troops or Wounded Warrior Foundations. They step in when the Veteran Affairs and Department of Defense fall short.
It’s not unusual for wounded veterans to seek financial help while waiting for benefits to kick in. Many soldiers don’t know there are advocacy organizations out there that can assist them with the mountain of paperwork the VA requires. During the sometimes-lengthy paperwork process military families can lose their homes, cars and jobs.
These nonprofit organizations provide soldiers with money to pay for rent, electricity, food or even car payments. Without the support from a generous American population these wounded warriors may otherwise fall through the cracks and disappear into homelessness.
The bottom line for the VA to consider is the need to speed up an effective TBI/PTSD treatment program. The process must ensure that there are no military service members left behind or undertreated.
War weary American troops’ battles do not end on their return to U.S. shores. For those injured in combat their battles are just beginning and those transitioning to the civilian workplace face double-digit unemployment.
The experience HM2 Thor Wold faced after being wounded and receiving the Purple Heart Medal at the Battle of Fallujah is not uncommon. Thor was separated from the Navy while Navy medicine was preparing to submit him into the DoD disability system that would have provided him with the temporary disability Congress mandated for his injuries – nevertheless, the discharge prevailed over medical care. Fortunately for Thor, the VA stepped-up and looked after him. But that is not the case for thousands of other combat veterans.
In 2011, several veterans obtained class action status against the DoD to bring their claims for mental health injuries for which the DoD refused to apply federal law to help them. In the case of Sabo v. U.S., the DoD admitted it had not properly cared for nearly 4,500 service members and had discharged them improperly. But by applying the rules for class action lawsuits instead of making administrative corrections to their records, the DoD was able to exclude nearly half of the eligible veterans from receiving compensation and benefits. This is the mindset wounded veterans face at the DoD.
As if that were not bad enough, the DoD then prevailed upon Congress to eliminate the ability of service members from going to federal court to enforce their rights. Seems hard to believe that after DoD got spanked by the court for not applying federal law, the Congress would grant an almost exclusive jurisdictional prohibition against the wounded pursuing their rights in federal court and force them to fight within DoD administrative system that had willfully deprived them of their rights.
The DoD has been separating wounded troops from the services as fast as they can by avoiding medical issues. On the one hand it is understandable since DoD has a limited number of personnel, so when troops are injured, others have to do additional duty to maintain the operational tempo. On the other hand, warriors have an oath not to leave the fallen behind. The U.S. military goes to extraordinary lengths to bring home the dead and wounded, but the oath is not extinguished at the twelve mile U.S. territorial limit.
The solution is simple, but the application is not. The DoD disability system is akin to the civilian workers compensation system. It is a non-adversarial process that compensates the wounded based on the degree of incapacity to perform that their injuries warrant. While the DoD does not have a problem determining whether a troop is fit or unfit for continued service, the problem is the length of time it takes to make that determination on those in the medical system. Four to six hundred days is not uncommon to be processed through the system
Just as there have been technological breakthroughs in medical treatments, there have been significant advancements in treating TBI and PTSD. The all-volunteer troops serving in a long Middle East war deserve to be treated with the best PTSD/TBI protocol available and then the treatment plan needs to be individually tailored to meet each soldiers needs, according to Dr. Mark Wiederhold who has developed a new virtual-reality based PTSD program.
This often proves the private sector lays claim to the most up-to-date treatment methods.
However, the VA bureaucracy doesn’t act quickly enough or at all when providing the best care for returning war veterans. One program with a stellar record is Mt. Sinai hospital in New York City. Their TBI treatment employs a rigorous-daily cognitive therapy without the use of drugs.
Another highly successful, private sector PTSD treatment facility is located in San Diego, California. The Virtual Reality Medical Center uses virtual reality computer generated programs with physiological readings to monitor soldier’s reactions to incidents that cause them severe anxiety. The success for the $4-6 thousand program is 85 percent. However, the doctors running the virtual reality retraining sessions are working overtime to find ways to improve their success rate to more than 90 percent.
Side affect of war – suicide among soldiers on the rise
Army suicide statistics just released leave military officials trying to reverse a grim trend in the Iraq and Afghanistan wars.
A prior report showed that 32 soldiers killed themselves in June 2012; it is the highest number of suicides in a single month since the Vietnam era. At least 21 took their lives while on active duty and the other 11 were inactive National Guard or Army Reserve.
The Army admits seven of the soldiers killed themselves while serving in Iraq and Afghanistan. “There were no trends to any one unit, camp, post or station,” Col. Chris Philbrick said, of the Army’s suicide prevention task force. “I have no silver bullet to answer the question why.”
With no solutions on the horizon Philbrick said his department will: “look for opportunities we have been facing in terms of the challenges in the Army and continue to prevent these events from taking place.”
There is no doubt that streamlining the TBI/PTSD screening process is a step in the right direction, but what returning war zone soldiers really need is their quality of life.
Oftentimes when soldiers are separated from military service they lose extra-combat pay, housing allotments and their Tri-Care health insurance. The loss of income can split families apart, especially if there is a serious injury to contend with.
A country at war must live up to all the promises they offer military personnel. These brave soldiers should not have to lose their quality of life along with any means to earn an honorable income for their families.
America has done better, but as the “War on Terror” enters its ninth year, it must do better the all-volunteer forces are not expendable on any level.
Email Kimberly: Kimberly.firstname.lastname@example.org
Link to story on San Diego 6 News: http://www.sandiego6.com/story/Kimberly_Dvorak-20130915
Past breaking news story: http://www.examiner.com/article/did-cia-and-state-department-run-illegal-arms-trafficking-benghazi-1
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