Healing Combat Trauma

Congressman Filner on Health Care for Veterans

Closing remarks of Congressman Bob Filner (D-CA), Chairman of the House Committee on Veterans Affairs, on the momentous passage of the GI Bill.  While the rest of Congressman Filner's remarks addressed education, he also commented on veterans ongoing health care needs and concerns, here:

"Last year, Congress made the largest increase in veterans’ health care funding in American history, when we increased VA funding by 30 percent, successfully adding $12 billion more than the President’s request and $39 billion more over five years. The new GI Bill is an even larger fiscal commitment to our nation’s veterans - providing a quality educational benefit for those to whom we owe so much.

While we have made much progress, new challenges continue to mount. Tens of thousands of service members are being discharged from the military without adequate diagnosis or treatment for post-traumatic stress disorder (PTSD) and traumatic brain injury. Refusing to face this challenge, leaders at the VA have attempted to manipulate suicide data to portray a lesser problem. In addition, the claims backlog for VA benefits now totals well over 600,000. The VA also failed to protect our veterans when they became more involved with research than providing treatment - When Chantix, an anti-smoking drug, was linked to suicidal thoughts and aggressive and erratic behavior, the VA failed to immediately eliminate their testing of veterans, placing them under increased risk.

It is obvious that our work has just begun, and I will continue to fight to hold the VA accountable for their actions and provide the very best care to our nation’s veterans. I will work to transition the VA from Veterans Adversary to Veterans Advocate!"

-- Congressman Bob Filner, Representative for California’s 51st Congressional District, and Chairman of the House Committee on Veterans Affairs, linked here.

Editor's note: Regarding Chantix, we did a post the other day, linked here, which talks about how to learn more about the medications being prescribed for PTSD, and how to learn about possible interactions with other drugs, such as Chantix.

Needless Trauma: What Vietnam Vets Still Don't Know about Their Service Could Hurt Them

Saw this recent press release from a California congressman, who himself is a decorated Vietnam vet, and wondered about the pain that comes from NOT knowing the full extent of what you've been exposed to, as you were serving your country.  For the particulars, keep on reading:

– Today (June 12), Congressman Mike Thompson (D-CA) took another step toward helping veterans who were unknowingly tested with chemical and biological weapons in the 1960s and 70s.

The House Subcommittee on Disability Assistance and Memorial Affairs held a hearing on a Thompson-authored bill that would give these veterans health benefits and compensation for illnesses resulting from “Project 112” weapons tests. Thompson hopes this hearing will ultimately push his bill toward consideration by the House.

Project 112, which included ship-based Project SHAD, was conducted between 1963 and 1973 by the Department of Defense (DoD) and other federal agencies. The DoD now admits that during these projects, unknowing military personnel were involved a number of chemical weapon tests such as VX nerve gas and Sarin nerve gas and were exposed to biological weapons such as E. Coli, Tularemia (Rabbit Fever) and Q fever.

“First the government denied the tests existed. Then they said the tests happened but were harmless. Now they admit dangerous substances were used on our military personnel, yet they still refuse to give them care for their illnesses,” said Thompson. “We can’t change the past, but we can begin to right this wrong by giving these men the proper healthcare and compensation they earned.”

HR 5954, introduced by Thompson and Congressman Denny Rehberg (R-MT) in May, provides veterans of Project 112 a “Presumption of Service Connection.” This means the Department of Veterans Affairs (VA) presumes the relationship between service and a health condition, making the veterans involved eligible for medical benefits and/or compensation for their conditions. For example, veterans exposed to Agent Orange during the Vietnam War are already given a “Presumption of Service Connection.”

“I understand security classifications and the sensitivity of our operation,” said Jack B. Alderson, a retired Lt. Commander from the U.S. Navy Reserves and resident of Thompson’s district. “However, these were not volunteers but service personnel ordered to do a dangerous job and they did it, and did it well, now their nation needs to take care of them.”

In 1964, Alderson was the officer in charge of five U.S. Army light tug boats that were used to test chemical and biological weapons. The tug boats acted as sampling stations and targets for disseminated weapon clouds.

After the DoD admitted to Thompson that the tests did exist and included harmful agents, they released more than 6,000 names of military personnel used in the tests. However, the GAO reported in February that the DoD had halted their efforts to disclose additional names and many veterans remain unaware that they were even involved. The Thompson-Rehberg legislation would require the DoD to hand over all the names to the VA, which must then notify the veterans.

The Thompson-Rehberg legislation has been endorsed by the Vietnam Veterans of America, Veterans of Foreign Wars, American Legion, Disabled American Veterans and Paralyzed Veterans of America.

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CONTACT: Anne Warden at (202) 225-3311, (703) 338-4480 and anne.warden@mail.house.gov.

For a link to Congressman Thompson's office, click here.

WA Legislator Shows Concern for Vets, PTSD

Washington state, which counts a large number of deployed servicemembers, veterans, and their families among the state's population, has shown some real leadership in veterans' issues, particularly with Senator Patty Murray (D-WA) -- a tireless and vocal veterans' advocate, who is a member of the Senate's committee on veterans affairs.  Now representative Jim McDermott (D-WA), apparently the only psychiatrist serving in Congress (hmmm, that would explain a lot!), according to a news article in yesterday's Seattle Post-Intelligencer, has also done something good for veterans.  He sponsored a veterans' forum to "honor, help and heal our soldiers," according to the PI, and basically provided an opportunity for local, Washington state veterans to vent about their difficulties with getting appropriate care.  Not sure if anything more constructive than venting was really the purpose of the meeting, but hey, even that sometimes really helps -- for people like veterans who may not feel that anyone is really listening to how difficult a struggle they're in, coming back from deployment and being faced with a number of serious obstacles to getting the help they need.  The article is linked here.

The Katz Email: Can We Just Call "Bullshh!it"?!

By far the most distressing revelation from the lawsuit by veterans against the VA, currently making its way through Federal court in San Francisco has to be the toxic email, disgracefully titled, "Shh!" and written by Ira Katz, M.D., the VA's top psychiatrist, about the not-exactly-light 'n humorous topic of veterans suicides.  The email essentially attempts to cover up the severity of the number of veteran suicides that are taking place by those who are undergoing treatment at the VA.  The contents of that email by now are fairly well known -- and the general reaction is to Katz's words, not surprisingly, is revulsion.  Senators Patty Murray (D-WA) and Tom Harkin (D-IA) are two legislators calling for Katz' removal.  There's been just enough stink about his ill-chosen words that Katz has been moved to make a very superficial apology for them, a la Roger Clemens.  An article in today's Seattle PI, linked here, quotes CBS News as saying Dr. Katz now calls his word choice "unfortunate."

Erm, well, can we just call "bullshit" on this?  Because, really, it's more than the choice of words people are reacting to -- they're sensing the specious and supercilious attitude behind them.  In the immortal lines from Oliver Wendell Holmes, "Even a dog knows the difference between being kicked, and being tripped over." 

The "Shh!" email brings to mind another bureaucratic bumbler of late, Michael Brown, head of FEMA during the Katrina crisis, who ostensibly fiddled while Rome burned, writing superficial emails to his colleagues preening about his choice in ties and lamely wondering if it was time for him to go home yet. "'Can I quit now?' FEMA chief wrote as Katrina raged," according to an article archived here on CNN.com.

Brown certainly seemed to be over his head (no Katrina puns intended) at FEMA; perhaps Katz, because of his psychiatry training is actually not.  However, they both have a world of learning to do in how to project empathic leadership.  There's nothing confidence-affirming about either one of their responses. Wounded warriors deserve a lot better from the top psychiatrist at the VA responsible for their care.  Those aren't just poorly-chosen words, there's an attitude of callous disregard for the patients behind them as well, that no thin veneer of apology really corrects.  Combat veterans struggling with alarmingly high and well-documented rates of PTSD and suicide need compassionate leaders with a vested interest in their care, not someone making light of the size and the severity of the problem.  In anyone but a psychiatrist, whose field after all is mental health, we might find this easier to understand or excuse.  But in a psychiatrist whose professional responsibility is the mental health of veterans?  Absolutely not.  That's a vote of no confidence, in someone who's sworn to uphold the Hippocratic oath to "first, do no harm."  The bumbling and apparent cluelessness of FEMA's Michael Brown in the face of a huge need for crisis management and control spurred calls for him to resign; perhaps outrage over Katz' email will do the same.  There's really no way to spin that into a positive.  The damage has already been done.

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Here's the content of the email Katz titled "Shh!" for those who haven't seen it.  According to the article in the Seattle PI, "Our suicide-prevention coordinators are identifying about 1,000 suicide attempts per month among the veterans we see in our medical facilities," Katz wrote in a Feb. 13 e-mail to Ev Chasen, the department's communication director. "Is this something we should [carefully] address ourselves in some sort of release before someone stumbles on it?"

Senators Harkin and Feingold Introduce Veterans Suicide Tracking Bill

Senators Tom Harkin (D-IA) and Russ Feingold (D-WI) on April 23rd introduced a bill requiring the Department of Veterans Affairs ("VA") to track veteran suicides.  The "epidemic" of veterans' suicides has been in the news recently, both because of the Federal court case being waged in San Francisco this week and next by veterans rights groups against the VA, and because of the recent CBS News investigation into the same.  It turns out the CBS report's high numbers were accurate; and documents produced during the trial implicate the VA's chief psychiatrist, Ira Katz, M.D., Ph.D., in attempting to suppress the true figures.  Various groups have called on Katz to resign.  The proposed legislation, entitled "The Veterans Suicide Study Act" would require the VA to report to Congress how many veterans committed suicide since 1997; and the VA would continue to issue reports annually.  For more information about the bill's introduction, click here.

New Hampshire's Carol Shea-Porter Has Veterans Issues on Her Mind -- in Congress

The Boston Globe has a profile today of freshman Representative Carol Shea-Porter, the first woman to represent New Hampshire on Capitol Hill.  Shea-Porter, a former social worker, is a member of the House Armed Services Committee, and makes veterans issues a priority.  The Globe profile says that highlights of Shea-Porter's first term include "the adoption of a bill guaranteeing that those who leave the military because of injuries sustained in the line of duty do not have to repay part of their enlistment bonuses. Shea-Porter, who managed floor debate on the bill, has made the health needs of veterans and troops a priority, in part based on her experience as a former military spouse.  "I understand we may differ on policy," she said of members of Congress, "but we have an obligation to honor our commitments to these troops."  (Porter counts 67,000 veterans in her district alone in New Hampshire.)

Such a simple concept -- that we the people, via our government, honor the commitment to support the troops.  I'd like to see every politician and especially every elected official make this a priority.  But since the Globe mentioned Shea-Porter's work in this regard, I figured I'd mention it on the blog.  Forget the yellow ribbons -- actually support the troops by giving them the benefits they need and have earned.  And don't let anything stand in the way until that happens.

For a link to more resources for New Hampshire veterans, via Shea-Porter's Congressional website, click here.  To educate yourself more thoroughly on who votes what on veterans issues, click this link to the relevant section of Project Vote Smart.

On the Campaign Trail: Obama Says Veterans "Have Earned Their Benefits"

The Associated Press has a story tonight about an emotional exchange between Democratic presidential candidate Barack Obama (D-IL) and a retired Air Force veteran, Andrew Hampton, who met on the campaign trail earlier today in Iowa.

Hampton told the presidential candidate that he feared today's returning combat veterans were coming back with serious injuries and often not getting the care they deserve, because of the whims of a mercurial Congress that plays "hollow politics" with their benefits.  In an emotional moment, the older veteran got weepy when he told Obama, "We can't desert them" (veterans).  Great point, Obama conceded -- veterans have clearly "already earned" their benefits.  He promised the teary-eyed older veteran that if he were elected president, veterans healthcare would be a priority.  He would "take care of veterans as a way of encouraging future generations to enter the military, as well as provide mental health screening and adopt a "zero tolerance" policy for homeless veterans.  "We have to fund all the services that have been promised to our veterans," Obama said. "We can't play politics with it."

While in truth there's no good reason to believe any candidate's promises as anything more than just good intentions and p.r. before the election -- the more important test is what happens afterward -- still and all, it's nice to see more attention focused on veterans issues, including healthcare -- and once again it's good to see older veterans from the Vietnam era taking care of younger veterans -- making sure that they get the care and the benefits they deserve.

Report Calls It "Highest Year Ever for Army Suicides"

USA Today has a story today about how an upcoming report will show that this past year, more Army soldiers killed themseles than ever before.  As the article states, "A total of 109 suicides this year would equal a rate of 18.4 per 100,000, the highest since the Army started counting in 1980. The civilian suicide rate was 11 per 100,000 in 2004, according to the Centers for Disease Control and Prevention [the CDC].

According to Senator Patty Murray, whose office shared the statistics with USA Today, and who is quoted in the article, "The military hasn't erased the stigma surrounding mental health issues, so troubled soldiers often do not seek help."  "I want to say I'm surprised...But when we're not doing everything we can to deal with mental health, when we know the Army is under such stress, it's not a surprise. It has to be a wakeup call."

(Although honestly, we should be well past wake-up call on this one.)

The article also mentions efforts the Army has made to combat the problem, including "mandatory training for every soldier about mental health and establishing a program to study its suicides."   However, a troubling angle to the whole suicide phenomenon is this one -- "Research released by the Army in August shows that almost 70% of suicides in 2006 were spurred by failed relationships."

Meaning, the soldier was already under significant stress, and the death of a key relationship just piled one more stressor on, and became the proverbial "straw that broke the camel's back."

If there's a concept like "total load" with mental health issues, it could very well be that ordinarily, people are capable of handling "only so much" stress, and when more gets added to the pile, it's hard not to topple under the strain.  Each person may have their own "breaking point," whose relative location changes regularly, according to how much stress they're under, or how much support they can count on (in addition to a number of other things.)  We're also talking about a younger military here than in years past, including many who didn't expect to be signing up for such extended tours, or possibly even war in the first place (okay, they should have considered it, but many did not).  Reservists in particular -- I can think of several people I know who joined to get better civilian benefits, and weren't remotely thinking they'd end up serving in Iraq or Afghanistan.

It will be interesting when more data comes out, and is studied in greater depth, to also take a look at prevalance of suicide, and see what else it's linked to.  There's already some concern, backed up by studies, that PTSD affects some troops more than others, and suicide would seem logically to follow those same trends.

In the meantime, thanks to Patty Murray for being a great supporter of veterans.  As a longtime Washington state resident, I remember her first being elected to office, and being derided and dismissed during the campaign as a "mom in tennis shoes," whose background as a teacher didn't qualify her for anything political.  As her background material indicates, she's the daughter of a disabled World War II veteran, and she's turned out to be an ardent veterans supporter, and the first woman to serve on the Senate Veterans Affairs committee. 

For media coverage on the great things she's done to support veterans, read the lower half of this page from her Senate website.  As one Seattle newspaper describes her, she's a "workhorse, not a showhorse" -- and thankfully a very committed veterans supporter.  We need more.  (This link to Project Vote Smart shows her voting record.)

Editor's Note: In related and current news, read the transcript of Todd Bowers, IAVA's director of government affairs, remarks as he testified before Congress yesterday on the topic of veterans suicides.  The transcript of his remarks is linked here.

Bill Richardson's Plan for Veterans - the Heroes Health Card

This blog's stance is intentionally apolitical, meaning, we're not getting involved.  There's enough slant and bias in the world without adding to it -- our focus is intentionally on those who serve, and helping them get the care they deserve.  Full stop.  That said, it's always nice to hear anyone jumping on the same bandwagon about care for veterans.  Apparently, Bill Richardson, governor of New Mexico, who's running for president, has a platform that includes a few benefits for veterans that seem worth noting.  He calls it "Keeping Our Promise," which is really the general idea, and states, among other things:

"I believe that we, as a nation, have a lifelong duty to our veterans," Governor Richardson said. "As President, I will reduce federal income taxes by five percent for all veterans for the rest of their lives. Senator Jim Webb-- one of our nation's greatest veterans-- is exactly right on this issue, and I will fight for his proposal. I also will eliminate federal income taxes on all troops in their first year out of the military. It is our responsibility to ease the frequently difficult transition from military to civilian life.  President Bush cut taxes for our nation's wealthiest citizens. I will cut taxes for our nation's bravest citizens."

More to the point, or at least to our point, he suggests:

Richardson laid out his plan to ensure that veterans receive the best possible health care, beginning with mandatory funding for the Department of Veterans Affairs (VA).

"When I am President, all veterans will be offered a Heroes Health Card," Richardson said. "If it is inconvenient for them to get to a VA hospital or clinic, you know where my plan would allow them to receive care? Wherever they need it. As we expand choice, we also must ensure that the VA system is the strongest it can be. I will guarantee full mandatory funding for the VA. No more year-to-year discretionary funding. No more political calculation. No more playing games with the health of our veterans.

"We also must recognize that not every injury can be treated with bandages and stents. Mental trauma, post-traumatic stress disorder and traumatic brain injuries also are battlefield injuries."

Given the fact that it seems like the VA cannot keep up with the demand for care it's experiencing, or at the level we would like, outsourcing doesn't seem such a bad idea.  I like the idea of veterans being able to receive competent, qualified, affordable care wherever is accessible to them, because "waiting for treatment" and "combat trauma/PTSD" really aren't a good combination.  Nor does it say how much we value veterans' service to make them wait to be seen, or treated in any substandard way.

Richardson apparently got sensitized to veterans issues because he serves in a state that has more  veterans per capita than pretty much anywhere else in the United States.  His office says that "one of his proudest accomplishments in New Mexico has been the purchase of a $400,000 insurance premium for every member of the state's National Guard, a step since taken by eighteen other states around the country."  Cool.  Much better to be an opinion leader than a follower.

Considering that it's apparently "National Military Family Appreciation Month" -- who knew -- it's also nice to see Richardson taking veterans' families into account.  Anyone who's watched the enormous sacrifice that goes on when a family member is wounded in action has to give that special honor.  Says Richardson:

"Often, spouses and parents are forced to leave their jobs in order to care for a wounded soldier," Richardson said. "As President, I will offer a comprehensive disability insurance policy to average $40,000. This policy would cover the necessary expenses when a spouse, parent, or other family member stays by the side of a wounded veteran during his or her recovery process. My plan also will offer up to a year of paid leave to provide financial stability for the families of recovering veterans."

Governor Richardson criticized President Bush's handling of the crisis at the Walter Reed Army Medical Center and said that when he becomes President, he will be accountable for the treatment of our veterans.

"The conditions that the world saw at Walter Reed were an insult to our veterans and an embarrassment to our nation," Richardson said. "President Bush should have stood up and taken responsibility, but as in so many other cases, he did not. Instead, we saw another game of Washington musical chairs. When the music stopped, the President scrambled to find himself a comfortable place to sit, well out of the way. When I am President, I will not sit back and watch our veterans suffer."

There's not much more to read in Richardson's press release than what I've quoted here, but if you're interested in reading more about his plans, here are two links:

To read Governor Richardson's policy for Veterans and Military Families, click here.

To see Governor Richardson's "Heroes" ad on veterans, click here.

VA Budget is Overdue - But Veterans Healthcare Can't Wait

Watch the ad, sign the petition...to make sure veterans get the healthcare and services they need, including treatment for combat trauma and PTSD.  More background can be found at IAVA.org and IAVAAction.org.