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05.22.2008 9:01 pm

Friday editorials: Failing the troops

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Disturbing new evidence emerged last week that the Department of Veterans Affairs continues to provide shoddy mental health care for soldiers and Marines returning from Iraq and Afghanistan.
Lack of effective screening, delayed care and denied diagnoses add up to a new kind of “don’t ask, don’t tell” policy that is completely unacceptable.
• A federal report released last September criticized the VA for a “lack of early identification techniques” to detect veterans’ mental health problems.
• VA facilities around the country are short about 3,800 mental health workers, including 1,400 doctors. Professionals at many facilities are working overtime, yet returning veterans continue to face long waits for services and even longer waits for diagnosis and benefits.
According to documents filed in a federal suit in San Francisco, more than 85,000 veterans faced a wait of longer than 30 days for mental health care as of April. Waiting times for decisions relating to service-connected disability compensation stretch into years.
• Repeated deployments to a war zone where there are no front lines have led to an overwhelming need for care. A RAND Corp. report released this month estimates that as many as one in five servicemen and women returning from Iraq and Afghanistan suffer from post-traumatic stress disorder or major depression. With 1.64 million deployed so far, that puts the number of veterans in need of care at about 300,000.

The latest evidence that they’re not getting the care they need came in an e-mail released last week. It was written by Norma J. Perez, the PTSD coordinator at a VA facility in Texas.
Because the facility is seeing more of what Ms. Perez described as “compensation-seeking veterans,” she urged mental health professionals there to “refrain from giving a diagnosis of PTSD (Post Traumatic Stress Disorder) straight out.”
A diagnosis of PTSD would qualify veterans for lifetime medical care, instead of the five years made available to all combat veterans. And it would make them eligible for at least some disability compensation.
Instead of diagnosing PTSD, Ms. Perez asked that therapists “consider a diagnosis of Adjustment Disorder, R/O (ruling out) PTSD.” Veterans with adjustment disorder generally are not eligible for disability payments.

That callous disregard of veterans’ rights is of a piece with the administration’s entire approach to war. It sent troops into combat with inadequate body and vehicle armor, issued so-called stop-loss orders that forced them to serve beyond the expiration dates of their contracts and repeatedly sent them to combat zones.
They came home to discover that the benefits and care they were promised either were not available or required extended and expensive waits. Even worse, the military and VA have tried to “manage” reality by denying it.
In April, lawyers for a veterans’ advocacy group released e-mails written by Dr. Ira Katz, chief of mental health at the VA. Under a subject line of “Shhh,” Dr. Katz revealed that the number of suicides by returning veterans was far higher than the VA publicly had acknowledged. He fretted about the implications if the real numbers — 1,000 suicide attempts a month — got out.
It’s not the public reaction to 12,000 suicide attempts a year or the cost of compensating servicemen and women for PTSD that should worry VA officials. It’s the fact that veterans, having already risked their lives in combat, are losing their futures to the unseen wounds of battles that ended long ago.

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The latest evidence that they’re not getting the care they need came in an e-mail released last week. It was written by Norma J. Perez, the PTSD coordinator at a VA facility in Texas.
Because the facility is seeing more of what Ms. Perez described as “compensation-seeking veterans,” she urged mental health professionals there to “refrain from giving a diagnosis of PTSD (Post Traumatic Stress Disorder) straight out.”

Is the Post editorial board more qualified on PTSD than Norma Perez? We absolutely must help every veteran with a real case of PTSD, but not everyone who comes in the door.

A worthwhile reading on this subject is “Posttraumatic Stress Disorder And The Non-Combat Veteran” by David Barker, © AMVETS Department of Ohio 2002. This is available on the Internet.

— Senior citizen
11:43 pm May 22nd, 2008

“That callous disregard of veterans’ rights is of a piece with the administration’s entire approach to war. It sent troops into combat with inadequate body and vehicle armor,”

How come we never hear from the PD that congress — and plenty of democrats in congress — voted to send the troop to combat also? It seems that if the presidency was/is at fault, congress share equal blame for this. And surely the initial lack of proper equipment has nothing to do with cutbaks in the military made during the Clinton years. Although I will say that not outfitting our troops with proper gear is horrible and should never happen regardless of the reason.

— GTB
6:49 am May 23rd, 2008

Regarding PTSD….a short poem I wrote.

If nightmares and dreams could be bottled like wine,

I’d send you a crate, vintage Tet 68,

So you could share some of mine.

— Old Sarge
7:41 am May 23rd, 2008

Without meaning to fault their brave efforts, is there a documented input as to the percentage of today’s veterans who actually experience close combat? Many in our Air Force, Navy, Coast Guard, and support personnel never do (Yes, we have Coast Guard people in the Middle East).

As to adequacy of body armor, it is well known that early body armor was not as good as today’s, and some unused armor deteriorated due to age. Even today’s armor is hot and heavy, so some of our people don’t wear full armor. Years ago, we lost people in Somalia because they only wore the front half of their heavy armor and got shot in the back (David Hackworth - “Hazardous Duty”). Even modern ceramic armor can’t stop a straight-on hit from the low-powered AK-47 cartridge.

— Bob H
9:00 am May 23rd, 2008

If the feds can’t competently manage legitimate, critical obligations such as veteran care, why do the government worshipers such as the PD editorial board push to expand federal powers into ever-expanding areas in violation of the Tenth Amendment? The waste, corruption, and incompetence of the federal government are already completely out of control and beyond our comprehension. What could possibly justify more usurpation of powers and resources by the bureaucracy?

— Bb
10:04 am May 23rd, 2008

Old Sarge,

I liked your poem (and not just because my father was an Old Sarge — he retired from the Air Force as a Chief Master Sgt. in 1970).

A few years ago (2005), I interviewed a guy who had flown in the same bomb group as my father during World War II. His war had ended 60 years earlier. But he still had vivid enough nightmares that his wife knew if he began thrashing about in bed, she should stay well clear.
He had been a rear gunner on a B-17. He wouldn’t tell me directly what he dreamed about. My guess is that he was struggling to make his way forward to the escape hatch so he could put on his parachute and bail out. His wife said he was still plenty strong enough to kick out that rear hatch — she had the bruises to prove it.

— John G. Carlton
10:43 am May 23rd, 2008

There you go Bb. Put Republicans in office who do nothing but use the state as an apparatus to help their friends and business interests, and then when its all over start crying about how we need to lower taxes because of “government inefficiency.”

— Adam
11:01 am May 23rd, 2008

This is indeed a problem. But the shortage of mental health professionals isn’t unique to the VA. Try finding a pediatric psychiatrist that is taking new patients.

— Nick Kasoff
12:29 pm May 23rd, 2008

Adam… you are evidently not familar with my other postings. The Republican Party is just as guilty as the Democrat Party of selling out to the special interest groups. The partisan bickering serves both well as a diversion from their atrocious behavior. Parasites and perverts on the left, preachers and plutocrats on the right. Neither side really cares about you as long as they stay on the gravy train.

— Bb
1:27 pm May 23rd, 2008

I looked at the e-mail and the Veterans for Common Sense report (I’ll read the Rand report over the week-end).

I have friends who served in VietNam, one of whom is a nurse who got hit with mortar fragments and just this past year (30 years later) finally got someone at the VA who said that her neck had been fractured. When it happened she was told it wan’t serious and went back to work shortly afterward.

The VA was okay for providing long-term care, but it was not set up to deal with the types of injuries and PTSD cases coming back from Iraq and Afghanistan, I doubt that there are too many facilities that are. The expectation is that military hospitals and facilities should be the places service personnel and veterans can expect to receive treatment.

I have been a war protestor and advocate of non-violence my whole adult life. I abhor war and the perceived need to go to war. I also think that those who actively and willingly serve in the armed forces should be taken care of by the country that asked them to fight. This is not an occasion for “bottom-line” thinking.

— RHarnack
2:29 pm May 23rd, 2008

Not to downplay the PTSD issue, but to add another facet:

Tonight PBS Channel 9 reported that the major cause of PTSD among women in the military is sexual abuse by their fellow soldiers.

— Senior citizen
10:40 pm May 23rd, 2008

1998
And The Beat Goes On and On and On and On…

There was a message on my answering machine from Earl. Sometimes I returned calls other times I just waited for people to call back. The phone rang. My wife answered. It was Earl. Frank Johnson was dead. He had shot himself in the head. I never thought Frank would kill himself. It seemed every time Earl called it was bad news about another dead vet. Last time it was about George. It seemed strange that Frank would kill himself. I wondered when The VA would realize what it had done to their patients. I felt numb about the whole thing. It seemed everyone I knew at the VA’s stress clinic was dead or dying. It had gotten to the point where I knew more guys who had died after the war than during the war and I had been a medic. Peace was hell.
“The Messenger of Death.” called again a few weeks later. Rich had killed himself over the weekend. I had just talked to Rich a few days earlier at the stress clinic. Rich had been down since his group leader retired. The group had been disbanded and nothing had been offered in its place. Rich felt abandoned and pissed off about the whole situation at the stress clinic. Rich was found by police, dead in his car, parked inside his closed garage. Couldn’t anyone understand the changes at that damn clinic had caused a storm of emotional chaos. There seemed nothing veterans could do. The VA didn’t listen to them or care about their opinions.
There was a memorial for Frank at the VA Chapel. I wasn’t going but found himself standing outside the chapel. Inside were a few veterans and some staff members from the stress clinic. I could feel the anger swelling up inside. I sat in the corner and listened to people say nice things about Frank and wondered why people didn’t tell Frank those things while he was alive. I wondered if the stress clinic staff really knew what had been going on in Frank’s life or had they just heard what they had wanted too, so as to maintain their professional boundaries. I was angry Frank was dead and that a system which was suppose to help him had let Frank down. Damn it. Frank was dead because he was made to feel people didn’t care about him or his problems any longer.
A place where Frank and Rich had felt safe and could come and share their feelings and get some help was destroyed. In the name of what? Who the hell knew or cared? I walked out and went to see my doctor. I didn’t tell her what had happened at the service. I said things were okay and got some more Prozac. It was easier that way. The doctor would likely defend the system or make me feel I was suffering from some sort of distorted thinking that needed to be reframed. It was easy , just to get in, and get out , and go home with the end result being an argument with my wife, my scapegoat for blowing off steam, which I should have been doing at the doctor’s appointment. Some type of therapy I thought to myself as I drove along the back streets of the city to my little home in the suburbs.

I found it strange that people who had no idea about how veterans felt, or knew what worked best for them, could tell veterans how they were suppose to feel, and what should be working for them. While a program that had worked was terminated with extreme prejudice. The hospital staff was always trying to reinvent the wheel for the care and treatment of stress patients. They were always looking for that elusive cure. They had trouble accepting the chronic nature of the disorder more than veterans did themselves. The staff didn’t want to admit they would be dealing with the veterans for the rest of their lives like all stress patients from all the previous wars and all future wars.
The VA would make themselves look as good as possible and then throw the blame back onto the veterans. It was always someone else’s fault. The VA was always the responsible caring entity. While the veteran, spouse or family member was always mistaken or presumed to be troublemakers.
Treating patients like human beings or equals and not just as clients or patients was against the VA rules. The VA hospital had in effect re-traumatized veterans in the stress clinic in its own unique way.
Damn the VA.
Damn War.
I hated being a veteran.
The phone rang.

Tim Connelly
Veteran of The Lost War –Vietnam

— Tim Connelly
10:56 pm May 25th, 2008