First Lady Michelle Obama and Jill Biden’s Joining Forces initiative, the Association of American Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM) have created a new generation of doctors, medical schools and research facilities that will focus on treatment options for military veterans.
“I’m inspired to see our nation’s medical schools step up to address this pressing need for our veterans and military families,” First Lady Michelle Obama said. “By directing some of our brightest minds, our most cutting-edge research, and our finest teaching institutions toward our military families, they’re ensuring that those who have served our country receive the first-rate care that they have earned.”
While this new program is welcomed by injured military veterans, the signature war wounds for the signature Middle East Wars, Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD) have seen numerous successful treatment plans in the private sector.
Most recently Arizona Congresswoman Gabrielle Giffords was shot in the head by a mentally unstable gunman. Rep. Giffords received the best medical treatment her generous Congressional health insurance provided. As a result, she has recovered at a remarkable pace. Many argue that the military veterans are not given the same opportunity as an elected politician.
Another example of successful head trauma treatment is ABC News reporter, Bob Woodruff. He survived a bomb blast covering the Iraq War. Mr. Woodruff, was treated for TBI in New York City, received excellent medical treatment in the private sector, and has returned to work.
Woodruff has spoken about his and Giffords’ head injuries. “First, there is hope. Like the doctors who saved me almost five years ago, her surgeons knew exactly what to do. Her brain was swelling just like mine. They removed partof her skull on the left sideof her head almost exactly like mine, and she (was put) in a drug-induced coma so that her brain could recover.”
However, complaints from many service members suggest military treatment requires excessive paperwork and bland treatment options for their TBI and PTSD injuries.
Together, the AAMC and AACOM hope to advance their veteran-related injury education programs, focus laboratory research, and improve clinical care for military families. This cooperative effort seeks to better address health issues suffered by returning troops from the Middle East Wars.
Specifically, these organizations will focus on the following;
· Train their medical students as well as their current physicians, faculty, and staff to better diagnose and treat our veterans and military families;
· Develop new research and clinical trials on PTSD and TBI so that we can better understand and treat those conditions;
· Share their information and best practices with one another through a collaborative web forum created by the AAMC; and
· Continue to work with the VA and the Department of Defense to make sure that everyone is providing the best care available.
“Because of our integrated missions in education, clinical care, and research, America’s medical schools are uniquely positioned to take a leadership role in this important effort,” Darrell G. Kirch M.D., president and CEO of the Association of American Medical Colleges said. “Medical schools have long recognized the sacrifice and commitment of our military, veterans, and their families. The relationship between the Department of Veterans Affairs medical centers and academic medicine dates back to the end of World War II and serves as a model for successful partnerships between public and private institutions. Our work with the White House on Joining Forces is a natural extension of our efforts in this area and renews our commitment to the wellness of our nation’s military.”
For more information about Joining Forces visit; http://www.joiningforces.gov
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© Copyright 2012 Kimberly Dvorak All Rights Reserved.
A lawsuit was established to get much-needed care and monetary compensation for veterans who suffered Post Traumatic Stress Disorder (PTSD) in the Middle East Wars has extended the deadline allowing more veterans to sign on to the pending ligation.
The lawsuit was brought on behalf of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans by the National Veterans Legal Services Program (NVLSP) and pro-bono counsel Morgan, Lewis & Bockius LLP. Military veterans who were discharged between December 17, 2002 and October 14, 2008 are eligible to join the class-action lawsuit if they think they were short-changed with their military separation benefits.
Judge George W. Miller of the U.S. Court of Federal Claims signed an order giving eligible veterans who served in Iraq or Afghanistan until November 10, 2010 to join (or “opt-in to”) Sabo v. United States.
The agreement reached with the military services could establish veterans who join the lawsuit a disability rating upgrade and expedited records review which could result in improved health care for veterans and their families.
There are approximately, 42 percent, or 1,835 veterans, who signed and sent in “Opt-in Forms” before the extension. At least 2,623 other veterans are eligible to join the lawsuit and become class members, according to NVLSP.
While the extension was welcome news for the law firm that brought class-action lawsuit against the government, other veterans questioned the need for any deadlines when it comes to treatment and care combat veterans.
Since the Veteran Affairs has relaxed its rules on PTSD/TBI, this case should be held in abeyance until Department of Defense and VA get their act together and then use it to force compliance if long delays continue to plague veterans, one Marine said.
“More than a third of the eligible veterans are severely disabled, with VA disability ratings for PTSD of 70 to 100 percent,” said Bart Stichman, co-executive director of the NVLSP. “It’s not easy for them to understand the legal notice and what are the advantages of joining the lawsuit, even though they stand to potentially gain significant lifetime financial and health care benefits for themselves and their families.”
Stichman also said NVLSP plans to continue calling eligible veterans for the next three months, and is encouraging families and friends of eligible veterans to get involved on behalf of OIF/OEF veterans.
“Anyone who knows an Iraq or Afghanistan veteran discharged between December 17, 2002 and October 14, 2008 because of PTSD should ask if he or she has received a legal notice and opted into this lawsuit,” said Stichman. “These veterans and their families were treated unjustly and denied the benefits to which they were entitled. This is about getting them the lifetime military benefits that they have earned and deserve. More information is available at http://www.ptsdlawsuit.com.”
Eligible veterans who join the lawsuit are entitled to review of their PTSD disability rating by the military on a priority basis, a guaranteed correction of military records to show a higher military disability rating for PTSD for the six-month period following the date of release from military service, as well as a determination of whether the new rating should be permanently increased, decreased, or remain the same after the six-month period, a NVLSP statement read.
As a result of an increase in their military rating for PTSD, class members could receive back pay of disability benefits, reimbursement for healthcare expenses the military should have covered, as well as a higher amount of future benefits to which they and their families are entitled –the judgment could potentially provide millions of dollars in additional benefits over time.
“The disability ratings which are the subject of the lawsuit are critically important to ensuring veterans receive the benefits which they have earned and deserve,” NVLSP explains. “For years, the law has required the military to assign a disability rating of at least 50 percent to all veterans discharged for PTSD. A permanent disability rating of 30 percent or more entitles a veteran to monthly disability benefits for the rest of the veteran’s life, to free lifetime health care for the veteran and his or her spouse, and to free health care for their minor children.”
Requirements veterans must meet to join the class-action lawsuit include;
1. Veterans who served on active duty in the U.S. Army, Navy, Marine Corps, or Air Force.
2. Veterans who were found by a Physical Evaluation Board to be unfit for continued service due to or at least in part, to PTSD.
3. Veterans who were assigned a disability rating for PTSD of less than 50 percent.
4. Veterans who were released, separated, retired, or discharged from active duty after December 17, 2002, and prior to October 14, 2008 (regardless of whether such release, separation, retirement, or discharge resulted in the individual’s placement on the Temporary Disability Retirement List).
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The signature wounds of the “War on Terror” are ones not readily visible to the human eye; the disability resides in the mind and body of the soldier and the complexity that is the human brain. Many times these wounds of warfare do not rear their ugly heads immediately, but can manifest when warriors return to their lives in America. Traumatic Brain Injury and Post Traumatic Stress Disorder are the hidden injuries and the new battlefront for military health care professionals.
As the military forges onward into a new century with a streamlined military arsenal, the Department of Defense and Veterans Affairs must now zero in on the complex and unpredictable world of mental health issues.
The science of mental health treatment varies with each recipient and the hidden battles combat veterans fight on a daily basis upon return need to be uncovered in order to restore faith and ensure the health of the military’s readiness for future battles.
While watching the battles unfold on cable news can be compelling, so too are the stories of these everyday heroes who battle physical therapy for visible and invisible injuries. The glamour may be on the battlefield, but the compassion plays out everyday as veterans overcome the odds and stare down the demons of war.
The real war stories
For those who serve during wartime often enter the military knowing full well what may lie ahead. The gritty courage of soldiers, their determination and their love of country makes America’s all-volunteer armed forces the best in the business. If the U.S. wishes to guarantee this tradition the military must keep its promise, as the Surgeon General says Navy Medicine – “World Class Care…Anytime Anywhere” for the military and families of returning warriors.
When soldiers are hurt in the line of duty, they often refer to their injury as “Alive Day” – meaning they are breathing and the hard work of recovering begins anew. A different battle must be waged, one that will test their inner courage and tenacity for life.
One such story comes from the book “Hidden Battles on Unseen Fronts.” The book details many stories of these brave soldiers who must face a new enemy – their own bodies.
For Army SPC Walter Blackston it would be that fateful September day that would result in his call to duty from the Army Reserve. His real-world experiences lent much needed improvements in the way communications were handled for Medevac crews in the Middle East. His confidence and skill garnered him multiple medals and citations while on duty.
However, a week before Blackston was to return home he went out to pick up injured servicemen from a Black Hawk helicopter crash. The chopper went down in the middle of a field, unfortunately for Blackston the large field would be filled with landmines and on his way back to his vehicle with injured soldiers, Blackston’s partner took a bad step- the blast killed the soldier, Blackston survived.
He was stitched up and told to have his injuries checked out when he returned stateside in a week. As it turned out that week-long wait would cost the Army Reservist major nerve-damage in his arms. Blackston would require multiple surgeries for the next three years on his arms and spine – he would also discover symptoms of PTSD and TBI after he recovered from the visible injuries.
Not only did the Army Reservist fight for his life while he received treatment at Walter Reed Army Medical Center he overcame the horrific living conditions at the infamous Building 18. (It was not uncommon to hear military personnel complain of mold, cockroaches, rats and robberies on a regular basis.)
This led to a low point in SPC Blackston’s life. He attempted to commit suicide twice unaware that his yet to be diagnosed TBI was worsening by the day.
As he described, nearly three years later the Army released Blackston and declared him fit for duty, despite the fact that he was treated for PTSD for more than a year. “The scarring was so terrible. The skin had healed like a web under both my arms but they only rated me 20 percent disabled,” he explained.
From this moment Blackston’s life spiraled out of control and he explains there were times when he didn’t know where he was and there was no job waiting for him. Oftentimes it is the wait for VA benefits to kick in that does the soldiers in. First Blackston drained his savings, and then he borrowed money from his family and finally maxed out his credit cards. He lost his house, his car, his fiancée and “his mind.”
While waiting to receive his benefits, Blackston was finally diagnosed with TBI. With the discovery of the new problem he realized his fate was increasingly in his own hands. The benefit folks at the VA were not sympatric to Blackston’s dilemma and asked him to move home with his parents at the age of 47.
However, he was having none of this. Out of frustration he demanded to see a VA supervisor. Once the supervisor entered the room, Blackston removed his shirt and shouted “this is what I live with every day.” The supervisor off the VA was humbled and apologized.
The goal was not to make someone feel sorry for him, but give him the tools he would need to get back on his feet. This episode resulted in a 90 percent disability rating and the new beginning he was looking for. His new paycheck would be $2,500 per month, only a portion of what he made in the private sector, but a start. (Since that was a service-connected injury incurred in combat I question why VA does not counsel these individuals to be reevaluated by DoD as they are probably entitled to a full DoD military disability retirement in addition to their VA benefits. These additional funds from DoD would give Blackston approximately $1,500 tax-free, plus all the benefits that come with a military retirement.)
The Army Reservist’s proactive role in his recovery has given himself the tools needed to go on. He admits thoughts of suicide still come and go, but his new found faith in God has given him the strength he needs to get up everyday.
Although Blackston’s symptoms of TBI are still persistent his commitment to therapy pushes the ball closer to the goal line. “I just want to lead a fruitful life…It’s all on me. And if I had one thing to say to vets like myself it would be, ‘We earned the right to be proud of who we are.’”
Stories like these are not uncommon with the Operation Iraqi Freedom and Operation Enduring Freedom veterans. What the military should be embarrassed about is not that these guys come home battered and broken, but the treatment or lack thereof for these volunteer forces.
Not only do they give their body and minds for this country if they are injured they often lose their families in the process. The romantic notion of World War II (albeit the men in WWII died on the battlefield and didn’t survive catastrophic injuries the “War on Terror” soldiers are now surviving) when men went to war and came home to adoring significant others, is less likely. Today’s soldiers face a myriad of hidden injuries, loss of income and find themselves in the bureaucracy health care.
Self-assessment of PTSD is not working
In the private sector if a patient is diagnosed with a psychological ailment they are given a battery of tests by a trained professional in the mental health field. When soldiers return from the warzone they are given a questionnaire “self assessment” to determine their mental state.
The screening questions revolve around the traumatic events they faced on the battlefield; “Have you had nightmares about it or thought about it when you did not want to? Have you tried hard not to think about it or went out of your way to avoid situations that reminded you of it? Are you constantly on guard, watchful or easily startled? Do you feel numb or detached from others, activities or your surroundings?”
Approximately 30 percent of the armed forces questioned about mental health last year reported having some trouble acclimating to life stateside. Of these numbers the VA doesn’t have the clinical practitioners needed to treat all the returning soldiers.
This is where the Department of Defense and VA need to open up all available resources, including TRICARE and allow returning soldiers to get treatment, with state-of-the-art remedies from the private sector. It has been estimated that treating PTSD within the military ranks would take approximately three years. And just as there’s more than one way to skin a cat, there is more than one way to treat PTSD.
As of 2009 the VA trained more than 1,200 mental health providers while the DoD has more than 600 mental health clinicians for the delivery of PTSD treatment.
Currently the military relies on multiple pills to alleviate mood swings. The soldiers take uppers, downers and sleeping tablets. One veteran even admitted he was taking up to 40 pills a day and still he wasn’t improving.
It wasn’t until this veteran found Dr. Rick Levy, a clinical psychologist who specializes in mind-body medicine, did this soldier’s quality of life improve. For those who are open to alternative treatments, they can obtain sanity without heavy drugs. After years of medicated treatments, Dr. Levy was able to use psychotherapy and clinical hypnosis as a method to abate PTSD and curtail other medical problems that often require medication.
With all the tools from Dr. Levy, the veteran was able to reduce his pill count to just three. He now leads a productive life. Once he learned the story behind the story, this soldier was able to regain control over his life with clinically guided meditation.
While this treatment may not work for everyone, the military needs to accept alternative methods of treatment for PTSD to ensure the mental health of all our military personnel.
I know best
From day one armed forces are taught to think about the mission first, their unit second and themselves last. So when the mission is complete, military personnel are sent home and the questionnaires presented many soldiers don’t answer openly or honestly for fear they may break the military code.
Take Army Second Lieutenant Sylvia Blackwood-Boutelle. She was called to duty and would serve in Iraq. She would be serving on the front lines as a reporter for the military. Her ability to report the news alongside Time magazine and the New York Times was exciting to Boutelle. The only caveat the military expected was for her to report positive stories.
Upon her return home to her family Boutelle was asked to take the PTSD questionnaire. She exhibited positive factors on her first assessment. She displayed all the symptoms for PTSD; however she was having none of it. She asked to retake the test. She admitted later that she had answered every question differently because she didn’t want to ruin her career.
“I’m a high-energy person. I figured I could deal with it myself,” Boutelle explained. This method of dealing with her emotions landed her back in Iraq until she couldn’t stay busy enough to push the PTSD aside.
Her emotional state continued to unravel without professional treatment. Once she realized she needed therapy she reached out and overcame the stigma associated with PTSD. “You have to get ‘team you’ together. You can’t be afraid to ask for help,” Boutelle said.
She remains in the Army and hopes to pursue a writing career when she finishes her PTSD treatment.
The sad truth of warzone trauma
In the words of Dr. Joseph, Roshi, MD, PhD, “Ours is a disposable culture; our children, our elders, our ill and infirm…are often ignored, overlooked, forgotten or mistreated.” He goes on to explain the impacts of war are legend and the invisible wounds radiate deep and wide into a person’s life.
Dr Roshi also believes Congress can’t fix the problem by simply throwing money at it. The real fix will come in the form of effective treatment for mental health issues, for the soldier and their family. Inside the broken mind a soldier can provide immeasurable strength, he says. “Resilience runs deep, but its resources need to be nurtured,” Roshi said. “It is like a seed that has been buried in a disaster; it needs tending, attending.”
Another doctor, Mitchell Tepper, PhD, MPH admits changes need to be made in the mental health care arena.
“Our service members get some of the nation’s best medical and physical rehabilitation services, but access to mental health services is both limited and often ineffectual, as it is in the civilian health care arena. We need to work more aggressively to identify and get into treatment those struggling with depression, combat-related stress, PTSD and mild brain injury.”
To that end, Dr. Roshi concludes that families affected by the side-effects of war also need to gain mental health care treatment to ease the burdens associated with care-giving duties and sporadic behaviors related to TBI and PTSD symptoms.
There are countless stories like these across the country. Many service members are able to cope with the extreme environment that war presents and those soldiers are to be commended for their service to America.
But for those who come back with major injuries, nightmares, amputations and the inability to return to a normal life, the U.S. owes those more. They given up their quality of life, many lost their significant others to divorce while others taken their lives. For the ultra- tormented soldiers who turn to drugs and alcohol to suppress their fears and depression, the DoD and VA need to do more.
America is built with the courage of those who serve in the armed forces; they should never feel like they let anyone down or take their own lives because they fail to receive adequate treatment. The men and women in uniform must be treated with respect and dignity.
In a world filled with movie stars, professional athletes and comic book superheroes – Americans should always remember the true heroes are the unsung leaders in the military, their guts, candor and determination to serve proudly should be the benchmark by which children look to when it comes to heroes they can believe in.
References and organizations that focus on veterans
Give an Hour- founder Barbara Romberg focuses on national network of mental heath professionals who provide free mental health services to U.S. troops and their families.
VA Suicide Prevention Hotline- Focuses on military veterans in immediate trouble.
Polytrauma Transitional Rehabilitation Program- Located at the Minneapolis VAMC, this program focuses on the TBI and PTSD issues that accompany major trauma.
Rick Levy, PhD- is a licensed psychologist in private practice who is the leading pioneer in mind-body medicine. His groundbreaking work has garnered him media exposure on Prime Time, FOX News, ABC and other print publications.
Dissemination and Training Division of the National Center for PTSD- located in the VA’s central office in Palo Alto Health Care System. Studies based on evidence-based psychotherapies.
Come Home Project/Deep Streams Zen Institute- Dr. Joseph Bobrow Roshi, MD, PhD. Focuses on alternative treatment for TBI and PTSD issues.
The Sexual Health Network, Inc. and SexualHealth.com- This organization deals with the sexual issues that accompany major trauma, TBI and PTSD. These conditions can dramatically impair a person’s capacity for intimacy.
Veterans Education Project- A group that trains veterans to share their stories and life lessons with classrooms and communities. The group also supports military families to provide support for veterans and educate others on the issues troops face on their long journey home.
As the nine-year “War on Terror” rages onward, high suicide rates, multiple deployments and lack of psychological treatment for Post Traumatic Stress Disorder (PTSD) alarms military personnel and many point to the real cost of the Middle East offensive will be health care after the war has ended. This disparity will likely exact a large toll on the nation’s military readiness in future conflicts.
Several reports including the Rand Study, Harvard Study and Dole-Shalala Commission find that the real cost of the war effort will come long after the fighting has ended and soldiers seek treatment for a myriad of injuries they suffered on the battlefield.
The signature injuries and perhaps the hardest to document are the elusive and well-hidden Traumatic Brain Injury or TBI and PTSD.
When soldiers return from the Middle East they are subjected to a plethora of details that need to be taken care of so they are able to receive adequate treatment, make their adjustment to life outside the battlefield and return to their families.
Since most deployments last months if not more than a year, most returning service members hastily scan through the mountains of paperwork in an effort to get home quickly.
Among the forms each soldier receives is a self-assessment for PTSD. When asked what the questions consist of and how many questions are on the PTSD evaluation form, Walter Reed Army Medical Center, Gigail “Gail” Cureton media relations said, “That’s not information we release.”
However, the question doesn’t lie with how many or what the content of the questionnaire contains, but the fact it is a self-assessment. Many soldiers may not show signs of TBI/PTSD until weeks or even months after they return home and as many reports cite there are simply not enough military trained staff to adequately take care of the men and women who serve in conflict zones overseas.
The Harvard Study concluded that the Veterans Health Administration (VHA) is already overwhelmed by the volume of returning veterans and the seriousness of their health care needs, and it will not be able to provide high quality of care in a timely fashion to the large wave of returning war veterans without greater funding and increased capacity in areas such as psychiatric care.
The study also pointed out the Veterans Benefits Administration (VBA) needs structural reforms
to deal with the high volume of pending claims and that the present claims process is unable to handle the current volume and will be completely inadequate to cope with the high demand of returning war veterans once the troops come home next summer.
With regard to the budgetary costs of providing disability compensation benefits and medical care to the veterans from Iraq and Afghanistan over the course of their lives the estimates range from the $350 – $700 billion and this scares many in Congress.
The Harvard Study concluded that the money needed to care for the soldiers depends on the length of deployment, the speed they claim disability benefits and the inflation rate of pending health care costs.
This staggering cost of medical treatment threatens to further bankrupt the Department of Defense and VA agencies and cause grave concern to some on Capitol Hill.
Yet, the summer offensive in Afghanistan rolls onward and injuries and death tolls continue to mount.
Key recommendations the Harvard Study suggests include more staffing in preparation for the influx of soldiers, increased funding especially in the mental health care treatment, funding of “Vet Centers” and perhaps the toughest is the need to restructure the benefit and claim process the VA uses.
Currently there are 37 bills, two resolutions, and two amendments to bills relating to Post Traumatic Stress Disorder and/or Traumatic Brain Injury somewhere in the legislative process. At least 11 of these deal with both issues. Of these bills, resolutions and amendments, three are now law (H.R. 2647, H.R. 3288, S. 1963), but none solves the problems facing returning veterans.
In a recent Military Times article the Veterans Affairs Department was asked how they should handle the tsunami of soldiers headed their direction. “In my judgment, it cannot be fixed,” said Peter Levin. “We need to build a new system, and that is exactly what we are going to do,” said the Veterans Affairs Department’s chief technology officer.
Among the plethora of issues facing the VA is the current backlog of 1.1 million claims that are awaiting decisions and how to best fix the error rate that hovers around 17-25 percent margin.
While veterans are waiting for their claims to be processed or reprocessed they run into all kinds of problems with managing their daily expenses which can lead to the loss of their cars and homes.
“It looks like we are going backwards rather than forward,” Congressman Bob Filner (D-CA) said. “No matter how much we raise the budget, no matter how many people we hire, the backlog seems to get bigger. People die before their claim is adjudicated. They lose their home. They lose their car,” Filner explains in the same Military Times article.
Solutions, however, are harder to come by in the bureaucratic quagmire of Washington DC. The VA Secretary
Eric Shinseki suggests the VA needs to hire more people to process claims. But what the VA really needs is more medical staff to treat the influx of soldiers suffering from TBI/PTSD and this process takes years to train workers something the VA does not have.
The VA hierarchy is looking at a three-to five-year range to fully train medical professionals to take care of the “War on Terror” veterans.
In the meantime, soldiers will be asked to wait.
The Rand Study titled “Invisible Wounds of Wars – Psychological and Cognitive Injuries, their consequences and services to assist recovery,” further delves into the serious problems returning soldiers face when it comes to treatment.
The study focuses on post-traumatic stress disorder, major depression and traumatic brain injury. These injuries were at the forefront “not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other service members, family members and society in general. All three conditions affect mood, thoughts, and behavior; yet these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it,” the report summarized.
In July of 2007, President Bush received a report on a study his administration requested. Oftentimes when reports are commissioned, facts are dissemination, parties questioned and recommendations made. However more often than not these commissioned reports are read, talked about and put away in a drawer with no further thought of change.
Nowhere is this more true than the bipartisan report the Bush Administration requested from Bob Dole and Donna Shalala; “Serve, Support, Simplify Report of the President’s Commission on Care for America’s Returning Wounded Warriors” dated, July 2007.
The 40-page report suggested the Department of Defense and VA should develop integrated care teams of physicians, nurses, and allied health professionals from relevant specialties like, social workers and vocational rehabilitation staff.
These teams would be able to create injured service members’ initial ‘Recovery Plans,’ which would start with a comprehensive clinical evaluation upon return from the war theater.
The DoD and VA would direct staff at military medical facilities to complete these Recovery Plans and a plan be created for all service members who have been seriously injured since the beginning of the Afghanistan and Iraq conflicts. This would make future treatment of wartime injuries easier to document and get benefits to those who served in a time efficient manner.
The Dole-Shalala report also drove home the point that DoD and VA needs to work with the Commissioned Corps of the Public Health Service and Department of Health and Human Services to develop a cadre of well-trained, highly-skilled Recovery Coordinators (however these coordinators only added another layer of bureaucracy and their results have been negligible).
At the conclusion of the Dole-Shalala report they included results from an Operation Enduring Freedom and Operation Iraqi Freedom survey. The numbers were not encouraging.
It is thought that many young people join military service as a way to earn money for a college education, but the report found that only 21 percent of demobilized reservists and 31 percent of retired/separated service members actually enrolled in an educational program leading to a degree. It is also worth pointing out that OEF/OIF soldiers are suffering from unemployment numbers in the 20-30 percent range.
When it comes to understanding the claim and benefit process the numbers were even more disturbing.
Approximately 38 percent of active duty, 34 percent of reserve component and 38 percent of retired/separated service members are “very” or “somewhat” satisfied with the disability evaluation system. Only 46 percent of active duty, 36 percent of reserve component, and 40 percent of retired/separated service members say they “completely” or “mostly” understand the military’s disability evaluation process. While 42 percent of retired/separated service members who filed a VA claim report that they “completely” or “mostly” understand the VA claims process. All of these numbers give the DoD and VA a failing grade.
Dole-Shalala also believe the DoD and VA needs to create a single, comprehensive, standardized medical examination and that it be administered by the DoD. The single examination would serve Department of Defense’s purpose of determining fitness so the Veteran Affairs’ can determine the initial disability rate.
If service members are found unfit because of their combat-related injuries Dole-Shalala say they should receive comprehensive health care coverage and pharmacy benefits for themselves and their dependents through DoD’s successful TRICARE program.
When it comes to TBI and PTSD many see psychological problems as nonsense. It is up to the DoD to intensify its efforts to reduce the stigma associated with PTSD and ensure they question all returning war-theater soldiers to set benchmarks for future treatments.
Part of this process could include strengthening family support programs; expand DoD respite care and extending the Family and Medical Leave Act for up to six months for spouses and parents so they can care for their seriously injured soldiers.
Now that Congress has passed a health care reform bill, private insurance companies will begin the arduous task of transferring all medical records onto a new electronic data base. However, it may make sense for the Department of Defense and Veteran Affairs to ‘jointly’ develop an interactive “My e-Benefits” website that provides a single information source for all service members to access. Most agree that the DoD and VA is a small microcosm of the American population making it the perfect organization to integrate the electronic medical record keeping program.
The consolidation of electronic medical records should be tied to a Social Security number, similar to how the Social Security retirement program is currently operated. Military experts say this process would cut red tape for veterans when it comes to receiving services in either the DOD or VA.
Currently the military medical programs operate on entirely different systems causing unnecessary delays in care and headaches for those attempting to navigate the complex DoD/VA benefits system. The creation of an e-benefits page would allow soldiers to have a one-stop site to chart their benefits and be reminded of important deadlines and treatments.
Lastly, understanding the unquantifiable problem of Post Traumatic Stress Disorder requires an immense amount of work something the military has been reluctant to embrace.
The self-assessment for PTSD must be changed and it has been suggested an in-depth test administered by psychological health care professional that is better qualified to determine the PTSD problems the returning war veterans may or may not have.
The 2007 estimates on soldiers suffering from PTSD of varying degrees of severity affects approximately 12 to 20 percent of returnees from Iraq and six to 11 percent of returnees from Afghanistan. However, most psychological medical professionals believe that number to be much higher as many don’t return with symptoms right away and a future event could trigger the PTSD at anytime.
Through 2007, 52,375 soldiers have been seen in the VA for PTSD symptoms. Severe and penetrating head injuries or TBI can be readily identified, but cases of mild-to-moderate TBI can be more difficult to identify and their incidence is much harder to determine.
A recent report indicated that approximately 35,000 returnees were believed to be healthy after a screening test; however 10 to 20 percent had apparently experienced a mild TBI during their deployment. Medical experts agree that those soldiers who suffer from TBI will most likely have PTSD. Multiple deployments automatically increase the odds of soldiers getting both TBI and PTSD during the Middle East conflict.
Once a soldier is severely injured in the ‘War on Terror’ their life will be forever changed. However, what remains unchanged is the quality of life issue. The earning ceiling for those who survive amputations, serious head trauma and other debilitating injuries will be in play the moment the injury occurs.
The earnings/loss payments are supposed to make up for any reduced earning capacity and quality-of-life issues. Nevertheless these payments that are meant to compensate for permanent losses of various kinds of injuries needs to be reviewed to provide better reimbursements for those who will have trouble reentering the civilian workforce.
If service members are found unfit because of their combat-related injuries they should receive lifetime, comprehensive health care coverage and pharmacy benefits for themselves and their dependents through DoD’s favorable TRICARE program.
Daily stressors will continue to plague soldiers the rest of their lives, at the very least the government can ensure money matters are not a part of the equation for the injured soldier and their families. Americans would do well to remember that these soldiers made a life-long sacrifice to ensure the freedom and safety of all – as a result they need to be honored with integrity and respect.