While the public focus in Afghanistan is the killing of civilians by an American soldier, little is reported on the toll this war is taking on veterans and their families.
The never-ending war in the Middle East has consequences, serious consequences. According to an October 2011 policy brief the U.S. Armed Services are losing the suicide battle on the home front.
The report concludes that a U.S. veteran kills himself every 80 minutes while Operation Iraqi Freedom/Operation Enduring Freedom service members is committing suicide every 36 hours. These statistics are staggering in light of the fact that only one-percent of the American population serves in the military, yet the military accounts for roughly 20 percent of the national suicide rate.
Veterans and service members report substantial paperwork and even longer wait times as one reason they don’t get the proper treatment for Post Traumatic Stress Disorder (PTSD) or Traumatic Brain Injury (TBI).
Another challenge military personnel face is the stigma attached to the term PTSD. Many service members can be ridiculed by fellow soldiers, told to toughen up by superiors or don’t fill out the required paperwork to seek counsel.
The military disconnect regarding the pervasiveness of PTSD within the military is a contributing factor to suicide. If the military leadership wants to turn the suicide numbers around, mental health care providers must work in concert with commanders to enforce guidelines for PTSD/TBI diagnosis and treatment.
“The responsibility inherent in military service, the importance of tasks assigned to relatively junior personnel and the high level of interaction among unit members establish the importance and usefulness of each unit member, particularly in an operational environment. In contrast, the experience of living in a garrison environment (for active component personnel) or returning to a civilian job (for Guardsmen, Reservists and veterans) or, worse, unemployment, can introduce feelings of uselessness. Individual accounts of military suicide both in the media and in interviews with us echo this sentiment. Over and over, these accounts show that individuals withdrew, felt disconnected from their units and their families, and perceived themselves as a burden,” Dr. Margaret Harrell and Nancy Berglass cited in their study.
While senior military leaders at the Department of Defense say they are exerting more energy than ever before to prevent the skyrocketing suicides, the dysfunctional relationship between DOD and the Veteran Affairs does little to provide adequate treatment options for veterans suffering from PTSD/TBI.
The DOD touts its “Never Let Your Buddy Fight Alone” program as a successful deterrent to suicide. And the VA’s Veterans Crisis hotline said their efforts to recognize the seriousness of suicide prompted nearly 150,000 hotline calls. The VA claims they saved 7,000 “actively suicidal veterans.” Yet, suicides remain alarmingly high.
The military must protect and care for those who voluntarily serve the country and return home with PTSD/TBI injuries. Suggestions made by this report includes; unit cohesiveness (returning soldiers should remain together as a group for at least 90 days after deployment), ensuring the military either has access or hires enough mental health providers to meet the needs of returning soldiers, and Congress needs to establish a federal pre-emption of state licensing, so providers can be treated across state lines.
Another area the military hierarchy must improve is dramatically changing the questions contained in the “Post Deployment” questionnaire.
“As service members return home from deployment, they complete a post-deployment health assessment (PDHA). As part of this assessment, they are asked questions about their physical and mental health, such as, “Did you encounter dead bodies or see people killed or wounded during this deployment?” and “During this deployment, did you ever feel that you were in great danger of being killed?” There are also self-evaluative questions, such as, “Are you currently interested in receiving information or assistance for a stress, emotional or alcohol concern?” While we do not question the contents of the assessment, its administration has been problematic,” the report explained.
According to a 2008 study (Christopher H. Warner et al., Importance of Anonymity to Encourage Honest Reporting in Mental Health Screening After Combat Deployment), when Army soldiers completed an anonymous survey, the reported rates of depression, PTSD, suicidal attempts and an interest in receiving care were two to four times higher than the current PDHA test used by military personnel.
“Likewise, our interviews with veterans uncovered numerous accounts of returning service members whose unit leaders advised them to fabricate answers. Individuals across all services have been told, ‘If you answer yes to any of those questions, you are not going home to your family tomorrow.’” This may be factually correct, but it neglects to inform service members of the implications of answering untruthfully – namely, that they will have difficulty receiving treatment or compensation for mental health problems that appear after their service. As an improvement, the 2010 National Defense Authorization Act requires trained medical or behavioral health professionals to conduct the PDHA evaluations individually and face-to-face, in the hope that service members will respond honestly to a trained health professional. PDHA evaluations individually and face-to-face, in the hope that service members will respond honestly to a trained health professional.”
In conclusion, the study outlined the military’s vulnerabilities concerning the treatment of PTSD/TBI. “Although a goal of no suicides may be unachievable, the increasing number of suicides is unacceptable. Additionally, although benefits and services available from the Veterans Health Administration will likely remain the best system of care for veterans, the DOD has a moral responsibility to acknowledge and understand former service members,” researchers said.
“America is losing its battle against suicide by veterans and service members. And, as more troops return from deployment, the risk will only grow. To honor those who have served and to protect the future health of the all-volunteer force, America must renew its commitment to its service members and veterans. The time has come to fight this threat more effectively and with greater urgency.”
The real question Americans need to ask, “is the 10-year Middle East War worth the cost in blood and treasure? And if so, how do military personnel intend to care for those who suffer the invisible PTSD/TBI wounds?
The clash in Afghanistan is between cultures, religions, and political institutions. Returning warriors continue to complain that Afghanistan will never be molded into a “state” with the ability to be a productive member of the world community. Its tribal tendencies will always shift with opportunities from religious zealots. Bush was wrong to “nation-build” in Afghanistan, and Obama is wrong to continue to feed the corruption and profiteering of Afghan President Karzai’s sect at the expense of American warriors. How do the military/civilian leaders intend to care for soldiers with visible or invisible wounds?
Yes, war is hell, but unless U.S. soldiers are authorized to “win” all Americans should stand together and demand an end to a seemingly endless war.
Following are links to four stories written by this reporter last year questioning the continuation of military/political actions in Afghanistan. The staggering levels of corruption alone should jolt Americans from their complacency; especially since the U.S. debt surpasses $16 trillion.
Part one; http://www.examiner.com/county-political-buzz-in-san-diego/u-s-troops-fight-and-die-to-preserve-shariah-law-afghanistan
Part two; http://www.examiner.com/county-political-buzz-in-san-diego/us-payments-to-taliban-afghan-warlords-threaten-american-nato-troops
Part three; http://www.examiner.com/county-political-buzz-in-san-diego/billion-dollar-corruption-within-the-u-s-picked-afghan-regime
Part four; http://www.examiner.com/county-political-buzz-in-san-diego/terrorism-s-down-payment-the-form-drugs-and-u-s-aid-money-part-4
For more stories; http://www.examiner.com/homeland-security-in-national/kimberly-dvorak
© Copyright 2012 Kimberly Dvorak All Rights Reserved.
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 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 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.
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 recent report showed that 32 soldiers killed themselves in June; 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.
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.