Tag Archives: DoD

The ‘equal opportunity war’ bring equal opportunity trauma

Much of the information below was gleaned from a well written USA Today story entitled Mental toll of war hitting female servicemembers.   Early in the story the writer tells about Master Sgt. Cindy Rathbun who began losing hair in clumps within 3 weeks of arriving in Iraq.   She is now enrolled in the first group of a new Women’s Trauma Recovery Program which is a 60 to 90 day program for female warriors. 

Cindy is suffering from the stress and trauma of war, but also from sexual trauma from prior to her deployment by a military superior.

Some tidbits of information directly from the article cited:

More than 182,000 women have served in Iraq, Afghanistan and the surrounding region — about 11% of U.S. troops deployed, the Pentagon says.

That dwarfs the 7,500 who served mostly as nurses in Vietnam and the nearly 41,000 women deployed during the brief Gulf War.

Although some of those women suffered PTSD, few saw actual fighting or were subjected to the stress of multiple deployments.

In Iraq, “there are no lines, so anybody that deploys is in a war zone,” Rathbun says. “Females are combat veterans as well as guys.”

 To be sure, women are barred from ground jobs, technically assigned to support roles, but guess what?   Those support roles include guarding checkpoints, driving supply convoys and searching women in neighborhood patrols.   Dangerous duty just the same. 

Attacks come from IED’s, mortars, and suicide attacks on checkpoints as well as from enemy fighters.   The stress is there.  The fear is there.  The fatigue is there, the unknown is there, the worry about the home folks is there.  Death and destruction are evident every day.   More than 100 of our female warriors have died and almost 600 wounded.

 More from the article cited:

The ranks of psychologically wounded from this war are far larger. In 2006, nearly 3,800 women diagnosed with PTSD were treated by the VA. They accounted for 14% of a total 27,000 recent veterans treated for PTSD last year.

In June, the Defense Department’s Mental Health Task Force reported that the number of women suffering from combat trauma might be higher than reported. It cited “a potential barrier” for women needing mental-health treatment as “their need to show the emotional strength expected of military members.”

The report also said that after leaving the military, “many women no longer see themselves as veterans” and might not associate psychological symptoms with their time in the war zone.

Did you notice that?  Women represent 11% of the deployed but have 14% of the cases, even though the DoD thinks they are under reported.  Battle lines or not, they are being affected at a much higher rate than men, some possibly due to MST, Military Sexual Trauma that was being diagnosed and treated as PTSD.

Here is a link to Oldtimer’s PTSD Videos which includes a video on MST.

It is about time that this problem is being addressed early in the process for our returning heroes.   Our warriors are the best and deserve the best, black, white, male and female.    

Wear the uniform, deserve the best

Our programs should never be just about the men. 

It should be about our heroes.

Oldtimer

Advertisements

Barack Obama: Veterans/Poverty Headlines and Video

Barack and Veterans Issues

Ok, I’m not trying to influence any votes here, nor run off any readers.  It’s just that I’m impressed with what I’ve heard said by Senator Obama regarding homelessness and veterans and what the press and veterans advocates have said.  I don’t know if you have seen them.   He does have the advantage of being a member of the Senate Veterans’ Affairs Committe.   I acknowledge that there are other important issues than veterans and homelessness to consider in a campaign, but that is what we are about here, so that is my focus.

I do have an couple of links to the Clinton side.  There is an equal-time segment at the bottom that will give you a look see between the top two Democratic candidates on veterans issues.   I may come back with more of this and feature a Republican or two later.  We will see how this plays out with my readers first.  Are you interested in politics?

BarackObamadotcom  (Video) Dinner with Barack Obama:  Four grassroots donors talk to Barack Obama about veterans and poverty during dinner.

I’ve mentioned Obama and Veterans in a previous post where he discusses his plan to improve veterans care and help get the homeless veterans off the streets as reported by a wire service.

Here are a few more headlines and links on this subject:

SEN. OBAMA: VETERANS ADMINISTRATION DENIED HEALTH CARE SERVICES TO NEARLY 9,000 ILLINOIS VETERANS IN 2005

Sen. Barack Obama (D-IL) today announced that the Department of Veterans Affairs (VA) denied health care to 8,944 Illinois veterans last year as part of a Bush Administration cost-cutting policy begun in 2003. Nationally, more than 260,000 veterans were denied access to VA hospitals, clinics and medications in Fiscal
Year 2005

Clinton v. Obama, Veterans Version

The tit-for-tat between Sens. Hillary Rodham Clinton and Barack Obama has expanded to new territory:   veterans benefits.

This week, the “Commission on Care of America’s Wounded Warriors” issued recommendations for improving treatment for veterans who return injured from the front. Clinton and Obama responded the way members of Congress often do to government reports – with legislative language.  

(…)  explains different positions

Obama, McCaskill sponsor bill on care for veterans

Sens. Barack Obama (D-Ill.) and Claire McCaskill (D-Mo.) are sponsoring legislation to improve the lives of recovering veterans at Walter Reed, while Sen. John Kerry (D-Mass.), a cosponsor of the Obama-McCaskill legislation, said that he would explore ways to direct new funds to Walter Reed and make immediate improvements to its veteran housing.

Barack Obama Honors Sacrifice of America’s Veterans

Barack Obama has a record of helping the heroes who defend our nation today and the veterans who fought in years past. As a grandson of a World War II veteran who went to college on the G.I. Bill and a member of the Senate Committee on Veterans Affairs, Obama has successfully reached out to Republicans and Democrats to pass laws to combat homelessness among veterans, improve care for troops recovering from injuries, ease the transition of new veterans into society, and make the disability benefits process more equitable.

Veterans Issues  From Obama’s website

Homeless Veterans

Every year, 400,000 veterans across the country, including an estimated 38,000 in Chicago, spend some time living on the streets. Senator Obama has been a leader in fighting homelessness among veterans. He authored the Sheltering All Veterans Everywhere Act (SAVE Act) to strengthen and expand federal homeless veteran programs that serve over 100,000 homeless veterans annually. During the debate on the Fiscal Year 2007 budget, Senator Obama passed an amendment to increase funding for homeless veterans programs by $40 million. These funds would benefit programs that provide food, clothing, mental health and substance abuse counseling, and employment and housing assistance to homeless veterans.

Working with Senators Akaka and Craig, Senator Obama passed legislation in December 2006 to provide comprehensive services and affordable housing options to veterans through the Department of Veterans Affairs, Department of Housing and Urban Development and nonprofit organizations. This legislation was signed into law and is modeled on parts of the SAVE Act and the Homes for Heroes Act, a measure that Senator Obama had previously authored.

Benefits Disparities

The Bush Administration’s approach to handling veterans’ health care ignores the reality of increasing demands on the VA, and the additional burden placed on veterans. The Administration has established a means test for VA health care eligibility, and it has banned hundreds of thousands of veterans – some who make as little as $30,000 a year – from enrolling in the system. These changes affect both older and younger veterans, and Senator Obama has opposed them, fighting instead for greater funding for veterans’ health care.

Greater Funding for Veterans Health Care

In January 2007, Senator Obama reintroduced the Lane Evans Veterans Health and Benefits Improvement Act to improve the VA’s planning process to avoid budget shortfalls in the future. The bill requires the VA and the Department of Defense to work together and share data so that we know precisely how many troops will be returning home and entering the VA system.

Food for Recovering Soldiers

Senator Obama introduced an amendment that became law providing food services to wounded veterans receiving physical therapy or rehabilitation services at military hospitals. Previously, service members receiving physical therapy or rehabilitation services in a medical hospital for more than 90 days were required to pay for their meals.

Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI)
 

Senator Obama fought a VA proposal that would have required a reexamination of all Post Traumatic Stress Disorder (PTSD) cases in which full benefits were granted. He and Senator Durbin passed an amendment that became law preventing the VA from conducting a review of cases, without first providing Congress with a complete report regarding the implementation of such review. In November 2005, the VA announced that it was abandoning its planned review.

Senator Obama passed an amendment to ensure that all service members returning from Iraq are properly screened for Traumatic Brain Injury (TBI). TBI is being called the signature injury of the Iraq war. The blast from improvised explosive devices can jar the brain, causing bruising or permanent damage. Concussions can have huge health effects including slowed thinking, headaches, memory loss, sleep disturbance, attention and concentration deficits, and irritability.

Easing the Transition to the VA

Senator Obama passed an amendment that became law requiring the Department of Defense (DOD) to report to Congress on the delayed development of an electronic medical records system compatible with the VA’s electronic medical records system. DOD’s delay in developing such a system has created obstacles for service members transitioning into the VA health care system.

Part of the Lane Evans Veterans Health and Benefits Improvement Act, which Senator Obama reintroduced in January 2007, would help veterans transition from the DOD health system to the VA system by extending the window in which new veterans can get mental health care from two years to five years. The Lane Evans bill also would improve transition services for members of the National Guard and Reserves.

For Equal Time’s sake:

Compare Senator Obama’s site with Senator Clinton’s site, both on Veterans Issues.

Oldtimer

GAO Testimony – DOD and VA

Transition Field Unit staffingGAO Testimony – DOD and VA

This is a troubling situation.  We have our kids off at war and they become severely injured, physically and mentally.   Our country has pulled out all stops to provide the best possible care for them and still we have problems.  Due to the protective gear and terrific and speedy medical care, thankfully more and more are surviving.  This shift in the severity and long term recovery needs requires major adjustments in our programs for treatment and rehabitation, for our benefits and compensation programs.  The cause and effect has driven the case loads and delays out of sight at the expense of our wounded heroes.

The good news is that that there is a scramble going on to correct these problems as soon as possible. There are people in high places capable of fixing the problem that have a heart for our heroes and are working very hard to fix the problems.  There are people in our VA and in militray trauma centers that are just as frustrated as we are.  There is a continuum of care mentality for our soldiers starting at the battlefield and continuing through our VA system. There are programs under development to reduce the time required to make determinations before our heroes get the treatment and benefits they need.

The bad news is there are still more than 150,000 cases more than 6 months old among the pending 600,000 cases in the VBA system, and we have no idea how old these cases really are.  The GAO found that new programs designed to correct the problems are not yet fully off the ground and there are severe staffing problems in key places, both on the active duty side and the veteran side of the picture. It appears to me that some of it is due to needing to move physicians from one program to staff another, leaving both under staffed. 

(Download Here)

What the GAO found

Warrior Transition Unit

Challenges have emerged for staffing the Warrior Transition Unit in which servicemembers are assigned to three key staff – a physician care manager, a nurse care manager, and a squad leader. For example, as of mid-September 2007, over half the U.S. Warrior Transition Units had significant shortfalls in one or more of these critical positions. In addition the number of recovery coordinators and how many servicemembers each would serve have yet to be determined.

Transition Field Unit staffing

This table shows that in actuality we have only 35% perminent staffing for these teams.  More than 450 of the existing staff (19%) have been borrowed from elsewhere, likely reducing the staff, already short, in othere facilities.   The table below shows where those with less than 50% staffing are located. 

 Staffing problem locations

PTSD and TBI 

Three independent review groups examining the deficiencies found at Walter Reed identified a range of complex problems associated with DOD and VA’s screening, diagnosis, and treatment of TBI (Traumatic Brain Injury) and PTSD, signature injuries of recent conflicts. Both conditions are sometimes referred to as “invisible injuries” because outwardly the individual’s appearance is just as it was before the injury or onset of symptoms. In terms of mild TBI, there may be no observable head injury and symptoms may overlap with those associated with PTSD. With respect to PTSD, there is no objective diagnostic test and its symptoms can sometimes be associated with other psychological conditions (e.g., depression).

TBI and PTSD chart
 
This table outlines what is being implimented (or planned) for handling TBI and PTSD better.   However, according to Army officials and the Independent Review Group report, obtaining qualified health professionals, such as clinical psychologists, is a challenge, which is due to competition with private sector salaries and difficulty recruiting for certain geographical locations. 

Data Sharing

In addition, the Dole-Shalala Commission noted that while VA is considered a leader in PTSD research and treatment, knowledge generated through research and clinical experience is not systematically disseminated to all DOD and VA providers of care.

Data Sharing

This table shows the efforts being taken to improve the data sharing between organizations. 

Disability Evaluations

As GAO and others have previously reported, providing timely and consistent disability decisions is a challenge for both DOD and VA. To address identified concerns, the Army has taken steps to streamline its disability evaluation process and reduce bottlenecks.   To address identified concerns, the Army has taken steps to streamline its disability evaluation process and reduce bottlenecks. The Army has also developed and conducted the first certification training for evaluation board liaisons who help servicemembers navigate the system. To address more systemic concerns, the Senior Oversight Committee is planning to pilot a joint disability evaluation system. Pilot options may incorporate variations of three key elements:

(1) a single, comprehensive medical examination;

(2) a single disability rating done by VA; and

(3) a DOD-level evaluation board for adjudicating servicemembers’ fitness for duty.

DOD and VA officials hoped to begin the pilot in August 2007, but postponed implementation in order to further review options and address open questions, including those related to proposed legislation.

Fixing these long-standing and complex problems as expeditiously as possible is critical to ensuring high-quality care for returning servicemembers, and success will ultimately depend on sustained attention, systematic oversight by DOD and VA, and sufficient resources.

You are invited to download and read the entire report here:  GAO Report (pdf – 32 pages)

Oldtimer

REFORM NEEDED: Brain-injured vets getting lost in the VA

REFORM NEEDED:

Brain-injured vets getting lost in the VA

I found this in the Opinion Section of the Atlanta Journal Constitution.  It dovetails with an article I was already writing and  nicelly illustrates the enormous problem of finding enough doctors and specialists to adequately care for our heroes that need treatment NOW.  I’ve decided to post it now and follow up with just released GAO testimony relating to the problem which will appear in my next post.  “Stay tuned.”  

Oldtimer

By Kevin Ferris
Philadelphia Inquirer

Published on: 11/12/07

Allen McQuarrie is looking for a few good doctors.  He wants them to volunteer their time and talents to their local Veterans Administration hospital.  Nothing against the quality of the folks already working there. The problem is. there simply aren’t enough doctors and specialists to go around for diagnosis and treatment — or to guide vets through the bureaucratic maze.

Worse, one of the current conflict’s signature wounds — brain injuries — makes it difficult for some vets to juggle the appointments, record-keeping and other demands the VA puts on them.

“We’re doing a wonderful job of getting the wounded off the battlefield and into a hospital in Germany and then back here,” McQuarrie says. “But continuing care once they’re out of the military is what needs systemic change.”

McQuarrie learned of the system’s shortcomings because of his son Doug, a 21-year veteran of the Navy SEALs who has back and brain injuries sustained in combat and training.

Doug McQuarrie has shuttled from the VA to civilian doctors, while trying to hold down a job and support his family in Virginia. The civilians say he needs immediate care, but the VA can’t see him for months — although he can call daily, hoping for a cancellation.

Allen McQuarrie has tried to help from his home in Doylestown, Pa., calling the VA but also seeking assistance from senators and representatives. In the process, he’s learned that Doug’s case isn’t unique — and that the VA desperately needs help.

Despairing and angry, he wrote to Sen. Bob Casey (D-Pa.): “It may be better for our men and women to come home dead than to suffer such painful and ultimately mortal deterioration.”

In the same letter, he asked for emergency legislation to encourage civilian doctors to “adopt” vets and provide the immediate neurological care many need. He suggested tax incentives and improved military insurance to help offset the volunteers’ costs.

McQuarrie’s hopes for a more responsive, faster-acting VA are shared by others including Congress’ Veterans Disability Benefits Commission.

One commission member, retired Marine Corps Maj. Gen. James E. Livingston, a Medal of Honor recipient, emphasizes three required changes.

Have a single review for disabilities. Now there are two.

Streamline the record-keeping process as vets move from care by the Defense Department to the VA.

Adopt the technology that will improve efficiency and speed up treatment.

And don’t worry about the costs.

(there is more to this story in the AJC – click on the link above and read the rest)

Now you have a flavor of the problem:  Not enough doctors to go around, too much paperwork, not enough technology – as viewed from the patient/family side of the problem.   Stay tuned for the recent GAO Testimony on the problem, coming up in my next post.

Oldtimer

Veteran Disability Determination Changes Recommended

Task Force on Returning Global War on Terror Heroes

Recommendation P-1:

 Develop a Joint Process for Disability Determinations

Agencies Responsible for Action: Defense and Veterans Affairs

Lead Agency: Defense
Recommendation: VA and DoD develop a joint process for disability determinations

Background: The Disability Evaluation System (DES) is the mechanism for implementing retirement or separation due to physical disability. There are four elements of DES: physical evaluation, medical evaluation, counseling, and final disposition. The DES physical evaluation has two major components: the Medical Evaluation Board (MEB) and the Physical Evaluation Board (PEB).

VA’s Schedule for Rating Disabilities (VASRD) is codified in statute and serves as a guide for the evaluation of disabilities resulting from diseases or injuries incident to military service. There are evaluation criteria for each condition listed, with disability levels ranging between zero and 100 percent, generally at 10 percent increments, as appropriate to the severity of the condition. The disability rating level is linked to a monetary amount determined by Congress.

In a December 1988 report, the then General Accounting Office said there had been no comprehensive review of the VA rating schedule since 1945, that the rating schedule contained outdated terminology and ambiguous classifications, and had not incorporated recent medical advances. The report recommended that VA thoroughly review the schedule and establish a process for an ongoing evaluation and update. VA agreed to do so and has been conducting a comprehensive revision of the schedule ever since. VA published an advance notice of proposed rulemaking for each of the 15 rating schedule body systems and contracted with an outside consultant, who gathered panels of medical experts for each system, to recommend changes in the rating schedule. Eleven of the 15 body systems contained in the schedule have been revised to date.

While both DoD and VA use the VASRD, not all the general policy provisions set forth in the VASRD apply to the military. Consequently, disability ratings may vary between the two. DoD rates conditions determined to be physically unfitting, compensating for a military career cut short. VA rates all service-connected impairments, combinations of impairments, or service-aggravated conditions, thus compensating for loss of earnings capacity resulting from injuries that could impact civilian employability. Another difference is the term of the rating. DoD’s ratings are permanent upon final disposition. VA’s ratings may change over time, depending upon the progress of the condition(s).

Further, DoD disability compensation is affected by years of service and basic pay; VA compensation is a flat amount based upon the percentage disability rating with possible variance related to number of dependents. Appendix C contains charts depicting the DoD and VA disability processes.  (NOTE from Oldtimer: I’ve already published these charts in earlier posts)

Gap Analysis: For DoD, the terms “permanent and stable” are used extensively in Title 10 but are not clearly defined. These words are the basis for important decisions to retire, separate, and temporarily retire servicemembers. The terms require uniform definition to facilitate consistency and fairness. Many medical and disability authorities have questioned the use of a disability retirement threshold. Historically, the disability retirement threshold stems from “A Report and Recommendation for the Secretary of Defense by the Advisory Commission on Service Pay” (December 1948). The historical record discussion associated with Recommendation 27 (Disability Retirement: Officers, Warrant Officers, and Enlisted Personnel), states:

“Therefore, the standards of disability as used by the Veterans Administration [later became Department of Veterans Affairs], which are civilian standards, are recommended for classification of disability cases into those which may be considered real disability warranting continuing monetary benefits and minor disability not warranting such benefits”.

Congress ultimately incorporated the recommendation in the Career Compensation Act of 1949. Logically, the disability retirement threshold creates an adversarial situation within the DES, when the DES is primarily charged with deciding fit/unfit status.

Servicemembers obviously endeavor to reach the threshold because it results in lifelong benefits such as health care, commissary/exchange privileges, etc., as well as annuity payments. This contributes to tension in the process, adds to servicemember discontent in a system that places the burden of proof on the servicemember who, in many cases, does not have the experience or knowledge, despite assistance, to build a proper case. Additionally, a major challenge is navigating the confusing, inconsistent, and patchwork laws associated with DES. This has resulted in the service branches being inconsistent at times with each other in determining fitness/unfitness and the level of disability.

For VA, examinations performed by DoD for purposes of determining fitness for continued service are generally not adequate for application of the VASRD in determining, for VA disability compensation purposes, the average impairment in earning capacity resulting from all disabilities or diseases incurred in, or aggravated by, service. Unless participating in the Benefits Delivery at Discharge (BDD) program, VA must wait until a servicemember is discharged and files a claim before obtaining service medical records, including any MEB/PEB proceedings, prior to determining if additional examinations are needed. This contributes to the lengthy claims process faced by veterans.

How the Recommendation Addresses the Gap: The development of a joint process whereby VA and DoD cooperate in the assignment of a disability evaluation that would be used in determining fitness for retention, level of disability for military retirement, and VA disability compensation would result in less discontent among servicemembers who believe they are assigned lower disability evaluations by DoD than by VA. This would also help VA provide better service to newly separated veterans by completing their claims in a timelier manner. There are, potentially, a number of provisions that could be undertaken to effect this recommendation, including providing Benefits Delivery at Discharge type service to those servicemembers undergoing the MEB/PEB process.

The impact of implementing this recommendation will be significant. In the near term, having DoD and VA work together to improve the VA disability claims process and the DoD MEB/PEB disability process should provide improvement across the services in consistency of decisions. In the longer term, having full cooperation in the disability claims process should provide improved service to servicemembers and veterans at a lower cost to the Government through increased efficiencies.

Implementation Action and Target Date:
Develop an in-depth plan for VA/DoD collaboration in the MEB/PEB process: Using the present interagency process provided by the Benefits and Joint Executive Committees (BEC and JEC), DoD and VA will develop options presented to leadership in both VA and DoD for review.

Target Date: Begun April 3, 2007;

VA to participate in Advisory Council meeting on May 3, 2007.

Note:  All highlights and bold type are Oldtimer’s – I hope it is not distracting from the report.  This is one recommendation in the Report to the President.  There are a total of 15 recommendations concering veterans.  You can find them all here

DoD Disability Evaluation System

DoD Disability Evaluation System

  DoD Disability Evaluation ChartPhysical Evaluation Board Chart

NOTE: The above information came from The US Department of Veteran’s Affairs, Task Force on Returning Global War on Terror Heroes, Report to the President, Appendix C