Tag Archives: veterans

Traumatic Brain Injury – TBI and Spinal Cord Injury SCI

The VA says this about TBI and SCI: 

Due to the ongoing conflicts in Afghanistan and Iraq, Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI) accounts for almost 25% of combat casualties.

Improvised explosive devices, blast (high pressure waves), landmines, and explosive fragments account for the majority of combat injuries in Afghanistan and Iraq. Although Kevlar helmets and advances in body armor have saved the lives of many soldiers, they do not protect against blasts and impacts to the head, face and cervical spinal cord.

Blast injuries often result in multiple traumas, including injuries to internal organs, limb loss, sensory loss, and psychological disorders. The term “polytrauma” has been coined to describe the co-occurring injuries.

The information above and below come from here which are part of an introduction and overview prepared by Joel Kupersmith, MD, Chief Research and Development Officer, VA for the purposes of a proposal solicitation.  I thought the overview might be of interest to those with these injuries and their families.

Traumatic Brain Injury:

Kevlar helmets have done much to protect the head but leave the forehead unprotected. The left and right frontal lobes, located behind the forehead control intellectual abilities such as the ability to plan and organize. This area of the brain also controls personality, behavior, and emotional control.

Concussion or mild TBI is the most common form of combat-related injury. Mild TBI can occur even in those not directly hit by the blast, without obvious external injuries, without loss of consciousness and without visible findings from acute Magnetic Resonance Imaging. Problems with memory, lack of concentration, increased anxiety and irritability are common hallmarks of mild TBI. Although evidence suggests that the majority of OIF/OEF soldiers who suffer mild TBI will recover over time, early diagnoses and treatment are critical so that aberrant behaviors due to TBI are not misinterpreted and soldiers are spared the risk of second impact syndrome. Appropriate recognition of TBI will facilitate quick return to pre-injury activity levels, including return to duty status.

In addition to mild TBI, soldiers close to the blasts are experiencing severe diffuse and contrecoup injuries. Soldiers with a moderate to severe TBI often show the similar symptoms as mild TBI yet also report: worsening headaches; repeated vomiting or nausea; seizures; inability to awaken from sleep; slurred speech; weakness, numbness and loss of coordination. Unlike mild TBI, these problems and others can persist long-term or result in permanent difficulties with memory, reasoning, emotion and expression making it impossible to return to duty, hold steady employment or regain pre-injury quality of life.

Penetrating focal injuries from mortar rounds or other forms of heavy artillery resulting in severe brain injury are not as prevalent. However, focal destruction of brain tissue is the most life-threatening, intractable type of brain injury causing permanent damage to the affected area and the functions it controls.

Spinal Cord Injury:

Current designs in military protective gear and advanced evacuation procedures have resulted in both a decrease in the percentage of spinal cord injured soldiers and an increase in the number of those that ultimately survive. Blast force and shrapnel injuries are most common. For those that survive, the cervical spinal cord, the unprotected and most mobile portion of the spinal cord, is the most common site of injury.

Soldiers with cervical SCI face short- and long-term consequences of losing motor and sensory function below the level of injury, coupled with a loss of autonomic regulation. Every organ system may be affected by cervical spinal cord injury. Alterations in the gastrointestinal, renal, skin and musculoskeletal organs are common, and respiratory problems are the overwhelming cause of morbidity and mortality. In addition, patients may experience chronic pain at or below the level of injury and, less frequently, above it.

Alterations in respiratory mechanics, and the development of alveolar hypoventilation, pneumonia, aspiration of gastric contents, pulmonary embolism, pulmonary edema, and sleep apnea are a few of the common respiratory complications associated with cervical SCI. Ultimately, dysfunction depends on the level and extent of injury. Lesions above C3 paralyze all respiratory muscles. When SCI involves C3 to C5 lesions, profound respiratory muscle dysfunction occurs leaving the patient unable to generate a cough or clear secretions. Because of this, neuroprotective strategies that rescue even one or two segments may be of significant functional benefit to veterans with SCI.

Let’s pray that this proposal results in research that leads to significant help for our injured veterans.    

Oldtimer

VA Research Factsheet on PTSD

The following is a factsheet from the VA’s Research Advances Series titled Posttraumatic Stress Disorder (PTSD),  published in September, 2007:

Soldier from VA BulletinSoldier from VA Bulletin VA’s Office of Research & Development supports a strong program of research directed to understanding, treating, and preventing Posttraumatic Stress Disorder (PTSD), which is an unrelenting biological reaction to the experience of a traumatic event. In the case of veterans, the trauma may occur from combat duty or other experiences where one’s safety or life is threatened. VA researchers have long been leaders in discovering new advances for treating and understanding PTSD.    The photo came with the article in 2007    I found a larger version here They title it “Prayer”.    I don’t know who the original photographer was.

Examples of VA research advances

Drug already used by millions may be effective in the treatment of PTSD – In an exciting new treatment development, VA researchers found that prazosin, an inexpensive generic drug already used by millions of Americans for high blood pressure and prostate problems, improved sleep and reduced trauma nightmares in a small number of veterans with PTSD.  Plans are under way for a large, multi-site trial to confirm the drug’s effectiveness.

Prolonged-exposure therapy effective in treatment of women veterans with PTSD– VA researchers found that prolonged-exposure therapy – in which therapists helped them recall their trauma memories under safe, controlled conditions-was effective in reducing PTSD symptoms in women veterans who have developed PTSD as the result of sexual trauma in the military, and that such reductions remained stable over time. Women who received prolonged-exposure therapy had greater reductions of PTSD symptoms than women who received only emotional support and counseling focused on current problems. This approach may be tested in, and applied to, other PTSD populations.

First ever clinical trial for the treatment of military service-related chronic PTSD– The largest study of its kind, involving 400 veterans from 20 VA medical centers nationwide, is being conducted to determine if risperidone, a medication already shown to be safe and effective in the treatment of PTSD, is also effective in veterans with chronic PTSD who continue to have symptoms despite receiving standard medications used for this disorder.

Facts About PTSD:

PTSD is a psychiatric disorder that can affect people who have experienced life-threatening events, such as combat, a terrorist attack, or a personal assault. Symptoms include flashbacks, nightmares, depression, and social withdrawal, as well as physical health changes. Treatment often includes anti-anxiety drugs or other medication, as well as exposure therapy, a form of cognitive-behavioral therapy in which patients recall their traumas in a safe setting and gradually learn to adjust their emotional response. VA Research has long been leaders in making new advances for treating and understanding PTSD.

http://www.research.va.gov
Research & Development
Veterans Affairs

Oldtimer’s Comment: There are 17 of these factsheets.  Below is a linked list of them.    You may find something of interest in one or more of them.   For example, PTSD is mentioned in several.

Factsheets

  • Alzheimer’s Disease (193 KB, PDF)
  • Depression (192 KB, PDF)
  • Diabetes (168 KB, PDF)
  • Hearing Loss (194 KB, PDF)
  • Heart Disease and Stroke (223 KB, PDF)
  • Hepatitis C (198 KB, PDF)
  • HIV / AIDS (205 KB, PDF)
  • Iraq / Afghanistan (232 KB, )
  • Low Vision (248 KB, PDF)
  • Mental Health (191 KB, PDF)
  • Obesity (214 KB, PDF)
  • Osteoarthritis (175 KB, PDF)
  • Parkinson’s Disease (179 KB, PDF)
  • Personalized Medicine (208 KB, PDF)
  • Post-Traumatic Stress Disorder (PTSD) (189 KB, PDF)
  • Prosthetics / Amputations (209 KB, PDF)
  • Spinal Cord Injury (205 KB, PDF)
  • Substance Abuse (175 KB, PDF)
  • Womens’ Health (201 KB, PDF)
  • Oldtimer

    PTSD Payments Vary State to State

    PTSD Payments Vary State to State

    I’m indebted to the blog at Healing Combat Trauma for alerting me to this information in which they refererence an article published in Military.com with the above title.   You should read the information at Healing Combat Trauma as it is told better there than I can do it.   Below is a summary of information.

    It seems that the McClatchy Newspapers chain did extensive research through the freedom of information act and discovered that there is wide variation in the way disability ratings are given depending on where the veteran lives.   A veteran returning from Iraq that lives in Ohio or Montana for example, is typically given a much lower disability rating on average than one that returns to New Mexico.

    The study involved some 3 million disability claims records.  Consider these quotes from the Military.com article:

    “The VA workers who decide PTSD cases determine whether a veteran’s ability to function at work is limited a little, a lot or somewhere in between. They examine the frequency of panic attacks and the level of memory loss. The process is subjective, and veterans are placed on a scale that gives them scores – or “ratings” – of zero, 10, 30, 50, 70 or 100.

    “McClatchy’s analysis found that some regional offices are far more likely to give veterans scores of 50 or 70 while others are far more likely to stick with scores of 10 or 30.

    “Consider the New Mexico and Montana offices, where there are big differences up and down the scale.

    “In Montana, more than three-quarters of veterans have ratings of zero, 10 or 30. In New Mexico, a majority of the veterans have ratings of 50 or 70.

    “On top of that, 6 percent of New Mexico veterans had the highest rating possible – 100, worth $2,527 a month – compared with just 1 percent of Montana veterans.”

    The initial ratings pretty much stick with a veteran for the rest of their life, and the disparity in how the disability is rated may make a difference of hundreds of thousands over the remaining lifetime of the veteran.   Apparently some offices make a point of being generous in their ratings and some apparently are downright stingy, not giving a proper rating. 

    “Of recent vets processed in Roanoke, Va., 27 percent have high ratings for post-traumatic stress disorder. In Albuquerque, N.M., the number is 56 percent.”

    You need to read the Healing Combat Trauma article for some excellent commentary and also the military.com article for some extra details.   The research suggests that something is wrong with the VA’s rating system when one city rates twice as many of their veterans higher than in another city.   The VA does not treat our heroes fairly if they happen to live in the wrong part of our great country.

    Oldtimer

    Surge Seen in Number of Homeless Veterans

    Surge Seen in Number of Homeless Veterans

     Oldtimer’s Comment:  I’ve seen a number of these types of articles.   Although the estimates vary depending on the subject area from 400 to about 1500, the word on the street is that the returning soldiers from Iraq and Afghanistan are showing up in shelters much faster than in previous wars.  The problem stems from higher rates of PTSD and TBI (traumatic brain injury) which still take too long to diagnose, and which are resulting from the combined effect of IED’s and higher survival rates.    The VA has long under diagnosed these problems and only recently, after much heat, begun to actively pursue it. 

    Photo by Jeff Swensen for The New York Times
    Frederick Johnson, a veteran of the Iraq war, lives in temporary housing provided by the V.A. after spending a year on the streets.

    By ERIK ECKHOLM

    WASHINGTON, Nov. 7 – More than 400 veterans of the Iraq and Afghanistan wars have turned up homeless, and the Veterans Affairs Department and aid groups say they are bracing for a new surge in homeless veterans in the years ahead.

     

    Photo by Brendan Smialowski for The New York Times
    Joe Williams lives in a homeless shelter in Washington.

    Experts who work with veterans say it often takes several years after leaving military service for veterans’ accumulating problems to push them into the streets. But some aid workers say the Iraq and Afghanistan veterans appear to be turning up sooner than the Vietnam veterans did.

    “We’re beginning to see, across the country, the first trickle of this generation of warriors in homeless shelters,” said Phil Landis, chairman of Veterans Village of San Diego, a residence and counseling center. “But we anticipate that it’s going to be a tsunami.”

    With more women serving in combat zones, the current wars are already resulting in a higher share of homeless women as well. They have an added risk factor: roughly 40 percent of the hundreds of homeless female veterans of recent wars have said they were sexually assaulted by American soldiers while in the military, officials said.

    “Sexual abuse is a risk factor for homelessness,” Pete Dougherty, the V.A.’s director of homeless programs, said.

    Special traits of the current wars may contribute to homelessness, including high rates of post-traumatic stress disorder, or PTSD, and traumatic brain injury, which can cause unstable behavior and substance abuse, and the long and repeated tours of duty, which can make the reintegration into families and work all the harder.

    Frederick Johnson, 37, an Army reservist, slept in abandoned houses shortly after returning to Chester, Pa., from a year in Iraq, where he experienced daily mortar attacks and saw mangled bodies of soldiers and children. He started using crack cocaine and drinking, burning through $6,000 in savings.

    “I cut myself off from my family and went from being a pleasant guy to wanting to rip your head off if you looked at me wrong,” Mr. Johnson said.

    (…)  Read more about Fredrick at the link above

    Poverty and high housing costs also contribute. The National Alliance to End Homelessness in Washington will release a report on Thursday saying that among one million veterans who served after the Sept. 11 attacks, 72,000 are paying more than half their incomes for rent, leaving them highly vulnerable.

    Mr. Dougherty of the V.A. said outreach officers, who visit shelters, soup kitchens and parks, had located about 1,500 returnees from Iraq or Afghanistan who seemed at high risk, though many had jobs. More than 400 have entered agency-supported residential programs around the country. No one knows how many others have not made contact with aid agencies.

    More than 11 percent of the newly homeless veterans are women, Mr. Dougherty said, compared with 4 percent enrolled in such programs over all.

    Veterans have long accounted for a high share of the nation’s homeless. Although they make up 11 percent of the adult population, they make up 26 percent of the homeless on any given day, the National Alliance report calculated.

    Oldtimer’s comment:   My studies show that homeless male veterans make up 43% of the homeless male population, far in excess of what would be expected.

    According to the V.A., some 196,000 veterans of all ages were homeless on any given night in 2006. That represents a decline from about 250,000 a decade back, Mr. Dougherty said, as housing and medical programs grew and older veterans died.

    Oldtimer’s comment:  Oops!  That is a deliberately misleading statement.   A GAO report states that the drop from 250,000 a decade ago was due to a major change in how homeless veterans are counted.   While it is true that our older veterans are dieing off, many more veterans are joining the ranks of the homeless and make up for it.  There has been no real decline, and actually there has been a steady increase in the percentage of homeless veterans vs the overall population of veterans.

    The most troubling face of homelessness has been the chronic cases, those who live in the streets or shelters for more than year. Some 44,000 to 64,000 veterans fit that category, according to the National Alliance study.

    On Wednesday, the Bush administration announced what it described as “remarkable progress” for the chronic homeless. Alphonso R. Jackson, the secretary of housing and urban development, said a new policy of bringing the long-term homeless directly into housing, backed by supporting services, had put more than 20,000, or about 12 percent, into permanent or transitional homes.

    Oldtimer’s comment:  I’m not sure where these numbers come from.  It appears the HUD secretary is talking about all chronic homeless, not just veterans.   20,000 is 12% of 166,000, which is about right for the chronic homeless for the entire homeless population. To get a feel for progress among veterans, see the following two paragraphs.

    Veterans have been among the beneficiaries, but Mary Cunningham, director of the research institute of the National Alliance and chief author of their report, said the share of supported housing marked for veterans was low.

    A collaborative program of the Department of Housing and Urban Development and the V.A. has developed 1,780 such units. The National Alliance said the number needed to grow by 25,000.

    Mr. Dougherty described the large and growing efforts the V.A. was making to prevent homelessness including offering two years of free medical care and identifying psychological and substance abuse problems early.

    Oldtimer’s Comment:  ‘Bout Time!

    (…)

    Homeless Veterans’ Reintegration Program 28 cents a day per vet

    Homeless Veterans’ Reintegration Program

    US Department Of Labor HVRP Fact Sheet

    Oldtimer’s comment:  You must read to the bottom of this to get the whole story, my fact checker. 

    The purpose of the Homeless Veterans’ Reintegration Program (HVRP) is to provide services to assist in reintegrating homeless veterans into meaningful employment within the labor force and to stimulate the development of effective service delivery systems that will address the complex problems facing homeless veterans.

    HVRP was initially authorized under Section 738 of the Stewart B. McKinney Homeless Assistance Act in July 1987. It is currently authorized under Title 38 U.S.C. Section 2021, as added by Section 5 of Public Law 107-95, the Homeless Veterans Comprehensive Assistance Act of 2001. Funds are awarded on a competitive basis to eligible applicants such as: State and local Workforce Investment Boards, public agencies, for-profit/commercial entities, and non-profit organizations, including faith based and community based organizations.

    Grantees provide an array of services utilizing a case management approach that directly assists homeless veterans as well as provide critical linkages for a variety of supportive services available in their local communities. The program is “employment focused” and veterans receive the employment and training services they need in order to re-enter the labor force. Job placement, training, job development, career counseling, resume preparation, are among the services that are provided.

    Supportive services such as clothing, provision of or referral to temporary, transitional, and permanent housing, referral to medical and substance abuse treatment, and transportation assistance are also provided to meet the needs of this target group.

    Since its inception, HVRP has featured an outreach component using veterans who themselves have experienced homelessness. In recent years, this successful technique was modified to allow the programs to utilize formerly homeless veterans in various other positions where there is direct client contact such as counseling, peer coaching, intake, and follow-up services.

    The emphasis on helping homeless veterans get and retain jobs is enhanced through many linkages and coordination with various veterans’ services programs and organizations such as the Disabled Veterans’ Outreach Program and Local Veterans’ Employment Representatives stationed in the local employment service offices of the State Workforce Agencies, Workforce Investment Boards, One-Stop Centers, Veterans’ Workforce Investment Program, the American Legion, Disabled American Veterans, Veterans of Foreign Wars, and the Departments of Veterans’ Affairs, Housing and Urban Development, and Health and Human Services.

    For more information about U.S. Department of Labor employment and training programs for veterans, contact the Veterans’ Employment and Training Service office nearest you, listed in the phone book under United States Government, U.S. Department of Labor or at this link.

    ———————————————————————— 

    Oldtimer’s comment:  The above is copied in full from the Dept of Labor at the link at the beginning of this post.  There are other services and publications available as links at the same site.  Worth a look-see if you are a homeless veteran or know of one in your community.  

    However, they farm all of this stuff out to certain areas of the country through grants to a few private and public organizations in 30 states.  Most areas have no such programs, including 20 entire states that received no funding.

    I took the liberty of looking up the grants provided by this program. 

    In 2007 they provided 87 grants totaling 20 Million dollars and some change.  The grants went to such places as Goodwill ($1.54 Million), Nashville’s Operation Stand down ($300,000), both of  which Wanderingvet, our homeless veteran friend, either wrote about or visited.  I’m not sure that he would claim we get our money’s worth.  Some city, county and state govenments benefitted.  The HVF mentioned in a previous post was not listed among the grantees. 

    There were 12,877 planned enrollments which are expected to result in 9113 employments, at a cost of $2226 per placement at an average salary of $9.87 and hour.   The highest rate was $11.50 and the lowest $6.95 an hour.  Cost of placement varies by location.  Nevada for example can employ a veteran at a cost of $971 while others go as high as more than $5000 per placement such as in California.

    OK Department of Labor:  What are you going to do if the other 190,000 homeless veterans show up?  It is gonna be a long line.  You have funded $101.42  per homeless vet.  That works out to 27.7 cents per day!   Pencil and a few sheets of paper anyone?

    Creative Commons photo provided courtesy of [martin]

    Department of Labor:  You are not doing enough for our homeless heroes!

    Oldtimer

    Homeless Veteran Fellowship

    The Homeless Veteran Fellowship (HVF) is located in Ogden, Utah.   Their motto is “Veterans Helping Veterans and Our Community”.  It was founded in 1989 by a group of veterans. 

     

    Main Office, drop in center and some residences

    Folks, this is a pretty neat operation!   They provide 32 transitional residences for needy veterans.   They also provide a comprehensive range of services to assist the homeless veteran to move from transitional housing to independent living by providing:

    Substance-free, zero-tolerance, stabilized transitional housing.
    Acquisition of skills and knowledge necessary to obtain suitable employment.
    Acquisition of life skills necessary for independence and self-sufficiency
    Employment development and placement in suitable occupations which maximizes the resident’s income potential
    Substance abuse counseling to promote maintained abstinence from drugs and/or alcohol.
    Mental health counseling to assist residents to process issues that may impede their ongoing development.

    They consider themselves as an aid station for behind the lines assistance to veterans in need of help.

    They have a drop in center that welcomes homeless veterans.    The Drop-in center is manned by volunteers and transitional housing members. People working in the drop-in center are prepared to discuss program basics and initiate paperwork, assist with Veterans Administration needs (DD 214, ID Card, etc.).   The drop in center has a small library of donated paperback books for those who just want to rest and relax.

    The drop-in center provides hot coffee, donuts, and reading material for visitors, workers, and residents. Donated supplies, including coffee, sugar, plastic ware, pastries, creamer, cups, napkins, and cleaning supplies.  Also paperback books, magazines, board games, card games, food items, such as canned goods, boxed or packaged items.   Hygiene items (soap, toothpaste, tooth brushes, deodorant, etc.) are also available for those living on the street.

    HVF provides referral services through the Veteran Affairs Medical Center in Salt Lake City, and through other local agencies. HVF also provides extensive case management services for clients to ensure that all critical needs are met.

    There is a licensed Clinical Social Worker and Substance Abuse counselor on staff to provide both individual and group counseling for Veterans in the Transitional Housing program.

     HVF’s employment development program consists of a full-time Employment Development Specialist to assist clients in obtaining meaningful employment. HVF has a vendor license with the Utah State Office of Rehabilitation for Supported Job Based Training (SJBT).

    The Homeless Veterans Fellowship provides a Transitional Housing Program which is designed to temporarily stabilize the housing needs of veterans, both single and with families.

    Main Housing Unit (there are 3 others)

    Facilities:

    The HVF Office building houses the Drop-In Center, Director’s Office, Employment Specialist, VA Counseling Services and apartments.
    Next Door to the Office Building is the main housing facility with apartments available for male, female, or family participants.
    To the rear of the main housing facility there is a renovated house that has been converted into apartments to support residents.
    Just up the road about a block is a 4th facility with apartments to support residents.
    In all there are facilities to house 32 participants
    .

    This looks like a program that could be emulated across the country.  Homeless Veterans Fellowship is a non-profit organization, as such, it depends totally upon the generosity of the community and public and private grants.

    That is the way to minister to the homeless veteran! 

    Oldtimer

    Cold to the Bone

    I wrote this last January 29, 2007.  I didn’t want to wait until it got that cold to publish it again. There are too many men, women and children in the woods as I write this.  Too many of the adults are veterans – Heroes, but the cold doesn’t care.  Everyone hurts.  All need help. 

     I hope that this helps inspire someone to help at least one homeless person find shelter, find warmth and find a way out of the mess they find themselves in before it gets unbearably cold again. 

    ——————————————————————————-

    It was 16 degrees F. when I got up this morning, 67 inside.

    Cold to the bone

    What was it like around the campfire…

    When the embers went out?

    What was it like under the train trestle…

    Where no fire could be built?

    What was it like in the bushes…

    When the old man had to go?

    What was it like in the tent…

    When it was really just a box?

    What was it like to be outside…

    Where it is… Cold to the Bone?

    Were you warm last night? ,,,,,  Count your blessings.

    They are still out there

    Grace and Peace,
    by Jim Tabb/Oldtimer

    Won’t you volunteer somewhere today?