SgtSloppy's blog: "Veteran's Issues and Rights"

How the U.S. Is Failing Its War Veterans By Dan Ephron and Sarah Childress Newsweek March 5, 2007 issue - After returning from Iraq in late 2005, Jonathan Schulze spent every day struggling not to fall apart. When a Department of Veterans Affairs clinic turned him away last month, he lost the battle. The 25-year-old Marine from Stewart, Minn., had told his parents that 16 men in his unit had died in two days of battle in Ramadi. At home, he was drinking hard to stave off the nightmares. Though he managed to get a job as a roofer, he was suffering flashbacks and panic attacks so intense that he couldn't concentrate on his work. Sometimes, he heard in his mind the haunting chants of the muezzin—the Muslim call to prayer that he'd heard many times in Iraq. Again and again, he'd relive the moments he was in a Humvee, manning the machine gun, but helpless to save his fellow Marines. "He'd be seeing them in his own mind, standing in front of him," says his stepmother, Marianne. Schulze, who earned two Purple Hearts for wounds sustained in Iraq, was initially reluctant to turn to the VA. Raised among fighters—Schulze's father served in Vietnam and over the years his older brother and six stepbrothers all enlisted in the military—Jonathan might have felt asking for help didn't befit a Marine. But when the panic attacks got to be too much, he started showing up at the VA emergency room, where doctors recommended he try group therapy. He resisted; he didn't think hearing other veterans' depressing problems would help solve his own. Then, early last month, after more than a year of anxiety, he finally decided to admit himself to an inpatient program. Schulze packed a bag on Jan. 11 and drove with his family to the VA center in St. Cloud, about 70 miles away. The Schulzes were ushered into the mental-health-care unit and an intake worker sat down at a computer across from them. "She started typing," Marianne says. "She asked, 'Do you feel suicidal?' and Jonathan said, 'Yes, I feel suicidal'." The woman kept typing, seemingly unconcerned. Marianne was livid. "He's an Iraqi veteran!" she snapped. "Listen to him!" The woman made a phone call, then told him no one was available that day to screen him for hospitalization. Jonathan could come back tomorrow or call the counselor for a screening on the phone. When he did call the following day, the response from the clinic was even more disheartening: the center was full. Schulze would be No. 26 on the waiting list. He was encouraged to call back periodically over the next two weeks in case there was a cancellation. Marianne was listening in on the conversation from the dining room. She watched Jonathan, slumped on the couch, as he talked to the doctor. "I heard him say the same thing: I'm suicidal, I feel lost, I feel hopelessness," she says. Four days later Schulze got drunk, wrapped an electrical cord around a basement beam in his home and hanged himself. A friend he telephoned while tying the noose called the police, but by the time officers broke down the door, Schulze was dead. How well do we care for our wounded and impaired when they come home? For a country amid what President Bush calls a "long war," the question has profound moral implications. We send young Americans to the world's most unruly places to execute our national policies. About 50,000 service members so far have been banged up or burned, suffered disease, lost limbs or sacrificed something less tangible inside them. Schulze is an extreme example but not an isolated one, and such stories are raising concerns that the country is failing to meet its most basic obligations to those who fight our wars. The question of after-action care also has strategic consequences. Iraq marks the first drawn-out campaign we've fought with an all-volunteer military. In practice, that means far fewer Americans are taking part in this war (12 percent of the total population participated in World War II, 2 percent in Vietnam and less than half of 1 percent in Iraq and Afghanistan). Already, the war has made it harder for the military to recruit new soldiers and more expensive to retain the ones it has. If we fall down in the attention we provide them, who's to say volunteers will continue coming forward? The issue of veterans' care jumped into the headlines last week when The Washington Post published a series about Walter Reed Army Medical Center in Washington, D.C. The stories revealed decay and mismanagement at the hospital, and provoked shock and concern among politicians in both parties. "The doctors were fantastic," a Walter Reed patient, 21-year-old Marissa Strock, tells NEWSWEEK. "But some of the nurses and other staffers here have been a nightmare." Strock suffered multiple injuries, including broken bones, a lacerated liver and severely bruised lungs, when her Humvee rolled over an improvised explosive device on Nov. 24, 2005. She later had both her legs amputated. "I think a big part of [Walter Reed's problems] is they just don't have enough people to adequately handle all the wounded troops coming in here every day," she says. (Walter Reed did not respond to requests for comment about Strock's case.) The Pentagon responded swiftly to the Post series. It vowed to investigate what went wrong and immediately sent a repair crew to repaint and fix the damage to the aging buildings. The revelations were especially shocking because Walter Reed is one of the country's most prestigious military hospitals, often visited by prominent politicians, including the president. But it is just one part of a vast network of hospitals and clinics that serve wounded soldiers and veterans throughout the country. A NEWSWEEK investigation focused not on one facility but on the services of the Department of Veterans Affairs, a 235,000-person bureaucracy that provides medical care to a much larger number of servicemen and women from the time they're released from the military, and doles out their disability payments. Our reporting paints a grim portrait of an overloaded bureaucracy cluttered with red tape; veterans having to wait weeks or months for mental-health care and other appointments; families sliding into debt as VA case managers study disability claims over many months, and the seriously wounded requiring help from outside experts just to understand the VA's arcane system of rights and benefits. "In no way do I diminish the fact that there are veterans out there who are coming in who require treatment and maybe are not getting the treatment they need," White House Deputy Press Secretary Tony Fratto tells NEWSWEEK. "It's real and it exists." The system's shortcomings are certainly not deliberate; no organization is perfect. Some of the VA's hospitals have been cited as among the best in the country, and even in extreme cases, the picture is seldom black-and-white. Before he killed himself, Schulze was seen by the VA 46 times, VA Secretary James Nicholson told Congress this month. (He did not elaborate on what care Schulze received.) Yet, as the number of veterans continues to grow, critics worry the VA is in a state of denial. In a broad sense, the situation at the VA seems to mirror the overall lack of planning for the war. "We know the VA doesn't have the capacity to process a large number of disability claims at the same time," says Linda Bilmes, a Harvard public-finance professor and former Clinton administration Commerce Department official. Last month Bilmes released a 34-page study on the long-term cost of caring for veterans from Iraq and Afghanistan. She projects that at least 700,000 veterans from the global war on terror (GWOT) will flood the system in the coming years. As it is, for some veterans the wait can be agonizing. Patrick Feges was on hold for 17 months until his first disability check from the VA came through. An Eagle Scout from Sugar Land, Texas, Feges enlisted in 2003 and found himself in Ramadi a year later. In October 2004, a mortar exploded on his base about 50 yards from him, spraying him with shrapnel, slicing his intestines and severing a major artery. Feges lost consciousness and was flown to Walter Reed, where he underwent surgery. Long scars trail down his legs and midsection. At the hospital a fellow Texan came to visit: President Bush stood by his bed and chatted with him. Feges is a polite 22-year-old with a military manner. He addresses strangers by last name and an honorific, even when prodded to drop the formality. "I was brought up right, sir," he explains. But his voice rises slightly when he describes his ordeal with the VA. A case officer in Houston processed Feges's request for disability in September 2005, then lost his application. Feges was summoned to repeated medical evaluations at the Houston center, but a year later he was still waiting for a check. By then, Feges had been accepted to culinary school in Austin and did not want to put off his studies. His mother, an elementary-school teacher, took a second job at a local McDonald's to help support him. For discharged service members, the VA serves two functions: it provides medical care for service-related conditions at its clinics and hospitals across the country, and it reviews claims for disability benefits—chiefly, the monthly payments wounded veterans get for the rest of their lives. The review process can be complicated. It requires veterans to prove, through documents and sometimes through the testimony of fellow soldiers, that their afflictions are a result of their time in the military. Feges listed on his application all the ways he'd been affected by the wounds: he'd lost mobility in his ankles and knees, he suffered regular stomach cramps from the intestinal wound, he lost sensation in his hands and legs, he had trouble standing for long periods. NEWSWEEK presented the VA with the names and details of the veterans whose stories are told here, but a spokesman for the agency declined to comment on individual cases, citing doctor-patient confidentiality. Speaking generally, Dr. Michael Kussman, the VA's acting under secretary for health, tells NEWSWEEK that the department is trying to reach veterans earlier, as they approach their date of discharge, and that he does not believe Iraq and Afghanistan are straining resources severely. "The impact on the VA so far has been relatively small," Kussman says. "It has not kicked the system over in our budget and in our ability to absorb it." Still, a jump in disability claims in recent years has created a bottleneck. Daniel Cooper, the VA's under secretary for benefits, confirmed his department was coping with a backlog of 400,000 applications and appeals; 75 percent of them were still within a "reasonable" reviewing time frame, he says. Yet, most of those claims were filed by veterans of previous wars (a veteran can file or appeal a claim even decades after discharge). As more servicemen and women return from Iraq, the backlog is likely to increase. Cooper says the average waiting time for a benefits claim is about six months. NEWSWEEK turned up a number of veterans who'd waited longer. Keri Christensen, a National Guard veteran and a mother of two, says the VA in Chicago took 10 months to process her application. Rory Dunn, who nearly died in an IED attack outside Fallujah, says his application was delayed because, among other things, the VA mixed up his file with that of a Korean War veteran. Feges's claim was finally approved last month: after NEWSWEEK and the advocacy group Veterans for America began looking into his case, he got a call from a VA official in Waco, Texas, with the news that his money would come through. Last week he received back pay to the date of his application. The compensation is not huge. A veteran with a disability rating of 100 percent gets about $2,400 a month—more if he or she has children. A 50 percent rating brings in around $700 a month. But for many returning servicemen burdened with wounds, it is, initially at least, their sole income. "When I started school, that's when it became really hard not to have that money," says Feges. One reason to worry about a crush of new vets at the VA has to do with the proportion of wounded to dead Americans in Iraq. Though we tend to mark the grim timeline of the war by counting fatalities, what really distinguishes this conflict is how many soldiers don't die, but suffer appalling injuries. In Vietnam and Korea, about three Americans were wounded for every one who died. The ratio in WWII was nearly 2-1. In Iraq, 16 soldiers are wounded or get sick for every one who dies. The yawning ratio marks progress: better body armor and helmets are shielding more soldiers from fatal wounds. And advanced emergency care is keeping more of the wounded alive. The VA's Kussman says that soldiers who survive the first few minutes after an explosion have a 98 percent chance of surviving altogether. But that means an increased burden on the VA's health-care system. Two such survivors are Albert and Connie Ross. Albert lost a leg when a rocket-propelled grenade landed close to him in August 2004 while he was on patrol in Baghdad. Connie lived through a 2004 suicide bombing in Mosul but suffered multiple fractures and burns. When the two met in a hallway at Brooke Army Medical Center in San Antonio, Texas, Connie thought she noticed a certain swagger in Albert's walk. "He had this weird dip in his walk, so I asked him, 'Why are you pimp-walking in a hospital?' And he said: 'I'm not pimp-walking, I'm an amputee.' I was so embarrassed." The two married earlier this year and are expecting a child. Though he's been in the VA system for more than two years now, Albert still doesn't have a primary-care doctor. Without one, getting appointments with specialists can be difficult. "You're supposed to be assigned one right away," says Albert, who now lives in San Antonio. "I'm not frustrated so much as worried—worried if and when something does go wrong, something will happen with one of my legs ... They [primary-care doctors] are the ones who have to fill out a work-order form; it's impossible to do anything without them." One thing Albert desperately wants to do: get a new prosthetic. He's one of the early African-American amputees of the war. But the fake limb he's been given matches the skin tone of a Caucasian. It so embarrasses Albert that he always wears a sock over it—even if he's in sandals. "He's very self-conscious about it," says Connie. "It really bothers him." Albert's situation is probably atypical. The VA says a huge majority of veterans get primary-care doctors within 30 days. But people inside the system do concede there's a shortage of mental-health workers at many of the VA's hospitals and clinics across the country. And Schulze is not the only veteran to commit suicide after being turned away. In a similar case in 2004, the VA twice neglected to treat Iraq veteran Jeffrey Lucey for posttraumatic stress disorder (the second time because he was told alcoholics must dry out before being accepted to an inpatient program). By the time a VA counselor tracked down a bed in a New York facility with a built-in detox program, Lucey had already hanged himself. "The system doesn't treat mental health with the same urgency it treats general health care," says a senior VA manager who did not want to be named talking about shortcomings in the agency. Even when veterans get to the right doctors, understanding how to leverage what they need from the system can be mind-bending. Tonia Sargent, whose husband, Kenneth, nearly died in a sniper attack in Najaf in 2004, says no one ever sat her down and explained the benefits and how to access them. Her husband's brain injury made him often incapable of understanding his own care. Key decisions fell to her alone. It's a "don't ask, don't tell system," she says. Kenneth is a Marine master sergeant who'd been in the Corps for nearly 18 years. He was on his second tour in Iraq when a sniper bullet ricocheted off the metal hatch on his vehicle and hit him directly below the right eye, grazing the front of his brain and exiting near his left ear. Among other things, he was diagnosed with traumatic brain injury, which has become the signature wound of the Iraq war. Tonia had to fight the Marine Corps to keep him from being discharged, figuring he'd get better medical care if he remained in active service. But some of his treatment has been outsourced to the VA. One of the tricks she learned early on was to demand photocopies of her husband's records—every exam, every X-ray, every diagnosis—and personally carry the file from appointment to appointment. "I don't know if there is a more formal protocol for transferring documents, but I know that what I brought ... was definitely put to use." When Sargent was transferred to the VA's lauded Polytrauma Center in Palo Alto, Calif., doctors there encouraged her to go home to Camp Pendleton near San Diego and treat his stay at the hospital as if it was a deployment. "After two weeks, they asked me how long I was planning to stay with my husband," she says. "They said it was his rehab, not mine. But I needed to learn how to care for him, and he suffered from extreme anxiety without me." She pushed back, staying in Palo Alto until he completed his care. How can the system improve? Bilmes, who authored the Harvard study, proposes at least one drastic change—automatically accepting all disability claims and auditing them after payments have begun. (The VA says that would be an irresponsible use of taxpayer money.) Other critics have focused on raising the VA's budget, which has been proposed at $87 billion for 2008. More money could go toward hiring more claims officers and more doctors, easing the burden now and preparing the VA for the end of the Iraq war, when soldiers return home en masse. But veterans' support groups and even some former and current VA insiders believe there's a reluctance in the Bush administration to deal openly with the long-term costs of the war. (All told, Bilmes projects it could cost as much as $600 billion to care for GWOT veterans over the course of their lifetimes.) That reluctance, they say, trickles down to the VA, where top managers are politically appointed. Secretary Jim Nicholson, a decorated Vietnam War veteran who was chosen by Bush in 2005, tends to be the focus of this criticism. The senior VA manager who did not want to be named criticizing superiors told NEWSWEEK: "He's a political appointee and he needs to respond to the White House's direction." Steve Robinson of Veterans for America levels the accusation more directly. "Why doesn't the VA have a projection of casualties for the wars? Because it would be a political bombshell for Nicholson to estimate so many casualties." The VA denies political considerations are involved in its budgeting or planning. Nicholson declined to be interviewed but Matt Burns, a spokesman for the VA, called Robinson's comments "nonsensical and inflammatory," adding: "The VA, in its budgeting process, carefully prepares for future costs so that we can continue to deliver the quality health care and myriad benefits veterans have earned." Fratto, the White House deputy press secretary, says money is not the problem. He points out the VA has had a hard time filling positions in some remote parts of the country. "You need to find people who are trained in PTSD and other disorders that are affecting veterans and find those who are willing to go to places where they are needed." As is often the case in America when government institutions falter, however, community groups are already stepping into the void. Veterans of Foreign Wars has advocates helping vets negotiate the VA bureaucracy, much the way health facilitators in the private sector help consumers get the most from their health insurance. Robinson, of Veterans for America, has pulled together teams of volunteers—physicians, psychologists, lawyers—who give vets free services when the local VA branch falls down. At his office recently, he was coordinating a traumatic-brain-injury screening with a private doctor for a veteran who'd been denied access to VA care. The fact that Americans are coming forward doesn't absolve the VA of its obligation to provide first-rate care for veterans. Most of the wounded's problems just can't be solved by private citizens and groups, no matter how well meaning. But it does serve to remind us that we should take better care of veterans wounded in the line of duty as they make their way home, and try to remake their lives. With Jamie Reno, Eve Conant, John Barry, Richard Wolffe, Karen Springen, Jonathan Mummolo and Ty Brickhouse URL: http://www.msnbc.msn.com/id/17316437/site/newsweek/

By Linda Robinson Posted 4/8/07 In the middle of a battle in Fallujah in April 2004, an M80 grenade landed a foot away from Fred Ball. The blast threw the 26-year-old Marine sergeant 10 feet into the air and sent a piece of hot shrapnel into his right temple. Once his wound was patched up, Ball insisted on rejoining his men. For the next three months, he continued to go on raids, then returned to Camp Pendleton, Calif. Chad Miller The former Oregon national guardsman was wounded by bombings in Iraq in 2005. Miller, 39, is appealing his zero disability rating.KEVIN HORAN-AURORA FOR USN&WR But Ball was not all right. Military doctors concluded that Ball was suffering from a traumatic brain injury, post-traumatic stress disorder (PTSD), chronic headaches, and balance problems. Ball, who had a 3.5 grade-point average in high school, was found to have a sixth-grade-level learning capability. In January of last year, the Marine Corps found him unfit for duty but not disabled enough to receive full permanent disability retirement benefits and discharged him. Ball's situation has taken a dire turn for the worse. The tremors that he experienced after the blast are back, he can hardly walk, and he has trouble using a pencil or a fork. Ball's case is being handled by the Department of Veterans Affairs-he receives $337 a month-but while his case is under appeal, he receives no medical care. He works 16-hour shifts at a packing-crate plant near his home in East Wenatchee, Wash., but he has gone into debt to cover his $1,600 monthly mortgage and support his wife and 2-month-old son. "Life is coming down around me," Ball says. Trained to be strong and self-sufficient, Ball now speaks in tones of audible pain. Fred Ball's story is just one of a shocking number of cases where the U.S. military appears to have dispensed low disability ratings to wounded service members with serious injuries and thus avoided paying them full military disabled retirement benefits. While most recent attention has been paid to substandard conditions and outpatient care at Walter Reed Army Medical Center, the first stop for many wounded soldiers stateside, veterans' advocates say that a more grievous problem is an arbitrary and dysfunctional disability ratings process that is short-changing the nation's newest crop of veterans. The trouble has existed for years, but now that the country is at war, tens of thousands of Americans are being caught up in it. Now an extensive investigation by U.S. News and a new Army inspector general's report reveal that the system is beset by ambiguity and riddled with discrepancies. Indeed, Department of Defense data examined by U.S. News and military experts show that the vast majority-nearly 93 percent-of disabled troops are receiving low ratings, and more have been graded similarly in recent years. What's more, ground troops, who suffer the most combat injuries from the ubiquitous roadside bombs, have received the lowest ratings. One counselor who has helped wounded soldiers navigate the process for over a decade believes that as many as half of them may have received ratings that are too low. Ron Smith, deputy general counsel for the Disabled American Veterans, says: "If it is even 10 percent, it is unconscionable." The DAV is chartered by Congress to represent service members as they go through the evaluation process. Its national service officers are based at each rating location, and there is a countrywide network of counselors. Smith says he recently asked the staff to cull those cases that appeared to have been incorrectly rated. Within six hours, he says, they had forwarded him 30 cases. "So far," Smith says, "the review supports the conclusion that a significant number of soldiers are being fairly dramatically underrated by the U.S. Army." Magic number. In an effort to learn how extensive the problem is, U.S. News spent six weeks talking to wounded service members, their counselors, and veterans advocacy groups and reviewing Pentagon data. At first glance, the disability ratings process seems straightforward. Each branch of service has its own Physical Evaluation Boards, which can comprise military officers, medical professionals, and civilians. The PEBs determine whether the wounded or ill service members are fit for duty. If they are, it's back to work. Those found unfit are assigned a disability rating for the condition that makes them unable to do their military job. The actual rating is key, and here's why: Service members who have served less than 20 years-the great majority of wounded soldiers-who receive a rating under 30 percent are sent home with a severance check. Those who receive a rating of 30 percent or higher qualify for a host of lifelong, enviable benefits from the DOD, which include full military retirement pay (based on rank and tenure), life insurance, health insurance, and access to military commissaries. But the system is hideously complicated in practice. The military doctors who prepare the case for the PEBs pick only one condition for the service member's rating, even though many of the current injuries are much more complex. The PEBs use the Department of Veterans Affairs ratings scale, which grades disabilities in increments of 10-a leg amputation, for example, puts a soldier at between 40 and 60 percent disabled. The PEBs claim they have the leeway to rate a soldier 20 percent disabled for pain, say, rather than 30 percent disabled for a back injury. If rated at 20 percent or below and discharged, the soldier enters the VA system as a retiree where he is evaluated again to establish his healthcare benefits. Ball, for example, was found by the VA to be 50 percent disabled for PTSD. Since 2000, 92.7 percent of the disability ratings handed out by PEBs have been 20 percent or lower, according to Pentagon data analyzed by the Veterans' Disability Benefits Commission, which Congress formed in 2004 to look into veterans' complaints (Page 47). Moreover, fewer veterans have received ratings of 30 percent or more since America went to war in Afghanistan and Iraq, according to the Pentagon's annual actuarial reports. As of 2006, for example, 87,000 disabled retirees were on the list of those exceeding the 30 percent threshold; in 2000, there were 102,000 recipients. Last year, only 1,077 of 19,902 service members made it over the 30 percent threshold (chart, Page 49). The total amount paid out for these benefit awards has remained roughly constant in wartime and peacetime, leading disabled veterans like retired Lt. Col. Mike Parker, who has become an unofficial spokesperson on this issue, to allege that a budgetary ceiling has been imposed to contain war costs. A DOD spokesperson, Maj. Stewart Upton, said that the Pentagon "is committed to improving the Disability Evaluation System across the board and to ... a full and fair due process with regard to disability evaluation and compensation." Other data reveal glaring discrepancies among the military services. Even though most of those wounded in Iraq and Afghanistan have been ground troops, the Army and Marine Corps have granted far fewer members full disabled benefits than the Air Force. The Pentagon records show that 26.7 percent of disabled airmen have been rated 30 percent or more disabled, while only 4.3 percent of soldiers and 2.7 percent of marines made the grade. Services engaged in close combat, experts say, could be expected to find more members unfit for duty and meriting full retirement benefits. Instead, the Air Force decided that 2,497 airmen fall into that category while the much larger Army, with its higher tally of wounded, has accorded those benefits to only 1,763 soldiers since 2000. How many of these veterans' cases have been decided incorrectly? Nobody knows. These statistics show trends that are clearly at odds with what logic would dictate, but there has been no effort to discover how many of those low ratings were inaccurately conferred or to ascertain why the number receiving full benefits has declined during wartime or why there is such a discrepancy between the Air Force and the other services. But there is abundant anecdotal evidence of a process cloaked in obscurity and riddled with anomalies, and of ratings that are inconsistent and often arbitrarily applied. DAV lawyer Smith, for example, took on the case of a soldier whose radial nerve of his dominant hand had been destroyed, the same affliction former Sen. Bob Dole has. Like Dole, the soldier was unable to write with a pen or to button his shirt. "There is one and only one rating for that condition, which is 70 percent disability," says Smith. The PEB gave the soldier 30 percent, the lawyer said, "which I found to be fairly outrageous." Upon appeal to the Army Physical Disability Agency, the entity that oversees that service's disability evaluation process, the rating was raised to 60 percent. Smith recently took on another case, that of Sgt. Michael Pinero, a soldier who developed a degenerative eye condition called keratoconus that required him to wear contact lenses. Army regulations prohibit wearing contacts in combat, which should have made him ineligible for deployment and therefore unfit to perform his specific military duties. But the PEB ignored the eye condition, which Smith believes merited a 30 percent rating or more, and rated Pinero 10 percent disabled for shin splints. Smith has asked the Army to clarify whether it considers the regulation on contact lenses binding or, as one board member alleged, merely a guideline. Disputes over such distinctions are common in the Alice in Wonderland world of disability ratings. Controversy frequently surrounds decisions on which conditions make a soldier unfit for duty. Smith took issue with a recent statement made by the Army Physical Disability Agency's legal adviser, quoted in Army Times newspaper. The official said that short-term memory loss would not necessarily render soldiers unfit for duty since they could compensate by carrying a notepad. "Memory loss is a common sign of TBI," Smith said, using the abbreviation for traumatic brain injury, which has afflicted many soldiers hit by the roadside bombs commonly used in Iraq. "The rules of engagement are a seven-step process.... If a suicide bomber is coming at you, you cannot stop and consult your notepad," he added. "I find this demonstrative of the attitude that pervades the Physical Disability Agency," which is in charge of reviewing evaluations for accuracy and consistency. Trying to overturn a low rating can be a full-time job-and an exasperating one. Take Staff Sgt. Chris Bain, who lost the use of his arms but not his sense of humor. "They call me T-Rex because I have a big mouth and two hands and I can't do nothing with them," he jokes. He left the Army in February, but he still has plenty of fight in him. During an ambush in Taji, Iraq, in 2004, a mortar round exploded 2 feet away from him, ripping through his left arm and hand. A sniper's bullet passed through his right elbow. His buddies saved his life, throwing Bain on the hood of a humvee and rushing him to a combat hospital. Once transferred to Walter Reed, Bain refused to have his arm amputated and underwent eight surgeries to save it. That choice cost him. While an amputation would have automatically put him over the 30 percent threshold, the injury to his left arm was rated at 20 percent even though he cannot use the limb. Bain was angry. A noncommissioned officer who had planned on 20 or 30 years in the Army, he knew his career was over, but he wasn't going to go quietly. "I wanted to be an example to all soldiers," he said. "My job was to take care of troops." He went to find Danny Soto, the DAV representative at Walter Reed he'd heard so much about. "Danny is just an awesome guy. He took great care of me, but he should not have had to," Bain says. Soto is a patron saint to many soldiers at Walter Reed. He walks the halls, finding the newly injured and urging them to collect documents for their journey through the tortuous-and, to many, capricious-system. Many soldiers are young, and after they have spent months or years recuperating, they just want to get home and are unwilling to argue for the rating they deserve. Even though he missed his wife and three children, Bain decided: "I've already been here two years, another one ain't going to hurt me. Too many people are getting lowballed." With Soto's help, Bain gathered detailed medical evidence of his injuries and went to face the board. They gave him a 70 percent rating for injuries related to the blast except for his hearing loss, which was not considered unfitting since he had a hearing aid. Oddly enough, however, the board put him on the temporary disabled retirement list instead of the permanent list. "What do they think, that after three years, my arm is going to come back to life?" A lifetime of adjusting lies ahead for Bain. "I can't tie my shoes, open bottles of water, or cut my own food," he says. "I have to ask for help." The 35-year-old veteran has found a new sense of purpose. He's decided to run for Congress in 2008, and fixing the veterans' system is his top priority. "I do not want this s--- to happen again to anyone. No one can communicate with each other. The paper trail doesn't catch up." It's a tall order, but the soldier says that he has "100,000 fights" left in him. A systemic fix doesn't appear to be anywhere in sight. A March 2006 report by the Government Accountability Office found that Pentagon officials were not even trying to get a handle on the problem. "While DOD has issued policies and guidance to promote consistent and timely disability decisions," the report concluded, "[it] is not monitoring compliance." But the GAO report did spur Army Secretary Francis Harvey, who was forced to resign last month in the wake of the Walter Reed scandal, to order the Army's inspector general to conduct an investigation of the disability evaluation system. After almost a year of work, the inspector general's office last month issued a 311-page report that begins to pierce the confusion and opacity surrounding the process. While it does not determine how many erroneous ratings were accorded to the nearly 40,000 soldiers rated 20 percent disabled or less since 2000, it does make three critical points: 1) the ambiguity in applying the ratings schedule should end; 2) wide variance in ratings is indisputable, even among the three Army boards, and 3) the Army's oversight body is not doing its job. Way overdue. Army officials met with U.S. News to discuss the inspector general's report. "This is something that has been near and dear to our hearts for a long time, and it's probably way overdue as far as having someone go and take a look at it," says a senior Army official. The inspector general's team found that Army policy was not consistent with the policies of either the Pentagon or the Department of Veterans Affairs. It recommended that the Army "align [its] adjudication of disability ratings to more closely reflect those used by the Department of Veterans Affairs." For years, the Army has asserted that it has the right to depart from VA standards on grounds that it is assessing fitness for duty and compensating for loss of military career, not decreased civilian employability. Veterans' advocates argue that federal law requires the military to use the Veterans Affairs Schedule for Rating Disabilities as the standard for assigning the ratings. But over the years, Pentagon directives on applying the schedule have opened up a whole new gray area by saying the schedule is to be used only as a guide. And the services have interpreted them in different ways, engendering further discrepancies. Soto, the DAV national service officer at Walter Reed, says that inconsistencies are especially prevalent in complex cases of traumatic brain injury and post-traumatic stress disorder. "There is a saying going around the compound here," Soto says, "that if you are not an amputee, you are going to have to fight for your rating." The inspector general's report calls for ending the ambiguities. "What we're saying is it shouldn't be left to interpretation; it should be clearly defined," says one Army official. "If there were a way to cut down on that ambiguity, I think that variance would decrease." Finally, the report bluntly concludes that the system's internal oversight mechanism is not functioning. "The Army Physical Disability Agency's quality assurance program does not conform to DOD and Army policy," it says-the same conclusion the GAO came to a year ago. The inspector general's report adds evidence of just how little the watchdog is doing to ensure that cases are correctly decided. The agency is supposed to send cases to either of two review boards when soldiers rebut their rating evaluations, but from 2002 through 2005, the agency sent only 45 out of 51,000 cases to one of the boards. The other review board has not been used at all. The inspector general's team made 41 recommendations in all, finding among other things that the Army lacks a formal course for training the liaison officers who are supposed to guide soldiers through the PEB process, that the disposition of cases lags badly, that the computerized information systems are antiquated, and that the two key medical and personnel databases are not integrated and cannot communicate with each other. The report has been forwarded to the action team that Army Vice Chief of Staff Richard Cody convened-one of many official groups formed since the revelations of substandard conditions and bureaucratic delays at Walter Reed. Veterans' advocates are skeptical that the administration or the military bureaucracy will make major changes anytime soon. In testimony to Congress last month, Veterans for America director of veterans' affairs Steve Robinson recommended taking the entire ratings process away from the Pentagon and giving it to the Department of Veterans Affairs. "It's hard to ignore the fact that in time of war they are giving out less disability," he says. "Is it policy? I don't know. But it is a fact." Congress has not responded to this problem. Says Rep. Vic Snyder, the Arkansas Democrat who chairs the House Armed Services subcommittee on military personnel: "This whole issue of disability ratings is very complex. It is not well understood by many people, including many in Congress. That is why we set up the [ Veterans' Disability Benefits] Commission in 2004. We are hoping it will help us sort this out." A lot is riding on the commission. Its chairman is Lt. Gen. Terry Scott, who retired in 1997 and ran Harvard's Kennedy School of Government's National Security Program until 2001. After the Pentagon data on the disability process were presented to the commission last week, Scott said "we still don't understand the whys and wherefores" of the skewed ratings. The core problem, he believes, is that "the military was not designed to look after severely wounded people for a long time." The commission has not yet decided what changes it will recommend, but he said there is a general sense that "one physical exam at the end of service should be enough for both agencies, DOD and VA." Cash and staff. Any solutions that call for transferring more responsibility to the Department of Veterans Affairs will have to be matched by enormous infusions of cash and staff. Already, the VA is reeling under a backlog of over 600,000 claims from retired veterans, which the agency predicts will grow by an additional 1.6 million in the next two years. Harvard Prof. Linda Bilmes, an economist who has published two studies on the costs of the Iraq war and the associated veterans' costs, projects that as much as $150 billion more will be required to deal with the wounded returning from Iraq and Afghanistan. Meanwhile, people like Danny Soto want to know who is going to stop the military boards from giving out ratings like the 10 percent given to one soldier for a skull fracture and traumatic brain injury, when the VA later assigned a 100 percent rating. Soto is also frustrated by a recent case in which a soldier whose legs had been severely injured in a blast in Iraq was given only a 20 percent disability rating for pain and by the treatment of a man who has a bullet hole through his eye and suffers from seizures. As Soto sat with that soldier in front of the board, he asked why he had been placed on the temporary list. "At what point do you think he is going to fall below 30 percent?" Soto is unsparing in his criticism of the bureaucracy. "This system," he says, " is so broke." Old soldiers say the root of the problem is an Army culture that preaches a "suck it up" attitude. "If you ask for what you are due, you are perceived to be whining or trying to pad your pocket," says a retired command sergeant major. "If you're not bleeding, you're not hurt. That's what we were taught." With Edward T. Pound This story appears in the April 16, 2007 print edition of U.S. News & World Report. Print | E-mail

Thanks Nanda Insult to Injury New data reveal an alarming trend: Vets' disabilities are being downgraded By Linda Robinson Posted 4/8/07 In the middle of a battle in Fallujah in April 2004, an M80 grenade landed a foot away from Fred Ball. The blast threw the 26-year-old Marine sergeant 10 feet into the air and sent a piece of hot shrapnel into his right temple. Once his wound was patched up, Ball insisted on rejoining his men. For the next three months, he continued to go on raids, then returned to Camp Pendleton, Calif. Related News Video: Bush Calls for Walter Reed Probe More From Nation & World More From This Issue But Ball was not all right. Military doctors concluded that Ball was suffering from a traumatic brain injury, post-traumatic stress disorder (PTSD), chronic headaches, and balance problems. Ball, who had a 3.5 grade-point average in high school, was found to have a sixth-grade-level learning capability. In January of last year, the Marine Corps found him unfit for duty but not disabled enough to receive full permanent disability retirement benefits and discharged him. Ball's situation has taken a dire turn for the worse. The tremors that he experienced after the blast are back, he can hardly walk, and he has trouble using a pencil or a fork. Ball's case is being handled by the Department of Veterans Affairs-he receives $337 a month-but while his case is under appeal, he receives no medical care. He works 16-hour shifts at a packing-crate plant near his home in East Wenatchee, Wash., but he has gone into debt to cover his $1,600 monthly mortgage and support his wife and 2-month-old son. "Life is coming down around me," Ball says. Trained to be strong and self-sufficient, Ball now speaks in tones of audible pain. Fred Ball's story is just one of a shocking number of cases where the U.S. military appears to have dispensed low disability ratings to wounded service members with serious injuries and thus avoided paying them full military disabled retirement benefits. While most recent attention has been paid to substandard conditions and outpatient care at Walter Reed Army Medical Center, the first stop for many wounded soldiers stateside, veterans' advocates say that a more grievous problem is an arbitrary and dysfunctional disability ratings process that is short-changing the nation's newest crop of veterans. The trouble has existed for years, but now that the country is at war, tens of thousands of Americans are being caught up in it. Now an extensive investigation by U.S. News and a new Army inspector general's report reveal that the system is beset by ambiguity and riddled with discrepancies. Indeed, Department of Defense data examined by U.S. News and military experts show that the vast majority-nearly 93 percent-of disabled troops are receiving low ratings, and more have been graded similarly in recent years. What's more, ground troops, who suffer the most combat injuries from the ubiquitous roadside bombs, have received the lowest ratings. One counselor who has helped wounded soldiers navigate the process for over a decade believes that as many as half of them may have received ratings that are too low. Ron Smith, deputy general counsel for the Disabled American Veterans, says: "If it is even 10 percent, it is unconscionable." The DAV is chartered by Congress to represent service members as they go through the evaluation process. Its national service officers are based at each rating location, and there is a countrywide network of counselors. Smith says he recently asked the staff to cull those cases that appeared to have been incorrectly rated. Within six hours, he says, they had forwarded him 30 cases. "So far," Smith says, "the review supports the conclusion that a significant number of soldiers are being fairly dramatically underrated by the U.S. Army." Story contines here: Link

Important article on homeless vets below. Please check it out, post it, and pass it on. For more on homeless vets and the story of Herold Noel, please check out the important film When I Came Home. San Francisco Chronicle Sunday, April 15, 2007 Vets are home and homeless After fighting in Iraq, some end up on streets Jonathan Curiel, Chronicle Staff Writer Three years ago, when he returned from Iraq and a stint in the U.S. Army, Herold Noel thought he'd be treated as a hero. Instead, he faced a series of degradations, including learning he was ineligible for public-housing assistance. That's when Noel went back to the red Jeep that had become his home at night. That's when Noel -- fueled by alcohol -- took out a gun. That's when Noel fired the bullet intended to pierce his skull and kill himself instantly. Noel misfired, then passed out. When he woke up, he realized what had happened. "I was fed up with this situation," he says now, speaking on the phone from New York about the housing setbacks, job rejections and other stresses that pushed him to attempt suicide. "I just felt like I'd rather die on my feet than on my knees. This country was putting me on my knees. I said I'd rather die with a little bit of pride, because they stripped me away from all that." Homelessness was a central factor in Noel's desperation, just as it is for many veterans returning to cities and towns all across the United States from the conflicts in Iraq and Afghanistan. On any given night, an estimated 100 to 300 vets who were part of Operation Iraqi Freedom or Operation Enduring Freedom (the government's name for its Afghanistan campaign) live in transient conditions, according to organizations that help homeless ex-GIs. These men and women who once proudly represented the U.S. military now live on the street, in shelters, in their cars, with their friends -- anywhere they can unload their belongings for a night or two or longer. The number may seem low, but homeless advocates worry that these wars will eventually produce tens of thousands of homeless vets, as the Vietnam War did. Brian Dadds, a Navy veteran whose ship monitored missile strikes on Iraq in the war's first months, now bides his time in San Francisco, where he has slept everywhere from Ocean Beach to a city-run homeless shelter. His hair much longer than in his military days, Dadds, 24, says he'll often just "walk around town" before deciding on a place to sleep. Swords to Ploughshares, the San Francisco organization that helps former military personnel who are homeless, has seen more than 20 Iraq War veterans. Vietnam Veterans of California, which has temporary housing sites throughout Northern California, says it has assisted more than 60 veterans of Operation Iraqi Freedom and Operation Enduring Freedom who were in need of permanent housing. Historians often compare the Iraq war to Vietnam in terms of scope, casualties and military aims gone awry, but for homeless advocates, there's a disturbing difference between the conflicts: The Vietnam War, which lasted more than a decade, produced a steady stream of homeless vets in the years after hostilities ended; the Iraq and Afghanistan campaigns, which are less than 6 years old, have resulted in homeless vets while hostilities are still going on. Many of those who join today's volunteer army, like Noel, come from economically depressed backgrounds, say homeless advocates, and when they return home, they face the same financial vulnerabilities they had before, but now they might suffer from post-traumatic stress disorder (Noel has been diagnosed with it) and might rely on alcohol or other drugs to cope with their traumas. They may also be reluctant to admit their problems to the Department of Veterans Affairs or the many nongovernmental organizations that help homeless veterans. "What happens sometimes is that young men and women come home from Iraq and Afghanistan, and they think everything is going to be cool and that life is going to begin again," says Cheryl Beversdorf, president of the National Coalition for Homeless Veterans in Washington. "But then things start occurring, like they begin recognizing symptoms of PTSD or depression or whatever, and some people say, 'I'm not going to the VA -- that's where my dad went.' Or they say, 'There's nothing wrong with me.' Or they don't know about community-based organizations (that help homeless vets)." About 200,000 veterans are homeless in the United States, according to estimates by the Department of Veterans Affairs, with about 80,000 having been in Vietnam. About 2.8 million Americans served in Vietnam. So far 1.5 million U.S. troops have been deployed to Iraq and Afghanistan. Judging by experience, tens of thousands of Americans who went to Iraq and Afghanistan will eventually become homeless -- a number that Veterans Affairs is woefully unprepared for, says Paul Rieckhoff, a former Army lieutenant who fought in Iraq in 2003 and 2004 and now heads a group called Iraq and Afghanistan Veterans of America, which lobbies on behalf of homeless vets. "History is repeating itself," Rieckhoff says. "Systemwide, there's not an adequate plan in place to deal with homelessness. ... It starts with a lack of adequate transitional resources and capacity, but there's also a lack of beds, a lack of outreach, a lack of good data. One of my biggest criticisms of the VA is that they don't have an accurate tracking mechanism. If you ask the secretary of the VA how many people are homeless, he won't be able to tell you adequately. He can't even tell you how many people are dead, because there is no registry. That's one of the legislative initiatives that we've been pushing for -- a Department of Defense registry that tracks everyone from the moment they get home." After the Vietnam War, the Department of Veterans Affairs did establish homeless outreach programs around the country. VA medical centers, such as the one in San Francisco's outer Richmond District, have coordinators who specialize in homeless services. The VA has a national director of homeless programs and a multimillion-dollar budget that, among other things, pays for temporary housing. But the staggering number of Vietnam vets still on the streets 30 years after the war ended reveals the extent of the problem, including the VA's role, say homeless advocates. Upon returning to the United States, veterans must register with a system already backlogged with 400,000 applications for disability benefits, a bottleneck that puts veterans at risk of homelessness, warns Linda Bilmes, a Harvard lecturer in Public Policy who is the author of a paper published in January, "Soldiers Returning from Iraq and Afghanistan: The Long-term Costs of Providing Veterans Medical Care and Disability Benefits." During the long wait for their first disability check -- six months or longer -- "veterans, particularly those in a state of mental distress, are most at risk for serious problems, including suicide, falling into substance abuse, divorce, losing their job, or becoming homeless," Bilmes warns in her report. Noel was one of those vets forced to wait six months for his first disability check. At one point, he stayed in a homeless shelter in the Bronx, where he says someone stole his Iraq War medals and photos. Noel would sometimes sleep on the roof of a building. His nightmares followed him wherever he went. During his seven months in Iraq in 2003 and 2004, Noel delivered fuel for tanks and other military vehicles. His tanker was shelled by militants, and every time he took to Iraq's roadways, Noel feared he would be killed. During his deliveries, he carried an M16 that he fired at people he believed were trying to harm him. In other interviews he's given after his appearance in the 2005 documentary "When I Came Home" (which is about homeless veterans), Noel has implied that he had killed eight Iraqis. He says he witnessed the deaths or dead bodies of many other people. After Iraq, Noel's marriage collapsed in divorce. Two of his three kids lived with another family in New York, while he and one son slept in Noel's SUV, usually parking it on the streets of Brooklyn. "Although he now can afford to rent his own apartment, Noel still has thoughts of suicide. "We came back to a country that won't fight for us," Noel says. "We're still sacrificing." Noel, 27, says homelessness among former service members should spark as much outrage as the conditions at Walter Reed Army Medical Center, where a Washington Post probe prompted a shakeup. The government is trying to do something about vet homelessness, says Peter Dougherty, director of homeless programs for Veterans Affairs. In the past 15 years, as the VA has boosted services to homeless vets, the number of ex-GIs who are homeless has decreased by 50,000, he says. About 300 members of the military who saw duty in Iraq and Afghanistan have stayed in VA-sponsored housing for homeless veterans, Dougherty says. Instead of being a foreboding sign, he says, the number of new veterans seeking shelter is an opportunity for the government to work with veterans in vulnerable positions -- to offer assistance before problems get out of control. "I'm of the theory that the earlier we can intervene, the better off that veteran is going to be," Dougherty says. "Some people always ask me, 'Isn't it tragic that we're seeing these veterans?' Well, it's tragic we're seeing anyone. But I think the best news we have is that the earlier we see them, the more likely it is that they're going to get better, faster, and get on with their lives." During this fiscal year, Washington is spending $210 million on programs directly related to helping homeless veterans, Dougherty says. Next year's budget is scheduled to increase by $77 million. Homeless veterans who enter the doors of the San Francisco VA clinic on Third and Harrison streets have access to showers, storage lockers, and a clean place to sit with other veterans who are trying to right themselves. They can meet with counselors and medical staff, and attend group sessions on ending abuse of alcohol and drugs. Among those who have recently visited the center, according to clinic head Bobbie Rosenthal, are an Iraq vet who lives in a van on a street near AT&T Park and another who lives with his girlfriend "on the edge" of homelessness. The ex-serviceman in the van has overcome a drinking problem, Rosenthal says, while the other man is struggling with the effects of post-traumatic stress disorder. Dadds says he doesn't have a drug or alcohol problem, nor is he struggling with emotional trauma from his time in the Persian Gulf. Though he learned to shoot and was assigned guard duty on his Navy ship, his main task was to work in the vessel's computer room, he says. Since his Navy service ended in July 2003, Dadds -- a native of Maryland who has lived in Florida and San Diego -- has been traveling from city to city, content with living on the street if he can't find a temporary bed to his liking. In San Diego, he slept on the street for four months. At shelters, he has met veterans who fought in the 1991 Persian Gulf War, and in the 1992-94 Somalia operation. Dadds avoids reading or watching news about the war. "The less I see it, the less I hear about it, the less I think about it," Dadds says. Dadds would one day like to "settle down" into a steady job and home, but for now, he's unconcerned about his transient lifestyle, even if it means sleeping on a mat in a strange shelter. Compared with the tens of thousands of people who have died in the Iraq War, Noels, Dadds and other young veterans are fortunate. The reality, though, is that homelessness can be a debilitating experience, and for veterans, nothing they ever expected when they first put on a uniform. #

Generic Drug takes the sting from PTSD nightmares for war veterans Contact: Jeri Rowe, Veterans Affairs Research Jeri.rowe@med.va.gov 206-764-2435 SEATTLE -- A generic drug already used by millions of Americans for high blood pressure and prostate problems has been found to improve sleep and lessen trauma nightmares in veterans with posttraumatic stress disorder (PTSD). "This is the first drug that has been demonstrated effective for PTSD nightmares and sleep disruption," said Murray A. Raskind, MD, executive director of the mental health service at the Veterans Affairs Puget Sound Health Care System and lead author of a study appearing April 15 in Biological Psychiatry. The randomized trial of 40 veterans compared a nightly dose of prazosin (PRAISE-oh-sin) with placebo over eight weeks. Participants continued to take other prescribed medications over the course of the trial... At the end of the study, veterans randomized to prazosin reported significantly improved sleep quality, reduced trauma nightmares, a better overall sense of well being, and an improved ability to function. "These nighttime symptoms are heavily troublesome to veterans," said Raskind, who also is director of VA’s VISN 20 (Veterans Integrated Service Network #20) Mental Illness Research, Education and Clinical Centers program (MIRECC). "If you get the nighttime symptoms under control, veterans feel better all around." Raskind, also a professor of psychiatry and behavioral sciences at the University of Washington, estimates that of the 10 million U.S. veterans and civilians with PTSD, about half have trauma-related nightmares that could be helped with the drug. Participants were given 1 mg of prazosin per day for the first three days. The dose was gradually increased over the first four weeks to a maximum of 15 mg at bedtime. The average dose of prazosin in the trial was 13.3 mg. By comparison, typical prazosin doses for controlling blood pressure or treating prostate problems range from 3 mg to 30 mg per day in divided doses. The drug did not affect blood pressure compared to placebo, though some participants reported transient dizziness when standing from a sitting position during the first weeks of prazosin titration. Other occasional side effects included nasal congestion, headache, and dry mouth, but these were all minor, according to the authors. "This drug has been taken by many people for decades," said Raskind. "If there were serious long-term adverse side effects, it is likely we would know about them by now." The relatively small size of the study was due to the easy availability of this generic drug, Raskind said. "If you are doing a study with a new drug, the only way people can get it is to be in the study. With prazosin, we have approximately 5,000 veterans with a PTSD diagnosis taking it already in the Northwest alone. So we had to find veterans with PTSD who were not [taking it]." For treating PTSD, prazosin costs 10 to 30 cents a day at VA contract prices. It is not a sedating sleeping pill, emphasized Raskind. "It does not induce sleep. But once you are asleep, you sleep longer and better." And better sleep can make a big difference. "This drug changes lives," Raskind said. "Nothing else works like prazosin." Trauma nightmares appear to arise during light sleep or disruption in REM sleep, whereas normal dreams—both pleasant and unpleasant— occur during normal REM sleep. Prazosin works by blocking the brain’s response to the adrenaline-like neurotransmitter norepinephrine. Blocking norepinephrine normalizes and increases REM sleep. In this study, veterans taking prazosin reported that they resumed normal dreaming. One dose of prazosin works for 6 to 8 hours. Unlike similar drugs, prazosin does not induce tolerance; people can take it for years without increasing the dose. But when veterans stop taking it, Raskind said, the trauma nightmares usually return. Aside from the VA-funded study he just published, Raskind is working on three larger studies of prazosin. One, a VA cooperative study slated to start this month, will enroll about 300 veterans at 12 VA facilities. The second, a collaborative study with Walter Reed Army Medical Center and Madigan Army Medical Center, will enroll active-duty soldiers who have trauma nightmares. The third study, funded by the National Institute of Mental Health, will look at prazosin in the treatment of civilian trauma PTSD.

Brain injuries plague soldiers by Cary Leider Vogrin In what may be the largest study of its kind by a military installation, Fort Carson has found that 178 of every 1,000 soldiers returning to the post from the Middle East suffered from at least a mild form of traumatic brain injury. “As it turns out, TBI may very well be the signature injury of this war,” Col. John Cho said Tuesday while announcing the results of a 22-month study that included 13,440 soldiers. The post began screening soldiers for traumatic brain injuries in June 2005. In all, 2,392 of the soldiers analyzed received a TBI diagnosis. The injuries being seen among Fort Carson soldiers are overwhelmingly caused by explosions, said Cho, who commands Evans Army Community Hospital on post... While shock waves from ex- plosions are the leading cause of the injuries, TBI also can be caused by penetrating wounds from bullets or shrapnel. Symptoms associated with mild TBI include headaches, memory loss, irritability, difficulty sleeping and balance problems. “We don’t have a cure for the common cold, but we do treat the symptoms,” Cho said, referring to treatment protocols such as prescribing low doses of Celexa for irritability. The post also is focusing on “mind therapy” — encouraging soldiers to engage in card games, board games, crosswords and other activities to stimulate the brain. And the earlier the better; studies have shown outcomes improve with early treatment. In addition to a TBI questionnaire given to each soldier as he or she returns to Fort Carson, soldiers with potential injuries are being assessed on the battlefield, he said. Evaluations include a series of questions about potential TBI-inducing incidents as well as exercises meant to test memory and concentration, such as having the soldier repeat specific words. Cho said much remains to be learned about TBI and, like post-traumatic stress disorder, there is no “identifying marker” for an easy diagnosis. “We have an obligation to determine what the long-term effects are of TBI,” he said. “No one has that answer, but you have to start somewhere.” Fort Carson will be submitting its study results to a leading medical journal for review and possible publication, said Col. Heidi Terrio, chief of deployment health at Evans. In many instances in the post’s sample group, symptoms of TBI did not occur until months after a soldier’s return, and in others, symptoms resolved themselves even before a soldier got home. The post relies on a second screening 90 to 120 days after homecoming and on input from family members and the chain of command. “It’s important to screen more than once,” Cho said. “Symptoms can present themselves at different points in time. And you might ask why. I can only surmise that when a soldier returns to the United States and is subjected to the activities of daily living — traffic, making formation . . . perhaps the stressors then bring some of these symptoms to light. The good news in all of this is we have the mechanism to catch this.” Capt. Matthew Staton, 30, noticed he was having symptoms of TBI after returning home from a 2003-04 deployment during which he was exposed to multiple blasts. “It’s like getting your bell rung,” he said of the explosions. His short-term memory is affected, and he relies on a digital voice recorder and palmtop computer to remember things. He also is quick to anger. Staton attends weekly rehabilitation sessions at Memorial Hospital and will be medically discharged from the Army. He said the injury has been stressful not just for him, but his wife, too. Another Army wife, Shelia Scott, said she knows what he’s talking about. Her husband, Sgt. Leroy Scott, was in Iraq. Scott, an Army medic, had been in Iraq for four months when his vehicle was ripped open by a roadside bomb in July 2005. A skull fracture and bleeding on the brain were just two of many injuries. Scott’s right leg was amputated below the knee and he also had several bone fractures and a collapsed lung. The TBI — the injury that’s the least apparent — has been one of the most difficult to deal with, Shelia Scott said. She said her husband is easily angered and has difficulty concentrating and sleeping. He’ll dwell on little things — the dishes not being done or the sidewalk not shoveled as the snow falls, she said. “We don’t know when he’ll snap,” she said. “It’s hard on a family. “When he does not sleep, I don’t sleep. He will keep me up — turning lights on, turning the TV on.” Scott and his wife recently separated. “The boys seem a lot happier because they don’t have to walk on eggshells,” she said of the couple’s three children. Still, she said she checks on her husband daily, stopping by their home in Falcon. She also advocates for his health care as he transitions out of the Army. “I worry,” she said of her husband of 12 years. “You can find people who can do great, skiing and swimming and just a wonderful story. But there’s a lot of people who are suffering. The wives are suffering, the kids are suffering. Life’s not ever going to be the same.”

By Julian E. Barnes, Times Staff Writer April 12, 2007 Graphic WASHINGTON — The Pentagon ordered 90-day extensions Wednesday for all active-duty Army troops in Iraq and Afghanistan, stretching their overseas tours from 12 to 15 months in a move that will exert new strain on a struggling military but allow the Bush administration to continue its troop buildup in Baghdad well into next year. Defense Secretary Robert M. Gates' announcement came amid expectations that the Pentagon was about to order longer tours for some units, but the new policy is a far more sweeping and drastic step, stretching deployments for more than 100,000 members of the Army. "I realize this decision will ask a lot of our Army troops and their families," Gates said, adding that it would ensure that the administration would not be forced to withdraw forces before it was ready. "This approach also upholds our commitment to decide when to begin any drawdown of U.S. forces in Iraq solely based on conditions on the ground." The extension order also came at a crucial time in the war and the political debate surrounding it as congressional Democrats push for troop withdrawals. It marked the second time in four months that the administration has responded to pressure for withdrawals by taking a dramatic step to expand U.S. involvement in Iraq. The bipartisan Iraq Study Group in December recommended troop withdrawals, just weeks before President Bush announced the current buildup. Gates said the extensions were not a signal that he had decided to stretch out the troop buildup. But military experts said that by extending all of the active-duty brigades, the administration would be able to continue the increase into 2008. "It was always envisioned that the only way you could do it [the troop increase] was to extend tours of duty; that was known right from the outset," said Jack Keane, a retired Army general and one of the architects of the current strategy, who recommended across-the-board extensions in December. The announcement also demonstrated how the partnership between Gates and the new top commander in Iraq, Army Gen. David H. Petraeus, differed from the team that preceded it. Under former Defense Secretary Donald H. Rumsfeld, known for his preference for small numbers of ground forces, commanders were reluctant to demand more troops. But Petraeus has made it plain that he will ask for more troops if needed. So far, Gates has granted those requests. "The good news here is we have a commander in Iraq who is saying what he needs," said William Nash, a retired Army major general now at the Council on Foreign Relations. Gates addressed a hastily convened news conference at the Pentagon as details of the extensions were given to unit commanders. Normally, units would be told of new orders 48 hours before any public announcement, but Gates moved up the announcement after news leaks revealed the likelihood of extensions. Gates, angered by the leaks, said they caused "hardship not only for our service men and women, but their families, by letting them read about something like this in the newspapers." Gates' decision will immediately affect about 79,000 soldiers in Iraq, 18,000 in Afghanistan and 7,000 in Kuwait, according to Army officials. The first combat units to be affected in Iraq will be those that were due to come home this summer. The extensions do not affect the Marine Corps, whose members currently serve for seven months in Iraq before returning home for six months, or the National Guard. The Minnesota National Guard's yearlong tour was extended in January, when Bush announced the troop increase. But Pentagon officials since have promised they would mobilize Guard troops for only one year at a time, including training, which means their Iraq tours will probably be about 10 months. Nash is among experts who see a likely connection between the extensions and the flexibility to continue the troop buildup. "The fact is we are going to keep doing what we are doing," Nash said. "Absolutely, it will go into next year. That is why they went to 15 months." He added: "To sustain the surge, they have to keep folks longer so you build up higher troop levels. This is a 'plus up' of the surge, in my view." The extensions also may signal that the administration believes that the initial buildup of forces is having a positive effect in Baghdad and in Al Anbar province, said Andrew F. Krepinevich Jr., a former Army major and an expert on counterinsurgency strategy who heads the Center for Strategic and Budgetary Assessments. "We are reinforcing success; some things are breaking right for us," he said. "Maybe Secretary Gates wants to generate real success so Congress will get off his back." But Krepinevich also added that the performance of Iraqi units continued to disappoint American military leaders. The extensions make it clear that the extra U.S. forces will need to take more of a leading role in operations for some months, he said. The extensions allow the Army to continue the flow of forces into Iraq to sustain the troop increase without decreasing the training period at home — what the military calls dwell time — between deployments. Military experts have expressed concern over shrinking training time, saying it increased the risk of units being unprepared for complicated counterinsurgency combat. While difficult for families of soldiers, the extensions are likely to mean that a more experienced group of soldiers is working the streets. "The longer you spend with the people, the relationships you have with them, it all adds to the potential success of the operations. The more change you have, the tougher it is to build continuity," Keane said. But Paul Rieckhoff, founder of Iraq and Afghanistan Veterans of America, said there is little evidence that the lack of progress is due to short tours. "Put yourself in the boots of those troops," Rieckhoff said. "Fifteen months is a long time to be away from your spouse and children. This decision is undoubtedly going to have a negative impact on retention … and the Army's already strained recruiting." Toni Johnson, 24, thought she was prepared for life as a military wife when she married her high school sweetheart, Jeff, an Army mechanic based at Ft. Hood, Texas. But an extended war, and now news of a 15-month deployment, are testing her patience, she said. "That's three extra months without my husband, three extra months of our kids missing their father," said Johnson, a Republican who voted for Bush. "It will definitely be a hardship." The couple have three children, ages 3, 4 and 9. "It's hardest on the younger ones because they don't understand why Daddy is gone," Johnson said. "I underestimated how hard it is to be a military wife." Krepinevich, who once was extended for a month while serving in Korea, said there was no denying the deep effect the extensions would have on soldiers. "The months start to seem like years after a while," Krepinevich said. "On the other hand, this is what war is about. It is about ever-changing circumstances, it is about military leaders making tough choices, it's about taking calculated risks. And that is what is going on here." As the Pentagon was announcing the extensions Wednesday, the White House said it was weighing the appointment of a new "high-profile" official to coordinate the assignment of personnel from the national security agencies to the wars in Iraq and Afghanistan. "One of the considerations is to place someone of … a slightly higher profile that can help cut through bureaucracy and make sure that these policies are being implemented to their best possible ability," said Dana Perino, a White House spokeswoman. She said no one had been offered the job so far. A former senior defense official confirmed a report Wednesday in the Washington Post that Keane, retired Marine Gen. John J. Sheehan and retired Air Force Gen. Joseph W. Ralston had been approached about the job. The former official said the White House proposal was not intended to usurp the authority of the Defense Department to run the war. The extension order seemed likely to sharpen tensions between war critics in Congress and the Bush administration. The two are headed toward a showdown over the next war-funding bill as Democrats in the House and Senate push for a timetable for troop withdrawals and Bush demands a measure with no strings attached. Sen. John Kyl (R-Ariz.), a member of the Senate Republican leadership team, sought to cast the troop extension as a warning to congressional Democrats who are battling with the president over the war supplemental funding bill. Critics of the war said the announcement outlined the problems with the administration's current strategy. House Speaker Nancy Pelosi (D-San Francisco) said the extensions were an "unacceptable price" for troops to have to pay. "Today's announcement just underscores the fact that the burden of the war in Iraq has fallen upon our troops and their families," Pelosi said in a statement. "The Bush administration has failed to create a plan to fully equip and train our troops, bring them home safely and soon, and provide our veterans with the quality care they deserve." Sen. Carl Levin (D-Mich.), chairman of Senate Armed Services Committee, said the mass extensions were the inevitable consequences of the Bush administration's missteps in Iraq. "Once again, the failures of this administration are being underwritten by our troops," Levin said. "The cost of this will fall on the backs of the brave men and women already serving in harm's way, and their families."

U.S. Army prosecutions of desertion and other unauthorized absences have risen sharply in the past four years by Paul Von Zielbauer U.S. Army prosecutions of desertion and other unauthorized absences have risen sharply in the past four years, resulting in thousands more negative discharges and prison time for junior soldiers and combat-tested veterans of the wars in Iraq and Afghanistan, military records show. The increased prosecutions are meant, in effect, to serve as a deterrent to a growing number of soldiers who might be looking for a way to avoid heading - or heading back - to Iraq, several U.S. Army lawyers said during interviews. The use of courts-martial for these violations, which before 2002 were treated mostly as unpunished nuisances, is a sign that active-duty forces are being stretched to their limits, said military lawyers and mental health experts. "They are scraping to get people to go back, and people are worn out," said Thomas Grieger, a senior Navy psychiatrist... Though there are no current studies to show how combat stress affects desertion rates, Grieger, cited several examples of soldiers absconding or refusing to return to Iraq because of psychiatric reasons brought on by wartime deployments. At an army base in Alaska last year, for example, "there was one guy who literally chopped off his trigger finger with an axe to prevent his deployment," Grieger said. The increase in prosecutions comes even though the rate of desertions is lower than it has been at many points in recent years, even during the Vietnam conflict. From 2002 through 2006, the average annual rate of army prosecutions of desertion tripled compared with the five-year period from 1997 to 2001, to roughly 6 percent of yearly deserters from 2 percent, army data show. Between these two five-year spans prosecutions for similar crimes, like absence without leave or failure to appear for unit missions, have more than doubled, to an average of 390 per year from an average of 180 per year, army data show. Since 2002, the army has court-martialed twice as many soldiers for desertion and other unauthorized absences than it did on average each year between 1997 and 2001. Deserters are soldiers who leave a post or fail to show up for an assignment with the intent to stay away. Soldiers considered absent without leave - or AWOL, which a presumes that they plan to return - are classified as deserters and dropped from a unit's rolls after being absent 30 days. Most soldiers who return from unauthorized absences are punished and discharged. Few return to regular duty. Officers said the crackdown reflected an awareness by top U.S. Army and Defense Department officials that desertions, which exceeded one percent of the active duty force in 2000 for the first time since the post-Vietnam era, are in a sustained upswing again after ebbing in 2003, the first year of the Iraq war. At the same time, the increase in desertions and other illegal absences, starting in 2002, highlights a cycle long known to army researchers: as the demand for soldiers increases during a war, desertions rise and the U.S. Army tends to lower enlistment standards, recruiting more people who are, statistics show, far more likely to become deserters. In the financial year 2006, 3,196 soldiers deserted, the U.S. Army said, a figure that has been climbing since financial 2004, when 2,357 soldiers absconded. In the first quarter of the current financial year, 871 soldiers deserted, a rate that, if it remained on pace, would produce 3,484 desertions, an 8 percent increase over financial 2006. The army said that the desertion rate was within historical norms, and that the surge in prosecutions, which were at the discretion of unit commanders, was not a surprise given the profound impact that absent soldiers can have during wartime. "The nation is at war and the army treats the offense of desertion more seriously," Major Anne Edgecomb, a U.S. Army spokeswoman, said. "The army's leadership will take what ever measures they believe are appropriate if they see a continued upward trend in desertion, in order to maintain the health of the force." Army studies and interviews also suggest a link between the rising rate of desertions and its expanding use of moral waivers to recruit people with poor academic records and low-level criminal convictions. At least 1 in 10 deserters surveyed after returning to the army between 2002 to mid-2004 had required a waiver to enter the service, a 2004 report by the Army Research Institute found. "We're enlisting more dropouts, people with more law violations, lower test scores, more moral issues," said a senior noncommissioned officer involved in U.S. Army personnel and recruiting. "We're really scraping the bottom of the barrel trying to get people to join." Most deserters list dissatisfaction with army life or family problems as primary reasons for their absence, and most go AWOL in the United States. But since 2003, 109 soldiers have been convicted of going AWOL or deserting war zones in Iraq or Afghanistan, usually during their scheduled two-week leaves in the United States, army officials said. Desertions, while a chronic problem for the army, are nowhere near as common as they were at the height of the Vietnam War a generation ago. Between 1968 and 1971, for instance, about 5 percent of enlisted men deserted.

Service-connected disabilities - File Early ! Posted By Doug Nelson at 5:17 AM So far, We've talked about Post-traumtic Stress Disorder as a service connected disability. Actually, you have the right to file a claim for health problems and injuries incurred in military service, or, if pre-existing, were aggravated by military service. Why file a claim? You may be paid compensation for the degree to which the disability affects your ability to earn a living. If severe enough, you may get Vocational Rehabilitation, a better education deal. You may file VA Form 21-526e as you leave the service, IF you can be sure that your service medical records will be sent in to the VA Regional Office in your state of residence along with this form. If you are already out, get VA Form 21-526 from www.VA.gov and start working on it. Keep a copy of Copy 4 of your DD214 to send in with it. Get to a local veterans services rep, or a trusted member of a veterans services organization for help with the particulars of doing this. What are some examples of disabilities? Injuries, not limited to combat wounds. Some real-life examples include: A soldier loaded with combat gear jumped from an armored carrier. His boot heel caught on something, twisting his back on the way down. Many are injured in vehicle crashes in the military. Broken bones, injuries to internal organs, head and neck injuries can all be claimed. Another real life case - a knee injury in a military-sanctioned sports event. This happened to the guy in the 70's, and now he has developed arthritis in the knee. Actually, injuries in grab-ass games aren't excluded, just be sure it wasn't due to misconduct. Illnesses that are likely to resurface, such as high blood pressure, or chronic bronchitis should be claimed. If its been a while, you'll need to show medical evidence that the problem is chronic - that it has been hanging around. Hearing loss, the sooner you claim it the the better. You want the VA to give you an audiology test within a year of your discharge. These claims carry a greater credibility if you were in combat, suffered an IED incident (even if you were not hurt otherwise) were exposed to naval or ground artillery, mortars, or were exposed to high-frequency jet engine noise. Be able to document the illness or injury with times and places, and the dispensary or hospital that treated you. If you kept any of your own medical records, send copies, or send the originals after you've made your own set of copies. Be sure to tell where and when you got any treatment since military service. Here's the reason I emphasize making your claim within the year - the date of your claim, and so the date the VA will start paying you compensation, will be the date after you left the military. In some cases, such as hearing loss, and PTSD, the test or treatment that will document the existence of the problem will be the only evidence you have that it existed in the military. Treatment and disagnosis within a year work in your favor. The VA will presume the problem was incurred during your service.

Saturday, April 7, 2007 Our Returning Iraq War Veterans by D Mann Many wounded returning Iraq War Veterans are not being advised well about filing their VA claims for benefits. Most of the time, the only assistance the veteran receives is one printed sheet that they get during the discharge process that tells them to get on the VA website and to file their claim electronically. If an Iraq veteran has been wounded with a permanently disabling injury, the veteran needs to file a claim. Unfortunately, returning vets with PTSD (post traumatic stress syndrome) are often mentally unable to complete the forms needed to file a claim. Their stress levels leave them unable to concentrate on the task of completing the forms, gathering documents needed, and stating the cause of their PTSD. Simply writing down the events frequently leaves them so stressed and anxious that they are unable to function on a daily basis. Ironically, these veterans need help with their PTSD as soon as possible. Vietnam veterans fought the VA to be acknowledged as disabled with PTSD. PTSD is nothing new. In wars past, it was called “shell-shock” (World War I) and “combat fatigue” or a “nervous condition” (World War II). Gulf War veterans, too, have “undiagnosed” problems with aches and pains and odd symptoms that doctors are unable to put their finger on to treat. These veterans, too, need to file VA claims. Their problems are caused by exposure to harmful chemicals and gases that were used by both sides fighting in the Gulf. Returning Iraq War veterans that have permanent injuries, burns, scars or other problems from combat are advised to file VA claims. Scars, especially on the face, are considered “disfiguring” and are worthy of a disability rating by the VA. Even if a disability is rated at zero-percent disabling by the VA, it is important for these young veterans to have the disability acknowledged by the VA. As a person ages, disabilities that seem very tolerable at 25 years of age become arthritic and painful to a person at 50 years of age. The disability can be re-rated at a later date and it is much easier to have a disability re-rated at a higher rating than to try to establish the disabilty 30 years after discharge. Deborah Mann and her husband, Richard, have helped many veterans with their disability claims for over ten years. The Manns have helped veterans get claims as far back as 1955 and are masters at dealing with the Veterans Administration. Article Source: http://EzineArticles.com/?expert=D_Mannhttp://EzineArticles.com/?Our-Returning-I raq-War-Veterans&id=507282 In accordance with Title 17 U.S.C. Section 107, this material is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes. Reference: http://www.law.cornell.edu/uscode/17/107.shtml [Non-text portions of this message have been removed]