June 5 VA E-Mail Scandal Update: Top VA Mental Health Official Contradicts VA Manager at Senate Hearing, Says VA Facility is Using Improper Diagnoses for Mental Health

Posted on June 5, 2008 by Team VCS

June 4, 2008, Washington, DC – Today, U.S. Senator Patty Murray (D-WA) questioned top Department of Veterans Affairs (VA) officials over a recent e-mail that discouraged VA employees from diagnosing veterans with Post Traumatic Stress Disorder (PTSD). The e-mail, which was written by VA manager Dr. Norma Perez, directed VA staff at a facility in Temple, Texas to diagnose “compensation-seeking veterans” with adjustment disorder, a diagnosis that has a lower disability payout than Post Traumatic Stress Disorder (PTSD). Dr. Perez appeared at the Senate Veterans Affairs Committee hearing and was joined by Dr. Ira Katz, the VA’s top mental health official.

During questioning, Dr. Ira Katz said that he did not agree with diagnosing veterans with adjustment disorder in the way that Dr. Perez described – often more than a year after a veteran had returned home. Diagnostic guidelines for adjustment disorder say that it should not be diagnosed more than six months after the traumatic event.

“Unfortunately, today’s hearing raises more questions than it answered,” Murray said after the hearing. “Instead of getting to the bottom of this damaging e-mail, we learned that there may be deeper, systematic problems with how facilities are diagnosing mental health disorders.”

“When the head of the VA’s mental health program says that veterans are being misdiagnosed at any facility, it should raise flags for the whole VA system. Is this isolated or are our vets getting the wrong diagnosis, treatment and care across the country? This is a problem and we need honest answers immediately.”

The VA Committee is awaiting an Inspector General’s Report investigating diagnosing practices.

“About the adjustment disorder diagnoses, my read is actually close to yours,” Katz told Senator Murray during the hearing. “And I would disagree with my colleague about the diagnoses of an adjustment disorder a year after an event, relating it to that event.”

Senator Murray is a senior member of the Veterans Affairs Committee. The witnesses at today’s hearing included Norma J. Perez, PhD, Mental Health Integration Specialist, Austin Outpatient Clinic, and former Coordinator, PTSD Clinical Team, Temple, Texas VA Medical Center, Michael Kussman, MD, Under Secretary for Health, Department of Veterans Affairs, Ira Katz, MD, Deputy Chief of Patient Care Services, Officer for Mental Health, Patrick W. Dunne, Acting Under Secretary for Benefits, Department of Veterans Affairs, and Brad Mayes, Director of Compensation and Pension Service.

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Military Kids Tell How Tough Deployments Can Be

Posted on June 5, 2008 by Team VCS

June 3, 2008 – Emi Geye likely knows at least as much about how combat deployments affect soldiers’ children as the psychiatrists, school counselors and pediatricians who filled the room around her Monday.
Her Army dad has been deployed three times since 2002 – twice for 15 months, and once for 12 – and he just left their DuPont home Monday morning for another three-week assignment in Iraq.

So the experts who gathered at McChord Air Force Base for a three-day summit on behavioral health issues for military children and teens hung on the 16-year-old’s every word.

When a parent is sent off to war, Emi said, the remaining parent and the kids need separate places to go when they’re driving each other crazy.

“And afterwards, there has to be a mandatory rehabilitation cycle,” she said.

“Deployment is a handicap that needs to be rehabilitated. An appendage of your family has been lost, and now you have to figure out how to work with it again,” she said.

Just the kind of “concrete, specific, actionable items” that Col. Elspeth Ritchie, the Army’s top psychiatrist, said she and the service’s medical leadership are looking for out of the McChord summit. About 150 people from across the Army and other services as well as academics and civilian counselors and school officials are attending.

In the last year, the American Psychological Association, the American Academy of Pediatrics, the Department of Defense Task Force on Mental Health and others have all called for increased attention to the behavioral health needs of military children.

“I think we all know that this is such an important subject,” Ritchie said. “We need to really move out on it and stick to it.”

This week’s meetings, sponsored by Madigan Army Medical Center, follow a statewide conference last November aimed at increasing public awareness of military children’s issues.

The audience this week is much more specific: Ritchie said Army leaders want the summit to draw from practices at installations around the country to come up with plans for a comprehensive, service-wide behavioral health program for children.

Madigan will play a leading part in developing that program. Officials said Monday that the Army surgeon general approved the Fort Lewis hospital’s request for $2.5 million over the next 18 months to set up a “military child and adolescent center of excellence.”

Maj. Keith Lemmon, a Madigan pediatrician, said the center can pull together prevention and treatment programs, with a focus on children whose parents are deployed.

On Monday, experts said there are several good prevention programs in place across the military – in schools, in the family readiness groups and in other settings – that teach kids what to expect during deployments, and some skills for dealing with their problems.

They said more research is needed on the effects on families dealing with multiple deployments, and on the effects that soldiers’ war-related stress and injuries have on families.

Ritchie said the Army is looking for programs that can be standardized across the service to intervene when kids have more serious problems.

She said the service also needs to press the Army’s health insurance system, TRICARE, to increase its reimbursement rates for mental health care providers. There are complaints that low rates make it difficult to accept many military family members as patients.

One idea that got support from military children Monday was pushing pediatricians to ask more about whether their patients were experiencing a deployment, and how that was going for them.

It’s an approach that Army doctors have used in dealing with post-traumatic stress disorder and mild traumatic brain injury. Soldiers’ primary care doctors are being trained to ask their patients about their experiences, rather than leaving that to mental health specialists.

Geye and three other military children who talked to the group Monday – brothers Matthew and William Rambin, ages 13 and 11, and Brittani Moser, 18 – said their pediatricians didn’t ask if they had a parent deployed.

All said they think being a child with a military parent has placed special demands on them: to grow up quicker and to learn to adapt to changing situations and to make new friends.

“You are bigger than what you are up against, you are bigger than what you are going through, because you have to be,” Geye said. “There’s no other choice. …You have to be strong at home because there is no other option. We have to keep going.”

Lemmon noted that two of the four youths on Monday’s panel planned to pursue careers in the Army, while the others said they wanted to become a dentist and a chef.

“This is what our military culture breeds, future leaders and people dedicated to serving others,” Lemmon said. “We can’t afford to get this wrong. We’ve got to take care of our military children and adolescents.”

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Editorial Column: Outrageous VA E-mails

Posted on June 5, 2008 by Team VCS

June 4, 2008 – Many of our combat troops have served multiple and extended tours of duty in Iraq and Afghanistan, where terrorists and enemy insurgents are relentlessly bent on killing and maiming them.

Naturally, because they are human, the experience changes many of these troops. Memories of gunfire, bloodshed and destruction are not easily repressed upon return to civilian life. They can haunt a veteran, causing him to have nightmares, to be easily angered, to distrust even his family and friends, to reject relationships, to have trouble holding a job, and to start drinking heavily or taking illegal drugs.

There is a name for this: PTSD, or post-traumatic stress disorder. It has been associated with combat veterans for decades. Just last week the Associated Press reported that 40,000 troops have been diagnosed with PTSD since 2003.

The country has a moral obligation to veterans diagnosed with this condition, and fulfilling that obligation is the job of the federal Veterans Affairs Department, regardless of cost.

This is why the Senate Committee on Veterans Affairs is holding a hearing this morning to inquire whether this obligation is being fully met.

Testifying before the committee will be Norma J. Perez, the former PTSD coordinator at the Veterans Affairs hospital in Temple, Texas. On March 20 she sent this e-mail to mental health professionals whom she supervised: “Given that we are having more and more compensation-seeking veterans, I’d like to suggest you refrain from giving a diagnosis of PTSD straight out.” As an alternative, she suggested that veterans be tagged with “adjustment disorder,” a less intense condition that disqualifies veterans from receiving PTSD disability benefits.

She also wrote that “we really don’t have time to do the extensive testing that should be done to determine PTSD.”

Just months ago, internal e-mails written by the VA’s top mental health official were also leaked, showing that suicides among veterans were being downplayed in public statements.

The Senate VA committee should determine whether these e-mails reflect the opinions of individual staffers — or Bush administration policy.

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A Critical Mass for Disarmament

Posted on June 5, 2008 by Team VCS

Speaking to the Los Angeles World Affairs Council on March 26, Sen. John McCain surprised many listeners when he said that “the United States should lead a global effort at nuclear disarmament.”

It has been a long time since a Republican candidate for president said anything close to this, let alone seemed to think it would help him win election. But McCain senses what many may have not: This is a rare moment in national and international politics, a period of rapid change that promises a transformation in global nuclear policy.

This transformation is the result of four converging factors. The first is the deep and ongoing concern about existing nuclear threats. These threats include the possibility that a terrorist group might get hold of a nuclear weapon; the fact that there are still 26,000 existing nuclear weapons held by nine nations today; the efforts of a few countries — most prominently Iran and North Korea — to develop their own nuclear weapons for the first time; and the possible collapse of the Nuclear Nonproliferation Treaty regime triggering a cascade of proliferation.

The second factor is the widespread sense, among policymakers and the public, that existing U.S. policies have failed to lessen these dangers. President Bush sought to maintain U.S. supremacy through a reduced but still large nuclear arsenal, new nuclear weapons (like his “nuclear bunker buster” or the artfully dubbed “reliable replacement warhead”), rejection of treaties limiting U.S. freedom of action and preemptive military action against hostile states. But nuclear threats only increased as confidence in American leadership decreased.

Third (and in response to this policy collapse), there is a new drive for the complete elimination of nuclear weapons. This once utopian dream (held a few decades ago only by those on the left of the foreign policy mainstream) is now the focus of a bipartisan appeal from Republicans George Shultz and Henry Kissinger and Democrats William Perry and Sam Nunn in two Wall Street Journal Op-Ed articles for “A World Free of Nuclear Weapons.” They are not alone. The foundation I lead funds dozens of institutes working on plans for sweeping change in nuclear policy, including the Council on Foreign Relations, the Monterey Institute for International Studies and the Physicians for Social Responsibility.

Finally — and this is what may make it all come together at last — there is a nearly simultaneous leadership turnover in most of the world’s major nations, creating openings for new leaders less rigidly wed to the failed policies of the past. By early 2009, four of the five permanent members of the U.N. Security Council, seven members of the G-8 and a number of other major states will have installed new executives. Among them: Australia, France, Germany, Italy, Japan, Russia, Pakistan, South Korea, Britain, the United States and possibly Israel and Iran.

Together, these factors offer an extraordinary opportunity to advance new policies that can dramatically reduce and even eliminate many of the dangers that have kept political leaders and security officials worried about a nuclear 9/11.

How extraordinary? Consider this: The drive to reduce and eliminate nuclear weapons comes from the very center of America’s security elite. The conservative Hoover Institution at Stanford University, where Shultz and Perry are both scholars, is the epicenter of this nuclear policy earthquake. Of the 24 former national security advisors and secretaries of State and Defense who are still living, 17 have endorsed the Hoover campaign for a series of practical steps leading toward nuclear abolition.

They favor deep reductions in our and others’ nuclear arsenals, as well as a complete ban on nuclear tests and on the production of bomb materials. They’ve also called for the rapid securing of all bomb materials to prevent nuclear terrorism and taking U.S. and Russian missiles off hair-trigger alert so a president has more than 15 minutes to decide if he should initiate Armageddon.

These former officials — including former Republican Cabinet members from every administration going back to President Nixon — recognize that the current strategy has not worked.

The clearest failure is the Iraq war. The war was the prototype for what the Bush administration hoped would be ongoing U.S. policy: the use of military means to stop proliferation preemptively. Bush said on its eve, “Facing clear evidence of peril, we cannot wait for the final proof — the smoking gun that could come in the form of a mushroom cloud.”

But there was no Iraqi nuclear weapons program — and there were no chemical or biological weapons either — and the war, in the end, actually provoked Iran and North Korea to accelerate their programs. Both have made more progress in the last five years than in the previous 10.

The idea that we and our allies could keep our nuclear weapons and simultaneously prevent others from getting them also proved bankrupt. While opposing, correctly, nuclear efforts in Iran, the Bush administration blessed, incorrectly, the nuclear weapons program in nearby India with a special trade deal and looked the other way while Pakistan continued work on its bomb program and nuclear trade until it was too obvious to ignore.

Indeed, the most dangerous country in the world today is not our adversary Iran, which is still five to 10 years from a nuclear capability, but our ally Pakistan. Its unstable government, growing mountain of nuclear weapon material and tolerance of Al Qaeda bases within its territory give Osama bin Laden the best chance he has ever had of acquiring the nuclear weapon he seeks.

This is one reason realists like Kissinger have concluded that we must turn “the goal of a world without nuclear weapons into a practical enterprise among nations.” This policy is in tune with the American people, with 70{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} favoring nuclear elimination in polls. McCain has now adopted some of the new policies; Sen. Barack Obama has embraced the entire plan, including his pledge to secure all loose nuclear materials — thus preventing nuclear terrorism — in his first term.

We cannot know for certain if these plans will work. But we do know these policy moments do not last long. As quickly as they open, they close. The next two to three years will tell if the leaders we elect will have the wisdom and courage to make the change they promise and the people desire. We may not get another chance.

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ACLU At Guantánamo For Arraignment Of Khalid Sheikh Mohammed Today

Posted on June 5, 2008 by Team VCS

June 5, 2008, Guantanamo Bay, Cuba – As part of a $15 million commitment to provide adequate legal defense for several Guantánamo detainees, attorneys from the American Civil Liberties Union are present for the arraignment today of Khalid Sheikh Mohammed on terrorism-related charges before the Bush administration’s military commissions. Earlier this week, attorneys David Nevin and Scott McKay met for several hours with Mohammed as part of the John Adams Project, a partnership between the ACLU and the National Association of Criminal Defense Lawyers (NACDL) to supplement the under-resourced military defense teams that have been assigned to the detainees.

“At every step of the way, these commissions have denigrated our country’s historic commitment to the principle of due process and compromised America’s reputation in the eyes of the world,” said ACLU Executive Director Anthony D. Romero, who is in Guantánamo for today’s arraignment of Mohammed and four other detainees. “The time has come to scrap this illegitimate system and make a fresh start by moving these cases to federal criminal courts or traditional military courts where constitutional guarantees still apply.”

The military commissions allow convictions based on secret evidence, hearsay, and evidence derived from torture – including waterboarding, a technique the government has acknowledged it used on Mohammed.

“The prosecution of Khalid Sheikh Mohammed will undoubtedly raise the issues of torture, hearsay and secret evidence,” said Nevin. “If the government’s evidence is as strong as it claims, you have to wonder why it lacks the confidence to prove its case in a real court with constitutional protections.”

The proceedings have also been subject to unlawful political influence and are now being rushed through to sway public opinion before the November elections.

“The government has had over six years to build its case and is giving the defense just three short months to prepare for trial – all in an effort to steamroll the process to meet an arbitrary court date clearly designed to influence the elections,” added Romero. “This is a direct assault on the fundamental concepts of American justice and due process.”

The government has scheduled a September 15 trial date for Mohammed and the other four detainees.

“This case is a critical test of the deeply flawed military commission system,” said McKay. “These prosecutions must reflect core American principles of justice and fairness. We can’t just throw out our constitutional values and decide to adhere to the rule of law depending on who is being prosecuted and what the alleged crimes are. That subverts the entire notion of justice.”

Supporters of the ACLU’s efforts include families of 9/11 victims.

“Like others who mourn family members killed on 9/11, I wish for justice and accountability for my son. But secretive proceedings tainted by the use of torture are outside the system of justice on which the honor of this nation depends,” said Patricia Perry, mother of NYPD Officer John William Perry.

“I lost someone I dearly loved on September 11, and have waited too long to see those responsible brought to justice. But these special military tribunals that are stained by politics and deny detainees the basic American principle of due process smack of revenge rather than justice, and mock our legal system and those we lost,” said Valerie Lucznikowski, who lost her nephew, Adam Arias, on 9/11. 

ACLU staff attorney Hina Shamsi is also in Guantánamo this week observing the military commission hearing of Saudi national Ahmed Mohammed Al Darbi, who has been held in U.S. custody for nearly six years. Al Darbi has been charged with conspiracy and providing material support for terrorism based on alleged connections to al-Qaeda. The ACLU has attended every military commission proceeding since the system’s inception in 2004.

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June 6, VCS in the News: Judge Orders VA into Court to Explain VA E-Mail Discouraging PTSD Diagnoses

Posted on June 5, 2008 by Team VCS

Judge to consider newly-surfaced e-mail in vet care trial

June 5, 2008, San Francisco, CA — A federal judge considering a lawsuit that alleges inadequate veterans medical care ordered government lawyers on Thursday to explain an e-mail by a U.S. Department of Veterans Affairs (VA) psychologist suggesting that counselors diagnose fewer post-traumatic stress disorder cases in soldiers.

The hearing ordered by U.S. District Court Judge Samuel Conti follows a two-week trial that ended last month. Veterans groups had sued the VA, saying it inadequately addressed a “rising tide” of mental health problems, especially post-traumatic stress disorder and suicides.

The plaintiffs asked Conti to reopen the case in light of the e-mail discovered after the trial ended.

The judge agreed, saying “the e-mail raises potentially serious questions that may warrant further attention.” He ordered lawyers for both sides to appear in court Tuesday to discuss whether the e-mail has any bearing on the case.

The document in question is a March 20 memo written by Norma Perez, who helps coordinate a post-traumatic stress disorder clinical team in central Texas.

“Given that we are having more and more compensation-seeking veterans, I’d like to suggest that you refrain from giving a diagnosis of PTSD straight out,” Perez wrote to VA counselors. “We really don’t or have time to do the extensive testing that should be done to determine PTSD.”

The e-mail was forwarded to VoteVets.org, an Iraq and Afghanistan war veterans lobbying group opposed to the Bush administration’s handling of the war and veterans issues.

Lawyers for the veterans groups argue that Perez’s e-mail goes to the heart of their case, showing the VA’s indifference to treating mental health.

“This is not Joe the janitor writing this,” vets’ lawyer Arturo Gonzalez said. “This is a supervisor and it shows how the VA thinks.”

Gonzalez wants the judge to add the e-mail to the evidence given to him at the non-jury trial in support of the lawsuit.

Government lawyers representing the VA didn’t return a telephone call Thursday. But on Wednesday, Justice Department lawyer James Schwartz wrote the judge a letter arguing that the e-mail was a mistake, that Perez had been “counseled” and that it has nothing to do with the lawsuit.

“It was the action of a single individual that in no way represented the policies of VA, that, once discovered, was dealt with quickly and appropriately,” Schwartz told the judge.

Perez told senators Wednesday at a Senate Veterans Affairs Committee hearing called to investigate the e-mail that her message was poorly written and she meant to remind counselors that they could initially diagnose patients with a less severe stress condition known as “adjustment disorder.”

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U.S. General in Iraq Takes Measures to Prevent Suicides

Posted on June 4, 2008 by Team VCS

June 2, 2008, Washington – The U.S. general responsible for operations in Baghdad announced today that he is taking proactive measures to prevent soldiers in his command from taking their own lives.
Soldiers are his “top priority,” Army Maj. Gen. Jeffery W. Hammond, commander of Multinational Division Baghdad and the 4th Infantry Division, told Pentagon reporters during a satellite-carried news conference from his Baghdad headquarters.

“We take proactive measures to improve soldier access to mental health care and prevent suicides and identify early symptoms of post-traumatic stress disorder,” Hammond pointed out.

Hammond said he has established a suicide elimination policy that features training for leaders, rank-and-file servicemembers and behavioral health care providers. A key element of the program, he noted, is de-stigmatizing the act of seeking care for mental health issues.

Additionally, the command’s chaplains and mental health care providers are directed “to visit our combat outposts, be with our soldiers in our joint security stations — and listen,” Hammond said.

These efforts are paying off, the general observed, noting there’s been a 35-percent decrease in medical evacuations to the United States of command personnel for mental health reasons.

Emphasizing that “any suicide is one too many,” Hammond also noted that his division’s suicide rate is currently below the 2007 Army in-theater average.

The servicemembers in his command are performing well in Iraq, Hammond emphasized.

“They’re doing one heck of a job,” Hammond said of his troops’ endeavors, noting their work in Iraq is striking a blow for freedom and is helping the Iraqi people realize a better tomorrow.

“I think, clearly, that it’s an encouraging situation we have right now” in Baghdad, Hammond continued. “But, we still got a lot of work we got to get done.

“And, we’re up for it,” he added. “We’re up for it, and I’m looking forward to tomorrow.”

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Researchers’ Complaints Ignored Over Anthrax Vaccine Problems

Posted on June 4, 2008 by Team VCS

June 1, 2008 – Despite the enormous investments in developing an anthrax vaccine, senior employees at the Israel Institute for Biological Research have warned that there are problems with the product. However, institute director Dr. Avigdor Shafferman ignored their claims, and demoted one of the complainants, a senior manager.

The Biological Research Institute, one of the most secret institutions in Israel, employs 350 persons and operates with nearly no external supervision. In terms of administration, the institute answers to the Prime Minister’s Office, while physical and field security are handled by Malmab – the body responsible for security in the defense establishment at large.

According to foreign publications, the institute conducts research and development on biological and chemical weapons, and also develops antidotes – including medicines, vaccines and antibodies – against poison gas, microbes and viruses like anthrax, the plague, chicken pox and cholera.
Anthrax is a virus that generally affects animals, but can also harm humans. During the Gulf War in 1991, the United States feared Saddam Hussein might use biological weapons against its troops, and some 40,000 members of its armed forces were vaccinated against the disease, which targets the respiratory system.

Biological science researchers at the Nes Tziona institute, then headed by Dr. Shafferman, conducted intensive research on the virus, and as a result of their work, the institute decided to try to develop a vaccine.

In 2001, scientific and defense sources said the institute had developed a vaccine for anthrax, and that large-scale production would commence within a few months, enough for the entire population of Israel.

Intelligence assessments hold that countries in the Middle East, including Syria, Egypt and Iran, have developed anthrax as a biological weapon.

However, a senior manager at the institute, Dr. Yaakov Hadar, recently complained that the institute’s management of the anthrax vaccine was problematic. Dr. Hadar presented the issues in writing to Dr. Shafferman, who reprimanded Dr. Hadar, and convinced him to withdraw his letter of complaint.

Hadar was later demoted. Dr. Hadar refused to comment on the case, and directed Haaretz to Dr. Shafferman.

In its response to Haaretz’s inquiry, the Defense Ministry did not acknowledge the claims that there are problems with the vaccination.

“During the development of the anthrax vaccination that was carried out on behalf of the defense establishment, there were no problems in the conduct of any party,” the ministry spokesman told Haaretz.

Dr. Shafferman was appointed to head the institute in 1995, and employees have complained of his “dictatorial rule” several times.

The State Comptroller began an investigation last year into allegations that Shafferman allegedly had advised a pharmaceutical firm in developing anti-anthrax and nerve agent medicines, which would have been a conflict of interest.

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Soldiers: Long Tours Create ‘Lot of Stress’

Posted on June 4, 2008 by Team VCS

May 30, 2008, Washington, DC – Three soldiers receiving Purple Hearts today at Walter Reed Army Medical Center spoke about the strains on soldiers in Iraq that contributed to a record number of suicides last year in the Army.

The Army reported Thursday there were 115 suicides in 2007, the highest number since it began keeping records of suicides in 1980. So far this year, there have been 38 confirmed suicides.

“There’s a lot of strain because probably a lot of people are ready to come home,” said Staff Sgt. Bennie Lamb, 40, of Macon, Ga., who was on his third tour in Iraq when he was wounded March 14 by a suicide bomber.

The uncertainty of extended tours, Lamb said, only adds to the pressure on soldiers.

“Don’t know when you’re leaving,” he said. “With this 15-month, 12-month tour thing, you know, that’s a lot of stress. That’s a lot of stress.”

Army officials said their statistics do not demonstrate a direct link between repeated deployments and a rise in suicides, but Army psychiatrist Col. Elspeth Ritchie acknowledged the intense stress of a combat zone takes a toll on soldiers.

“We see a lot of things that are going on in the war which do contribute,” Ritchie told Reuters. She pointed specifically to long months away from home, the horrors of combat, the ready availability of loaded weapons and the high activity levels of current Army operations.

Chief Warrant Officer Brian Callan, 42, of Adamstown, Md., an Apache pilot who was wounded Sept. 11 in Baghdad, said it’s especially stressful for anyone who goes off base.

“Anytime you go outside, especially flying,” he said. “If you were to go down out there, then obviously it’s a race against time trying to get you recovered.”

Shorter tours should help
Pfc. Luis Villalba-Cabrera, 22, was wounded by a roadside bomb just 24 days after deploying to Iraq last November. Being away from his family was his hardest adjustment.

“Just being away, being far away,” he said. “Communicating by phone – not the best way of communicating.”

Villalba-Cabrera said soldiers play video games and hang out with friends to keep their minds occupied as much as possible.

“It’s a stressful environment,” he said. “We are in a war conflict, so pretty stressful.”

All three agree the impending cutback in tours from 15 months to 12 months will be a big help.

“Oh, yes, oh, yes,” Villalba-Cabrera said, chuckling. “That few months makes a big difference. Being back at home as much as possible is always great.”

“I think that will help, for sure,” Callan said. “It definitely can’t hurt.”

“Six months would be a whole lot better,” said Lamb, laughing.

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VA Denies Money a Factor in PTSD Diagnoses

Posted on June 4, 2008 by Team VCS

June 3, 2008, Washington, DC – A Veterans Affairs psychologist denies that she was trying to save money when she suggested that counselors make fewer diagnoses of post-traumatic stress disorder in injured soldiers.

Norma Perez, who helps coordinate a post-traumatic stress disorder clinical team in central Texas, indicated she might have been out of line to cite growing disability claims in her March 20 e-mail titled “Suggestion.” She said her intent was simply to remind staffers that stress symptoms could also be adjustment disorder. The less severe diagnosis could save the VA millions of dollars in disability payouts.

“In retrospect, I realize I did not adequately convey my message appropriately, but my intent was unequivocally to improve the quality of care our veterans received,” Perez said in testimony prepared for delivery Wednesday before a Senate panel.

The Senate Veterans’ Affairs Committee and the VA inspector general are investigating whether there were broader VA policy motives behind the e-mail, which was obtained and disclosed last month by two watchdog groups. The VA has strenuously denied that cost-cutting is a factor in its treatment decisions.

“One question that was raised repeatedly about this latest e-mail was, ‘Why would a clinician be so concerned about the compensation rolls?'” said Sen. Daniel Akaka, D-Hawaii, who chairs the Senate panel. “As an oversight body, we must know whether the actions of these VA employees point to a systemic indifference to invisible wounds.”

VA Secretary James Peake has called Perez’s e-mail suggestion “inappropriate.” VA officials this week said her e-mail was taken out of context.

“The e-mail, as characterized by others, does not reflect the policies or conduct of our health care system,” said Michael Kussman, VA’s undersecretary for health, in testimony prepared for the Senate hearing. “We certainly agree that it could have been more artfully drafted.”

In her e-mail to staffers at the VA medical center in Temple, Texas, Perez wrote, “Given that we are having more and more compensation-seeking veterans, I’d like to suggest that you refrain from giving a diagnosis of PTSD straight out. … We really don’t or have time to do the extensive testing that should be done to determine PTSD.”

Many veterans and injured troops have long charged that the government might seek to reduce disability costs by assigning a lower benefits rating. Last year, retired Lt. Gen. James Terry Scott, chairman of the Veterans’ Disability Benefits Commission, said he believed the Army might at least subconsciously consider cost. A lawsuit filed in San Francisco accuses the VA of misclassifying PTSD claims.

In her testimony, Perez said symptoms for PTSD and adjustment disorder are often similar, as are the treatments for them. She said by making an initial diagnosis of a lesser disorder, VA staff can begin treatment right away without going through the arduous process of deeming it PTSD.

Perez also noted that awarding disability benefits is not part of her staff’s work, but she did not say why she chose to cite that as a factor in urging fewer PTSD diagnoses. Veterans diagnosed with PTSD are eligible to receive up to $2,527 a month in government benefits.

A recent Rand Corp. study found about 300,000 U.S. military personnel who served in Iraq or Afghanistan are suffering from PTSD or major depression, potentially saving the government millions of dollars if lesser diagnoses are used _rightly or wrongly — in disability benefits decisions.

“Although our clinic is a treatment clinic, we all fully support the compensation process and the department’s policy of erring in the best interest of the veteran whenever there is any doubt,” Perez wrote.

Perez’s testimony comes after Peake was called to Capitol Hill last month to answer questions about internal e-mails suggesting that VA officials were hiding the number of veterans trying to kill themselves. One of the e-mails, disclosed during a San Francisco trial, started with “Shh!” Some lawmakers have said the VA’s top mental health official who wrote it, Dr. Ira Katz, should be fired, but Peake has said he has no plans to do so.

On the Net:
A copy of Perez’s e-mail can be found at: http://www.citizensforethics.org/node/31690
Department of Veterans Affairs: http://www.va.gov/
Senate Veterans’ Affairs Committee: http://www.senate.gov/veterans/public/

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