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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Associated Press: Senator Clinton Lost Presidential Election Due to Her Vote for Iraq War Plus Her Failure to Repudiate Her Vote

Posted on June 4, 2008 by Team VCS

June 4, 2008, Washington, DC – On her first campaign visit to New Hampshire, in February 2007, Hillary Rodham Clinton was confronted by a voter who demanded she explain her 2002 Senate vote authorizing the U.S. invasion of Iraq.

“I want to know if right here, right now, once and for all and without nuance, you can say that war authorization was a mistake,” Roger Tilton asked Clinton. “I, and I think a lot of other primary voters — until we hear you say it, we’re not going to hear all the other great things you are saying.”

Clinton replied, as she would repeat in the ensuing months: “Knowing what we know now, I would never have voted for it.”

Her refusal to admit error failed to satisfy Tilton, a 46-year-old financial analyst from Nashua even though he loved her position on health care and capping Iraq troop levels.

That exchange, pounced upon by some reporters to the displeasure of Clinton’s aides, foreshadowed her demise. Her refusal to back off that vote tied her to the past and to an unpopular war. It embodied her campaign’s fundamental miscalculation: the decision to present her as the standard-bearer for Washington experience, ready for office on Day One.

As such it was a telltale moment in the former first lady’s dizzying 17-month slide from prohibitive front-runner to also-ran — upended by Barack Obama, a rookie on the national political scene, and by his message of change, in a year voters hungered for change.

By itself, Clinton’s Iraq vote didn’t cost her the nomination. There were other culprits: her ever-changing campaign themes, poor financial planning, squabbling staff and a field organizing plan designed for quick victory rather than a 50-state delegate hunt.

And there were events along the way that were omens of her downfall — many not fully appreciated in the bright glow of her near-universal name recognition, endorsements from the party establishment and long early lead in the polls.

The first quarter of 2007 ended with a big surprise for the Clinton campaign, the reputed powerhouse of Democratic fundraising: Obama raised $25 million from more than 100,000 donors in those three months. While the New York senator had raised $26 million from 60,000 donors, just $20 million was for primaries, $6 million for the general election. Obama’s total included $23 million for the primaries.

At first, word of Obama’s stunning success led to near-panic within the Clinton team. Eventually, the agitation gave way to a wary calm. “He raised a lot, we raised a lot,” spokesman Howard Wolfson mused.

Their first response turned out to be more accurate. Obama had shattered the establishment approach to soliciting campaign cash.

Clinton’s money had come largely from squeezing wealthy individuals for the maximum legal contribution of $2,300 for the primaries and $2,300 for the general election. The Obama campaign mined the Internet for small donations from people who could be re-solicited throughout the campaign.

Obama would eventually raise more than $265 million for the primaries from more than 2 million individuals. Clinton raised about $215 million, and would end her campaign more than $30 million in debt. Most important, Obama’s army of small donors paid for the impressive field organization he would build, drawing on grass-roots support across the country and penetrating states Clinton couldn’t afford to contest.

In May of last year, a memo from Clinton deputy campaign manager Mike Henry leaked that both foreshadowed and helped produce dire events for her campaign. Henry recommended the New York senator skip the leadoff Iowa caucuses. The document roiled her campaign and revealed the first of many staff disputes. It also would help seal her poor showing in the state months later, which gave Obama a chance to show that white voters would support a black presidential candidate.

All along, Clinton’s advisers had fretted about her chances in Iowa. Bill Clinton did not campaign in the state in his first presidential run in 1992, and the couple had never built the organization needed to win the caucuses.

Supporters like former Gov. Tom Vilsack warned that Clinton was starting dangerously late and needed to visit the state more. Campaign people worried that Clinton was sticking to a rigorous schedule in the Senate, not spending serious time in Iowa until late summer 2007.

Although the notion that she wouldn’t compete in the campaign’s first contest was never seriously considered by campaigns chiefs, Henry had the respect of many in the campaign including top adviser and delegate-hunter Harold Ickes, and he was encouraged to put his concerns about Clinton’s Iowa chances in writing.

The leak of Henry’s memo — which accurately pointed out that Iowa was Clinton’s weakest state and would require a multimillion-dollar investment that might be better spent elsewhere — was a blow that put her on the defensive in Iowa for the remainder of the campaign.

Sure enough, it cost Clinton $25 million to finish third in Iowa — narrowly behind John Edwards but swamped by Obama, whose organizers had identified thousands of young, first-time caucus-goers to come out for him. Henry left the campaign not long after.

Clinton delivered strong performances in a long series of televised debates, but that streak came apart in a single moment in Philadelphia in late October 2007, when she was asked during a forum on MSNBC if she would support a proposal by her state’s governor, Eliot Spitzer, to allow illegal immigrants to obtain driver’s licenses.

“I did not say that it should be done, but I certainly recognize why Governor Spitzer is trying to do it,” Clinton said.

That response, and other non-answers that night, made her seem evasive and opportunistic. Media coverage, until then largely respectful, turned critical.

Until January of this year, former President Clinton had been viewed as an asset for his wife among her aides and supporters. Although reviled by conservatives for his affair with a White House intern, Bill Clinton remained a beloved figure among Democratic audiences, particularly blacks, who remembered the 1990s as relatively prosperous and his efforts on their behalf.

That changed in South Carolina, where the former president campaigned vigorously for his wife. Her advisers, aware of his tendency to go off message, had urged him to stay positive and talk up her accomplishments, not criticize Obama.

But Bill Clinton chafed at the campaign’s reluctance to take on the Illinois senator, particularly over what the former president viewed as conflicts between Obama’s rhetoric of opposition to the Iraq war and his voting record. So he took it on himself to speak out, with calamitous results.

Obama soundly won South Carolina, and Bill Clinton then made things worse. He seemed to diminish Obama’s triumph by noting that civil rights leader Jesse Jackson, never the presidential contender that Obama had already become, had also won the state’s primary years earlier.

Once so popular among blacks he was dubbed the first black president by author Toni Morrison, Bill Clinton had helped drive those voters away from his wife. Obama’s already strong black support would climb to as much as 90 percent of the black vote in subsequent contests.

Super Tuesday primaries on Feb. 5 looked at first to be a strong showing for Clinton, though not the knockout blow her camp once anticipated.

In fact, a miscalculation about that day propelled her long and steady decline.

Although she won large state primaries — California, New York, New Jersey and Massachusetts — she all but ceded caucuses to Obama in places like Colorado, Minnesota and Kansas. By the final count a few days later, Obama had collected a few more delegates than Clinton of the nearly 1,700 at stake that day.

Clinton had developed an aversion to caucuses after her bad experience in Iowa; she even publicly called them unrepresentative and undemocratic. Combined with poor budgeting and a poor understanding of the party’s system of proportional allocation of delegates, that led to catastrophic strategic planning for the Super Tuesday contests.

When Clinton was still riding high in the polls, campaign chairman Terry McAuliffe, chief strategist Mark Penn and other advisers believed she would come close to clinching the nomination by winning large — if expensive — primary states. The campaign had budgeted accordingly.

Other Clinton advisers, including Ickes, had vainly warned that proportional allocation would allow Obama to pick up plenty of delegates in the states Clinton won on Super Tuesday and dozens more in the caucus states if Clinton did not contest them.

Those warnings went largely unheeded and the big-state Super Tuesday strategy failed badly. Clinton’s campaign was left nearly broke, with no real plan for how to approach the contests to come. Obama scored 11 straight wins in February alone, while Clinton was forced to lend her campaign $5 million just to stay afloat. He took the overall delegate lead Feb. 12 and never lost it.

In March, a self-inflicted wound did more than anything else to undermine her claim of foreign policy experience — and her efforts to reassure voters of her trustworthiness. More than once she personally described coming under sniper fire as first lady during an 1996 airport landing in Bosnia.

“There was supposed to be some kind of a greeting ceremony at the airport, but instead we just ran with our heads down to get into the vehicles to get to our base,” Clinton said during a foreign policy speech in Washington. In the hours and days afterward, her claim was discredited by video of the landing which surfaced on television news and YouTube. But Clinton stuck to her story for a week before finally acknowledging she misspoke. “A minor blip,” she called it.

Her aides knew it to be anything but. Privately, they were horrified by the gaffe and saw almost no realistic way to defend it.

In the end, none of the mistakes by Clinton and her campaign team was fatal in and of itself. She and her husband were experts in extricating themselves from death-defying jams.

But Obama proved to be more than just a traditional opponent. In the end, the Clintons’ usual tactics — big-scale fundraising, high-powered political connections, old-fashioned grit and determination — were no match for Obama and a candidacy uniquely suited to the moment.

Campaigning in the final primaries, Clinton said, “I’ve really enjoyed the process of being able to go out and see this country anew.”

But what she saw was a country that wanted someone new.

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The War-Hero President and the Pacifist

Posted on June 3, 2008 by Team VCS

June 2, 2008 – ‘I may not be able to see you,” the partially blind, stroke-impaired Ted Sorensen told a crowd at the John F. Kennedy Library in Boston last week, “but I have more vision than the president of the United States.” Over 1,000 people gathered to hear JFK’s speechwriter discuss his new book, “Counselor: A Life at the Edge of History.” Those who expected a satisfying draught of the old Kennedy mystique were not disappointed. In the conclusion to his book, Sorensen writes, “Today’s sorry political leadership, so different from JFK’s, spurred me on as I wrote, rekindling my memory and reinvigorating my conscience.”

Sorensen draws credit as Kennedy’s soaring wordsmith. But perhaps that vigorous conscience was more to the point than rhetorical flair. Coming of age during the unquestioned World War II, the young Nebraskan took for granted that he would serve in the army, but the war ended when he was 17. The next year, registering for the draft, Sorensen applied for noncombatant service as a conscientious objector. He would serve his country in the military, as a medic perhaps, but, he explained to the draft board, “I could kill no man . . . I am what is called a pacifist.”

Sorensen’s application for conscientious objector status would be used against Kennedy, would feature in Sorensen’s secret FBI file, and, eventually, would destroy his chances of becoming Jimmy Carter’s CIA director in 1976. An underappreciated fact of history is that Kennedy, remembered as the paradigmatic cold warrior, so intimately depended on a man who boldly renounced any glorification of belligerence. No surprise, then, that the most important Kennedy-Sorensen collaboration is equally unappreciated – the resounding declaration of peace that Kennedy delivered as a commencement address at American University 45 years ago next week.

After staring into the abyss of nuclear war over Berlin and Cuba, Kennedy chose that June as the “time and place to discuss a topic on which ignorance too often abounds and truth is too rarely perceived – yet it is the most important topic on earth: world peace.” That speech went beyond the reviled Neville Chamberlain (“peace for our time”) by calling for “not merely peace in our time, but peace for all time.” Instead of aiming, with Woodrow Wilson, to “make the world safe for democracy,” the speech proposed to “make the world safe for diversity,” a step back from triumphalist claims made for American democracy during the Cold War.

Most momentously, the speech broke with the Cold War judgmentalism that always blamed the attitudes of the other side, proposing instead “that we must examine our own attitudes – as individuals and as a nation – for our attitude is as essential as theirs” in causing conflict. The speech rejected Cold War demonizing, for “no government or social system is so evil that its people must be considered as lacking in virtue.” Here was an American president proclaiming the need for self-criticism, and affirming the possible goodness of the enemy.

In calling for new structures of international law and negotiations toward disarmament, and in declaring a moratorium on atmospheric nuclear testing, the American University speech marked the end of JFK’s rhetoric of toughness. “For in the final analysis, our most basic common link is that we all inhabit this small planet. We all breathe the same air. We all cherish our children’s future. And we are all mortal.”

The speech was heard loud and clear in the Soviet Union. Little more than a month later, the Partial Test Ban Treaty was agreed to, the beginning of the arms control regime that saved the world – what Kennedy called a shaft of light cutting into the darkness.

Ted Sorenson was never more himself than in the work he did for the American University speech. Neither, he believes, was Kennedy. The journey of the war-hero president and the pacifist he trusted was a progression this nation desperately needs to resume. No accident that it was at American University in January that Senator Edward Kennedy endorsed Barack Obama. “A new leader and a new era are on the way,” Sorensen concludes in his book, and I will continue to fight, to write, and to hope.”

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June 3 VCS Exclusive: Medication Effects and the Invisible Wounds of War – Why We Need A Blue Ribbon Panel on Soldier Suicide and Iatrogenic Harm

Posted on June 3, 2008 by Team VCS

June 3, 2008 – “Is U.S. Health Care Really the Best in the World?”   Such was the title of Dr. Barbara Starfield’s clarion call to fellow medical professionals in a July 2000 issue of JAMA, the prestigious journal of the American Medical Association.  Drawing upon statistics from a variety of high quality sources – including a pivotal 1998 meta-analysis of drug-induced fatalities, and a 1999 report by the Institute of Medicine on medication errors – the author revealed that the health care system itself had become the third leading cause of death in our country, after heart disease and cancer.  

In the eight years which have passed since the appearance of the Starfield paper, the scope of iatrogenic injury has expanded rather than reversed.   Presumably, denial has played no small role in this problem.  It is notable that the CDC’s annual health care statistics have consistently excluded the categories of “medication adverse effects” and “deaths due to medication errors.”  One wonders if the federal government has believed that by ignoring these problems, they might encourage others to do the same.
 
It is against this backdrop of recalcitrant denial that military and civilian medical professionals, along with government officials, have turned their attention to the problem of soldier and veteran suicide.  According to the Army’s top psychiatrist, Colonel Elspeth Richie, Army suicides in 2007 reached the highest level on record with 115 confirmed fatalities, and an incidence rate of 19 suicides per 100,000 soldiers.   Similar developments have plagued non-active duty personnel.  According to Veterans Affairs Secretary, Dr. James Peake, the true incidence of veteran suicide remains unknown.  However, the VA has recently estimated that 6,500 former soldiers, airmen, and sailors die by suicide each year.   Using the U.S. Census Bureau’s most recent figures of 23.7 million veterans, the annual incidence rate of suicides in this population is 27 per 100,000.  In short, the problem of soldier suicide is at least two times higher than the national background rate, and it is expected to worsen over time.

Reacting in part to this epidemic of self-destruction, the RAND corporation recently completed a comprehensive report on the prevalence and treatment of neuropsychiatric injuries among the active duty and veteran communities.  Entitled “Invisible Wounds of War,” the study focused upon the problems of Traumatic Brain Injury, PTSD, and major depression. 

In the process of producing a work which spanned 498 pages, the authors focused upon “evidence based” recommendations drawn essentially from corporately funded sources.   Perhaps the RAND researchers were unaware of the 2008 paper by Turner et al., in which it was revealed that a full 31{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of the clinical trials involving antidepressants – most of them negative – went unpublished.  Unsurprisingly, the RAND report conveyed a myopic view of pharmacotherapies which excluded a serious discussion of iatrogenic harm.  For example, the problem of antidepressant-related suicide received a mere twelve lines of attention.  Even then, no mention was made about the existence of Black Box Warnings for this hazard, and no information was presented with respect to the physiological mechanisms through which these drugs would be reasonably expected to induce or worsen impairments of judgment, mood, and impulse control.

The composition of the VA’s newly formed Blue Ribbon Work Group on Suicide Prevention portends a set of treatment recommendations marked by similar oversights and omissions.   Of nine civilians appointed to a special Expert Panel on suicide, it is striking that one third of them have past or continuing financial ties to the pharmaceutical industry.  More importantly, in contradiction to valid epidemiological and scientific findings, these members have repeatedly denied the link between antidepressants and self-harm.   While financial conflicts of interest need not prevent an objective consideration of epidemiological evidence and neurobiology, what makes this panel so special is the fact that it features members who have voted against, testified against, or publicly railed against the Food and Drug Administration’s decision to add (and then strengthen) warnings about drug-related suicide.  

More than likely, it is too late for Dr. Peake to change the composition of this specific  advisory panel to the Blue Ribbon Work Group.  However, for the sake of the safety and well-being of the men and women in uniform, of their families, and of the public at large, one must hope that federal officials will eventually insist upon the formation of a new
panel or committee – one that will be qualified and willing to discuss a number of pressing concerns, including:

– the prudence of initiating or continuing troops on mind-altering drugs in theater

– the possibility that drug-induced violence can never be reliably predicted or
      prevented via “frequent monitoring”

– the potential for returning troops to experience drug-withdrawal suicide (or homicide), due to temporal gaps between treatment in-service and treatment within the VA system

– the probability that psychiatric drugs change the brain in ways which prevent, rather than facilitate, long term recovery.

Psychiatrists, both within and beyond the military, have historically ignored the problems of target organ toxicity and allostatic load, including the iatrogenic phenomena of endocrine disruption and chemical imprinting.  A full discussion of each of these issues lies beyond the scope of this essay.  However, no less than the neurological and psychological conditions which arise from the events of the battlefield, it is time for a Blue Ribbon Work Group to prevent and mitigate the consequences of neuropsychiatric drugs.  For far too long, these have also contributed to the “Invisible Wounds of War.”
 
Selected References

Hefling K (May 8, 2008).  “Questions and answers about veteran suicide.”  Accessed on 01 June 2008 at: http://www.signonsandiego.com/news/military/20080508-1325-veteransuicide-q&a.html

Lazarou J, Pomeranz BH, and Corey PN (1998).  Incidence of Adverse Drug Reactions in Hospitalized Patients: A Meta-Analysis of Prospective Studies.  JAMA 279 (15): 1200-1205.

Lorge EM (May 30, 2008).  “Army Continues Fight Against Soldier Suicides.”  Accessed on 01 June 2008 at: http://www.army.mil/-news/2008/05/30/9523-army-continues-fight-against-soldier-suicides/

Starfield, Barbara (2000).  Is US Health Really the Best in the World ?  JAMA 284 (4):
483-485.

Turner EH, Matthews AM, Linardatos E, Tell RA, and Rosenthal, R (2008).  Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy.  New England Journal of Medicine 358: 252-260. 

Note:  Dr. Grace E. Jackson is a former Navy psychiatrist who resigned her commission in 2002 for reasons of professional conscience.  A private practice clinician, forensic consultant, lecturer, and author, she can be reached at grace.e.jackson@att.net.

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Ft. Stewart’s Commanding General Calls 15-Month Tours ‘Traumatic’

Posted on June 3, 2008 by Team VCS

June 3, 2008, Savannah, GA – Returning home from 15 months in Iraq, Fort Stewart’s commanding general said Monday adding three months to Army combat tours has proven “more traumatic” for troops — including himself.

“It doesn’t matter if you’re the private or the general, 15 months is a long time,” said Maj. Gen. Rick Lynch, who applauded the Army’s decision to return to 12-month Iraq tours next year.

Lynch, commander of the 3rd Infantry Division, said spending more than a year separated from their families meant many troops missed several special occasions twice.

Lynch was no exception. His wife celebrated two birthdays while he was deployed.

“From a personal perspective, in those extra three months, you miss two of something,” Lynch after arriving at Hunter Army Airfield on a plane with 265 troops. “In my case, I missed two of Sarah’s birthdays. Some of my soldiers missed two anniversaries. … That made it even more traumatic.”

The 3rd Infantry, which began sending troops home in March, was the first Army division called up for a third tour in Iraq. Its soldiers are also among the first to return from serving 15-month deployments.

Despite the strains, Lynch said the division had no problem reaching its re-enlistment goals while overseas. He said his troops are proud of the progress they see in Iraq.

Lynch commanded a task force of 46,000 U.S. and Iraqi troops as well as thousands of Iraqi police south of Baghdad in an area the size of West Virginia. When they arrived, it was an area rife with insurgents plotting attacks, training recruits and building bombs.

By the time he left, the general said, attacks on civilians in the area decreased by 90 percent.

“We did our job over there against the dirtbags. We killed or captured about 6,000,” Lynch told reporters. “In our area, we went from an average of 25 attacks a day to less than two a day. We took the place called the ‘Triangle of Death’ and we morphed it into the ‘Triangle of Life.”’

He noted that by saying “dirtbags” he was referring to “insurgents that come running around causing trouble,” not the Iraqi people in general.

At the same time Lynch returned to Fort Stewart, about 40 miles southwest of Savannah, about 4,000 soldiers of the division’s 3rd Brigade are having their homecoming at Fort Benning in Columbus. About half the 3rd Infantry remains in Iraq, and the last of its troops aren’t expected back until February.

Lynch, meanwhile, has been nominated for promotion to lieutenant general and expects to take command of the Army’s III Corps at Fort Hood, Texas, later this summer. The Senate must first confirm his promotion to a three-star general.

After 15 long months at war, Lynch said he looked forward to days off with his wife, his children and their Labrador retrievers, as well as a ride on his Harley-Davidson motorcycle. But before that, a relaxing soak and a stiff drink.

“I’ll be in the hot tub this afternoon, and I will indeed have my glass of whiskey and my cigar,” Lynch said. “And I’ll be talking to my family.”

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Nearby Firing Ranges Complicate Soldiers’ Recovery from PTSD

Posted on June 3, 2008 by Team VCS

June 3, 2008, Fort Benning, GA – Army Sgt. Jonathan Strickland sits in his room at noon with the blinds drawn, seeking the sleep that has eluded him since he was knocked out by the blast of a Baghdad car bomb.
Like many of the wounded soldiers living in the newly built “warrior transition” barracks here, the soft-spoken 25-year-old suffers from post-traumatic stress disorder. But even as Strickland and his comrades struggle with nightmares, anxiety and flashbacks from their wartime experiences, the sounds of gunfire have followed them here, just outside their windows.

Across the street from their assigned housing, about 200 yards away, are some of the Army infantry’s main firing ranges, and day and night, several days each week, barrages from rifles and machine guns echo around Strickland’s building. The noise makes the wounded cringe, startle in their formations, and stay awake and on edge, according to several soldiers interviewed at the barracks last month. The gunfire recently sent one soldier to the emergency room with an anxiety attack, they said.

“You hear a lot of shots, it puts you in a defensive mode,” said Strickland, who spent a year with an infantry platoon in Baghdad and has since received a diagnosis of PTSD from the military. He now takes medicine for anxiety and insomnia. “My heart starts racing and I get all excited and irritable,” he said, adding that the adrenaline surge “puts me back in that mind frame that I am actually there.”

Soldiers interviewed said complaints to medical personnel at Fort Benning’s Martin Army Community Hospital and officers in their chain of command have brought no relief, prompting one soldier’s father to contact The Washington Post. Fort Benning officials said that they were unaware of specific complaints but that decisions about housing and treatment for soldiers with PTSD depend on the severity of each case. They said day and night training must continue as new soldiers arrive and the Army grows.
“Fort Benning is a training unit, so there is gunfire around us all the time,” said Elaine Kelley, a behavioral health supervisor at the base hospital. If a soldier had a severe problem, it would have been identified, she said.

Lt. Col. Sean Mulcahey, who recently took command of the Warrior Transition Battalion, where wounded soldiers are assigned, said: “No soldier has talked with me about the ranges.” If it is an issue, “we will address it,” he said, stressing that the battalion’s mission is “getting those soldiers to heal.”

Under Army rules, commanders of warrior transition units are supposed to enforce “quiet hours.” Officials said the location of the barracks for wounded soldiers, along with a $1.2 million Soldier and Family Assistance Center, was chosen for its proximity to central facilities such as the hospital. About 350 soldiers are assigned to the battalion — including 176 who live in the barracks near the ranges — where they stay an average of eight months, Mulcahey said. An estimated 10 to 15 percent of the soldiers have PTSD, he said.

The soldiers are part of a growing group of an estimated 150,000 combat veterans of the wars in Iraq and Afghanistan who have PTSD symptoms. The mental disorder has been diagnosed in nearly 40,000 of them.

PTSD symptoms include flashbacks and anxiety, and noises such as fireworks or a car backfiring can make sufferers feel as though they are back in combat. Health experts say that housing soldiers near a firing range subjects them to a continual trigger for PTSD.

“It would definitely traumatize them,” said Harold McRae, a psychotherapist in Columbus, Ga., who counsels dozens of soldiers with PTSD who are at Fort Benning. “It would be like you having a major car wreck on the interstate” and then living in a home overlooking the freeway, he said. “Every time you hear a wreck or the brakes lock up, you are traumatized.”

Fort Benning, which covers more than 180,000 acres, is one of the Army’s main training bases, with 67 live-fire ranges. The base has thousands of housing and barracks units. “There is no excuse” for the housing situation, said Paul Ragan, an associate professor of psychology at Vanderbilt University, who treats veterans with PTSD. “Charitably put, it’s very untherapeutic.”

Brig. Gen. Gary Cheek, director of the Army’s Warrior Care and Transition Office, which oversees 12,000 wounded soldiers, said: “I can see how that would be a problem. It’s something we haven’t considered” but should. “We have alternatives for housing the soldiers who have issues” with the ranges, he said, adding that the barracks for wounded troops at Fort Benning are an interim facility.

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The gunfire “makes me crazy,” said a soldier who lives in the barracks and has PTSD and traumatic brain injury from a roadside explosion in Iraq. “It makes me jump and I get flashbacks.” He spoke on the condition of anonymity for fear of retribution from the Army.

Soldiers living at the barracks say their rooms are in good condition and have recently been outfitted with flat-screen TVs, laptop computers and free Internet service. They say that their rooms are inspected frequently for cleanliness and that even soap scum on a sink or sunflower seeds left on a counter are noted in records. But the soldiers said they have received no explanation for why they must live so close to the firing ranges, even though they said at least one soldier raised the question at a town hall meeting with battalion leaders several weeks ago.

“It . . . freaks me out,” said Sgt. Jonathon Redding, 27, of Little Rock. He said the gunfire has required him to increase his sleep medication. “I was under the impression I would get help here,” he said. Instead, he said, he “got considerably worse.”

‘It Just Kind of Drains You’

Rolling through Iraqi towns with his artillery unit during the 2003 invasion, Redding saw and smelled the charred corpses of Iraqis he helped kill. “You can never forget that,” he said, sitting in his room at Fort Benning last month.

When he returned home in August 2003, the Army did not screen him for behavioral health problems, he said.

Redding began “self-medicating” — which is common for PTSD sufferers — drinking several fifths of Southern Comfort a week. His weight dropped 30 pounds, to 135, in two months, and he grew withdrawn, sleepless and depressed.

According to Pentagon data, up to 15 percent of returning U.S. troops now show signs of PTSD, and the total number who receive diagnoses of chronic PTSD rose by nearly 50 percent last year.

Redding went home and joined the Arkansas National Guard. With help from a civilian doctor who gave him medicine for insomnia and anxiety, he limited his drinking and took a part-time job carrying caskets at the funerals of fallen soldiers. “I did about 90 funerals, I loved it,” he said.

But Redding was informed in September that he would be mobilized with a military police unit bound for Iraq. At Camp Shelby, Miss., where he went for training in January, gunfire and artillery practice caused him to “freeze up,” he said. He asked his civilian doctor for a prescription, but the company medic told him it was for a “non-deployable” medication, so if he was planning to deploy, his family would have to fill it and mail it to him — skirting the rules.

Redding took the prescription through proper channels and was sent to a behavioral health expert, who determined he had PTSD and depression. The expert advised that he not deploy and that he go to a community health organization at home in Arkansas. Instead, in February, Redding was sent to Fort Benning, where he awaits orders to leave. “I went from a bad situation to a worse situation,” he said. “In formations, they would be shooting and I would just be cringing. . . . I’d want to see where it’s coming from.”

Redding complained to his doctor about his housing. “She said it didn’t make any sense,” he said. He said his psychologist at the base hospital called the location “stupid.” His chain of command said they would “look into it,” he said.

But he still waits for relief from the constant gunfire. “It just kind of drains you,” he said.

‘Near-Constant Fear’

The 29-year-old Army specialist palmed the wheel of his 2003 Cadillac on the way to his psychotherapy appointment in downtown Columbus, just outside Fort Benning. He reached into the leather armrest, filled with bottles of prescription medicine: tranquilizers, antidepressants, pills to calm anxiety. He popped a couple of tablets in his mouth and turned into the clinic parking lot.

Spec. Keith, who spoke on the condition that only his first name be used in order to protect his privacy, has what he calls “daymares” — flashbacks caused by chronic PTSD that has left him paranoid. “Anytime I see a U-Haul truck pull up, in my mind I think it might be a car bomb,” he said.

Last July, Keith was nearly killed in Iraq when insurgents fired 107mm rockets, hitting his tent. Shrapnel shredded his uniform, narrowly missing him. He soon began suffering headaches, dizziness and nausea. Doctors told him his ailments would go away, but they “only got worse,” he said.

In November, he arrived at Fort Benning, where the live ammunition reminds him of the attack. “I have a hard time sleeping at night when they do night firing,” Keith said. “For a moment I think something bad is going to happen, then I try to sit back and realize that it is a firing range.”

Keith lives in “near-constant fear of being shot or killed,” said an Army evaluation written by a doctor at Fort Benning in April.

Two weeks ago, the Army released him, so he loaded his car, pills close at hand, and drove away.

Strickland, who says he is lucky if he can get four hours of sleep a night, said the sounds from the firing ranges return him to the sweltering August night in Baghdad when the bomb threw him to the ground. He came home from Iraq in March 2005 and PTSD was diagnosed. But when his unit was called up to serve in Iraq late last year, his superiors encouraged him to go.

The “commander told me if I got back on the deployable list, I’d get my promotion,” said Strickland, whose wife is expecting their second child. “I was trying to look after my family and get more pay.”

He was ultimately pulled from the deployment and sent to Fort Benning, where he awaits paperwork to allow him to return to Arkansas. In the meantime, he looks out the window of his third-floor room onto firing ranges where recruits blast at targets.

“We’ve been there, we’ve fought in it, we’ve lost friends there,” Strickland said, his mind in a distant war zone. “I’m not going to get any better in this environment.”

Click here to watch a short video.

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Ex-Marine and Family Detail Struggles of Living with PTSD

Posted on June 3, 2008 by Team VCS

June 3, 2008 – When Marine Marty Smith, 27, was medically discharged in 2006, military officials said it was because of damage to his hearing. But after returning home, his hearing wasn’t the only dramatic change his wife, Heather Smith, noticed.

“That’s when I started seeing the anger, temper and him wanting to be alone and never around us,” said Heather Smith, 33, who had only been married to Marty Smith for only three weeks before his deployment.

Military doctors also saw the early warning signs.

A medical physical after serving in Iraq in 2003 diagnosed the Hattiesburg resident with post-traumatic stress disorder, an anxiety disorder that can occur after you have been through a traumatic event. Military personnel advised him to check in with the local Veterans Affairs office for treatment, but he put it off until this year.

“I did what most do,” said Smith, who spent eight years in the military and served six months in Iraq. “I was too worried about getting a job and settling down with the family.”

The U.S. Army last week released data showing a rise in the number of troops who have been diagnosed with PTSD after tours of duty in Iraq and Afghanistan.The data collected from U.S. military facilities from January 2003 to Dec. 31, 2007, has the total number of cases at nearly 40,000 for all four branches of the U.S. Armed Services.

For many soldiers like Smith, who was stationed on the border of Kuwait where he and other troops “stopped and shot rounds every few miles all the way to Baghdad,” being on constant guard is exhausting, said Beverly Smallwood, psychologist at The Hope Center.

“Having confronted danger and death itself, people feel they must constantly be on guard to protect themselves and those they love,” Smallwood said. “The body stays constantly prepared to confront threats… the classic ‘fight or flight’ syndrome of stress.”

Although Marty Smith didn’t think anything was wrong, Heather Smith said she and the couple’s three children – ages 7, 8, and 13 – saw the shift in his demeanor. Despite the couple’s two separations, it was a threat of violence toward his wife that forced him to finally seek treatment.

“He got so mad at me and he’d never threatened me like that,” she said, speaking of his threat to break both of her arms during an argument. “I got up the next morning and went to the recruiting office here and asked what kind of help was out there, because he either needed to get help or I was gone.”

Marty Smith’s PTSD was rated at 10 percent at the end of his tour, but after seeing a psychologists at the VA in Biloxi, his percentage increased to 70 percent and doctors told him he couldn’t work. Because of his temper, he wasn’t able to keep a job so the rediagnosis has allowed him to collect disability while he seeks treatment.

When describing his anger and temperament, Smith compares it to the Incredible Hulk – calm and controllable, but when it changes, all should steer clear. He said he can be triggered by anything – from a person’s open disrespect to the way a person dresses.

“In my mind, if it’s things that wouldn’t fly in the Marine Corps, those are the things I get mad about,” he said.

Heather Smith recalled an incident when her husband was furious after losing a can of smokeless tobacco while at a local golf course.

“I was chewing everybody out,” he said. “People would walk by and I would just chew them out.”

She said the family isn’t close to being the same as before his deployment. Now, the children avoid their father when his mood changes.

“If they know that I’m calm, they will come around, but the first bit of anger, they go away,” he said. “It makes me feel bad, but it also makes me think things will get better.”

Heather Smith now is pushing for a Hattiesburg PTSD support group to cater to the needs of families and veterans. Currently, group support is only offered to veterans through the VA in Biloxi.

Marty Smith has issues with the discharge process and feels the psychiatric evaluation barely scratches the surface.

“It’s almost like hurry up and get them out,” he said. “They don’t dig in and find out exactly what’s wrong with you.”

He didn’t remember seeing a psychiatrist but his wife insists the time was minimal.

“He saw a psychiatrist for 20 minutes,” she said.

Smallwood said specific treatment options include exposure therapy that gradually exposes a person to the things that trigger the post traumatic reaction and gives ways to cope with it.

“It’s not an either or treatment,” she said. “Medication can calm down symptoms but a person still needs to address the issues.

“The tendency is to try to avoid them (the issues) but then the world becomes smaller and smaller and a person also finds themselves overreacting to other things and the family pays the price with the irritability and anger.”

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Editorial Column: Why Won’t Republicans Do Right for the Veterans They Sent Off to War?

Posted on June 2, 2008 by Team VCS

June 2, 2008 – Monday’s Memorial Day celebration reminded us of the supreme sacrifice of this country’s fallen heroes killed in war. It is because of them that we are insured our many freedoms and our way of life.

 

Given the nature of the holiday and what it symbolizes, one would think that those who provide medical care for surviving veterans would treat them with the dignity and respect they deserve.

 

Unfortunately, there are those who choose to ignore the military service offered by millions and decide that their sacrifice is of little consequence and can be overlooked. These misguided individuals make decisions that do not reflect the national conscience of caring for the nation’s veterans and negatively impact the veterans’ ability to maintain a healthy lifestyle, both mentally and physically.

 

It was recently reported that Norma Perez, a physician and team leader in charge of the post-traumatic stress disorder (PTSD) program at the Olin E. Teague Veterans Center in Temple, has done unbelievable damage to that program and the many area veterans who have sought help there.

 

In a March 20 e-mail, Perez told her staff members, mental health specialists and counselors, to stop diagnosing PTSD because so many veterans were seeking government disability payments for the condition. Her e-mail states, “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 suggested diagnosing the veteran with an “adjustment disorder,” which is a less severe reaction to PTSD and would result in a lesser disability benefit payment to the veteran.

 

Only one part of Perez’s e-mail was truthful. Since the beginning of the war in Iraq there has been a significant increase in applications for disability benefits regarding PTSD.

 

According to independent veterans organizations that have tracked the increasing activity in PTSD applications by Vietnam veterans, there is solid evidence that the numbers have increased dramatically. In 1997 there were approximately 90,000 veterans with PTSD in VA mental health programs. By 2005, there were close to 200,000 and the numbers were growing.

 

There are several reasons for this spike in activity. First, the war in Iraq resurrects memories that have been dormant for decades. As a result, many Vietnam veterans refrain from watching the nightly news showing service men and women in the midst of battle because that activity alone, even though on television, stirs up recurring fears and anxiety.

 

Another significant factor causing that increase is due to Vietnam veterans coming into an age where there is more time available to think and remember days gone by. Vietnam vets have now raised their children, are on their own or living far from their families with no one to talk to. The days of scurrying around to PTO meetings, baseball practice, band practice, helping with homework and spending time with their children is gone forever. The Vietnam vet is thus having to cope with more free time, allowing long suppressed thoughts and images of what was done and endured during that period of their lives to come roaring back causing pain and suffering.

 

PTSD is an invisible condition known only to those who must deal with it. Those who suffer from this disorder may experience debilitating insomnia, anxiety, extreme reactions to loud sounds, flashbacks, wild and tortuous dreams of past combat experiences, problems concentrating, forgetfulness and impatience with others, alcohol and drug dependencies. And those are the less terrifying symptoms. Vets with PTSD have been known to act out previous combat situations and commit horrible, violent crimes against their families and others. Many commit suicide.

 

I called U.S. Representative John Carter to voice my concern and outrage about Perez’s e-mail. I provided my name, address and several phone numbers. Carter has not returned the call.

 

When questioned about this incident, Veterans Affairs Secretary James Peake said Perez’s e-mail was “inappropriate” and did not reflect the concern and level of medical attention given veterans. He added that Perez had been “counseled” but that she remains in her job. There is no indication of further investigation into the matter by VA.

 

However, Democratic presidential candidate Barack Obama fired off a strong letter to Secretary James Peake requesting an explanation of Perez’s e-mail and requesting an investigation into whether Perez’s e-mail is or has been VA policy.

 

Perez’s order to subordinates is unconscionable, mean-spirited and reflects badly on her views of those who served in the military. Remorse, an apology and counseling is not enough. Perez must go and should have her medical license revoked!

 

The families of our fallen veterans must never forget our gratitude for their sacrifice. They are our heroes as well.

 

As for Perez, I offer her a poppy, a symbol of the sacrifice celebrated on Memorial Day, as a grim reminder of how shallow and intolerant her understanding is of those who have served this country.

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Editorial Column: In Wake of McClellan Charges – When Bill Moyers Revealed How the Press Bought the War

Posted on June 2, 2008 by Team VCS

May 31, 2008, New York – Debate continues today over charges by former White House spokesman Scott McClellan, in a new book and on TV, that his former boss “hoodwinked” the media, and the public, into going along with the U.S. attack on Iraq in 2003.

Some reporters, such as NBC’s David Gregory — and anchors (past or present), such as Tom Brokaw and Charles Gibson — are actively defending their performance.

So it’s worth looking back at what I called, last year, the “most powerful indictment of the news media for falling down in its duties in the run-up to the war in Iraq.” The program appeared on April 25, a 90-minute PBS broadcast called “Buying the War,” which marked the return of “Bill Moyers Journal.”

I included my review in my new book “So Wrong for So Long: How the Press, the Pundits — and the President — Failed on Iraq.” An excerpt is published below.

 — While much of the evidence of the media’s role as cheerleaders for the war presented here is not new, it is skillfully assembled, with many fresh quotes from interviews (with the likes of Tim Russert and Walter Pincus) along with numerous embarrassing examples of past statements by journalists and pundits that proved grossly misleading or wrong. Several prominent media figures, prodded by Moyers, admit the media failed miserably, though few take personal responsibility.

The war continues today, now in its fifth year, with the death toll for Americans and Iraqis rising again — yet Moyers points out, “the press has yet to come to terms with its role in enabling the Bush Administration to go to war on false pretenses.”

Among the few heroes of this devastating film are reporters with the Knight Ridder/McClatchy bureau in D.C. Tragically late, Walter Isaacson, who headed CNN, observes, “The people at Knight Ridder were calling the colonels and the lieutenants and the people in the CIA and finding out, you know, that the intelligence is not very good. We should’ve all been doing that.”

At the close, Moyers mentions some of the chief proponents of the war who refused to speak to him for this program, including Thomas Friedman, Bill Kristol, Roger Ailes, Charles Krauthammer, Judith Miller, and William Safire.

But Dan Rather, the former CBS anchor, admits, “I don’t think there is any excuse for, you know, my performance and the performance of the press in general in the roll up to the war…We didn’t dig enough. And we shouldn’t have been fooled in this way.” Bob Simon, who had strong doubts about evidence for war, was asked by Moyers if he pushed any of the top brass at CBS to “dig deeper,” and he replies, “No, in all honesty, with a thousand mea culpas. … nope, I don’t think we followed up on this.”

Instead he covered the marketing of the war in a “softer” way, explaining to Moyers: “I think we all felt from the beginning that to deal with a subject as explosive as this, we should keep it, in a way, almost light – if that doesn’t seem ridiculous.”

Moyers replies: “Going to war, almost light.”

Walter Isaacson is pushed hard by Moyers and finally admits, “We didn’t question our sources enough.” But why? Isaacson notes there was “almost a patriotism police” after 9/11 and when the network showed civilian casualties it would get phone calls from advertisers and the administration and “big people in corporations were calling up and saying, ‘You’re being anti-American here.'”

Moyers then mentions that Isaacson had sent a memo to staff, leaked to the Washington Post, in which he declared, “It seems perverse to focus too much on the casualties or hardship in Afghanistan” and ordered them to balance any such images with reminders of 9/11. Moyers also asserts that editors at the Panama City (Fla.) News-Herald received an order from above, “Do not use photos on Page 1A showing civilian casualties. Our sister paper has done so and received hundreds and hundreds of threatening emails.”

Walter Pincus of the Washington Post explains that even at his paper reporters “do worry about sort of getting out ahead of something.” But Moyers gives credit to Charles J. Hanley of The Associated Press for trying, in vain, to draw more attention to United Nations inspectors failing to find WMD in early 2003.

The disgraceful press reaction to Colin Powell’s presentation at the United Nations seems like something out of Monty Python, with one key British report cited by Powell being nothing more than a student’s thesis, downloaded from the Web — with the student later threatening to charge U.S. officials with “plagiarism.”

Phil Donahue recalls that he was told he could not feature war dissenters alone on his MSNBC talk show and always had to have “two conservatives for every liberal.” Moyers resurrects a leaked NBC memo about Donahue’s firing that claimed he “presents a difficult public face for NBC in a time of war. At the same time our competitors are waving the flag at every opportunity.”

Moyers also throws some stats around: In the year before the invasion William Safire (who predicted a “quick war” with Iraqis cheering their liberators) wrote “a total of 27 opinion pieces fanning the sparks of war.” The Washington Post carried at least 140 front-page stories in that same period making the administration’s case for attack. In the six months leading to the invasion the Post would “editorialize in favor of the war at least 27 times.”

Of the 414 Iraq stories broadcast on NBC, ABC and CBS nightly news in the six months before the war, almost all could be traced back to sources solely in the White House, Pentagon or State Dept., Moyers tells Russert, who offers no coherent reply.

The program closes on a sad note, with Moyers pointing out that “so many of the advocates and apologists for the war are still flourishing in the media.” He then runs a pre-war clip of President Bush declaring, “We cannot wait for the final proof: the smoking gun that could come in the form of a mushroom cloud.” Then he explains: “The man who came up with it was Michael Gerson, President Bush’s top speechwriter.

“He has left the White House and has been hired by the Washington Post as a columnist.”

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Female Soldiers Know: Sexual Assault Can Lead to PTSD

Posted on June 2, 2008 by Team VCS

May 26, 2008 – Last month I attended a presentation on Post-Traumatic Stress Disorder, or PTSD, at the Anchorage Veterans Administration Clinic. PowerPoint slides provided a definition of PTSD and common causes of this disorder: IEDs, seeing the bodies of dead children, experiencing serious bodily injuries, and others.

I asked the briefer, a VA psychiatrist, whether the VA also considered Military Sexual Trauma an experience that can lead to PTSD. He replied “no.”

I looked at the physician with amazement. Many peer-reviewed journal articles assert that Military Sexual Trauma, or MST, is especially associated with PTSD. That the Veterans Administration continues to disassociate MST with PTSD is remarkable.

But it may be understandable, considering the military is a culture that ostracizes and ridicules women who “rock the boat” by reporting incidents of sexual assault and violence.

What is needed, if the military and VA are to respond appropriately to MST, is a broad-based, systemic change in the military’s culture. Like other large organizations, there is a reluctance to undertake such changes when the top leadership finds such change unnecessary.

Public Law 109-162, the Violence Against Women Act of 2005, is designed to “bring together the criminal justice, social service, and health systems in an effort to intervene and prevent domestic violence, dating violence, sexual assault, stalking, and rape.”

As a result, local, state and national laws have changed. Services, businesses and communities are responding to victims’ needs. Abusers are being prosecuted. Victims in greater numbers are seeking services and reporting crimes. VAWA helped forge new alliances between police officers, courts and victim advocates.

The act has performed as designed, except in our military.

The military prefers to handle potentially embarrassing matters such as MST “in-house.”

When considering the military’s archaic legal system and widespread sexually inappropriate behaviors, one may understand the commanders’ unwillingness to observe VAWA standards. The hierarchical chain of command provides higher-ranking persons with authority over those of lower rank. Commanders have full discretion when considering whether an investigation into sexual assault is conducted, whether a particular case goes to a military trial (courts-martial) and how the perpetrator is punished, or not.

I’ve seen commanders who were downright giddy about their power over others. I’ve witnessed atrocious things they have said and done, because they could.

Certainly, the commander working with the Judge Advocate General’s Corps uses laws and regulations spelled out in the Uniform Code of Military Justice. But this code has not been substantially revised since the 1950s.

Officers in charge can select which JAG officer serves as the prosecutor (representing the command) and which serves as the defense attorney (often with the same allegiance). Officers in charge can set the perpetrator’s punishment, if there is any.

In a state or federal court, different entities are responsible for these different trial functions. The system of military justice is not encumbered by concerns about conflict of interest or abuse of power. Military rules of evidence provide exceptions for sexual assault cases and, therefore, disallow the victim privacy and confidentiality.

Most alarming, questioning during a military trial permits the use of long-outdated sexist and stereotypical attitudes. State or federal courts prohibit questioning of the victim in this manner.

Military Sexual Trauma leading to Post-Traumatic Stress Disorder is not a new development. Sexual violence by service members against service members has gone on for decades and the military has not fully addressed this crime or its consequences.

At the end of the presentation at the VA Clinic in April, an elderly woman behind me, probably a Korean War veteran, raised her hand and acknowledged to the briefer “I have what she said.”

This veteran shed tears and spoke in a quivering voice as she expressed her pain without using clinically descriptive words. Those who listened could empathize with her, understand her pain, and in horror, share her traumatization and re-traumatization for more than 50 years. We should all be saddened to know that for this veteran and many others like her, the pain lingers and does not quickly dissipate.

And in hearing and knowing this, my heart broke … again.

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