New Survey: 36 Percent of Iraq and Afghanistan Veterans May Have PTSD

PTSD, depression surfaces in war returnees

February 1, 2008, Charleston, West Virginia — Thirty-six percent of the returnees from fighting terrorism in Iraq and Afghanistan suggested in a legislative survey they suffer post-traumatic stress disorder, and 44 percent showed signs of clinical depression.

PTSD, a post-war emotional roller-coaster first examined in Vietnam War veterans, covers a range of symptoms such as flashbacks, nightmares and intrusive thoughts.

Results of the survey, performed at the behest of select committee on veterans this past year, were unwrapped Friday by Dr. Joseph Scotti of the West Virginia University psychology department.

Questionnaires were sent in December to 6,400 state veterans, some of whom had service in Bosnia and Kosovo, along with Vietnam and Somalia.

Scotti’s report to lawmakers showed 550 filled out the survey, and so far, 471 have been analyzed. Another 1,000 surveys never reached veterans because of address changes.

In defense of the anonymous survey, as opposed to a sit-down examination with a clinical psychologist, Scotti said afterward he considers them as reliable, if not more so.

“People tend to be a little more honest on these anonymous surveys,” he said.

“Of course, some people exaggerate and some people downplay. But they do that face to face as well. We have thousands of studies, literally, that are survey-based, and in comparing them to face to face interviews, they’re in very good agreement. I think this is very reliable, valid data.”

Scotti advised the panel’s co-chair, Delegate Barbara Fleischauer, D-Monongalia, that trained professionals are necessary in treating affected war returnees, but some are reluctant to go.

“It sounds ironic that these people are avoiding exactly what might help the most,” Fleischauer said.

Asked if there’s a difference between talking problems out with friends and family and in going to a professional, Scotti said the latter is the only workable avenue.

“You may share a little bit with your friends or family,” he said.

“You tell your friends and family the horrors you’ve been involved in. They’re not trained to listen. Many therapists do the same thing. They’re not trained to listen to these things. It takes special training when you’re telling these stories.”

Sen. Jon Blair Hunter, D-Monongalia, the other committee co-chair, wondered aloud just what tack the Legislature should take in treating veterans coming home with severe emotional problems.

He got some strong advice from Jack Tincher, head of the West Virginia Veterans Coalition.

“Whatever legislation you write, whatever you do, keep that confidential,” he said.

“The military is a strange animal. They will end your career if you go for help.”

Ninety percent of the veterans indicated they are aware of the services, but 80 percent indicated they would use them if available. Sixty-three percent said they have sought help with PTSD and depression, while 48 percent of the “other veterans” not struggling with emotional stress looked for assistance.

“Is this a uniquely American problem?” asked Delegate Margaret Staggers, D-Fayette, an emergency room physician.

Staggers also wondered if somehow soldiers gearing up for combat could be “vaccinated” to head off emotional troubles.

“This is by no stretch a uniquely American problem,” Scotti assured her, noting war shows no discrimination in hurting victims.

Larry Linch, director of veterans affairs for the state, implored the panel not to make any distinction between physical and emotional problems of military personnel.

“I’ve got shrapnel in my arm,” the Vietnam veteran said. “There should be not difference in having shrapnel in my arm and having PTSD, and I have both.”

— E-mail: mannix@register-herald.com

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Senator Clinton Assists Wounded Warriors

January 29, 2008 – Senator Hillary Rodham Clinton announced that the revised Fiscal Year 2008 Department of Defense Authorization Act signed into law by the President on Monday includes a series of efforts she introduced to help address the urgent needs of wounded servicemembers. The bill contains measures offered by Senator Clinton from her Heroes at Home Act of 2007, Bridging the Gap for Wounded Warriors Act, and Restoring Disability Benefits for Injured and Wounded Warriors Act, among others.

“This is welcome news and it is a critical step forward in ensuring that our servicemembers and veterans get the care and services they have earned. These crucial measures will help improve screening for Traumatic Brain Injury, which is affecting so many who have served in Iraq and Afghanistan; smooth the transition for wounded servicemembers between DoD and VA healthcare systems; and cut red tape and streamline the disability benefits process. In a time when we are asking so much of our men and women in uniform, it is our responsibility to ensure that we honor their service and sacrifice by providing them with the best possible care and support.”

Senator Clinton’s measures signed into law by the President will:

* Mandate that the Department of Defense implement a screening protocol for Traumatic Brain Injury within 180 days. This provision builds on a measure that Senator Clinton first introduced as part of her Heroes at Home Act of 2007 to improve detection of mild and moderate TBI by developing an objective assessment tool to measure cognitive functioning of servicemembers both prior to and after deployment.

* Ensure interoperability of DoD-VA Joint Medical Record. Senator Clinton’s provision will make sure that efforts underway by the DoD and VA to create a joint electronic medical record result in a DoD-VA medical record that is compatible and synchronized with the national efforts to develop a nationwide coordinated health IT infrastructure, an issue on which Senator Clinton has been a leader. This measure builds on provisions, which would provide oversight and leadership for a joint DoD-VA interagency office, from Senator Clinton’s Bridging the Gap for Wounded Warriors Act.

* Reform the Disability Rating System. The final bill also builds on a measure from Senator Clinton’s Bridging the Gap for Wounded Warriors Act that would reform the current flawed disability rating system for wounded servicemembers by ending the DoD rating system and having military departments adopt the VA disability rating system.

* Ensure wounded servicemembers receive needed disability benefits. The bill also includes another measure from Senator Clinton’s Restoring Disability Benefits for Injured and Wounded Warriors Act: a provision to help make sure servicemembers receive disability benefits they need and deserve by requiring an independent review of disability benefit ratings below 20 percent and increasing disability benefits as warranted.

* Provide oversight of the disability rating system. The final bill also contains Senator Clinton’s provision to ensure needed oversight of the disability rating system for wounded servicemembers by continuing Government Accountability Office (GAO) reviews of treatment of wounded servicemembers. This measure also will ensure that disability benefit determination cases under review are prohibited from being reduced by a new determination. Senator Clinton proposed similar measures as part of her Restoring Disability Benefits for Injured and Wounded Warriors Act.

* Require research on servicemembers with TBI to monitor for signs of Alzheimer’s Disease and other neurodegeneration. This measure offered by Senators Clinton and Collins, co-chairs of the Congressional Task Force on Alzheimer’s Disease, requires that any longitudinal studies on members of the Armed Forces with TBI also identify early signs of Alzheimer’s disease, Parkinson’s disease and other neurodegeneration. Head injuries, after age and family history, are one of the leading risk factors for an individual developing Alzheimer’s disease. This amendment builds on a provision for a 15 year longitudinal study on long-term health and mental health consequences of TBI that Senator Clinton proposed and was included in the FY2007 John Warner National Defense Authorization Act.

* Improve transition from DoD to VA care. This measure, similar to provisions in the TBI Access to Options Act introduced earlier this year by Senator Clinton and Senator Evan Bayh (D-IN), will improve advocacy and assistance to wounded servicemembers, including those with traumatic brain injury, and their families as they transition from DOD to VA medical treatment, preventing them from getting caught in bureaucracy and red tape.

* Make active duty and veterans healthcare services available to all who have served in Iraq and Afghanistan. This measure builds on a provision proposed by Senator Clinton in her Bridging the Gap for Wounded Warriors Act. Specifically, Senator Clinton has called for providing a two-year “overlap” period during which active duty and medically retired health care services and benefits would be available to injured current and former military servicemembers.

As New York’s first Senator to serve on the Senate Armed Services Committee, Senator Clinton has made it one of her top priorities to ensure that our brave men and women in uniform have the healthcare and support they need. She has introduced legislation to improve the detection, assessment and treatment of traumatic brain injury and expand support systems for members and former members of the Armed Services with traumatic brain injury and their families.

Senator Clinton has also introduced legislation to help ensure wounded soldiers receive the disability benefits they need and deserve and to further protect military family financial benefits. She has called for a new GI Bill of Rights to once again honor the service and invest in the future of our men and women in uniform. She authored legislation signed into law last year that required an audit of widespread pay issues wounded soldiers are facing and was recently released by the Army showing continuing problems. Following recent reports that the Department of Defense was asking wounded servicemembers to re-pay portions of their enlistment bonuses, Senator Clinton joined Senators Sessions and Casey to introduce legislation to guarantee full payment of bonuses and incentives to veterans wounded in combat. Senator Clinton has fought to ensure servicemembers have the body armor they need. She also played a key role in securing into law access to TRICARE military health benefits for all drilling members of the National Guard and Reserves and their families.

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Denial in the Corps

February 18 Issue

Marine Lance Cpl. James Jenkins is buried in the same New Jersey cemetery that he used to run through on his way to high school, stopping at the Eat Good Bakery to get two glazed doughnuts and an orange juice before heading off to class. When his mother, Cynthia Fleming, visits his grave, she looks over the low cemetery wall at not only the bakery but the used-car lot where James used to sell Christmas trees during the winter and the nursing home where he worked every summer and says, “Lord, son, you’re on your own turf.” James, who died at 23, is buried in Greenwood Cemetery; the owners told Cynthia they’re proud to have him there.

During his short career as a marine, Corporal Jenkins received many commendations recognizing his “intense desire to excel,” “unbridled enthusiasm” and “unswerving devotion to duty.” It was for heroic actions performed during a fifty-five-hour battle with the Mahdi militia in Najaf that Jenkins was awarded a Bronze Star for valor. The fighting, which began on the city streets in August 2004 and moved into the Wadi al Salam Cemetery, was ferociously personal. Marines and militiamen were often only yards apart, killing one another at close range. When the battle was over, eight Americans and hundreds of militiamen were dead.

After that tour, his second in Iraq, Jenkins could barely sleep. When he did, the nightmares were horrible. He was plagued by remorse and depression, unable to be intimate with his fiancée, run ragged by an adrenaline surge he couldn’t turn off.

Back at San Diego’s Camp Pendleton the following January, Jenkins took to gambling, or gambling took to him; he became addicted to blackjack and pai gow, a fast-moving card game where you can lose your shirt in a minute. The knife-edge excitement felt comfortingly familiar. Jenkins went into debt, borrowing thousands of dollars from payday loan companies. Busted for writing bad checks, he was locked up in the Camp Pendleton brig that spring pending court-martial. In the months that followed, he was released, locked up and released again. He spoke often of suicide. The Marines never diagnosed his post-traumatic stress disorder (PTSD). When his mother called his command seeking help, Jenkins’s first sergeant, who had not served in Iraq, told Fleming he thought James was using his suicidal feelings to his advantage. “I have 130 marines to worry about other than your son,” she recalls the sergeant saying. When his command decided to lock him up a third time, James Jenkins ran.

On September 28, 2005, eight months after returning from Iraq, Jenkins found himself cornered in the Oceanside apartment he shared with his fiancée. A deputy sheriff pounded on the front door, while a US Marshal covered the back. The young man with the “intense desire to excel” decided he could not go back to the brig or get an other-than-honorable discharge. He would not shame his family or have his hard-won achievements and his pride stripped away. And he was in pain. “He said, ‘I can’t even shut my eyes,'” his mother says, recalling one of his calls home that month. “He said, ‘I killed 213 people, Mom.’ He said, ‘I can’t live like this.’ He said, ‘Everything I worked for is down the drain,’ and he was crying like a baby.” While the officers waited for his fiancée to open the door, Jenkins shot himself in the right temple.

In the wake of Jenkins’s suicide, the Marine Corps attempted to deny death benefits to his mother by claiming he’d died a deserter; but in a report based on that eligibility investigation, Thomas Ferguson, a special agent from the Naval Criminal Investigative Service, described the young man as a “salvageable marine” whose untreated PTSD had led to his suicide.

“LCpl Jenkins was a bona fide war hero,” Ferguson wrote. “Unfortunately, it is clear that when he most needed help from the military, the military failed him.”

James Jenkins is a casualty of the war in Iraq as much as his fellow marines who died in that cemetery in Najaf, abandoned by an organization that has little tolerance for broken marines and is itself under tremendous stress from sustaining multiple deployments. “They didn’t do anything,” his mother says. “They just kept locking him up.”

According to civilian and military defense lawyers, mental health professionals and veterans’ advocates, the trajectory of James Jenkins’s postdeployment life, with untreated PTSD leading to misconduct and then punishment, is all too common in the Marine Corps. A marine endures one, two, even three tours in Iraq, serves honorably and well, but returns suffering from combat trauma and starts to drink or abuse drugs or becomes violent at home, and suddenly finds himself ostracized, punished and drummed out of the Corps with an other-than-honorable or bad-conduct discharge. A history of service is tarnished, and the marine is denied benefits–even the treatment necessary to recover from combat trauma–and left with only a bitter sense of betrayal. A Corps review in 2007 of 1,019 other-than-honorable discharges issued to combat veterans during the first four years of the Iraq War found that fully a third of the discharged marines had evidence of PTSD or another combat-related mental illness. Lt. Col. Colby Vokey, the Marine Corps’s legal defense counsel for the western United States, estimates that of all the Iraq combat veterans his office defends, one-third have PTSD or another combat-stress mental health issue. Many of these clients have served at least two tours in Iraq.

The factors leading to the abandonment of combat-broken marines are both cultural and operational. The Marine Corps is the youngest, most male, most junior and least married of all the services. Sixty-six percent of the troops are 25 or younger; 13 percent are teens; and 39 percent hold the rank of private, private first class or lance corporal. Fewer than 7 percent are female. The Corps’s deeply macho culture, which values stoicism in the face of pain and disdains “weakness,” makes it hard for marines to seek help. Judith Broder, a civilian psychiatrist who treats Iraq and Afghanistan vets, says, “They all know of stories where buddies have asked for help and have been ridiculed by the chain of command or given some kind of treatment that is not really adequate and told they have to go back.”

This harsh culture is exacerbated by the relentless tempo of training and deployment, which pressures commanders to quickly replace broken marines with deployable ones. “You read the Marine Corps values and you’ll find that anybody that gets hurt isn’t courageous or doesn’t have honor,” Judith Litzenberger, a civilian defense lawyer and twenty-one-year Navy veteran, explains. “That’s how the marines interpret it: ‘I went to Iraq and I didn’t whine and I didn’t claim that I had a mental disorder, and damn well marines don’t do that–we suck it up.’ And it has to be that way because they have a mission that’s bigger than the number of people they have. They can’t spend all their time taking care of people who have mental disorders. They’ve got to wash them out quickly and move on.”

The Corps also places more emphasis on discipline than any other branch of the military. According to USA Today, the Corps prosecutes close to the same number of troops for misconduct as the Army does, though it is one-third the size. “I don’t think the legal system is being used improperly according to regulations,” Lieutenant Colonel Vokey says. “The problem is I don’t think the system accounts for these folks with PTSD. There’s got to be another way to handle this without lumping them in with every other marine who commits misconduct. They were fine when they went to Iraq, we broke them, this is what combat did to them, and I think we should feel some responsibility for what happens to them.”

Add to these factors the political and financial pressures surrounding the Iraq War, which have resulted in a mental health system so underfunded that last year a Pentagon Mental Health Task Force termed its staffing “woefully inadequate.” The Navy, which provides psychological healthcare to the Marines, has filled only 72 percent of its psychologist billets and 62 percent of its psychiatrist billets.

“The funding has just been awful, the worst I’ve ever seen in my twenty years in the military,” says Dr. Katherine Scheirman, a retired Air Force colonel who served as chief of medical operations in the Air Force’s Europe headquarters from July 2004 to September 2006. Scheirman says the current political environment has made it “impossible” to give wounded soldiers proper care. “It’s all about money,” she says. “Every kid that gets kicked out with PTSD is gonna be a lifetime of disability payments for the government. Every kid who gives up and kills himself, nothing.” Scheirman’s unit was in charge of evacuating the wounded from Iraq and Afghanistan and transporting them to the Landstuhl Regional Medical Center in Germany and on to the United States. She says politics infused every aspect of care. When she tried to beef up the hospital staff at Landstuhl, she was told, “No, we can’t put more doctors or nurses in there because it will look like we expect more casualties.” She was not allowed to send the visibly wounded home on commercial planes. “The rule,” she says, “was they couldn’t fly commercial if they had injuries that showed because it would upset the American people.” The military planes were so cold the Air Force ended up running clothing drives for hats, scarves and mittens–a situation that continues today. In one e-mail requesting donations, a lieutenant colonel wrote, “Mittens are preferred because they often fit better over wounded hands/fingers.”

“What kind of Army doesn’t provide mittens for its wounded soldiers?” Scheirman asks. “What’s sad is this isn’t the way it’s ever been before. I came into the military under Reagan, and George Bush’s dad–they treated people well. The Clintons treated people really, really well. It’s only this Administration that acts like the lives of these soldiers are expendable.”

When the fourth Army Mental Health Advisory Team (MHAT IV) traveled to Iraq in 2006 to assess the mental health of soldiers and marines in theater, they noted the intensely “personal” nature of duty there–that is, the high percentage of soldiers and marines who knew someone seriously wounded or killed and could describe an event that had caused them “intense fear, helplessness or horror”: seeing a friend liquefied in a tank, being attacked by IEDs, being caught in the open under sniper fire, “seeing, smelling, touching…dead people.” Last June the Pentagon’s Mental Health Task Force reported that 31 percent of the marines who served in Iraq or Afghanistan are suffering from traumatic stress, and Marine Corps suicide rates have been above average since the United States invaded Afghanistan. In 2004 the Corps reported thirty-two active-duty suicides, six of them from Camp Pendleton.

Marines have not only been heavily deployed during Operation Iraqi Freedom; they’ve been sent into some of Iraq’s most volatile areas, and they suffer 25 percent of the casualties, though they make up only 16 percent of ground forces there. “It has long been recognized that mental health breakdown occurs after prolonged combat exposure, a considerable number of Soldiers and Marines are conducting combat operations everyday of the week, 10-12 hours per day…for months on end,” the MHAT IV report explains. “At no time in our military history have Soldiers or Marines been required to serve on the front line in any war for a period of 6-7 months, let alone [a] year, without a significant break in order to recover from the physical, psychological, and emotional demands that ensue from combat.”

Their deployments generally run seven months, though last year 4,000 marines had their tours extended. Once home, they are given up to thirty days of leave to reconnect with their families, though many cannot even adjust to sleeping in a bed. Then they are back in training for their next deployment. The average break between tours is only six months. According to a mental health counselor at the Marine Corps Air Ground Combat Center in Twentynine Palms, California, who requested anonymity, marines suffering from combat trauma often decide not to seek counseling because they simply don’t have time. Moreover, they tell the counselor, since they’ll just be sent back into combat, what’s the point? “In some way it is miraculous if someone doesn’t have PTSD with these repeated tours,” says Judith Broder, the psychiatrist. She founded The Soldiers Project, which provides free psychological services to Iraq and Afghanistan vets and their families, including, currently, several active-duty marines. “There’s this heartbreaking sense these guys express of, ‘I don’t know who I am or what I did over there, and I have to hold myself together because I’m going to have to do it again, so don’t try to pull me back into something soft and sweet. This is not going to do me good.'”

“Maybe we have to recognize that after a deployment or two, you’re not able to deploy anymore because the stresses on the mind are just too great,” says Maj. Haytham Faraj, the lead defense counsel at Camp Pendleton. The case that made Faraj “the angriest I’ve ever been at the Marine Corps” involved a 19-year-old who was severely wounded by a rocket attack during his first tour in Iraq.

The marine’s wounds left him unable to control his bowels, and he lost sexual function. After being treated at several military hospitals, he was sent home to his parents on convalescent leave. His military counsel, former Marine Capt. Melissa Epstein Mills, now in private practice, says that during those months, the teen was “falling into the depths of depression dealing with these truly traumatic injuries and the death of his best friend, who died shortly after he was hit. [Then] his wife served him with divorce papers while he was in the hospital. His parents described it as a downward spiral.”

When they found themselves unable to help their son, his parents asked his command at Pendleton to come get him. The 19-year-old confessed to his company commander that he had been smoking pot while convalescing.

“He had been on some pretty heavy painkillers and was being transitioned off,” Epstein Mills explains, “but it was [also] a coping mechanism.” The young man’s regimental commander recommended him for an other-than-honorable discharge for drug use, which, Epstein Mills says, would likely have meant denial of his veterans’ benefits–including mental healthcare–for the rest of his life.

“What a lot of people miss is that, in general, it’s totally up to the commander what happens to their troop,” says Scheirman. “They can send him to the hospital and say, ‘Hey, this guy isn’t able to do his work. Would you look at him for PTSD?’ Or they can just kick the guy out.” A medical discharge, which is generally under honorable conditions, can take many months, sometimes longer, and all the while the commander is stuck with an undeployable marine. An administrative separation usually takes a few weeks, at most. “If you kick the guy out, you’ll get somebody to replace him,” she says. “So that’s the incentive for the commanders.”

Epstein Mills and the 19-year-old’s Marine Corps lawyer won him a general discharge under honorable conditions. Unlike an honorable discharge, it will not qualify him for educational benefits from the GI Bill, but he’ll probably get some medical benefits.

Before Lt. Col. Andrew Horne left Iraq in 2005, where he was the civil military operations officer for western Anbar province, he and every marine under him above the rank of staff sergeant attended a briefing on PTSD given by the division psychiatrist, a Navy officer. “They said it’s been determined that it comes from a feeling of helplessness, and elite units like Marines don’t get it,” Horne says. “And the ones who do get it have usually been discipline problems before or have a pre-existing problem. So it was really designed to, one, make you not report it yourself and, two, be suspicious of anyone who was reporting it.”

More than two years later, despite a growing acknowledgment within the Corps of the mental costs of war, PTSD remains underdiagnosed and undertreated. At Twentynine Palms, some of the civilian counselors on base avoid sending marines to division psychology because at least a dozen marines they referred there for treatment were given “personality disorder” diagnoses and kicked out of the service [for more on the personality disorder scandal, see Joshua Kors, April 9 and October 15, 2007]. Mary Jo Thornton, a licensed family therapist and former base counselor, remembers one Marine sergeant coming back from his appointment with the naval psychologist, saying, “Thanks, you ruined my career. Now they’re ad-sepping [administratively separating] me out of the military. The little guy talked to me for a half-hour and told me I had a personality disorder.” Many active-duty marines go off base to veterans’ centers for counseling, because only there do they feel safe from punishment.

When Cpl. Michael Cataldi, who served with the Third Light Armored Reconnaissance Battalion based at Twentynine Palms, returned from his first deployment, he was angry and depressed. “Helicopters scared me because I picked up a helicopter crash,” he says. “Thirty marines and one Navy corpsman all died, and we were the first four people there. I did a body count when I was 20 years old.” The pilot was on fire, and Cataldi had to put him out with a shovel. “I smell burning flesh when people grill chicken. I can’t be in crowds,” he says. “This all happened before I went over the second time.”

It took months between deployments for him to get an appointment with the regimental psychologist, and when he did he sensed the doctor was trying to talk him out of his symptoms. “He kind of told me, as I was telling him what I was feeling, that I wasn’t really feeling that,” he recalls. Cataldi was diagnosed with anxiety and depression, not PTSD, given anti-anxiety meds and antidepressants, and sent back to Iraq. There he was put in charge of the guard at Camp Apache.

After four months the medical officer left Iraq, and suddenly Cataldi had no more meds. “I had a breakdown,” he says. “I even defecated all over myself, and I don’t remember doing it.” Cataldi was evacuated to the combat stress center at Camp Al-Assad, where he was diagnosed with PTSD and given three weeks of treatment. When he returned to base, he began to get disciplinary write-ups: one for an unauthorized absence, the other for allegedly threatening his executive officer. “They were trying to take my rank and call me a horrible marine,” he says. Cataldi ended up facing a nonjudicial punishment proceeding and losing half a month’s pay. “They thought I was trying to go home,” he says.

When Cataldi returned to the States at the end of his second deployment, with only a few months left on his service contract, he stayed low to the ground, afraid his commanders would take his rank or kick him out. In his last evaluation before leaving the Corps, Cataldi had a fifteen-minute appointment with the naval psychiatrist on base, who told him he had “anxiety disorder.”

Unlike the Army and the Air Force, almost every Marine and Navy base has a brig on board, and that makes it easy to use the brig as storage for a troubled marine. “We think pretrial detention is overly prescribed,” Faraj says. “More often than not it’s used as a tool, because the command doesn’t want to deal with someone.” Consequently, marines with mental health problems are not only locked up in a brig without adequate mental healthcare but are asked to make serious legal decisions while actively suffering from mental disorders. “I think doing a court-martial at that time is a setup,” Judith Litzenberger, the civilian defense lawyer, says. “It’s totally devoid of due process. You don’t have a client there that you can talk to. We need some long-term psych hospitals that can treat these guys.” The hospital at Pendleton lost its psych treatment certification a few years ago and never worked to get it back, so the camp no longer has an inpatient psychiatric facility. Marines who attempt suicide in the brig are sent to the Naval Medical Center in San Diego, but the naval hospital offers only acute care to marines, so once the suicidal marine is stabilized, he is sent back to jail. Though commanders do not purposely use pretrial detention to break a marine, that is often the effect on a marine suffering from PTSD–as it was in the case of Sgt. Patrick Uloth.

Uloth’s command thought “he walked on water,” Faraj says. After two tours in Iraq, they even recommended him for an officer-training program. “I thought the Marine Corps did no wrong,” Uloth recalls. “I could watch you do something and if the Marine Corps told me you didn’t do it, I believed it. I loved the Marine Corps that damn much.” But untreated PTSD, pretrial detention and official callousness destroyed his career in the Corps.

It began during his second deployment to Iraq, when Uloth and members of his unit manning a vehicle checkpoint fired on a car speeding toward them. “When they went to see what they’d gotten, in the car were a father and three young kids,” Faraj says. “That troubled him so much that he began to have nightmares, and that’s when the PTSD set in.” Two weeks before his tour ended, an explosive-filled truck detonated at another checkpoint, where Uloth saw two of his marines die. Under heavy fire, he retrieved the decapitated head and body of his best friend. Then he held the hand of a dying 19-year-old marine and told him he was going to be OK.

Once Uloth’s unit returned to Pendleton, he began to suffer from PTSD, depression and “conversion disorder,” characterized by flashback-related seizures. Each time he tried to see the unit psychiatrist, he was given an appointment weeks away–a typical wait, according to Faraj. Uloth decided to go home to New Orleans, where he checked himself into the psychiatric ward at a nearby Air Force hospital. After forty-five days, the Marines sent chasers to pick him up. Back at Pendleton, he was charged with unauthorized absence (UA) and thrown into the brig.

There, Uloth was put in isolation, stripped to his underwear for up to twenty-four hours a day and was so heavily medicated he felt like a “zombie.” Once a month he was taken in handcuffs and leg shackles to see a psychiatrist. Faraj wanted to go to trial, sure that they could beat the charges. But after two months in the brig, Uloth told him, “I can’t take it anymore. You got to get me out.” Faraj’s plea agreement included a reduction in rank to corporal and a general discharge under honorable conditions.

While Uloth waited for his discharge to come through, he was transferred to a new unit. When a marine faces misconduct proceedings, he is often transferred from his parent company to a headquarters unit. The people he served with in Iraq were busy training for redeployment or were back overseas, and the rear command knew him only as a marine charged with substance abuse or UA, another one of “the broke, lame and lazy.” In the new unit, Uloth, an experienced sergeant, was subject to daily ridicule and assigned to pick up trash.

Uloth told Faraj he couldn’t take it. Faraj told him to hang in there, but a few days later, Faraj got a call from the unit’s first sergeant, asking if he knew where Uloth was. Six months after that, Uloth was picked up again in New Orleans, this time on a DUI, and thrown back into the Pendleton brig.

The previous terms of his discharge were voided, but Uloth told Faraj, “Any way you can get me out, I just want out.” Uloth was separated with an other-than-honorable discharge, with all direct medical benefits denied him, his history of faithful service erased.

Now Uloth cannot afford medication to control his seizures, so he just “wings it” and has ended up in various emergency rooms. He uses alcohol to put himself to sleep. Recently, several of the marines who served with him in Iraq tracked him down. “We all served in combat together and all of them have the same problems,” Uloth says. “They’ve all been diagnosed with PTSD, their lives are upside down, a lot of them have tried committing suicide, a lot of them are alcoholics, they can’t keep a marriage or a relationship, everybody’s lives are shitholes.”

The Marine Corps has always taken pride in caring for its own, but its efforts to take care of mentally wounded marines have overwhelmingly failed, plagued by denial, machismo, an unrealistic war tempo and a severe shortage of resources. In the spring of 2007 the Corps set up the Wounded Warrior Regiment, where marines suffering from physical and mental injuries could be tracked and supported. “I spoke with the guy at Quantico who was going to be running this warrior regiment,” says Steve Robinson, a Gulf War veteran and veterans’ advocate. “And one of the first things he said that made me sit up in my chair was, ‘Look, we don’t want to diagnose marines with PTSD. We need them to get back into the fight. Call it something else, whatever you want to call it, and then we try to retrain them.'”

Robinson told him, “Well, that’s great, but the DSM-IV [Diagnostic and Statistical Manual of Mental Disorders] clearly states that if they have these signs and symptoms, they should be diagnosed.”

When members of President Bush’s Commission on Care for America’s Returning Wounded Warriors visited Pendleton last spring, they spoke with a group of marines housed in the wounded warrior barracks who said they felt they were being punished for being wounded. The marines pointed to the sterile living environment, rigid rules banning rest in their rooms during the day and menial tasks assigned to those well enough to work. In his report to the President’s commission, Lt. Col. Leslie Chip Pierce said visitors from the commission “were taken to a location in the barracks known to these wounded warriors as the petting zoo.” At the camp’s Behavioral Health Clinic, the staff expressed “frustration” too, saying, according to the report, that “line commanders are not always committed to PTSD identification and treatment once they have returned to home base.”

After the Marine Corps conducted its review of less-than-honorable discharges, Navy Capt. William Nash, who coordinates the Marines’ combat stress program, recommended, according to USA Today, that “any marine or sailor who commits particularly uncharacteristic misconduct following deployment…be aggressively screened for stress disorders and treated.” Almost a year later, the Navy and Marine Corps have yet to implement these screenings. They simply don’t have the manpower.

More than two years have passed since James Jenkins’s death, which Lieutenant Colonel Vokey describes as a “terrible tragedy” that should never have occurred. It was three months after returning from Iraq, in April 2005, that Jenkins first complained of depression and was referred to Division Psychology. There he was diagnosed with “adjustment disorder,” which meant he would not receive treatment for PTSD. He was then given Ambien to help him sleep and an antianxiety drug, Ativan–and declared fit for duty.

The Ambien didn’t help, and he took himself off Ativan. On May 5 he asked for help with his depression again. He was told to continue taking Ambien.

At the end of that month, Jenkins was confined to the brig to await his court-martial. While there, he filled out a Chronological Record of Medical Care, checking the “yes” box after the question “Have you had any thoughts of injuring yourself or others?” Beside that box, Jenkins wrote, “Combat, Kill the enemy.” Still he received no mental healthcare. The medical officer merely noted, “PT [patient] has hx [history] of Adjustment D/O [disorder] with depression and anxiety.”

Cynthia Fleming kept calling the first sergeant, trying to get her son help. “I told him my son was going to kill himself. They told me the brig was a form of suicide watch. I said, ‘That’s a jail.'”

Inside the brig, the situation took a bizarre turn. Another jailed marine, a gunny sergeant, tried to hire Jenkins to kill five people and kidnap another sergeant’s daughter. Jenkins informed his lawyer and was released in order to work as an informer. But when he began to gamble again and cash worthless checks, he was rearrested. Because his life would have been at risk inside Pendleton, Jenkins was locked up in the Miramar brig instead. A judge quickly released him, but his command decided to send him back to the brig at Pendleton. “Of course, he’s petrified of the guy who he’s reporting on and being back in the brig with him,” Vokey says. “That’s when he took off.”

Jenkins stole a gun from an Oceanside pistol range, a gun with one bullet, he told his mother on the phone. She called his unit; the defense lawyers called, too. “We had talked to the unit, trying to get them to go find this kid because he was going to kill himself, and didn’t get a lot of compassion,” Vokey says. “They were just fed up with him.”

Fleming told her son she could fly out to California the next day. “Tomorrow will be too late,” he said. “Tell everybody I’m sorry. Tell my sisters, tell my brother, tell my nieces, I’m so sorry. All I wanted to do is make you proud.”

When Fleming arrived at Scripps Memorial Hospital, James was brain-dead. Two noncommissioned officers were in the room with her, one of them James’s first sergeant. Fleming told the nurses, “See that sergeant right there? He said my son was using this to his advantage. But look at my baby now.”

His command gave up on him, but Jenkins never gave up on the marines–not when it counted. The citation accompanying his Bronze Star reads, in part, “With the squad pinned down under intense enemy fire in the Najaf cemetery, he moved along the lines to reestablish communication with Company B. When he reached their position, four enemy militiamen located to his direct front attacked. Without regard for his own well being, Lance Corporal Jenkins climbed on top of a tomb and fired directly down at the enemy…. After eliminating the four militiamen, he returned to the squad’s position and directed an attack that destroyed four additional enemy combatants. He continued to risk his own safety as he covered the withdrawal of his fellow Marines to friendly lines.”

These days, Cynthia Fleming rarely goes into the storage room where she keeps James’s belongings; the scent of him lingering on his clothes is too painful. “But one day I went out there and I picked up his boots that were in a box, and when I picked up his boots, the Iraqi sand fell out, and I lost it,” she says. “His boots was so worn you could tell that boy did some fighting and running over there in Iraq.”

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A Question of Care – Military Malpractice?

January 31, 2007 – Carmelo Rodriguez was dancing with his niece just last year. By all accounts Rodriguez, a 29-year old, loved life, his family and the Marine Corps. He was also an artist, a father, and a part-time actor. He once appeared with Katie Holmes in a scene on the TV series Dawson’s Creek.

An image of Sgt. Rodriguez with his Marine buddies in Iraq in 2005 shows him as a fit, gung-ho platoon leader.

CBS News correspondent Byron Pitts met Rodriguez two months ago. That once-buff physique had been whittled down to less than 80 pounds in 18 months by stage 4 melanoma. He was surrounded by family, including his 7-year-old son holding his hand. It was Rodriguez’s idea we meet.

When Sgt. Rodriguez was in Iraq, military doctors, he says, misdiagnosed his skin cancer. They called it “a wart.”

Eight minutes after Pitts met Sgt. Carmelo Rodriguez, and CBS News was preparing to interview him, he died.

At his family’s insistence, Pitts and the camera crew stayed. With his body in the very next room, Pitts sat down with his relatives.

Pitts asked: “Why have us here for such a painful moment for your family?”

“[It was] His wish to have this known, because he doesn’t want any other soldier to fight for his country and go through what he had to go through,” said Rodriguez’s uncle, Dean Ferraro. “To be neglected.”

“He said, ‘don’t let this be it. Don’t let this be it. Fight!'” his sister, Elizabeth Rodriguez, said. “That’s what we’re doing. We’re gonna fight for him.”

The “fight,” as they call it is over what’s known as the Feres Doctrine, a 1950 U.S. Supreme Court ruling that bars active-duty military personnel and their families from suing the federal government for injuries incidental to their service. In other words, unlike every other U.S. citizen, people in the military cannot sue the federal government for medical malpractice.

“When he enlisted in 1997, from his initial medical checkup – you know what I mean, physical – the doctor documented that he had melanoma, but never told him ‘have anyone follow up on it,'” Ferraro said. “And that was back in ’97. If we would have known back in ’97, he would still be with us.”

CBS News was given a copy of that medical report. The doctor notes skin as “abnormal.” In further details he describes it as “melanoma on the right buttocks.” There’s no recommendation for further treatment.

Eight years pass. Sgt. Rodriguez is in Iraq.

“If a birthmark is about that big [she holds up two hands], and … it has a raise like that and is pussing, just let it go and say it’s a wart??” his sister, Elizabeth, said. “Who does that; how does that happen? It’s not right. It’s not right.”

His uncle Wilfredo Negron said: “Twenty-nine years old! You know all his life is good. Never into drugs, never into partying. Served his country faithfully. Served his Lord faithfully! He held on positive because he’s a warrior. He’s a Marine. He fought for his country and also for his family.”

According to a veterans group that tracks soldiers who are misdiagnosed, there are hundreds of misdiagnosed cases across the country.

Twenty-five-year-old Air Force Staff Sgt. Dean Patrick Witt was one of them. Witt’s family says his appendicitis was repeatedly misdiagnosed. After emergency surgery, Witt ended up brain dead.

He later died.

Pitts spoke with Military law expert Eugene Fidell, who is an attorney.

“You talk to military families who believe they have a malpractice case against the military and you tell them what?” Pitts asked.

“It’s very very difficult when I get these calls, and I get these calls repeatedly over the course of a year. I probably get one ever couple months,” Fidell said. “These people have to be made to understand that the law simply doesn’t permit them to bring a lawsuit. They can bring a lawsuit, but their lawsuit will be a complete waste of time.”

Pitts showed Fidell a copy of Rodriguez’s medical records.

Military emails show that Sgt. Rodriguez’s commanding officer, Lt. Col B.W. Barnhill, quotes a military nurse who called Rodriquez case “a major screw up.”

An email also reads: “He should have been immediately seen and the wart removed and we may not have gotten to where we are now.”

Pitts said to Fidell: “When he’s in Iraq, the doctor says we’ll have someone look at it when you get back to the states in five months.”

He shook his head. “If I had a comparable condition myself, or a member of my family had, and somebody would have said, ‘sorry, no one can see you for five months,’ I would have fired the doctor!”

But Rodriguez didn’t have that option.

“No, he didn’t. I hope members of Congress are watching this show,” Fidell said. “The law has got to change.”

What’s the military’s response?

“I’m not prepared to discuss the Feres Doctrine,” said Navy Capt. William Roberts, the medical officer of the Marine Corps.

Three weeks after CBS News’ initial request, the Pentagon granted an interview with Roberts.

But he wouldn’t discuss the Feres Doctrine, or Rodriquez’s case, saying it was “under investigation.”

As for how many cases like the sergeants?

“I do not have those numbers at all,” Roberts said.

Is that because those numbers don’t exist or he can’t provide them?

“I certainly don’t know them,” he said.

“If Carmelo Rodriguez was a civilian, his family would have the right to seek damages,” Pitts said.

“I am sorry but I can’t comment on the legality of that type of redress,” he said.

For the Rodriguez family – the best they can hope for is a final report?

“They will get a final report if they ask for it,” Roberts said.

Because he was a Marine, Sgt. Carmelo Rodriquez received a military funeral. But, it was an honor his family paid for.

As it turns out, Rodgriquez was forced into retirement due to his illness. Since he was retired, the military was no longer obligated to pay for his funeral.

His son, Carmelo Rodriquez IV, was shown the gratitude of a grateful nation: An American flag – and 55 percent of his father’s benefits.

For those who would say these young men and women sign that line saying I turn my life over to the U.S. Military, hey willingly give up some of their rights?

“George Washington said that when a person puts on the uniform, he does not cede being a citizen,” Eugene Fidell said.

Rodriguez was a citizen.

But to his family and his friends, he was a so much more.

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Hurt Soldiers’ Medical Status Altered

January 29, 2008 – Army Staff Sgt. Jack Auble was in the process of being medically discharged after serving nearly 20 years in the military when he was sent to Baghdad last year.

Auble, 43, suffers from severe osteoporosis of the spine, bulging discs and compression fractures.

Auble had a “permanent” profile, meaning his condition would not improve, and because of his limitations, he did not meet the Army’s retention standards.

Nevertheless, Auble’s medical paperwork was changed. He received a new, “temporary” status, used to indicate his condition would improve, and he was redeployed. He said he was not re-examined by a medical professional at Fort Drum, N.Y., before receiving a new profile.

Several soldiers from Fort Carson also claim that their “temporary” profiles were downgraded to give them fewer restrictions so they could be deployed.

Regardless of the profile, a commander can send a soldier to war if there is a job the person can do within the limitations set by doctors, and if there is appropriate medical care in the theater of operations.

Army regulations allow the changing of profiles after a medical examination, but the question is, are all procedures being followed?

The Government Accountability Office began an investigation into the problem last summer; a report is expected at the end of February.

At the request of the House Armed Services Committee, investigators focused on cases of soldiers whose medical profiles had been changed shortly before their return to Iraq. Preliminary findings are now being discussed with military officials.

GAO investigators have identified cases of unfit soldiers deployed from Fort Drum and from Fort Stewart and Fort Benning in Georgia, said Brenda Farrell, director of defense capabilities and management investigations for the GAO.

The Fort Carson soldiers, who said they did not visit a medical professional before their profiles changed, declined to be named because they said they feared retribution.

Col. James Terrio, Fort Carson’s deputy commander of clinical services, said he knew of no profiles that were changed at the post without a soldier seeing a medical professional.

“I could write a profile for a soldier, say he’s got back pain or something like that. That brigade surgeon could come through and either re-evaluate, talk to the soldier — maybe one of the limitations I wrote was too restrictive — and change that profile,” Terrio said. He said only health-care providers change profiles.

Some cite push to meet goals

But some say the military is stretched so thin and under pressure to meet deployment goals that it sends into war zones injured soldiers who wouldn’t be there otherwise.

E-mails from the brigade surgeon in Fort Carson’s 3rd Brigade Combat Team, which sent 3,500 to 3,700 soldiers to war beginning late last year, said: “We have been having issues with reaching deployable strength, and thus have been taking along some borderline soldiers who we would otherwise have left behind for continued treatment.”

Army officials deny they are under pressure to fill combat slots.

“It has been a long-standing policy of the Army to carefully prioritize personnel assignments to those units deploying to combat zones,” according to Army spokesman Paul Boyce.

Commanders ultimately have the final say about who is deployed.

But in some cases, sending injured soldiers or those with medical conditions back to the battle zone may not benefit the effort.

In January 2007, for instance, Auble went to work in the operations center, a room full of computers where the battlefield is monitored, at Camp Striker in Baghdad, but he needed narcotics to dull excruciating pain.

“I took Percocet, and I also took Vicodin,” Auble said. “The guy who worked next to me . . . he noticed consistent grogginess, dozing off. I wouldn’t catch something that he would say and lose track of the battle and all of that stuff.”

Three months later, Auble, with the 10th Mountain Division out of Fort Drum, was medically evacuated from the war zone after he was sent to a doctor in the theater. He has since been permanently disabled retired.

A Fort Carson soldier with a shoulder injury, who asked not to be identified, said his profile was rewritten days before he deployed.

He said his original profile stated he was not permitted to carry a weapon or a rucksack or wear body armor.

His profile was changed to say that he could wear body armor and could do “combat missions fully geared up.” He said it didn’t “make any sense because my shoulder, obviously, still wasn’t healed.” He has since returned to the U.S.

Master Sgt. Denny Nelson, who has 19 years in the Army, was sent to the Middle East with a serious foot injury. His profile prohibited him from running, jumping and carrying more than 20 pounds. The Army assigned him to a job in Kuwait, but a medical professional there said he should never have been redeployed, and Nelson returned to Fort Carson.

“It’s not about the violation of a profile, it’s about the violation of a soldier’s safety and well being,” Nelson said. “The issue is, you’ve got soldiers that can’t put on their protective gear. Are they in light-duty jobs? Yes. But if they get mortared, they’re dead.”

Gen. Charles Campbell, commander of Army Forces Command, said the Army has “competent, seasoned, mature and compassionate brigade commanders making decisions with respect to deploying personnel. They are engaged, thoughtful and deliberate. I have confidence that the decisions they make consider the interests of the soldier and the unit.”

Fort Carson has 440 people in the medical evaluation board system, which reflects the number of people on post with permanent profiles. Fort Carson estimates it has 815 soldiers on post with “temporary” profiles.

“Most people think that if you go to war, you’re running around with all your body armor on, but in Kuwait, it’s kind of like being here except it’s a lot hotter and there’s a lot of sand. The threat there is very low,” Terrio said. “There are jobs where people just sit and answer their phone.”

Fort Carson sent 79 injured soldiers with the 3rd Brigade Combat Team to the Middle East in November and December to perform light-duty jobs. Most were sent to Iraq. Six of them have since returned.

GIs’ health a longtime issue

Dr. Stephen Xenakis, a retired Army brigadier general who served 28 years as an Army doctor, said balancing the needs of the Army with the health of soldiers is “always an issue you have to keep an eye on. You hear stories of this going all the way back to World War II. Years ago, there was a New England Journal article and then Physicians for Human Rights wrote a pamphlet on what they call dual loyalty — the conflict that military physicians are in with respect to the professional loyalty they’re supposed to have to the patients as well as the loyalty they have as soldiers to the service. These kind of situations demonstrate that conflict.”

Lawrence Korb, a senior fellow at a research group called the Center for American Progress who worked as an assistant secretary of defense under President Reagan, said sending injured soldiers to perform light-duty jobs is another sign of the pressure the Army is under.

“They are in a no-win position,” Korb said. “The Army is not big enough to support the surge, deal with Afghanistan and give people a minimum amount of time at home.”

The Army announced last week that it is considering cutting the length of tours from 15 months to 12 months because of stress on soldiers.

Also this past week, the National Priorities Project, a research group that analyzes federal data, released a report that showed fewer Army recruits have a high school diploma, a trend that has continued since the beginning of the war in Iraq. Soldiers are required to have a high school diploma or an equivalent.

The report said that nearly 71 percent of the Army’s 67,398 recruits last year had a high school education, while in 2005, 83.5 percent of recruits had at least a high school education.

Korb said more and more recruits are scoring below average on the armed-forces qualification test, and last year, the Army gave 8,000 “moral waivers” to recruits — 80 percent to recruits who committed misdemeanors and 20 percent for felonies, he said. Those with criminal records are not allowed into the service without such a waiver.

Korb said he thinks that after the U.S. withdraws from Iraq, it will take a decade for the Army to rebuild.

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Officials Want Probe of Army and VA Help for Injured Soldiers

January 30, 2008 – Fort Drum, New York – New York congressional leaders have asked Army Secretary Pete Geren to investigate a report that the Army is blocking Veterans Affairs’ officials from helping injured Fort Drum soldiers prepare their disability claims, potentially leading to reduced benefits.

Meanwhile, a national soldiers’ advocacy group said it planned to seek an official military Court of Inquiry probe into the situation at the northern New York Army post.

In a letter to Geren, U.S. Sen. Hillary Clinton expressed deep concern and said the allegations “should be taken seriously and investigated thoroughly.”

“If these allegations are true they run counter to our nation’s pledge made to our men and women in uniform,” Clinton wrote Geren. “It is our duty to eliminate obstacles standing in the way of our disabled service members and veterans, not to create them. Our wounded should not have to deal with endless bureaucratic red tape just to receive the basic care entitled to them.”

In a story Tuesday, National Public Radio reported that an Army ad-hoc group investigating military disability benefits _ known as a “tiger team” _ had recently told VA officers in Buffalo not to assist Fort Drum soldiers with their disability benefits applications.

Injured soldiers are given a 10-day period to comment on proposed disability rulings before they become final. Those forms help determine what benefits disabled soldiers receive after being discharged.

According to the NPR report, the Army did not want the VA to assist in filling out the forms because Fort Drum soldiers were receiving higher disability ratings with their help _ and thus would receive more money in benefits.

“Once again, we witness a military command which is more concerned with saving money than with providing adequate compensation for injured veterans,” said Tod Ensign, an attorney with New York City-based Citizen Soldier.

If a soldier receives a disability rating of less than 30 percent, he or she receives only a lump sum payment instead of a monthly disability payment, Ensign said.

“We are talking about young people, inexperienced, with no knowledge of medical terminology. What’s wrong with helping them? These are determinations that could have a bearing on the rest of their life,” Ensign said.

Ensign said he was working with a handful of active duty Fort Drum soldiers to file a formal request for an official Court of Inquiry. Such a panel can conduct a service-wide investigation into the Army’s policy, he said.

“I can’t imagine Fort Drum soldiers are alone in this,” he said.

Fort Drum spokesman Ben Abel said post officials had no comment about the NPR report, but added that post officials were not involved in any decision to withhold assistance from soldiers.

Army spokesman Lt. Col. George Wright said the Army has no policy against soldiers receiving outside assistance in preparing their disability applications. However, the “tiger team” thought the VA should not be helping soldiers with their applications and told the Buffalo regional VA office, he said.

The VA said it went along with the request because its officers are not qualified to help with soldiers’ disability paperwork.

“We do not train our employees about the intricacies of the military’s disability evaluation system. We would feel that it would be inappropriate for VA employees to apply VA standards to a Department of the Army process,” the VA said in a release.

Rep. John McHugh, whose district includes Fort Drum and is the ranking Republican on the House Armed Services Personnel Subcommittee, expressed his concerns about the situation at Fort Drum to Army Surgeon General Lt. Gen. Eric Schoomaker in a meeting Tuesday.

“The tenor of it certainly is contrary to what we’re trying to accomplish,” McHugh told The Watertown Daily Times. “We want to see more help for those wounded, not less.”

McHugh noted that the Defense Department Authorization Act signed Monday by President Bush included provisions for creating more cooperation between the VA and defense department.

Rep. Kirsten Gillibrand, another New York lawmaker on the House Armed Services Committee, also wrote to Geren.

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Retired Marine General James Jones Warns Afghanistan May Become Failed State

January 30, 2008 – Afghanistan will become a failed state unless urgent steps are taken to tackle worsening security, US experts said, as a British charity warned Thursday of a looming humanitarian “disaster.”

The reports came amid new concerns over the North Atlantic Treaty Organization’s commitment to providing more troops to fight a resurgent Taliban militia.

Canada’s prime minister made NATO reinforcements a condition of keeping his troops there.

“Urgent changes are required now to prevent Afghanistan from becoming a failing or failed state,” cautioned one report from the Atlantic Council of the United States, led by retired Marine Corps general James Jones.

Taliban control of the sparsely populated parts of Afghanistan was “increasing”, it said, while civil reforms, reconstruction, and development work had not “gained traction” across the country, especially in the south.

“To add insult to injury, of every dollar of aid spent on Afghanistan, less than 10 percent goes directly to Afghans, further compounding reform and reconstruction problems,” the report said Wednesday.

Southern Afghanistan has seen the worst violence since the Taliban were ousted in the US-led invasion in 2001, after the September 11 terror attacks masterminded by Al-Qaeda, whose leaders were given sanctuary by the Taliban.

As US and NATO-led troops wage an uphill battle to keep the Taliban at bay, civil sector reform “is in serious trouble”, despite the immense resources poured into the country and nearly seven years of efforts, the report said.

“If Afghanistan fails, the possible strategic consequences will worsen regional instability, do great harm to the fight against Jihadist and religious extremism,” the report said.

Europe needs to “wake up” to this crisis, said David Abshire, head of the Center for the Study of the Presidency, which examines the performances of the US presidents and relate its findings to present challenges.

Canadian Prime Minister Stephen Harper said Wednesday he endorsed a recommendation to extend the stay of 2,500 Canadian troops in Afghanistan’s volatile south after their mandate ends in February 2009 — but only with substantial reinforcement from NATO.

Another US expert panel, the Afghanistan Study Group, co-chaired by Jones and ex-US envoy to UN Thomas Pickering, asked the United States and NATO allies to replace the “light footprint” in Afghanistan with the “right footprint.”

The group called for the appointment of a US special envoy for Afghanistan, charged with coordinating all aspects of US policies toward it.

US Senator John Kerry warned that Afghanistan could snowball into Vietnam-like turmoil, as he launched the expert reports at Capitol Hill.

“Absent a new focus and a transformed strategy, I fear that may be happening again in Afghanistan,” said the Vietnam War hero.

Meanwhile British aid agency Oxfam warned of the risk of a humanitarian catastrophe in Afghanistan unless Western countries made a “major change of direction” in their strategy.

“We urge you to support a major change of direction in order to reduce suffering and avert a humanitarian disaster,” the group’s head Barbara Stocking said in an open letter to Prime Minister Gordon Brown.

Reacting to the US reports, the US State Department said there had been “real progress” since the Taliban ouster and underlined the need for NATO and others to maintain strong commitment to rebuilding Afghanistan.

“We know what a failed state in Afghanistan looks like. That was Afghanistan under the Taliban prior to 2001. Afghanistan today does not look like that,” said department spokesman Sean McCormack.

“There has been real progress where Afghanistan was six years ago. Is there a long way to go? Absolutely,” he said.

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Army Blocks Disability Paperwork Aid at Fort Drum

January 29, 2008 – Army officials in upstate New York instructed representatives from the Department of Veterans Affairs not to help disabled soldiers at Fort Drum Army base with their military disability paperwork last year. That paperwork can be crucial because it helps determine whether soldiers will get annual disability payments and health care after they’re discharged.

Now soldiers at Fort Drum say they feel betrayed by the institutions that are supposed to support them. The soldiers want to know why the Army would want to stop them from getting help with their disability paperwork and why the VA— whose mission is to help veterans — would agree to the Army’s request.

‘A Worn Pair of Boots’

One disabled soldier, who spoke on the condition of anonymity because he fears retaliation from the military, says it feels like a slap in the face.

“To be tossed aside like a worn-out pair of boots is pretty disheartening,” the soldier says. “I always believed the Army would take care of me if I did the best I could, and I’ve done that.”

At a restaurant near Fort Drum, the soldier described his first briefing with the VA office on base. According to the soldier, the VA official told a classroom full of injured troops, “We cannot help you review the narrative summaries of your medical problems.” The official said the VA used to help soldiers with the paperwork, but Army officials saw soldiers from Fort Drum getting higher disability ratings with the VA’s help than soldiers from other bases. The Army told the VA to stop helping Fort Drum soldiers describe their army injuries, and the VA did as it was told.

It’s unclear why the Army wanted to stop the soldiers from getting help with the disability paperwork. Cynthia Vaughan, spokeswoman for the Army surgeon general, says the VA was not doing anything wrong by helping soldiers at Fort Drum.

“There is no Army policy on outside help in reviewing and/or assisting soldiers in rewriting their narratives during the 10-day period which they have to review them,” Vaughan says.

She says the officers who asked the VA to stop helping Fort Drum’s soldiers were part of what the Army calls a “Tiger Team”— an ad-hoc group assigned to investigate, in this case, medical disability benefits.

According to Army spokesman George Wright, the Tiger Team thought the VA should not be helping soldiers with their medical documents. The Army delivered that message to VA officials in Buffalo, N.Y., who went along with the request, even though the VA’s assistance complied with Army policy.

The Army declined to provide any information about the Tiger Team members’ identities or their motivations in asking the VA to stop reviewing the soldiers’ paperwork. However, private attorney Mara Hurwitt points out that the Army has a financial incentive to keep soldiers’ disability ratings low.

“The more soldiers you have who get disability retirements, the more retirement pay is coming out of your budget,” Hurwitt says.

Qualified to Help?

Another question is why the VA would go along with the Army’s request.

Tom Pamperin, deputy director of the VA’s compensation and pension service, believes VA officers are not qualified to help with soldiers’ disability paperwork.

“We do not train our employees in the intricacies of the Defense Department’s disability evaluation system, so we would feel that it would be inappropriate for our employees to apply VA standards to a Defense Department process,” Pamperin says.

But Hurwitt argues the VA is more equipped than anyone to help soldiers with their paperwork.

“VA counselors understand the disabilities, what the different kinds of conditions are, how they should be properly described in the paperwork,” Hurwitt says.

She points out that VA officials have to look at a soldier’s medical history anyway to counsel him or her on VA benefits, which are separate from Army benefits.

“Really what it comes down to is you’re just helping the soldier get what he’s entitled to under law,” Hurwitt says.

System ‘Unfair’

This is just the latest in a string of controversies about disability payments for injured veterans.

Former Health and Human Services Secretary Donna Shalala, who co-chaired President Bush’s recent commission on veterans’ care, says stories like this one show how the whole disability rating system is broken and needs to change.

The system is “fundamentally unfair,” according to Shalala, “and that’s the point about the need for reform in the system. It has to be reformed for everyone.”

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More Veterans Returning Home With PTSD

January 29, 2008 – A growing number of war veterans are returning to their lives in Bucks County with mental health issues, military and mental health officials said Monday.

At a forum in Lower Makefield organized by Congressman Patrick Murphy, D-8, Bucks County law enforcement officials were told that a number of veterans returning from Iraq and Afghanistan were suffering from Post-Traumatic Stress Disorder. The disorder is caused by intense, traumatic events such as combat.

One in six veterans returning from Iraq and Afghanistan suffer from the disorder and one in three show symptoms of the disorder, also known as PTSD, according to Murphy, an Iraq war veteran.

Wary of the stigma of mental illness, many veterans ignore the signs of the disorder, which might lead them to hurt themselves or others before they are able to seek treatment, Murphy said.

“There’s a real level of denial,” said Carol Bamford, director of case management and crisis services with the Bucks County Department of Mental Health. “We need to convince these people that it’s not going to hurt just trying to talk to somebody.”

Veterans of all wars have suffered from the effects of PTSD, although the disorder was not recognized by the mental health community until years after the Vietnam War. Officials with the U.S. Department of Veterans Affairs are screening returning soldiers for this and other mental disorders, however, many veterans slip through the cracks, according to Dan Fraley, county government’s director of veterans affairs.

There are roughly 60,000 veterans living in Bucks, the fourth largest veterans population in the state, Fraley said. Since the start of the wars in Iraq and Afghanistan about 15 veterans of those wars have requested help from the county’s veterans services with eight Bucks soldiers filing claims for treatment from PTSD, Fraley said.

“We’re starting to see more of them,” Fraley said.

“It’s something we are all going to deal with,” said James Goss, a manager with the PTSD program at the Coatesville VA Medical Center in Chester County. “The good news is that it’s readily treatable.”

However, the problem addressed by some of the law enforcement officials at Monday’s meeting was that, due to medical privacy laws, it would be almost impossible to know which veteran was suffering from PTSD.

“I’d personally like to see us try to get out at the front of this problem, not at the end,” said Barry Pilla, Northampton chief of police and a Vietnam veteran. “I just don’t see a lot of people coming to us and saying: “I have PTSD.’ ”

Murphy said Monday’s meeting was the “first step” in dealing with the issue.

“You are on the front line of dealing with this and really being aware of it,” Murphy said. “This is just the first step in trying to combat this.”

Murphy represents the residents of Bucks County, some districts of Abington, Upper Dublin and Upper Moreland in Montgomery County and two wards in Philadelphia.

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Editorial – Wounded Soldiers, Substandard Care

January 29, 2008 – Given the praise President Bush heaped on our troops in his final State of the Union speech Monday night, we were outraged to read two stories Tuesday about how the government continues to let our wounded soldiers down. First, The Associated Press reports that questionable “substandard care” has led to the deaths of 19 veterans over the past two years.

The VA hospital in question, in Marion, Ill., allowed “many surgeries that its staffing or lack of proper surgical expertise made it ill-equipped to handle.” And then there was the issue of hospital administrators being “too slow to respond” once the problems became apparent.

Also, National Public Radio reports that Army officials have asked the VA to cease helping soldiers fill out Defense Department disability forms and crafting the “narrative summaries” necessary to determine their eligibility for health care and disability pay. A Madigan Army Medical Center spokesperson told us that this was not the case there, that there is no army policy against soldiers getting outside help with their narratives and Madigan officials have not asked VA officials to stop doing so. We couldn’t determine if Army officials had told VA officials in other places otherwise. We also can’t figure out what’s worse about what happened in upstate New York — that the Army sent in a “Tiger Team” to make things harder for its own, or that VA officials there agreed to stop helping soldiers fill out forms.

If the reason given to NPR is true, that VA staffers aren’t qualified to help soldiers with the paperwork, then it’s imperative that the DOD makes sure that someone can help them figure out the confusing disability rating system.

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