Veterans for Common Sense

Jan. 22 Update: VCS Releases New VA and DoD Fact Sheets

Dear VCS Supporters:

This week Veterans for Common Sense releases updated versions of our popular VA and DoD Fact Sheets. The statistics are very disturbing.

The Pentagon officially reported 72,043 battlefield casualties from Iraq and Afghanistan through Jan. 5, 2008.

VA hospitals and clinics have already treated 263,909 unplanned patients from the Iraq and Afghanistan wars. On top of that, VA reported 245,034 unanticipated disability claims from veterans of the two wars.

VCS issued warnings about this growing problem. On Veterans Day in 2007, VCS posted an editorial about how we believe VA and DoD mask the true costs of the two wars.

To assist you with making sense of the new Fact Sheets, a VCS analysis shows that between June 2007 and November 2007:

* The number of PTSD claims approved rose 80 percent (from 19,015 to 34,138), while the veteran population rose only 16 percent. The incidence of PTSD is dramatically rising, or VA is finally starting to take this problem more seriously, or both.

* 100 PTSD claims were approved every day. VA can expect tens of thousands, if not hundreds of thousands more PTSD claims from our new war veterans as more service members deploy to the war zone and then begin to return home.

* Veterans who served in the National Guard or Reserves were nearly three times as likely to have their VA disability compensation claim rejected (14{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} compared to 5{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d}). VCS remains concerned about the apparent unequal treatment faced by our veterans who were ordered to active duty in the war zone from the National Guard and Reserves.

While the PTSD claims situation may be improving slightly due to intense pressure brought about by the VCS and Veterans United for Truth lawsuit against VA, there are still nearly 18,000 Iraq and Afghanistan veterans diagnosed by VA with PTSD who are not yet receiving VA disability payments.

VCS believes that VA is still not properly reviewing and approving PTSD claims for veterans already diagnosed with PTSD by VA doctors. This means VA continues to deny and delay essential disability payments for our veterans that could be the difference between paying the rent or becoming homeless.

Wounded Warrior Update: Last week, the House voted to include the “Dignity for Wounded Warriors Act” (formerly S 1606 and then HR 1585), in the new Defense Bill, HR 4986. Now we are waiting on the Senate to approve the bill. Sadly, the provision allowing our Gulf War veterans tortured by Iraq to sue the new Iraqi government was watered down.

Please share the critical information in your VCS Update with your friends, reporters, and elected officials so that they know the facts about the Iraq and Afghanistan wars.

Please donate generously to VCS so we can keep reporting the accurate and complete facts about the human consequences of the Iraq and Afghanistan wars. We appreciate your support so we can provide the policy advocacy that all our veterans need.

Thank you,

Paul Sullivan
Executive Director
Veterans for Common Sense

VCS provides advocacy and publicity for issues related to veterans, national security, and civil liberties. VCS is registered with the IRS as a non-profit 501(c)(3) organization, and donations to VCS are tax deductible. VCS does not provide direct services to veterans.

January 22, 2008 – The percentage of Army recruits with a high school diploma dropped last year, continuing a trend that has worsened since the start of the Iraq war, according to a report released Tuesday.

National Priorities Project, a research group that analyzes federal data, found that nearly 71 percent of Army recruits graduated from high school in the 2007 budget year. It based its findings on data it obtained from the Defense Department through a Freedom of Information Act request.

All troops must have a high school diploma or an equivalent degree. The military prefers that they have a high school diploma because its studies have shown they are more likely to finish an enlistment term. Still, the Army has paid for some recruits to take General Educational Development preparation classes and take the test.

The Army’s goal is 90 percent high school graduates, which it hasn’t met since 2004. Each year since, the number of recruits with at least a high school diploma has steadily declined.

Douglas Smith, spokesman for the Army Recruiting Command at Fort Knox, Ky., acknowledged it has been a difficult recruiting environment. He said overall high school graduation rates are declining, which could be a factor.

Strained, in part, by military operations in Afghanistan following the Sept. 11, 2001, terrorist attacks and the 2003 invasion of Iraq, the military has had to increase the number of waivers and raise enlistment bonuses to fill its ranks.

“Every soldier that we put in the Army is qualified,” Smith said. “We don’t put unqualified people in the Army, but it’s something we’re watching.”

The National Priorities Project said the percentage of “high-quality” recruits — those with a high school diploma who scored in the top half on the military’s qualification test — declined from budget years 2004 to 2007. In that period, the number of high-quality recruits fell from about 61 percent to nearly 45 percent, the group said.

It also found that in the 2007 budget year, upper middle- and high-income neighborhoods were underrepresented by an even larger margin than three years earlier.

The Army has been under growing pressure to strengthen recruiting as part of an ongoing effort to increase its size.

Plans are to raise the number of active-duty Army, Army Guard and Army Reserve by 74,000 overall, with the active-duty force rising by 65,000 to a total of 547,000. In October, top Army leaders said they planned to move faster to expand the force by adding the full 74,000 soldiers by 2010, two years earlier than originally planned.

In September, Defense Secretary Robert Gates told reporters he’d like the see an increase in the percentage of recruits with a high school diploma. He said he was reluctant to accelerate an expansion of the force that would lead to a lowering of recruitment standards.

Paul Boyce, an Army spokesman, said recruitment has been strong in the first four months of this budget year.

January 21, 2008

“It cannot be stopped at the border;
Or trapped in a shelter of stone;
Or arrested by following orders.
War has been coming home.”

In my first column two months ago, I discussed the mental health problems that our troops returning from Iraq and Afghanistan are experiencing. I drew on a recent study of veteran suicides by CBS News and a study of homelessness by the National Alliance to End Homelessness.

Now comes a third study by the New York Times, “War Torn: Across America, Deadly Echoes of Foreign Battles,” which discusses some of the 121 cases that the Times uncovered in which veterans of the Iraq and Afghanistan Wars have been involved in or charged in killings.

Some of the stories are heart-breaking, such as the case of Stephen Sherwood. Sherwood lost his entire tank unit to a rocket attack while he was on leave to celebrate his son’s first birthday. Several months later, he returned from Iraq and shot his wife and himself.

Or Seth Strasburg, who shot and killed an Iraqi dragging a sack of gravel by the roadside, thinking the man was about to plant an IED.

While home on leave, his gun went off in a drunken scuffle and killed a man.

Stories like these should surprise no one. Mass murder, such as what typically happens in modern warfare, is not natural to the human species. The military goes to great lengths to break down societal conditioning against murder. Undoing such training may not always be as simple as those who glorify war might pretend. And such instances as these must be considered as part of the societal costs of war.

Many manage to readjust to civilian life, in spite of whatever wartime traumas they have lived through. However, there are some who have difficulty readjusting, and do not seek or receive needed help. Some of these end up living on the streets; and some end up killing themselves or others.

This is true of every war, from time immemorial. Some will bring the war back home with them with disastrous results for society. Take, for example, Timothy McVeigh.

McVeigh was awarded the Bronze Star for service in the 1991 Gulf War.

He claimed to have been shocked by being ordered to execute surrendering prisoners, and later wrote, “Do people think that government workers in Iraq are any less human than those in Oklahoma City? Do they think that Iraqis don’t have families who will grieve and mourn the loss of their loved ones? Do people believe that the killing of foreigners is somehow different than the killing of Americans?”

McVeigh was executed in 2001 for the Oklahoma City bombing which killed 168, including 19 small children, an act which he characterized as “revenge” against the government.

Fortunately, there is hope. As Lawrence Sherman, director of the Jerry Lee Center of Criminology remarked, “The real tragedy in these veterans’ cases is that, where PTSD is a factor, it is highly treatable,” and “when people are exposed to serious trauma and don’t get it treated, it is a serious risk factor for violence.”

In other words, there is treatment for the symptoms. But, how much better would it be to treat the disease, as well as the symptoms? War is the disease of which PTSD and other mental illnesses that plague our soldiers and veterans are merely symptoms.

This disease has plagued humanity for at least 10,000 years. We think we are cured, only to relapse and fight again and again. We recognize this every time we use phrases like, “perpetual war,” or “war without end.”

If we do not wish to be fighting “perpetual war” for the rest of eternity, then there is only one solution: Work for peace.

The opening quote is from the song “The War Has Been Coming Home,” by Charlie King.

Tom Sager is a retired professor at the University of Missouri – Rolla. His column appears weekly. He can be reached at tom@tomsager.org

January 22, 2008 (AP) The Senate voted Tuesday to approve a revised defense bill authorizing a 3.5 percent pay raise for troops while sidestepping a veto showdown with President Bush.

The 91-3 vote sends the $696 billion measure to Bush for his expected signature.

The president had rejected an earlier version of the bill because of a provision that would have guaranteed that victims of state-sponsored abuse can sue foreign governments in court and collect judgments by seizing its assets inside the United States. Bush said that would have exposed Iraq to high-dollar lawsuits over abuse during the Saddam Hussein era at a time when the country is struggling to rebuild its infrastructure.

The administration estimated that Iraq had more than $25 billion of assets invested in the U.S. that could be tied up in litigation.

Democrats reluctantly revised the measure to allow Bush to grant immunity to Iraq, so long as he determines that doing so promotes Iraqi reconstruction and that Baghdad remains a “reliable ally” in the war on terror.

The House passed the new bill last week by a 369-46 vote.

Sen. Frank Lautenberg, D-N.J., who sponsored the provision on abuse lawsuits, said the final bill still achieved his goal of “providing justice for American victims of terrorism at the hands of terrorist states like Iran and Libya.”

“I will not rest until all American victims of terrorism get the justice they deserve,” he added.

The revised bill also makes the 3.5 percent pay raise retroactive to Jan. 1.

The decision to change the bill without trying to challenge Bush’s rejection reflects the difficulty Democrats have had in challenging the president on even minor issues. Democrats lack the two-thirds majority needed to override a presidential veto.

Senate Majority Leader Harry Reid said Bush’s veto was a “terrible mistake” because it delayed implementation of the various benefit programs for troops included in the bill, including the pay raise.

The bill does not include a provision to bring troops home, as Democrats want. But they say they will try again this year with legislation aimed at giving soldiers and Marines more rest between combat tours, as well as measures intended to curb contracting abuse.

“Most Republicans chose to stuck with the president on Iraq, and it devastated our armed forces,” said Reid, D-Nev.

Senate Republican leader Mitch McConnell said he hopes Democrats will give up trying to bring troops home by a certain date.

“It was wrong to tempt fate when our progress in Iraq was uncertain,” said McConnell, R-Ky. “It would be foolish to do so when progress is undeniable.”

White House spokesman Tony Fratto said Bush is expected to sign the revised measure.

Teenage Bomber Strikes In Anbar: Suicide Attack Targets Meeting Of Tribal Leaders
 
January 21, 2008, Baghdad, Iraq – A 13-year-old boy wearing an explosives-packed vest blew himself up Sunday among a group of tribal leaders in the western province of Anbar, becoming one of the youngest suicide bombers since the U.S.-led invasion, Iraqi police said.

The explosion killed at least three other people and wounded eight in the city of Fallujah, according to local police Capt. Jasim Faiyadh.

Faiyadh said the boy was the son of one of the five most-wanted leaders of al-Qaeda in Iraq, a Sunni insurgent group that U.S. officials say is led by foreigners.

The attack targeted a meeting of leaders from the Anbar Awakening Council, a U.S.-supported group that has turned against al-Qaeda in Iraq. A tribal chief, Hadi Hussein al-Isawi, was among those killed, police and Fallujah hospital officials said.

Five of the wounded were in critical condition, said Mohammed al-Ani, a doctor at the hospital.

The explosion was one of the deadliest attacks in Anbar since the council drove most al-Qaeda in Iraq fighters out of the province last year.

Meanwhile, near the northern oil-rich city of Kirkuk, gunmen in a sedan opened fire on a checkpoint manned by U.S.-supported tribesmen battling al-Qaeda in Iraq, said police Col. Yadkar Abdullah. The attack, in the town of Hawijah, west of Kirkuk, killed a tribesman and wounded three others, he said.

In the holy Shiite city of Najaf, an operation has been launched to investigate the deadly attacks last week in southern Iraq that killed more than 70 people.

Ahmad Deabil, a government spokesman in Najaf, said 45 detainees from the Soldiers of Heaven, the obscure Shiite sect that staged the attacks, had been moved from the southern cities of Basra and Nasiriyah to Najaf. Thirteen of the captured men were religious leaders from Najaf, Deabil said. One of them was Hassan al-Hamami, the son of a revered Shiite cleric who died years ago.

Deabil said the investigation has revealed that the group is supported by Arab countries neighboring Iraq that he declined to identify.

Special correspondent Saad Sarhan in Najaf and Washington Post staff in Fallujah, Mosul and Kirkuk contributed to this report.

Fairmont, West Virginia, January 20, 2008 —  Spurred by last winter’s spate of stories about the poor living conditions and bureaucratic hassles encountered by wounded veterans of the Iraq and Afghanistan wars, state lawmakers ordered a study at the end of the last regular session.

The select committee was told to make recommendations on how the state can assist in getting them the care they deserve, according to the joint resolution setting it up.

The experience was “an eye-opening one for us,” said Delegate Richard J. Iaquinta, D-Harrison. The chairman of the House Veterans Committee, Iaquinta was a co-chairman of the select committee with state Sen. Jon Blair Hunter, D-Monongalia, and chairman of the Senate Military Committee.

Meeting in the spring and over the summer, the committee turned to Larry Linch, director of the state Division of Veterans Affairs and leaders of state veterans groups. Another key resource was rural health-care experts at West Virginia University. The state VA helped cut through red tape and privacy issues, providing a mailing list based on veterans who had earlier applied for a state military bonus for their overseas service.

The Legislature wants to ensure the latest group of combat veterans “get the health services and information about benefits that they may need in making the transition to civilian life,” Iaquinta said.

The survey by the Veterans Project Group at West Virginia University on the prevalence of post-traumatic stress disorder and depression is just one of the select committee’s products, he said.

Staying in touch with the new combat veterans and their families and relatives over the years is important, Iaquinta said.

Funding for more research and for training rural primary health caregivers on PTSD and depression is another issue.

Lawmakers will continue to work on issues like in-state treatment for veterans with traumatic brain injury from the concussion of roadside bombs, Iaquinta and Director Linch said.

The state is now ready to offer care for those with traumatic brain injury, Linch said.

Delegate Barbara Evans Fleischauer, D-Monongalia, said many veterans in the regular Army and Marine Corps have served multiple tours in Iraq and Afghanistan. So have some units of the state National Guard and Reserves, such as aviation units and other specialized units.

“They have a role over there of always being on the alert,” said Fleischauer. “They’re constantly on-guard and doing some terrific work. Then they have to shift back to normal life all of a sudden when they get back home.”

“We are just at the beginning of thinking what the results of the statewide survey means,” she said.

Getting health care to veterans and their families in rural areas is the key, committee members said.

“There are going to be continuing social and mental health needs for these veterans — and all our veterans,” said Delegate Linda Longstreth, D-Marion, and vice chairman of the House Veterans Affairs committee.

“These are legitimate mental health issues for all veterans and their families,” she said.

“The issue for us is how we can improve outreach for these vets and all our veterans and that we follow through.”

Linch, a Marine combat veteran of the Vietnam War, said the state agency wants to ensure access to treatment and services.

“We’re going to make sure these guys get treated better than Vietnam veterans were treated when they came home.”

E-mail Bill Byrd at bbyrd@timeswv.com.

January 17, 2008 – Both Montana Senators, Jon Tester and Max Baucus, are teaming up to call for an investigation into the state’s VA mental health care.

The senators want the VA’s top investigator to get to the bottom of recent news stories that show veterans from the Treasure state may be getting the short end of the stick on mental health care.

A letter has been drafted to the VA Inspector General, asking for a thorough review of any ‘significant disparity’ in post-traumatic stress disorder or PTSD ratings given to Montana’s Iraq and Afghanistan veterans. They also want the Inspector General to review the quality of care for those veterans who suffer from PTSD, and to look into the wait times Montana vets are enduring before they receive mental health care.

The senators are also asking for recommendations on ways to improve the system.

January 17, 2008 – WASHINGTON (AP) — President Bush on Thursday released $3.7 billion in emergency money that Congress requested to care for veterans, including those returning from Iraq and Afghanistan.

Bush released the emergency funds even though he said he thought the money should have been considered as part of the normal appropriations process. The emergency money was tucked in a $550 billion government spending measure that Congress passed last month before leaving for the holidays.

“While I believe that these funds should have been considered as regular appropriations, the men and women who have sacrificed for our country should not be held hostage to budgetary wrangling in Washington,” Bush said in a letter to House Speaker Nancy Pelosi.

Sen. Daniel Akaka, D-Hawaii, chairman of the Senate Veterans Affairs Committee, said the emergency funds were needed because the veterans budget proposed by the president would have underfunded the Veterans Affairs Department at a time when there was a need to expand mental health care, improve treatment for traumatic brain injuries and reverse a claims backlog.

“This could not be allowed to happen,” said Akaka, who wrote to the president urging him to release the extra money. “I am relieved that he has seen fit to do so.”

Rep. Chet Edwards, D-Texas, chairman of the House Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies, also applauded the president’s action.

Edwards said the added funding will help pay for more qualified doctors and nurses to improve medical services for veterans.

“For the 400,000 veterans, including combat wounded vets, who are having to wait too long to have their benefits cases reviewed, this bill means over 1,800 new VA case workers to reduce the unacceptable delays in receiving earned benefits,” he said. “For veterans with traumatic brain injury, post-traumatic stress disorder, mental health care issues, and lost limbs, this bill means renewed hope to rebuild their lives. For many of the 200,000 homeless veterans in America, it means the dignity of not having to sleep on the streets and hope for a better future.”

January 16, 2008 – Few federal programs have seen the kind of turnaround experienced by the Veterans Affairs Department’s health care system in the late 1990s. Formerly a poster child for substandard medical care and incompetent management, VA’s health care system now is considered by many to be the best in the country. Its ratings for quality of care and customer satisfaction have risen even as the patient load has increased. Major media outlets have credited the agency’s use of electronic medical records, unprecedented even in the private sector, with improving medical care, and Democratic presidential contenders Hillary Clinton and Barack Obama have held up VA’s system as a model for nationwide health care reform.

But the department’s success is in jeopardy, according to Dr. Kenneth Kizer, undersecretary for health at Veterans Affairs from 1994 to 1999 and the man many credit with leading the management reforms that ultimately fixed the broken health care system. Kizer now serves on the independent Commission on the Future of America’s Veterans, which is examining demographic and budgetary trends, as well as changes in both warfare and health care, with an eye to providing the most effective programs and services to veterans.

“We see a future that is not particularly bright for the VA,” said Kizer, speaking at a forum in Washington sponsored by the New America Foundation, a nonprofit public policy institute. Rising medical costs, aging infrastructure and an increase in patients with serious, and expensive, medical needs all are contributing to growing concern that medical care for veterans will deteriorate under the current system.

“Economics are going to be driving some very difficult decision-making down the road,” Kizer said. For that reason, the commission is planning to recommend later this year that Congress create a government-chartered entity, structured somewhat like the U.S. Postal Service, to manage health care for veterans, he said. The entity’s charter would detail its mission, funding, governance and assets, as well as requirements that senior managers hold specific skill sets and areas of expertise.

As a federal agency dependent on congressional appropriations, Veterans Affairs is increasingly ill-suited to manage health care for veterans, Kizer said. The annual appropriations process creates program instability and prevents strategic planning. In addition, the agency cannot exercise the kind of management judgment that corporations routinely exercise.

For example, VA has found it extraordinarily difficult to close underused or outdated hospitals since no member of Congress wants to lose a medical facility in his or her district, Kizer said. As a result, the agency can’t close hospitals in areas where they’re not needed or build new ones in areas where they are needed.

“The average age of VA hospitals is 50 years old,” said William Diefenderfer, former deputy director of the Office of Management and Budget and now a commissioner. “We haven’t built a new hospital in 20 years. We need a new hospital in Orlando, but we haven’t been able to do it.”

A government-chartered entity “would have the authority to buy and sell assets and borrow money against them,” Diefenderfer said. It also would be able to create new sources of revenue. For example, it could provide health care to all veterans and their families who have the ability to pay – something the VA cannot do currently.

Arthur Hamerschlag, former chief of staff at the Veterans Health Administration, the health care arm of Veterans Affairs, said he was not necessarily opposed to the creation of a government-chartered health system for veterans, but that a number of issues would first need to be resolved, including how the new entity would negotiate drug prices and whether or not it would accept Medicare – something VHA does not do now.

Veterans Affairs has been able to hold down drug costs because federal law allows the agency to negotiate below-market prices from pharmaceutical companies, something private health care systems would likely protest if a new quasi-private entity were created that could compete for patients, as the commission envisions.

“I think VA will find itself in the medical marketplace in a way it does not now,” said Hamerschlag. “That’s not necessarily a bad thing, but it will require a different skill set.”

January 20, 2008 – Fairmont, West Virginia – A recent survey of West Virginia’s combat veterans of Iraq, Afghanistan and Kosovo suggests that nearly half may have symptoms of post-traumatic stress disorder (PTSD) and/or depression.

It’s not only the nearly 3,000 of the state’s 6,400 veterans of those conflicts who are affected by PTSD or depression, said Dr. Joseph R. Scotti.

Their spouses or partners and children are also affected, said Scotti, a clinical psychologist who teaches at West Virginia University.

“This represents over 5,000 family members who may be impacted and who may themselves be in need of services,” said Scotti.

“There are effective treatments for PTSD and depression,” but they require a lot of work by the individuals affected, Scotti said.

The first of its kind in the state, the survey will provide a baseline. He hopes it leads to more research and that more ways to provide outreach, counseling and assistance for the state’s veterans are developed soon.

A psychology professor for 18 years, Scotti has worked with a number of trauma survivors, including persons who have been in bad car wrecks and industrial accidents. He also has worked with veterans of World War II, Korea and Vietnam who have PTSD and depression.

The 108-item survey that he and others at the university developed for a special legislative committee gives a snapshot of the state’s recent combat veterans.
Ginny Majewski, chairperson of the Division of Social Work, was the co-leader on the Veterans Project.

Using a mailing list from the state Division of Veterans Affairs, the survey was mailed to 6,400 veterans in early December. The list was drawn from veterans who had earlier applied for a state bonus for service in Iraq, Afghanistan and Kosovo. About 1,000 surveys were undeliverable because of changes in address. The surveys included “scales” or questionnaires on PTSD and depression.

Of the 550 anonymous surveys which were returned, a total of 471 were entered and analyzed in time for a Jan. 6 meeting of the select committee, Scotti said.

The results reflect findings from other national and regional surveys on veterans with PTSD and depression.

The sample of 471 includes veterans from all 55 counties. The average age is 39, with a range in age from 20 to 76. Nine percent are women; 91 percent are men.

A total of 95 percent are white; two percent are black; and 1 percent each are Hispanic, Asian or American Indian.

A total of 71 percent have at least a high school degree; 20 percent have a bachelor’s degree; and nine percent have a post-graduate degree.

The sample yielded 170 veterans or 36 percent of the surveys which had scores suggestive of PTSD.

Post-traumatic stress disorder is an anxiety disorder.

According to an on-line page by the National Institute of Mental Health, “it can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened.”

“Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents or military combat,” the NIMH reference states.

In his report to the select committee, Scotti said PTSD is characterized by “re-experiencing the event or events via flashbacks, nightmares, intrusive thoughts, etc.”

Persons with PTSD also avoid “reminders of the event or events, people and places” and have “emotional numbing.”

They also show “hyperarousal” and are “on-guard, easily startled, and are often irritable due to disturbed sleep patterns.”

Depression, Scotti said, is characterized by: Feelings of sadness; worthlessness; fear and hopelessness; poor appetite; crying spells and other symptoms.

A total of 207 surveys or 44 percent had scores suggesting clinical depression, he said.

When the surveys were analyzed for PTSD and/or depression, the total came to 48 percent (226).

Noting 73 percent are married, 79 percent are living with a spouse or partner and 48 percent are living with an average of one child under the age of 21, Scotti said “it’s important that family members and children of the affected veterans get help as well.”

About 90 percent of the veterans know that services are available to them.

“However, only about half of the veterans having used a level of service found it helpful,” Scotti said.

The fact that the average veteran in the sample is 39 is a good sign, Scotti said. Returning Vietnam veterans were in their late teens or early 20s, he noted.

“Older is better. Older veterans have had more difficult life experiences that they have managed to deal with,” he said.

“They have learned more coping skills, and typically have more material and social resources they can rely on,” Scotti said.

That the majority of the latest crop of combat veterans also have marriages, partners and families also is a good sign.

But PTSD and depression symptoms wax and wane. Symptoms might not be evident for years after combat exposure for some veterans, he said.

If a veteran ignores the symptoms and doesn’t get treatment, however, “in a worst-case scenario, he or she could lose those supportive relationships.”

His recommendations include more awareness about the risks combat veterans have for PTSD and depression.

The outreach should include veterans and their families, particularly those in rural areas. It also should cover primary care and mental health providers.

Older veterans are a resource. Scotti would like to see programs developed for groups like the Veterans of Foreign Wars, American Legion and Vietnam Veterans of America.

Education is also needed for clergy, psychologists, counselors, social workers and medical professionals, he said.