Injured Troops Struggle to Get Health Care

All Things Considered, April 20, 2007 · When service members are forced to leave the military by war injuries or illness, they face a complex system for getting health and disability benefits. Sometimes, health care gets cut off when new veterans find they need it most. Some retired soldiers and their families say they are worried that the Pentagon won’t spend enough money to give the injured the care they deserve.

Click here to listen to the NPR broadcast:  http://www.npr.org/templates/story/story.php?storyId=9710383

’10 Percent Disabled’

Tim Ngo almost died in a grenade attack in Iraq. He sustained a serious head injury; surgeons had to cut out part of his skull. At Walter Reed Army Medical Center in Washington, D.C., he learned to walk and talk again.

When he got back home to Minnesota, he wore a white plastic helmet to protect the thinned-out patches of his skull. People on the street snickered, so Ngo’s mother took a black marker and wrote on the helmet: U.S. ARMY, BACK FROM IRAQ. On this much, everyone agrees.

But here is the part that is in dispute: The Army says Tim Ngo is only 10 percent disabled.

“I was hoping I would get at least 50 or 60 or 70 percent,” Ngo says. “But they said, ‘Yeah, you’re only going to get 10 percent’… And I was pretty outraged.”

When a service member is retired for medical reasons, the military’s disability rating makes a difference. If Ngo had been rated 30 percent disabled or higher, he would have gotten a monthly disability check instead of a small severance check. He also would have stayed in the military’s health-care system.

Instead, Ngo enrolled with the Department of Veterans Affairs. Typically, there’s a waiting period for the VA.

In October, while he was uninsured, Ngo had a seizure, caused by his war injury. He remembers being outside and blacking out; he fell to the ground on the driveway.

“My girlfriend was freaking out because she didn’t know what to do,” Ngo says. “She didn’t know if I was going to die because I had hit the wrong side of my head.”

An ambulance took Ngo to the nearest emergency room for treatment. It cost him $10,000. Ngo says that today, the bills for the incident are still unresolved.

Shrinking Numbers

Since that day, Ngo has gotten health coverage through the VA. Earlier this month, the VA said it would pick up his leftover bills from the emergency room.

The VA has been more generous than the Army all around. It rated Ngo as 100 percent disabled compared with the Army’s 10 percent rating.

The VA gives him a monthly disability check, which helps with his finances; his head injury and post-traumatic stress disorder have prevented Ngo from holding on to even a simple job since he returned home.

Ngo’s mother, Hong Wyberg, says the Army gives soldiers such as her son low disability ratings to save money.

“I don’t fully think they were prepared for the length of time this war is going to last,” Wyberg says. “They had no idea of how many injuries or the type of injuries that were going to come out of this.”

Michael Parker retired from the Army in October, and he thinks Wyberg’s suspicion is correct.

“The more I looked into it, I realized that this system does not have the soldier’s back at all,” says Parker.

Parker was a lieutenant colonel when he retired last year. Today, he has a disabling condition similar to rheumatoid arthritis. Parker was able to get the Pentagon’s lifelong health coverage for himself and his family; he had been in the military long enough — for at least 20 years.

But Parker saw that a lot of other soldiers weren’t as lucky, and it inspired him to become an advocate.

“I started posting questions and concerns and opinions on various blogs,” he says, “and it just kind of mushroomed from there.”

Parker started digging through Pentagon data, and the numbers he found shocked him. He learned that the Pentagon is giving fewer veterans disability benefits today than it was before the Iraq war — despite the fact that thousands of soldiers are leaving the military with serious injuries.

“It went from 102,000 and change in 2001… and now it’s down to 89,500,” says Parker. “It’s counterintuitive. Why are the number of disability retirees shrinking during wartime?”

A ‘Cost-Saving Device’?

Retired Army Lt. Gen. James Terry Scott heads a commission, set up by Congress, to study veterans’ disability benefits. At a Senate hearing last week, Scott said that his commission had compared the way the Pentagon and the VA rated the same soldiers.

“The Department of Defense records were matched with VA records on 2.6 million veterans receiving disability compensation,” Scott said. “Those rated zero, 10 or 20 percent [disabled] by the Department of Defense were rated in the 30 to 100 percent range by VA more than half the time.”

In other words, troops often get small disability checks and no military health care when rated by the Pentagon’s disability boards. But when they go to a VA board — with the same injuries — they get much more.

Scott said one reason is that the military’s ratings determine whether a person is fit for duty, whereas the VA looks at all conditions that create health problems for a veteran. So the VA ends up rating more disabilities per retired service member.

But Scott said another reason may be that the Pentagon wants to keep down its costs.

“It is also apparent that the Department of Defense has a strong incentive to rate less than 30 percent, so that only severance pay is awarded,” Scott said.

These numbers yielded some tough questions for Pentagon officials at the Senate hearing, such as Deputy Defense Secretary Gordon England.

“How do you respond to [the] assertion [that] the Department of Defense reduces disability ratings as a cost-savings device?” asked Sen. James Inhofe (R-OK).

“I can tell you… there’s no incentive to do that, senator,” England replied. “I mean, maybe that’s read into that. But I can tell you, we try to treat people fairly and accurately. And so there’s certainly no incentive.”

Pentagon officials conceded that the disability system doesn’t work as well as it should. They admitted it is too bureaucratic and too often adversarial. They said they would listen to suggestions for change.

Navigating the System

But change in the future will come too late for many soldiers.

April Croft was serving in Afghanistan when she was diagnosed with leukemia. She was treated for a year at Walter Reed. The cancer seemed to go into remission and she was sent home.

“They told her that she was only eligible for a 10 percent rating with the illness of leukemia,” says her husband, Mark Croft. “She was livid. She’s actually contested that situation about three times already.”

The Army never increased its 10 percent rating, but the VA rated her 100 percent disabled.

Croft spoke from his wife’s room in a VA hospital in Seattle, where she recently underwent a bone-marrow transplant.

“The VA originally gave her 50 percent and upped it to 100 percent once… she got sicker,” Mark Croft explains.

The VA provided the life-saving operation April Croft needed, but the low rating from the Army still mattered: The VA only covers veterans, not their families. It is the military health-care system that will insure an entire family — but only if the vet has a disability rating of 30 percent or more. April Croft has two young children, who are living with their grandparents in California.

Her kids eventually did get military health care — but only recently, after their mother married Mark, who is still in the Army. Mark and April wed in Reno in March. Afterward, he was given leave from the Army. Instead of taking off for a honeymoon, the newlywed couple drove to Seattle and checked into the hospital.

It’s the kind of complicated arrangement that many veterans must make to navigate the military’s complicated disability system.

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Policy Shift in 1985 Cut Disability Retirements

Today’s Disability Retirement Squeeze Began Years Ago       

Wary of rising disability retirement costs, the Department of Defense under then-secretary Caspar Weinberger quietly sought and received an internal legal opinion that, to this day, tamps down the number of wounded or ill service members awarded military disability retirement.

The March 25, 1985, memo from the DoD office of general counsel, which only recently came to light, gave Defense health officials a green light to restrain military disability ratings without a change in law.

They did so by directing the services to stop setting disability awards based on all service-connected ailments found during medical evaluations, and start basing them only on conditions that leave members unfit for duty.

The policy change took effect in February 1986 with a revised DoD instruction to services. Its impact can be profound on individuals, particularly in wartime. The Veterans’ Disability Benefits Commission is studying the effects and its chairman this month sounded an alarm.

The advantages of receiving disability retirement, which requires a 30-percent or higher disability rating, are great for members with less than 20 years in service. Beside an immediate annuity, disabled retirees and their families gain lifetime access to TRICARE, to base shopping privileges and to a host of other perks tied to “retiree” status.

Veterans with disability ratings of 0 to 20 percent receive only a lump-sum severance payment upon discharge. They can apply to the Department of Veterans Affairs for a higher rating and will often get one, which can mean monthly VA compensation and improved access to medical care. But VA care isn’t available to families and VA doesn’t offer base-like support services.

The experience of Army National Guard Spc. Kenneth Parham, 47, shows the impact of the 1986 policy shift on disability awards today. In April 2005, Parham was in the gun turret of a Humvee when it drove over a bomb buried beneath a road outside Kirkuk, Iraq. The explosion tossed his Humvee high into the air. It was Parham’s third contact with an improvised explosive device in five months. This one collapsed a lung, fractured ribs and damaged discs in his neck and back.

Today, the once vigorous Parham, who as a civilian drove a moving van and lifted up to 5000 pounds of household goods a day, needs a motorized cart to shop in stores. He has chronic neck and back pain. He must walk slowly, sit frequently and can’t lift more than 20 pounds. Because he can’t wear a helmet or his carry a rucksack, the Army has found the former Marine unfit for duty. It plans to discharge Parham with a 20-percent rating and about $40,000 in severance. Next week, he will travel from his home in Lewiston, Idaho, to Fort Lewis, Wash., to appeal that rating decision before a physical evaluation board.

His wife, Cheryl, said a 20-percent rating is so unjust, given how her husband’s quality of life and job prospects have plummeted.

“How’s he going to support himself the rest of his life,” she asked. Service-connected ailments that the Army ignored in setting the 20-percent figure, she said, include post-traumatic stress disorder with nightmares, a weakened leg, the sleep apnea, high-blood pressure and arthritis.

Injured war veterans of Iraq and Afghanistan are becoming more aware of the critical 30-percent threshold. Some credit for that goes to retired Army Lt. Gen. James Terry Scott, chairman of the Veterans’ Disability Benefits Commission. Scott spotlighted the value of 30 percent ratings, and ruffled feathers of DoD officials, before a Senate hearing last week when he said the higher cost of disability retirement, versus severance pay, gives DoD “a strong incentive” to award 20 percent or less.

No service does it more often than the Army, according to fresh service data released by Scott. From 2000 through 2006, the Army gave ratings of 30 percent or higher to only 13 percent of soldiers deemed disabled. By comparison, the Navy awarded disability retirement to 36 percent of its disabled members. The Air Force number was 27 and the Marines Corps 18 percent. 

More troubling, Scott suggested, was data showing Army awarded a 0 percent rating to 13,646 soldiers that it found unfit for duty. The Navy, Marine Corps and Air Force had assigned 0 ratings only to 400 apiece.

Scott said he wasn’t speaking for the commission which won’t finish its report until fall. But he urged Defense officials to allow the services to begin setting disability awards based on all service-connected disabilities found.

To ease rating disparities across the services, and between DoD and VA, he recommended that the VA alone conduct all medical evaluations and set all disability ratings before members leave service.

Col. Andy Buchanan, deputy commander of the Army’s Physical Disability Agency (PDA), said he would quibble with some of the commission’s data but clearly there are troubling disparities in ratings between services that can’t be explained by “mission differences” alone.

“I know where we’re different right now, but I have to find out why,” said Buchanan. He has recommended an independent audit of service disability awards to identify the factors creating the service disparities. But Buchanan, in our phone interview, denied that the PDA or individual evaluation boards operate with any concern for how rating decisions  impact Army budgets.

The Army does not follow VA criteria to rate every condition. For example, the VA rates some sleep apnea as 50 disabling, higher than the loss of a limb, Buchanan said. Also, unlike the VA, the Army does not presume that every medical condition that surfaces while in service is “service-connected.”

“We’re pretty rigid – and that may be why we’re perceived as stingy — about following the rules, looking for evidence,” Buchanan said.

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Editorial – Levin Gives Cheney Reason to Smirk

Never before have I felt such irk from a Cheney smirk — the one with which he confidently assured CBS’s Bob Schieffer on Sunday’s “Face the Nation” that the Democrats will continue to vote to fund the war without including serious restrictions.

Cheney referred approvingly to the fact that “Carl Levin, who’s chairman of the Senate Armed Services Committee, has indicated that they definitely do want to pass funding for the troops.”

Cheney expressed confidence that the Democrats will “not leave America’s fighting forces in harm’s way without the resources they need to defend themselves.” And yes, the vice president went on to reassure viewers, against all evidence to the contrary: “We are making progress.”

The administration’s main objective could hardly be clearer, even to mainstream pundits allergic to spelling it out. By waving the flag of patriotism, the White House is confident it can continue to intimidate enough Democrats to get the only thing it really wants: enough money to stave off defeat in Iraq until President George W. Bush and Cheney are safely out of office. That, of course, also explains the foredoomed “surge” in troop strength.

But how is it that Cheney can enlist the likes of Carl Levin in a policy built on the backs of American troops? Based on recent casualty rates, some 1,500 American troops already “in harm’s way” will die, and several times that number will be wounded before Cheney and Bush leave office — not to mention the ever mounting casualties among Iraqis.

Is Cheney exaggerating the support he sees in Levin? Apparently not. The senior senator from Michigan seems ready to provide additional funding for the war, no matter what. On April 8, right after Senate Majority Leader Harry Reid announced he would cosponsor legislation cutting off all funding for combat troops after March 31, 2008, Levin undercut him by telling ABC’s “This Week”: “We’re not going to vote to cut the funding, period. … We’re not going to cut off funding for the troops. We shouldn’t cut off funding for the troops. … We’re going to vote for a bill that funds the troops, period. We’re going to fund the troops. We always have.”

Got that?

What would prompt Levin to undermine his own majority leader? Levin was challenged on that point last Sunday at the University of Michigan. He replied that cutting funding for the war is what Rush Limbaugh wants and would play into Bush’s hands. The Democrats would probably lose a battle over funding and end up looking “really bad,” added Levin.

Not very persuasive, senator — not when more and more are getting killed in Iraq every day.

Levin may be concerned about things other than looking bad. Those taking part in last month’s meeting of the America Israel Public Affairs Committee in Washington heard stern warnings from Israeli Prime Minister Ehud Olmert and Foreign Minister Tzipi Livni that America not show “weakness” on Iraq — warnings that a U.S. troop withdrawal would make the neighborhood far more dangerous for Israel.

Federal Election Commission records show that Levin has received more money from pro-Israel political action committees than any other senator. But, given his distinguished record, it would seem appropriate to give him the benefit of the doubt. It seems less likely that he is influenced by the money than by his penchant to see little or no daylight between what he perceives to be Israel’s interests and those of the United States.

This appears to be the kind of “passionate attachment” against which George Washington warned so strongly in his farewell address more than 200 years ago.

RAY McGOVERN was a CIA analyst for 27 years and is now on the steering group of Veteran Intelligence Professionals for Sanity (VIPS). Write to him in care of the Free Press Editorial Page, 600 W. Fort St., Detroit 48226 or oped@freepress.com.

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Why Were Soldiers With PTSD Discharged?

Six senators have requested an investigation into what they call “upsetting allegations” that the Army gave personality-disorder discharges to 18 Fort Carson, Colo., soldiers diagnosed with post-traumatic stress disorder or traumatic brain injuries.

“There are allegations of commanders at Fort Carson, Colo., denying soldiers access to mental health care and instead ordering them redeployed for additional tours in Iraq,” states a letter to the Government Accountability Office. “We have also heard of cases in which service members with PTSD are diagnosed as having ‘personality disorders’ that the Army considers ‘pre-existing,’ thus depriving otherwise eligible combat veterans of disability benefits and much-needed mental health care.”

The letter, dated April 19, is signed by Senators Barack Obama, D-Ill.; Barbara Boxer, D-Calif.; Christopher Bond, R-Mo.; Joe Lieberman, I-Conn; Tom Harkin. D-Iowa; and Claire McCaskill, D-Mo. It was also sent to Deputy Defense Secretary Gordon England and Acting Secretary of the Army Pete Geren.

“I’m especially troubled by reports of some DoD commanders downplaying the serious mental health conditions confronting service members returning home from Iraq,” Obama said in a statement, “and then redeploying those troops without proper treatment. It’s time for a full accounting of how many of our troops are affected by post-traumatic stress disorder, other service-connected mental health conditions and traumatic brain injuries.”

The letter requests that the following items be investigated:

• Known cases of improper discharges or misdiagnoses.

• The growing number of discharges for personality disorders.

• The overall number of misdiagnosed cases for PTSD, mental health conditions and traumatic brain injuries.

• Defense Department progress in mandatory screening and treatment.

• What is available to soldiers if they believe they have been misdiagnosed.

• The number of service members reporting mental health concerns because of sexual assault during deployment.

“We seek to ensure that the DoD has the resources necessary to diagnose and treat service-connected injuries that impact the mental health of U.S. service personnel,” the letter states. “It is vital that the U.S. military ensures it is treating the mental health needs of our forces with the same priority and resource investments it is devoting to physical injuries.”

The quest for information began after The Nation reported that 22,000 soldiers have been diagnosed and discharged from the Army for pre-existing personality disorders since the war began, as well as documenting cases of soldiers who believe their combat-related mental health issues were buried for the sake of saving money or quickly filling a slot with a deployable soldier.

Veterans for America then requested an Army surgeon general investigation into the cases of 18 soldiers discharged for personality disorders. Steve Robinson, director of veterans affairs at Veterans for America, said the Army surgeon general wrote the group a letter stating that the soldiers’ cases had been investigated, and that no improprieties took place.

However, Robinson said no one talked to any of the 18 soldiers during the investigation, thus sparking the congressional inquiry.

“Four months later, we got a letter saying, ‘We thoroughly and thoughtfully reviewed these cases,’ ” Robinson said. “But how can that be if they didn’t do follow-up exams and didn’t talk to the soldiers?”

Spc. Jon Town is one of those soldiers. “Nobody talked to me,” Town said. “It’s unbelievable that their investigation didn’t involve talking to the soldiers.”

Town was diagnosed with a traumatic brain injury when a rocket blew up two-and-a-half feet above his head in Iraq in 2005. “It was like I was kind of flying and then there was a fireball behind me,” he said of the explosion that caused his injury.

He bled from his ears and passed out cold for about three minutes. He rested for 24 hours, and then went to work the next day.

“As soon as I got back, it was in my medical records,” Town said. “But it took me two months to get my first appointment.”

He can’t hear in his left ear, lost 50 percent of his hearing in his right ear, and has short-term memory loss and headaches that never go away.

Town also has PTSD — common for soldiers with traumatic brain injuries.

“It’s rather scary,” he said. “Yesterday, me and my wife were going to my mom and dad’s house and someone blew a tire out. It scared the bejesus out of me.”

Town said his wife encouraged him to pull over and calm down, but said that he has flashbacks two or three times a day and only gets three hours of sleep a night.

Soon after he returned to Fort Carson, Town sat in a bathtub full of water. He plugged in a hair dryer, and then tugged it into the water.

“It was a really bad day, bad time,” Town said. “Fortunately, it short-circuited.”

Though he checked into a hospital the next day, his command wasn’t as helpful. He received a bad write-up when he overslept one day because of his medication. He was written up again after one of his sergeants said something offensive about a friend who died in Iraq.

“I just yelled at the person,” he said. “He was a staff sergeant, and I was disrespectful. But he had no right to say what he said.”

Soon, his mental health diagnosis changed.

“I had obvious symptoms of PTSD, and I was going to do the medical evaluation board,” he said. “But they sent me to psychiatrists who said I had a personality disorder.”

With no history of mental health issues in his past, Army physicians diagnosed Town with a personality disorder, then discharged him with no benefits because they determined the supposed disorder was a pre-existing condition.

“My commander told me it wouldn’t affect my benefits, and if I signed the paperwork, he could get someone to take my place,” Town said. “But I lost everything, and had to pay the Army $3,000 back because I re-enlisted and got a bonus. That’s what I got for seven years of service.”

He was chaptered out and has been waiting for six months for an appointment with the Department of Veterans Affairs.

Andrew Pogany, a former soldier who investigates cases for Veterans for America, said Town’s case is typical, and then listed several others:

• One Native American soldier served two full tours in Iraq and has not been able to get treatment for his PTSD. Instead, the soldier said, his chain of command disciplined him for alcoholism and harassed him by calling him a “drunk Indian.” Other soldiers signed statements saying the Native American soldier was mistreated, and that they were ordered not to cooperate with investigators.

• Another soldier served in Afghanistan for a year, then sought help for PTSD. He received none, then was redeployed to Iraq. While returning to Iraq after leave, he had a panic attack at the airport and said he could not get on the plane. He immediately called his unit, then sought mental health treatment. He was diagnosed with acute stress disorder, and then chronic PTSD. And then he was found guilty of “missing movement by design,” reduced in rank from specialist to private and given 45 days of extra duty.

• A 550-pound log fell on a specialist’s head causing lesions to his frontal lobe. His profile said he was undeployable and that he needed an urgent MRI, but he was cleared to go to Iraq. One month after arriving, he suffered another traumatic brain injury in an explosion and was medevaced back to Fort Carson. He faces an Article 15 for disobeying an order, even after a doctor said his brain injury was so severe he can’t comprehend orders.

• A soldier was given an other-than-honorable discharge even with signs of a traumatic brain injury. One day before he was kicked out, the soldier was diagnosed with the injury. He was discharged anyway.

“It’s just totally ridiculous,” Pogany said. “It flies in the face of what they say publicly.”

Publicly, Army mental-health experts have been fighting the stigma surrounding mental health issues, as well as the idea that service members will be punished for seeking help.

“I tell these stories to people who have nothing to do with the military, and they think I’m making this up,” Pogany said.

In Iraq, Pogany, a former staff sergeant and Army interrogator serving with an A team out of Fort Carson, had what appeared to be a nervous breakdown. Instead of providing him with medical treatment when Pogany said he needed help, the Army sent him home and charged him with cowardly conduct.

But he continued to have the symptoms he had in Iraq: panic, anxiety, nightmares, confusion and depression. Then his lawyer said other soldiers who had taken anti-malarial medication were having the same symptoms.

Pogany was medically retired in 2005 after his doctors said the medication caused brain damage.

“The drugs did damage to my brain stem. But I’m done with that. It just gets me worked up that these guys are falling through the cracks today.”

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Rural Veterans Lack VA Care, Groups Say

Privatized medicine, by law, may replace Department of Veterans Affairs care only if the VA is not physically available for former service members who live in rural areas.

But if veterans are waiting in line for months for initial exams, are the VA facilities “physically available”?

“I think we’ve established that there is a hardship already,” Andy Behrman, chairman of the Rural Health Policy Board of the National Rural Health Association, told the House Veterans’ Affairs health subcommittee at a hearing Wednesday. “That’s why we’re here.”

With 44 percent of service members today coming from rural towns, the committee hoped to come up with some solutions for the thousands of veterans not getting the care they need. Many veterans struggle because there are no VA facilities in their areas, because they can’t afford the travel expenses to VA facilities, because there is a national crisis in getting mental and specialized health care professionals to work in rural areas, and because the VA system is so backed up that veterans can’t get the care they need when they need it.

“I’m worried that protecting the system isn’t protecting the vets,” said Rep. Vic Snyder, D-Ark.

Representatives of veterans’ groups at the hearing said more funding must go to VA facilities to keep standards of care, as well as expertise in veterans’ issues such as post-traumatic stress disorder and traumatic brain injuries, at the maximum level.

“It’s very important to make sure the quality of care as well as the continuum of care Veterans’ Affairs is known for remain intact,” said Adrian Atizado, assistant national legislative director for Disabled American Veterans.

Atizado also said initial contracts with private companies always look good, but when it’s time to renew those contracts three years later, the costs can go up substantially. The quick fix of privatized care can’t fix the system in the long run and will cost more, he said.

He recommended better funding for the VA, as well as mobile health care clinics to travel to veterans. He also recommended stronger connections with medical schools, and providing veterans with sufficient reimbursement when they do travel long distances for care.

In addition to Atizado’s input, Behrman recommended more contracts with Federally Qualified Community Health Centers in rural areas, more case managers for traumatic brain injuries, and targeted care for minority and female veterans.

Gerald Cross, acting principal deputy undersecretary for health in the Veterans Health Administration, said the VA is holding its own, and noted that 98.5 percent of veterans live within 90 minutes of a VA facility.

“VA’s comprehensive approach for providing care to veterans residing in rural areas has proven successful,” he said. “New technologies and better planning are allowing us to provide quality care in any location.”

He said tele-health allows patients to receive care by phone, and home-based health care have helped people who can’t travel. VA also has increased the number of community-based outpatient clinics by 717 since 1995, and 45 percent of them are in rural areas.

But Shannon Middleton, deputy director for health for the American Legion, said many of the CBOCs “are at or near capacity,” she said, “and many still do not provide adequate mental health services to veterans in need.”

Cross said the VA planned to add 2,000 veterans with PTSD to the telemedicine program by 2008. At that rate, it would take 30 years to reach all of the veterans returning with PTSD, said Rep. Michael Michaud, D-Maine.

“There are 218,000 vets in southern Nevada who have no health care facilities,” said Rep. Shelley Berkley, D-Nev. “We will be taking care of their health care and mental health care needs for many years to come, and we can’t handle what we’ve got.”

Before the subcommittee had a chance to question Cross further about how the VA is addressing the problems, lawmakers had to adjourn the hearing to vote on other matters.

“We have to do better,” Michaud said as the hearing broke up. “I know VA is intending to do better.”

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VA Official Looks to Future of Veteran Care

SOUTHERN PINES — The Department of Veterans Affairs hopes to improve mental-health care, reduce the wait for appointments and build more clinics and offices, a top official said Tuesday.

President Bush has proposed a budget to improve problems in the services the department offers, according to Patrick W. Dunne, the department’s assistant secretary for policy and planning.

Dunne spoke to members of the Sandhills Chapter of the Military Officers Association of America at the Belle Meade Retirement Resort in Southern Pines. About 75 people attended.

The retired admiral said Bush has requested $87 billion for the Department of Veterans Affairs. Dunne said a large chunk of that money is allocated for medical care. He alluded to revelations of problems at Walter Reed Army Medical Center in Washington and to problems at VA Hospitals around the country, then said the department is trying to fix what went wrong.

“The VA can and will do better in the future,” he said. “One failure is unacceptable.”

Dunne, who has both a bachelor’s and master’s degree in mathematics, said part of his job is to use census data and other statistics to figure out where veterans live so the VA can determine where to build clinics and offices.

He said the VA sometimes struggles to link veterans with the services they need and said the department is planning to hire 100 patient advocates to help veterans navigate the system.

Ideally, he said, veterans would fill those jobs, “so that in essence, we would have veterans serving veterans.”

Dunne said the VA hopes to improve treatment for soldiers returning from Iraq and Afghanistan, especially those who have suffered traumatic brain injuries.

He said VA medical providers soon will be trained in recognizing brain injuries, and said the department plans to screen all soldiers returning from Iraq and Afghanistan for brain injuries.

He said the department is planning to move mental-health treatment into the VA’s primary care clinics, so that veterans can be treated for mental health problems at a primary care clinic.

“The fact is, VA is seeing more and more veterans with mental health syndromes,” he said.

Gary Geist, president of the Sandhills Chapter of the Military Officers Association of America, said he asked Dunne to speak at Tuesday’s luncheon because he thinks it is important that veterans learn about the services available to them.

He said he wanted to encourage members of the Sandhills Chapter to support local VA centers.

Dunne said the department is evaluating its programs and trying to fill gaps in service.

“We want to anticipate what’s coming in the future,” he said. “And be ready when it gets here.”

Staff writer Laura Arenschield can be reached at arenschieldl@fayobserver.com or 486-3572.

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Colorado Senate Backs Mental Healthcare for Iraq and Afghanistan War Veterans’ Families

(AP)  DENVER  The Senate gave initial backing Tuesday to a proposal that would pay for mental health counseling for the families of Iraq and Afghanistan war veterans.

The proposal (Senate Bill 146) would set up a three-year pilot program in Colorado Springs to provide mental health treatment and education to the families of veterans who cannot get services on their own.

The program would cost $300,000 a year, which would be taken from the state’s share of the national tobacco settlement. Families would pay up to $20 a month to participate.

Veterans are still eligible to receive mental health care through the military after they leave the service, but their families are not, said Sen. John Morse, D-Colorado Springs, the sponsor.

He said if spouses and children get counseling, veterans might be encouraged to do the same.

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Rate of U.S. Losses in Iraq is Highest Yet

Over the past six months, American troops have died in Iraq at the highest rate since the war began, an indication that the conflict is becoming increasingly dangerous for U.S. forces even after more than four years of fighting.

From October 2006 through last month, 532 American soldiers were killed, the most during any six-month period of the war. March also marked the first time that the U.S. military suffered four straight months of 80 or more fatalities. April, with 58 service members killed through Monday, is on pace to be one of the deadliest months of the conflict for American forces.

Senior American military officials attribute much of the increase to the Baghdad security crackdown, now in its third month. But the rate of fatalities was increasing even before a more aggressive strategy began moving U.S. troops from heavily fortified bases into smaller neighborhood outposts throughout the capital, placing them at greater risk of roadside bombings and small-arms attacks.

ROADSIDE BLASTS

Roadside bombs have long been the No. 1 killer of American troops in Iraq.

Since October, officials said, insurgents have been employing more sophisticated devices, with the most lethal results coming in Baghdad. Nearly 38 percent of military deaths since October have occurred in the capital, compared with 29 percent over the previous 12 months, according to the Iraq Coalition Casualty Count (http://icasualties.org), an independent, U.S.-based Web site that monitors military and civilian casualties.

At the same time, insurgents are leaving Baghdad to escape the crackdown, and in recent weeks U.S. and Iraqi troops have launched major operations outside the capital. Some of the heaviest fighting has occurred in Diyala province, northeast of Baghdad, where 44 American service members have died so far this year — more than in the previous 22 months combined.

In the past, U.S. fatalities had a tendency to spike in months of heavy combat, then drop to lower levels in subsequent months. April 2004 and November 2004 were the deadliest months of the war for American forces, due mostly to intense combat in Iraq’s western Anbar province.

But those high death tolls quickly dropped; for example, the death toll in April 2004 was 135, but fell to 42 two months later. The November 2004 toll was 137, but dropped to 58 in February 2005 and 35 the following month.

The past several months, however, have brought the longest period of sustained heavy casualties since U.S. troops entered Iraq in March 2003. December saw 112 soldiers die, the most since November 2004, and the subsequent three months registered 83, 80 and 81 fatalities, respectively.

Baghdad has supplanted Anbar as the deadliest region for American forces. Of the 58 deaths so far in April, 34 have occurred in the capital. The figures include all deaths, not just those that the military says occurred due to hostile action.

COALITION FORCES

Under Gen. David Petraeus, coalition forces have opened 31 joint U.S.-Iraqi security stations and 22 neighborhood outposts in Baghdad to create an around-the-clock military presence on the streets. Officials said the plan is working. The number of murders and executions of civilians in Baghdad had fallen by 26 percent since the start of the year, Caldwell said.

Statistics compiled by McClatchy Newspapers from several provinces also show an overall decline in killings, though recent data indicate that the trend might be reversing. The number of corpses found in Baghdad from March 15 to April 14, for example, rose 26 percent over the previous 30 days, the McClatchy-gathered statistics show.

The shift in military tactics nevertheless has raised the risks to soldiers.

”We do what we can to mitigate that risk,” said Lt. Col. Chris Garver, a military spokesman. ‘But General Petraeus’ plan is to be out there in the neighborhoods as opposed to hunkered down on a FOB [forward operating base].”

Commanders are employing a similar strategy in Baqouba, the capital of Diyala province located 35 miles northeast of Baghdad. Insurgent groups have been moving into Baqouba, a fierce battleground for Sunni militias.

A battalion of Stryker soldiers arrived in March and has been trying to secure Baqouba through neighborhood outposts, regular patrols and coordinated military operations, sometimes with Iraqi troops, said Lt. Col. Michael Donnelly.

”Over the last three to four months we’ve had several major operations,” Donnelly said. “When you put more troops into a battle space, the battle space gets more concentrated, and there’s a more likely chance you run into the enemy and cause him to maneuver.”

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Editorial – Benefit Disorder

For more than five years, the United States of America has been relying on its volunteer military to fight a war against radical Muslim terrorists. Just a couple hundred thousand Americans and their families are carrying this burden for the other 300 million of us. Over 3,000 have died, and tens of thousands more have been injured, many seriously.And how do we thank them when they are no longer fit for service? By cheating them out of their benefits.

The case of Army Specialist Jon Town, of Findlay, has been featured in the April 9, 2007 issue of The Nation magazine as well as Monday’s Courier. In brief, Town served in the Army for seven years, receiving numerous honors including a Purple Heart. He was injured in October 2004 in Ramadi, Iraq, when a rocket struck about 2 feet from his head. He survived, but he sustained permanent hearing loss and also continues to deal with depression, headaches and insomnia. At one point Town attempted suicide. An Army psychologist told him he had symptoms of post-traumatic stress disorder.

These symptoms should sound familiar to anyone who’s served in a war or known someone who has. But to the Army, which in 2006 convinced Town that he should be discharged, it was “personality disorder” “” a supposedly pre-existing condition that let the Army off the hook on paying benefits.

Town insists that he was promised by the Army psychologist who handled his case that if he agreed to be discharged under Chapter 5-13, all his benefits would remain intact. Instead, he received no disability pay and no long-term VA medical care, even though his medical condition was the direct result of injuries sustained in Iraq. And to top it off, he was told he had to repay most of his re-enlistment bonus. Town left Fort Carson, Colo., owing the Army $3,000.

Town’s Army psychologist says he never discussed benefits with him, and the Army continues to deny systematic cheating of soldiers in order to save money. But obviously there is a reason why more than 22,000 personality disorder discharges have been issued to U.S. troops over the past five years. Doesn’t the military screen enlistees? Of course it does. Town served not only honorably but with distinction until he was injured. For the Army to cheat him and others out of their benefits because they were wounded in the service of their country is an unconscionable breach of trust.

Town’s case seems to be finally getting the attention it deserves. But what of the other soldiers in similar cases? Retired Lt. Gen. James Terry Scott testified to Congress last week that preliminary results of a study by the Veterans’ Disability Benefits Commission, which he chairs, show there may indeed be an effort to keep costs down by underrating the severity of soldiers’ disabilities.

All Americans owe a debt to those who serve in the volunteer military. Medical care and benefits are the least we can do to repay them. We urge Congressman Jim Jordan and Sen. Sherrod Brown to fully investigate the stories of Town and others like him, and fight not only for the reinstatement of their full benefits but also to stop the Army’s systematic abuse of its volunteer soldiers, if such indeed is going on.

In addition, congressional Democrats need to quickly pass a generous and pork-free military spending bill so the Army has less reason to be overly careful with its money.

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TBI: Hidden Wounds Plague Iraq War Veterans

Colorado Springs – After the 5-ton Army truck stopped tumbling down an embankment in Iraq, Gary Watts found himself standing on his head, upside down in the cab of the truck.

“All I had was a sore neck and a bad, bad headache,” Watts said.

He rested for a couple of days after the July 24, 2003, accident, then went back to work. He would listen to his commander’s directions but hear only pieces of sentences. Twice, he ended up in the wrong convoy in Iraq, driving a truckload of supplies to the wrong place. His bosses chewed him out, and fellow soldiers made fun of him.

It took nearly three years for doctors to diagnose Watts with what is now known as the signature wound of this war – traumatic brain injury.

“Unfortunately, this may be what we are now creating, a whole population of people who are going to be mildly to moderately brain-injured,” said Dr. Sheldon Goldberg, medical director of Porter Adventist’s rehabilitation unit. “Just as Christopher Reeve’s spinal-cord injury brought spinal- cord injury into the limelight for the public to try and understand, I think very sadly our returning Iraq veterans are going to be bringing traumatic brain injury into the limelight now.”

Last week, Fort Carson revealed that 17.8 percent of troops who returned to the mountain post from Iraq in the past two years had a traumatic brain injury, or TBI.

Of 13,400 soldiers screened in the past two years, nearly 2,400 of them had brain injuries. Of those, 13 percent were not fit to return to Iraq. In many cases, those soldiers were medically discharged from the Army.

Camp Pendleton in California, Fort Bragg in North Carolina and Fort Hood in Texas found that between 10 percent and 20 percent of returning soldiers suffered brain injuries, most from improvised explosive devices, according to Charles Dasey, spokesman for the U.S. Army Medical Research and Materiel Command. At Walter Reed Medical Center in Washington, D.C., 30 percent of soldiers admitted had a brain injury.

“When you consider that 1.5 million people have served in Iraq [and Afghanistan], that’s 150,000 to 300,000 people who have TBI, and that’s an enormous, enormous problem that requires immediate action,” said Paul Sullivan, executive director of Veterans for Common Sense, a nonprofit advocacy group for vets.

Damage can be cumulative

In high-velocity, concussive-type accidents, the brain is like molded Jell-O tossed around in a wooden box. For soldiers who are exposed to dozens of blasts from improvised explosive devices, the likelihood of more damage increases with each event.

The severity of traumatic brain injuries varies, and it affects each person differently. Many soldiers recover within hours or in one to three months. For some, the brain may never heal.

“What happens to these people is, they don’t become stupid. It’s not that these people lose their cognitive ability; they just lose the ability to get the messages from one part of the brain to the other as fast as they used to,” Goldberg said.

Watts, 35, now receives 100 percent disability from the Department of Veterans Affairs. He lives with his wife, Danelle, 32, and their 10-month-old daughter, McKenna, in the mountain community of Divide.

After his injury, Watts knew something was wrong with his brain. He blew up at other soldiers when he thought they had moved his belongings.

Before he left Iraq and headed home in March 2004, a doctor did a checkup. Watts told him during the exam that he had an accident and memory loss, but at the time, brain injuries were not on the radar of Army doctors.

“They said: ‘Well, that’s kind of common over here in a war environment. Once you get back home, you should straighten out, so let your doctor know when you get back,’ ” Watts said.

In recent months, veterans advocacy groups have been critical of the military’s medical community because the Pentagon has not released hard numbers on how many troops have suffered from traumatic brain injuries.

Dr. Jonathan Jaffin, an Army colonel and acting commander of the Army’s Medical Research and Materiel Command, said the difficulty comes from a diagnostic dilemma.

“The question is: ‘Who has had a brain injury?’ The severe ones, that’s easy. … When you think about football players, how many football players get their bell rung? If you really look, a lot of them do. So getting that exact number of the mild ones can be tough,” Jaffin said.

The other challenge is that most traumatic brain injuries heal without medical care. If a soldier shows no symptoms, screening for a TBI does not occur at the nation’s Army installations. Veterans organizations want the military to document when a soldier has been exposed to a blast, should symptoms arise in the future.

Last week, a nine-member independent review group selected by Defense Secretary Robert Gates to respond to deficiencies in outpatient care at Walter Reed Army Medical Center recommended that the military adopt a policy for recording any exposure to a blast in a patient’s medical record, develop a coding system to record TBI, and screen troops before and after deployment to measure functional/cognitive abilities.

Symptoms only got worse

As Watts continued fighting the war in Iraq, his symptoms became worse. He couldn’t dismantle and assemble his Army rifle, a task that used to be as simple as tying his shoes. The Army sent Watts – considered a “go-to” guy – to Fort Hood to take a course and a test he needed for promotion. Watts failed the written test twice.

Before he left Fort Hood, two roommates told him they noticed something wasn’t right with him.

“I broke down, and I said: ‘Hey, I had an accident in Iraq. My head bounced all over the cab, and ever since then my memory has just been useless. I don’t even remember your name, and you’re my roomie. … If you don’t have it on your shirt, I don’t know.”‘

Back at Fort Carson, doctors diagnosed him with traumatic brain injury, but a medical board wanted more tests. He received a final diagnosis in late April 2006.

Danelle Watts said her husband becomes irritable because he is frustrated that he can’t remember what used to be automatic.

“He doesn’t remember what day of the week it is, when holidays are,” she said.

On a white, dry erase board, she reminds him: “Today is Wednesday, April 4.”

Before he was discharged from the Army in July, Watts got lost going to work at Fort Carson. After their daughter was born, Danelle had to quit the Army because her husband was not able to care for the girl himself.

Goldberg, the rehabilitation doctor, said there is no cure for traumatic brain injury. Whether Watts will fully recover is not known, but since he left the Army, he has begun to feel better.

He tries to manage his days and limit the unexpected.

“I’m not lazy, but I try to do as little as possible. If something pops up that I can’t control, that I can’t predict is going to happen, it throws a wrench in the works and I don’t know how to handle it,” Watts said.

The key to helping people with brain injuries is providing a safe, supportive environment, Goldberg said.

For the Watts family, that help came from Debra Berthold, a retired Army colonel who works with the Army’s Wounded Warrior Program.

Berthold called the family in August, when the Wattses were down to the last $30 in their checking account. Watts was out of the Army, and veterans’ benefits hadn’t kicked in.

The Wounded Warrior Program is designed “to make sure that we don’t do to these soldiers what we’ve done to our Vietnam soldiers,” Berthold said. Anyone who is given a ranking of 30 percent or more disability from the VA is eligible for help. Berthold has a caseload of 60 soldiers, and 80 percent of them have a brain injury.

It’s where Watts has received vocational-rehabilitation benefits.

For at least 30 hours a week, he works with Carl Reif, president of Advanced K-9 Training Inc., to learn to train dogs to detect drugs, bombs and cadavers and find lost people.

Training a dog requires repetition, and that repetition – giving the same commands again and again – will help strengthen Watts’ brain.

“If the brain is a connection of millions and billions of circuits, and all of a sudden a whole bunch of these circuits are torn or damaged in a very minute way,” Reif said, “… what you need to do is to keep sending the same message through on those circuits, to either help heal up those circuits or create new circuits within the brain that go around the injured area.”

Watts trains two times a month with Denver-area police officers in the hope that one day he’ll be able to have his own dog-training business. Over and over again, he practices.

“There’s not a prosthetic brain out there, so no, it’s never going to be normal again,” Danelle said. “Can he work ways around it? Yes. Are there ways to make it better? Yes. Is it going to take a long time? Sometimes.”

Staff writer Erin Emery can be reached at 719-522-1360 or eemery@denverpost.com.

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