VCS Spring Membership and Fundraising

Thank you for visiting our website.  Please feel free to look around. Perhaps you heard or saw one of our recent  interviews on NPR, the BBC or in the New York Times, regarding veterans mental health.  Were you wondering how you could help our efforts for veterans? One thing you can do is sign up to be  a member of our mailing list by clicking on the link below.

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Policy makers in DC always want to know how many people support Veterans for Common Sense. Strength in numbers matters a great deal in getting their attention. Your information will remain with us and will not be sold. You can also help us with our spring fund raising drive. We rely on individual donations.  We cannot keep up our fight for veterans with out your help. Join our cause and help us keep strong and  fighting into our second decade.  Thank you.

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Unemployment is a special challenge for veterans


They say that civilian employers don’t always appreciate their skills and maturity, and that a focus on PTSD and brain injuries has stigmatized those who have served in Iraq and Afghanistan.

By David Zucchino, Los Angeles Times

April 25, 2012, 4:54 p.m.

WASHINGTON — Matt Pizzo has a law degree, can-do attitude, proven leadership skills, and expertise in communications and satellite technology from his four years in the Air Force.

Yet the 29-year-old has been told that he’s overqualified, too old, too “non-traditional,” and that he’s fallen behind his civilian contemporaries.

“It was disheartening, to say the least,” he said of his latest job rejection. “But it’s typical, I’m afraid.”

For unemployed veterans of the wars in Afghanistan and Iraq, rejection is a special ordeal. Veterans’ advocacy groups, and many unemployed veterans, say civilian employers don’t always appreciate veterans’ skills and maturity. They point out that this is the first generation of employers who have no widespread military experience and thus no inherent appreciation for what the institution can provide.

Further, the increased military and media attention given topost-traumatic stress disorderand traumatic brain injury has had the effect of stigmatizing veterans, advocates say. Some employers fear that soldiers diagnosed with these conditions are prone to violence or instability.

The unemployment rate for veterans of Afghanistan and Iraq is 10.3{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d}, according to the Bureau of Labor Statistics. For veterans age 24 and under, the rate is 29.1{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d}, or 12 points higher than for civilians the same age. That compares with 8.2{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} unemployment nationally, and 7.5{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} for all veterans.

A survey this year by the advocacy group Iraq and Afghanistan Veterans of America found that a quarter of its members could not find a job to match their skill level, and half said they did not believe employers were open to hiring veterans.

“These veterans have skills and maturity a decade beyond their civilian peers,” said Tom Tarantino, the group’s deputy policy director, who couldn’t find work for 10 months after he left the Army in 2007. “It’s very frustrating for them to be told they have to retrain for jobs they’ve already been trained for in the military.”

Tarantino said that he spent 10 years as an officer who managed a multimillion-dollar budget and supervised 400 people.

“They just don’t get it,” Tarantino said of today’s employers. “It’s hard to make that cultural connection.”

**

When it comes to hiring barriers, PTSD is the often-unacknowledged obstacle.

The Department of Veterans Affairs estimates that 11{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} to 20{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of Afghanistan and Iraq veterans suffer from the disorder. A 2008 Rand Corp. study found that 30{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of returning veterans screened positive for PTSD, traumatic brain injuries or depression.

Hannah Rudstam of Cornell University‘s Industrial and Labor Relations School studies veterans’ employment, and says many employers consider PTSD and traumatic brain injury mysterious and threatening.

In a recent survey of human resource officers conducted by Rudstam and others, 73{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of respondents agreed that hiring veterans with disabilities would help their business. But at the same time, 63{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} said that employing workers with PTSD or traumatic brain injury would require more effort — and 61{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} said they were unsure whether they posed a workplace threat.

“We know it’s an issue,” said John Moran, who directs the Veterans’ Employment and Training Service at the Labor Department. An agency website offers employers a “tool kit” with detailed information about PTSD and traumatic brain injuries.

But veterans themselves don’t always do a good job at making their case to potential employers.

Lisa Rosser, a 22-year Army veteran who runs Value of a Veteran, a consulting firm, said many veterans didn’t translate their military experience into civilian language even though 81{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of military jobs have a close civilian equivalent.

For instance, the military’s Visual Information Equipment Operator-Maintainer MOS 25R would be, in the civilian world, someone who runs video teleconferencing.

“Employers don’t understand those resumes,” said Rosser, whose firm advises employers on hiring veterans. “But they have plenty of civilian resumes on hand to choose from, so they tend to go with what they understand.”

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Army warns doctors against using certain drugs in PTSD treatment

BY BOB BREWIN 04/25/2012

 From NEXTGOV.com

The Army Surgeon General’s office is backing away from its long-standing endorsement of prescribing troops multiple highly addictive psychotropic drugs for the treatment of post-traumatic stress disorder and early this month warned regional medical commanders against using tranquilizers such as Xanax and Valium to treat PTSD.

An April 10 policy memo that the Army Medical Command released regarding the diagnosis and treatment of PTSD said a class of drugs known as benzodiazepines, which include Xanax and Valium, could intensify rather than reduce combat stress symptoms and lead to addiction.

The memo, signed by Herbert Coley, civilian chief of staff of the Army Medical Command, also cautioned service clinicians against prescribingsecond-generation antipsychotic drugs, such as Seroquel and Risperidone, to combat PTSD. The drugs originally were developed to treat severe mental conditions such as schizophrenia and bipolar disorder. The memo questioned the efficacy of this drug class in PTSD treatment and cautioned against their use due to potential long-term health effects, which include heart disorders, muscle spasms and weight gain.

Throughout more than a decade of war in Afghanistan and Iraq, the military services have relied heavily on prescription drugs to help troops deal with their mental health problems during and after deployment. In a June 2010 report, the Defense Department’s Pharmacoeconomic Center said 213,972, or 20 percent of the 1.1 million active-duty troops surveyed, were taking some form of psychotropic drug — antidepressants, antipsychotics, sedative hypnotics or other controlled substances.

The Army, in a July 2010 report on suicide prevention, said one-third of all active-duty military suicides involved prescription drugs.

Mental health experts say the military’s prescription drug problem is exacerbated by a U.S. Central Command policy that dates to October 2001 and provides deploying troops with up to a 180-day supply of prescription drugs under its Central Nervous System formulary.

That formulary includes Xanax, Valium and three other benzodiazepines to treat anxiety: Ativan, Klonopin and Restoril.

The Army’s new PTSD policy makes it clear that the risk of treating combat stress with benzodiazepines outweighs the rewards: “Benzodiazepine use should be considered relatively contraindicated in combat veterans with PTSD because of the high co-morbidity of combat-related PTSD with alcohol misuse and substance use disorders (up to 50 percent co-morbidity) and potential problems with tolerance and dependence.”

Read the entire Broken Warriors series.After becoming dependent on these drugs, soldiers face enormous problems when they try to discontinue their use, the report said. “Once initiated in combat veterans, benzodiazepines can be very difficult, if not impossible to discontinue, due to significant withdrawal symptoms compounded by underlying PTSD symptoms which can only be compared to the likes of a Cymbalta withdrawal treatment or something of a similar nature,” the document said.

The Army policy memo highlighting problems with benzodiazepines for PTSD treatment dovetails with a study published in the April issue of Current Psychiatry Online by Jolene Bostwick, clinical assistant professor of pharmacy at the University of Michigan College of Pharmacy.

Bostwick wrote “benzodiazepine administration fails to prevent PTSD and may increase its incidence.” She added, “use of benzodiazepines for PTSD is associated with withdrawal symptoms, more severe symptoms after discontinuation and possible disinhibition, and may interfere with patients’ efforts to integrate trauma experiences.”

Army clinicians who prescribe Risperidone, Seroquel and other second-generation antipsychotic drugs “must clearly document their rationale concluding that the potential benefits outweigh the known risks and that informed consent has been conducted,” the policy memo said.

Seroquel has been implicated in the deaths of combat veterans and theVeterans Affairs Department reported in August 2011 that Risperidone was no more effective in PTSD treatment than a placebo. VA spent $717 million on the drug over the past decade. The military has spent $74 million over the past 10 years on Risperidone, a spokeswoman for the Defense Logistics Agency said.

An Army doctor who declined to be identified told Nextgov “these long-overdue policy changes are welcome, but they will further shift the mental health care of soldiers to an already overstressed VA and will result in the separation of many mentally stressed volunteers, who just months earlier had been counseled to steel themselves for a career of perpetual deployment and had been willing to sacrifice the best years of their lives to do so.”

This long-serving Army clinician said, “the nation needs to take a long, hard look at what delayed the institution of these policies, and why the priorities of our Army medical leaders have too often favored the manpower needs of the Army rather than the mental health of its soldiers.”

Dr. Grace Jackson, a former Navy psychiatrist who resigned her commission in 2002 “because I did not want to be a pill pusher” said the new Army policy shows “they are finally admitting to some problems associated with at least one class of psychiatric medication.” But, Jackson said, the Army policy does not address problems with other classes of prescription drugs, including antidepressants and selective serotonin re-uptake inhibitors (SSRIs), such as Prozac, in the treatment of PTSD. Clinical studies, Jackson said, have shown these drugs to be no better than placebos — but far more dangerous in the treatment of PTSD.

The Army also has ignored the role antipsychotic drugs play in the “sudden death” of troops diagnosed with traumatic brain injury due toundiagnosed endocrine abnormalities Jackson said.

The use of antipsychotic drugs to treat troops with TBI can cause changes in growth and thyroid hormones, which can in turn trigger a variety of cardiac-related events that could result in sudden deaths, Jackson said.

Though the Army has adopted a new policy on the use of benzodiazepines, Jackson said the Defense Department overall is still wedded to a policy of using drugs to treat mental problems even when scientific evidence “demonstrates poor risk-benefit ratios.”

The Army policy memo encouraged clinicians to look beyond drugs to treat PTSD and suggested a range of alternative therapies, including yoga, biofeedback, acupuncture and massage.

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A warrior unbowed: Captain’s wounds will never heal, but he’s a better man because of them

A very inspiring story.

 

Is Army Capt. D.J. Skelton a wounded warrior?

It sounds like a trick question. Insurgents attacked him in Iraq with a rocket-propelled grenade in 2004. His face and body were permanently damaged. The loss of his left eye is Skelton’s most visible injury, but in many ways it’s the least of his physical concerns. He’ll be going to hospitals and doctors for the rest of his life. His scars will always form part of new acquaintances’ first impressions.

“So I spend the rest of my life bumping into things on my left,” he said. “So what.”

It’s an accomplishment just that Skelton is still on active duty. He returned to the infantry last year after more than six years away. He served as a company commander in the 2nd Stryker Cavalry Regiment in Panjouway district, Afghanistan.

He was selected for promotion to major last month and will head to China this fall as a foreign-area officer.

Ask around the Army. Many who know his story will talk about his inspiring resilience, how he overcame his wounds to get back on the track he’d been on before.

But ask Skelton blunt questions and the road he talks about traveling leads far beyond anything he accomplished before he was wounded. It’s a path toward accepting what happened to him but moving forward and leading a far better life than he would have imagined, had he never been wounded. It’s about succeeding, not in spite of his wounds, but because of them.

Skelton is an infantry officer who developed quick rapport with war-hardened Afghan leaders, in part because they knew he’d seen the worst of combat. He’s the cofounder of a nonprofit that helps disabled people compete in extreme sports — an idea he came up with because he was wounded. He’s a man who appreciates family and friendship more than he did before, because he knows what it’s like to lie in a hospital bed and have a community gather around to support you.

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Skelton’s physical injuries will never fully heal, but he has learned to get better nonetheless. He isn’t a wounded warrior, he says, but he was once. That’s why going back to the infantry was an important milestone, but it’s nowhere near enough.

Leading combat troops “reconjugated the word, from ‘I am wounded’ to ‘I was wounded.’ It’s not me, who I am today,” Skelton said. “I don’t care about resilience. I care about the next part.”

Punishment tours

Skelton enlisted in the Army in 1997, after an academically unsuccessful semester at the University of South Dakota. Assigned to Monterey, Calif., to learn Chinese, he served for two years as an interpreter, including an assignment in Taiwan, before more senior soldiers suggested he apply to West Point.

His career there is best demonstrated by the scene when he attends West Point Founder’s Day reunion dinners.

The alumni are asked to stand and then slowly sit down in order of how many “punishment tours” — hours spent walking in a ceremonial uniform with a rifle — they received at the academy.

The graduates who had no punishment tours sit first, followed by those with a handful, then 20, and usually, finally, the so-called Century Men, who spent more than 100 hours working off their transgressions.

Skelton, West Point class of 2003, is always the last standing, with more than 400 hours of punishment tours for all kinds of offenses.

He was arrested for illegal BASE jumping. He was caught running a body-piercing operation from his barracks room — one with a “battalion-sized” clientele, as he told the West Point commandant.

“If you’re going to run a body-piercing shop in the academy, you’d better own that choice,” he said later.

He took soldiering more seriously after the terrorist attacks of Sept. 11, 2001.

He joined the infantry, trained at Fort Benning, Ga., and was assigned to Fort Lewis, Wash.

He was wounded just weeks into his first deployment, in Fallujah, Iraq, on the eve of one of the biggest battles of the post-invasion campaign.

Insurgents ambushed him as he moved ahead of his platoon on Nov. 6, 2004. A rocket exploded a concrete pylon, part of a highway overpass, and Skelton was hammered with metal and rock.

He was thrown from his feet. Shrapnel tore his right cheek, butchered the roof of his mouth and ripped out his left eye from the inside. Fighters opened up, riddling him with AK-47 rounds.

He felt it all, the most intense pain he could imagine. Skelton begged his soldiers to leave him behind, but they dragged him under fire and raced him away in a Stryker armored vehicle.

He did not pass out. Not for a long time.

Paradox and sympathy

Now, years later, when Skelton wears sunglasses or a baseball hat, it can be difficult to see his wounds at first glance. A close look reveals a prosthetic left eye that never blinks. Tears occasionally roll down his cheek, the product of a tear duct with a mind of its own and a lack of nerve sensitivity in that part of his face.

The momentous hunk of shrapnel that ripped through his eye traveled with a terrible, beautiful precision, leaving the eyebrow, nose and cheek more or less intact. An inch above or a trajectory angled just a few degrees higher and the metal would have pierced his brain. He would be dead.

Scars rise up on his arms, legs, torso. Shards of shrapnel ringed his heart but somehow missed it. Skelton’s right leg has so much metal holding it together and so few nerves that one of his party tricks is to stab a knife into his shin and walk around painlessly.

His left hand is nearly immobile, balled in a perpetual fist. He says he learned to make that injury less obvious by watching David Copperfield’s sleight-of-hand videos.

His favorite euphemism for undergoing yet another week in the hospital as surgeons perform yet another procedure is, “Playing Mr. Potato Head.”

For all the jokes, his recovery was horrendous. He was depressed at first and pitied himself. For five months at Walter Reed Army Medical Center, he didn’t get out of bed.

He endured scores of surgeries. Skelton still has a golf-ball sized hole in his palate. Without a custom prosthetic, he cannot eat, drink or, often, breathe.

Inspired largely by other patients, he fought to stay in the Army.

He returned to Fort Lewis for a while, then came back to Washington to work on wounded warrior issues for the deputy secretary of defense — first Paul Wolfowitz, later his successor, Gordon England.

A rock climber since childhood in South Dakota, Skelton started a nonprofit called Paradox Sports that organizes extreme athletic events for wounded and disabled people, including an annual ice-climbing outing for amputees called “Gimps on Ice.”

Eventually, he returned to Monterey, where he planned to study advanced Chinese before becoming a foreign-area officer specializing in Asia. He commanded the same training company he’d been a member of as a private in 1997.

It seemed like a suitable, positive outcome, but Skelton grew uneasy. The FAO program was a plum job, and Skelton was four years too junior in the Army to qualify for it. The Army wasn’t offering him the position because he had proved himself as a diplomat or linguist. It was because he was wounded. He’d thought that wouldn’t bother him, but it did.

“Hey, here’s this wounded soldier; luckily he speaks Chinese. … It pissed me off. I didn’t earn it. ‘Associate Dean of the Middle East School? Really?’” Skelton said, referring to one of the jobs he’d held at Monterrey. “If I was going to do anything in life, I was going to earn it. I didn’t want a government handout. I didn’t want a sympathy offer.”

‘Fallujah 2, D.J. nothing’

Skelton’s reputation as an advocate for wounded warriors grew. In 2009, the chairman of the Joint Chiefs of Staff, Adm. Michael Mullen, requested that he come back to Washington to work on the Sea of Goodwill program. A few months later, he went back to Iraq for two weeks through a program that takes wounded veterans to war zones as part of a healing process.

Riding in a Black Hawk helicopter over Fallujah, Skelton looked at the highway overpass where he’d been wounded in 2004. A gust of wind blew through the open doors and his prosthetic eye popped out, floating down to the ground 500 feet below.

Skelton let out an expletive, then said: “Fallujah 2, D.J. nothing.”

Besides the catharsis of returning to the place where he had been wounded, Skelton had an epiphany. He looked at his fellow soldiers, especially the veterans who had returned to civilian life. They often identified themselves first and foremost by the fact that they’d been wounded.

“It’s a great group of guys,” he said, “[but] they were riding the title of wounded warrior as a civilian. It’s like, get over it. What are you going to do? The system, our communities, we don’t really hold them accountable.”

Skelton realized more deeply than he had before that he’d acceded to a role in life that defined him by his battle scars. If he wanted something different, he had to make a choice. He needed a place, a home, a real role — and he needed to feel he’d earned it.

“It was, ‘D.J., the wounded warrior.’ It was not D.J. the foreign-area officer or infantry officer. It was, ‘D.J. the wounded advocate.’ What is that? Most people who advocate do it on the side when they have free time. It’s not a career,” he said. “That’s when I realized I was going to hold the Army accountable. Accountable for accepting me, training me, providing me all this opportunity.”

‘I had concerns’

Lt. Col. D.A. Sims, a 1991 West Point graduate, had been the executive officer of Skelton’s battalion in 2004 and served with him in Iraq. They stayed in touch afterward, an email every six or months or so.

In late spring 2010, he opened his email to find Skelton had sent a message congratulating him. Sims had just taken command of their old battalion, which had been reflagged and assigned to Germany, and was scheduled to deploy to Afghanistan.

“If you ever need a captain, let me know,” Skelton wrote.

Things moved quickly. He passed the captain’s career course at Fort Benning despite his physical limitations and was sent to the 2nd Stryker Cavalry Regiment. He was assigned to Sims’ squadron, learning he’d be taking over Comanche Troop, the same company he’d served in when he’d been wounded in Iraq.

Sims said he was eager to welcome Skelton, but he worried that the captain might not be physically up to the job.

“I had some concerns. I did. I’d be lying if I told you otherwise,” Sims said. “Would he be physically capable of the daily grind of combat? It wasn’t just firefights. It’s that we didn’t get a lot of sleep. Patrols were ongoing, and we need a company commander who can produce orders, maintain his area, literally lead from the front.”

Skelton caught up with the rest of his unit in Afghanistan in February 2011, serving for a few weeks as an operations officer while he waited to command Comanche Troop, 1st Squadron. Assigned to the most dangerous and violent part of his squadron’s area, he led a 1,000-soldier sweep of the central village of Nakhony on one of his first missions, searching house to house for weapons and other contraband.

His soldiers — Americans along with a detachment of Canadians, Australians and Afghan National Army — dug up a complex, weighted trigger for an improvised explosive device. Other troops reported an IED hidden in a wall. Satisfied that his men had things under control, Skelton went to check on another platoon.

He hadn’t walked more than a few hundred meters when he heard an explosion.

Rushed into action

“I instantly just felt sick to my stomach,” Skelton said. “I knew this was not a controlled detonation. Nobody does anything on their own like that.”

An eerie silence followed, then chaos. People screamed. Skelton ran back toward the sound of the explosion.

One of his troops, Tech. Sgt. Dan “Reese” Hines, lay on the ground, covered in blood. Though Skelton had not yet met all of the soldiers in his company, he’d gotten to know Hines.

Skelton rushed into action, working with the medics and other soldiers on the wounded troop. Hines was alive, but his head was bloody and he drifted in and out of consciousness.

He had likely lost his left eye — just as Skelton had.

Within minutes, Hines was aboard a helicopter en route to the hospital at Kandahar. Skelton scanned the mixed group of U.S. and Canadian soldiers left behind. He sensed their fear. He felt pangs of guilt, not so much because Hines had been wounded, but because he recognized the trauma he’d put his soldiers through years earlier.

“You look in their eyes and it’s this terror,” Skelton said. “‘Wow, this is what it was like for my guys [in Iraq].’ You never want to make people suffer, but you did. I did. And these guys are going to live with that image for the rest of their lives. It was pretty bad.”

Everyone was looking to him for leadership. One of Skelton’s medics was visibly shaken. Skelton saw one of his platoon leaders staring at him, not moving.

“Lieutenant,” Skelton said, “pick your guys up. You have one minute. We’ve got to finish the mission.”

‘The Pirate of Nakhony’

In the weeks that followed, Skelton settled into the lonely, grinding pattern of company command. The area that Comanche Troop was responsible for was “the most lethal portion of the squadron’s battlespace,” Sims recalled.

The regiment’s designation as the 2nd Stryker Cavalry Regiment was something of a misnomer, because Strykers couldn’t traverse the terrain and narrow roads. In eastern Panjuway, conditions were harsh. His soldiers were spread throughout the district, and Skelton tried to visit each platoon every day, sometimes traveling via helicopter, but often on foot. The Canadian unit that Skelton’s company replaced had referred to foot patrols as “IED hopscotch.”

“Every time they walked out, or at least every day, they were in a firefight,” Sims said of Skelton’s company.

Sleeping three or four hours a night and trading off so that at least one of them was awake at all times, Skelton and his first sergeant came up with a shorthand to tell each other that things were fine: “TIC, no CAS,” meaning “Troops in contact; no casualties.”

Besides leading his troops, Skelton had to mentor and advise an Afghan National Army battalion, and build relationships with local Afghan leaders. His visible war wounds gave him instant credibility with local leaders, most of whom had been fighting almost their entire lives. Keeping his prosthetic eye clean would have been difficult, so Skelton had his left eye socket stitched shut. His interpreter revealed that the locals had dubbed him “The Pirate of Nakhony” as a result.

 Read more…http://www.stripes.com/a-warrior-unbowed-captain-s-wounds-will-never-heal-but-he-s-a-better-man-because-of-them-1.175632?localLinksEnabled=false&utm_source=Stars+and+Stripes+Emails&utm_campaign=Daily+Headlines&utm_medium=email

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Obama cracks down on schools targeting troops


VCS has  worked hard to stop these school from taking advantage of our military and veterans. Thank you POTUS.

—-

By Rick Maze – Staff writer Posted : Thursday Apr 26, 2012 21:50:12 EDT

President Obama is wrapping up a week of talking about student loans with the signing of an executive order that attempts to limit deceptive or misleading practices by schools that target current and former service members and their families.

“Since the Post-9/11 GI Bill became law, there have been reports of aggressive and deceptive targeting of service members, veterans, and their families by educational institutions, particularly for-profit career colleges,” the White House said in a release.

The order Obama is expected to sign Friday during a visit to Fort Stewart, Ga., will require schools receiving the GI Bill or other Defense Department-funded veterans education benefits or tuition assistance to disclose more information to students using military tuition assistance, including a breakdown of the percentage of service members and veterans who complete courses or degrees, according to White House officials.

Course completion information and graduate rates are already available for most schools, but are not broken down by how service members or veterans might fare, White House officials said.

The executive order makes other changes:

• Schools that receive GI Bill or tuition assistance will be required to have academic and financial counselors for service members and veterans, and to ease policies for enrollment, re-enrollment and refunds if military-related duties interfere with classes.

• The government will attempt to trademark the term “GI Bill” so unscrupulous institutions will be prevented from using the name in advertising and on websites.

• Schools with overly aggressive or unscrupulous recruiting practices will be barred from military bases, blocking access to prospective students.

• A centralized complaint system will be created, with access to investigators, prosecutors and policymakers who enforce the law and regulations.

• Schools that fully comply with federal rules will be listed on a federal website, such as the VA’s GI Bill website, while schools that don’t comply will be excluded from listings.

CHANGES MOVING THROUGH CONGRESS

The White House has cherry-picked from veterans organizations’ recommendations and from pending legislation to come up with immediate steps that can be ordered by Obama without waiting for Congress.

Sen. Patty Murray, D-Wash., the Senate Veterans’ Affairs Committee chairman, has introduced the GI Bill Consumer Awareness Act of 2012, which has provisions similar to parts of the executive order, although her measure is more detailed.

For example, Murray’s bill requires the disclosure of student loan debt, transferability of credits earned, the number of veterans enrolled, job placement rates, and success in professional licensing or certification by students who have completed classes — far more information than covered by the executive order.

Her bill requires schools to have at least one employee who is knowledgeable about military and veterans education benefits; and to provide tutoring, career counseling, referrals to vet centers and other help for veterans, requirements that exceed the White House’s order that schools provide academic and financial counseling.

Additionally, Murray’s bill, endorsed by major veterans groups, requires VA to provide educational counseling to any veteran who seeks it.

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Veterans’ mental health treatment not as timely as contended

By Gregg Zoroya, USA TODAY

An internal investigation at the Department of Veterans Affairs released Monday says tens of thousands of veterans waited far longer last year to receive mental health treatment than what the VA contends.

 

An inspector general found that claims by the VA that 95{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of its patients are both evaluated for mental health problems and begin receiving therapy within a 14-day goal set by the department are false.

In fact, only about half of mental patients were evaluated within two weeks. The remainder waited an average of seven weeks, the investigation found.

On the time it takes to begin treatment, the probe corroborated findings by a USA TODAY analysispublished Nov. 9 which revealed that about a third of VA patients wait longer than 14 days to start treatment.

The VA Inspector General confirmed that only 64{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} are treated within 14 days, and the rest — a projected 94,000 patient appointments in 2011 — wait nearly six weeks on average before starting their treatment.

The VA’s “mental health performance data is not accurate or reliable,” the inspector general concluded, adding that the department “overstated its success.”

For follow-up sessions, the VA says it meets its 14-day goal for 98{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of its patients. But the investigation found that true only 88{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of the time, with patients beyond that date waiting nearly eight weeks for follow-on care.

The VA said it concurred with the investigation results and would move “rapidly” to revamp its process for measuring delays. Department officials said last year they have had chronic difficulty monitoring access to mental health care, partly because of a 25-year-old computerized scheduling system slated for replacement.

The wars in Iraq and Afghanistan have partly resulted in an increase every three months of 10,000 new patients arriving at the VA suffering post-traumatic stress disorder. The VA treats 1.3 million mental health patients, including 400,000 from the two conflicts, according to the department.

Sen. Patty Murray, D-Wash., chairman of the Senate Veterans’ Affairs Committee, requested the investigation in November after a survey of VA mental health workers last year revealed concerns about delays and staff shortages.

The VA announced Thursday it would immediately begin expanding its 20,000-member mental health staff by 1,900 to reduce delays in care.

USA TODAY reported this month that the VA has been unable to fill about 20{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of its existing psychiatric positions in hospitals in large sections of the nation.

The inspector general confirmed that according to interviews with VA staff the “greatest challenge has been to hire and retain psychiatrists.” Three out of four hospital sites visited by investigators lacked psychiatrists.

At one VA hospital in Salisbury, N.C., the shortage caused patients there to wait an average of three months to see a psychiatrist, the report says.

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A Lagging Indicator

Time Magazine credits VCS-VUFT Lawsuit with decision to increase mental health staff.

 

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By MARK THOMPSON

From Time’s Battleland Blog

Even as the pace of war, and the number of Americans waging it, is falling, their need for mental-health care is growing. On Thursday, the Department of Veterans Affairs announced it is boosting its mental-health workforce by 1,600 psychiatrists, psychologists and social workers – a 10{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} hike, as well as hiring 300 support staff to help them do their jobs.

“History shows that the costs of war will continue to grow for a decade or more after the operational missions in Iraq and Afghanistan have ended,” VA chief Eric Shinseki says. “As more veterans return home, we must ensure that all veterans have access to quality mental health care.” The trouble, of course, will be finding them. The civilian world has a shortage of such help, as does the Army. The VA will be no different.

 

The wars in Afghanistan and Iraq have triggered wave after wave of vets coming home with mental ills. They include post-traumatic stress and traumatic brain injuries, which often trigger depression, anxiety and other problems.

Much of the additional hiring will be to reduce current waiting times for mental-health care, veterans’ advocates say. Many wait weeks or months for appointments, and additional vets seeking care will only make such delays longer without additional help.

And make no mistake: Shinseki made his announcement under pressure from the judicial branch of the federal government. Last May, a federal appellate court ruled that the VA’s provision of mental-health care to vets is so poor as to make it unconstitutional:

The United States Constitution confers upon veterans and their surviving relatives a right to the effective provision of mental health care and to the just and timely adjudication of their claims for health care and service-connected death and disability benefits…their entitlements to the provision of health care and to veterans’ benefits are property interests protected by the Due Process Clause of the Fifth Amendment. The deprivation of those property interests by delaying their provision, without justification and without any procedure to expedite, violates veterans’ constitutional rights. Because neither Congress nor the Executive has corrected the behavior that yields these constitutional violations, the courts must provide the plaintiffs with a remedy.

In 2011, the VA provided mental health care to 1.3 million veterans. Since 2007, VA has seen a 35 percent increase in the number of veterans receiving mental health services, and a 41 percent increase in mental health staff.

“Right now, too many veterans fall through the cracks,” said Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veterans’ Affairs. “I am hopeful VA’s decision today, stemming from years of pressure and increased funding from Congress, will expand access for veterans and help them lead full and long lives.”

Read more: http://battleland.blogs.time.com/2012/04/20/a-lagging-indicator/#ixzz1ssyT7eXQ

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Army’s new PTSD guidelines fault Madigan’s screening tests

 

By HAL BERNTON

The Seattle Times

The Army Surgeon General’s Office has issued new guidelines for diagnosing PTSD that criticize an approach once routinely used at Madigan Army Medical Center.

The policy, obtained by The Seattle Times, specifically discounts tests used to determine whether soldiers are faking symptoms of post-traumatic stress disorder. It says that poor test results do not constitute malingering.

The written tests often were part of the Madigan screening process that overturned the PTSD diagnoses of more than 300 patients during the past five years.

Madigan medical-team members cited studies that said fabricated PTSD symptoms were a significant — and often undetected — phenomenon. They offered the tests as an objective way to help identity “PTSD simulators” among the patients under consideration for a medical retirement that offers a pension and other benefits.

The team’s approach once was called a “best practice” by Madigan leaders, including Lt. Gen. Patricia Horoho, a former commander who now serves as the Army’s surgeon general. But earlier this year, amid patient protests about overturned diagnoses, the team was shut down as the Army launched several investigations.

Though none of the Army findings have been publicly released, the April 10 “policy guidance” from the surgeon general charts new directions for PTSD screening at Madigan and elsewhere in the Army medical system.

PTSD is a condition that results from experiencing a traumatic event, such as a battlefield casualty. Symptoms can include recurrent nightmares, flashbacks, irritability and feeling distant from other people.

Some people recover from PTSD. For others, it may be a lifelong struggle.

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The new policy downplays the frequency of soldiers faking symptoms to gain benefits, citing studies indicating it is rare. It also rejects the view a patient’s response to the hundreds of written test questions can determine if a soldier is faking symptoms for financial gain, and it declares that a poor test result “does not equate to malingering, which requires proof of intent… ”

Broad approach to issue

The new policy offers broad guidance on how the Army medical staff should evaluate and treat patients for PTSD, a condition affecting 5 to 25 percent of soldiers returning from combat zones. The 17-page document was distributed to commanders throughout the Army medical system.

During more than a decade of war, the Army’s handling of PTSD often has been contested.

Some soldiers at Madigan and elsewhere have alleged their symptoms were improperly discounted and they were unfairly denied medical retirements.

Within the Army and Department of Veterans Affairs, others have argued PTSD has been over-diagnosed, and they pushed for improved ways to ferret out malingerers.

The surgeon general’s policy document says PTSD is being under — not over — diagnosed. It states that most combat veterans with PTSD do not seek help, and as a result their conditions are not recognized and identified.

The policy also questions the use of a class of drugs in treating anxiety in troops with PTSD and other mental conditions.

The document found “no benefit” from the use of Xanax, Librium, Valium and other drugs known as benzodiazepines in the treatment of PTSD among combat veterans. Moreover, use of those drugs can cause harm, the Surgeon General’s Office said. The drugs may increase fear and anxiety responses in these patients. And, once prescribed, they “can be very difficult, if not impossible, to discontinue,” due to significant withdrawal symptoms compounded by PTSD, the document states.

The policy also said the harm outweighs the benefits from the use of some antipsychotics, such as Risperidone, which have shown “disappointing results” in clinical trials involving PTSD.

PTSD patients may frequently have other physical and mental-health problems. The new memorandum encourages a range of treatment options, including yoga, biofeedback, massage, acupuncture and hypnosis.

“Very welcome step”

Sen. Patty Murray, who earlier this year pressed for investigations of the Madigan screening team, calls the new policy guidance “an overdue but very welcome step.”

“It shows that the Army has been responsive to many of the concerns that have been raised, and I’m hopeful similar directives will be given to all branches of the military,” said Murray, a Washington Democrat and chair of the Senate Veterans’ Affairs Committee.

Andrew Pagony, a veteran who assists other soldiers in the medical-retirement process, says the big question is whether the policy will be followed by the Army medical establishment.

“On the surface, this absolutely is moving in the right direction,” he said. “There have been plenty of policies published in the past that weren’t followed.”

More than five years ago, Pagony helped document the struggles of Fort Carson, Colo., soldiers as they returned home from combat duty. Then, PTSD was seldom rated as a condition debilitating enough to render soldiers unfit for duty and eligible for a medical retirement with pension.

In 2008, Congress approved an overhaul of the disability system, saying a soldier rendered unfit for duty by PTSD qualified for a medical retirement.

Since then, the number of Army personnel with PTSD receiving a temporary disability (the first step in the retirement process) has escalated sharply. More than 2,790 soldiers were given a PTSD-related temporary disability in 2011, more than a fivefold increase since passage of the congressional overhaul.

The pensions, health insurance and other retirement benefits are financed through the Defense Department, which is facing significant budget cuts as Congress struggles to trim federal spending.

In a controversial presentation to colleagues last fall, Dr. William Keppler, then the leader of the Madigan screening team, said a PTSD diagnosis could cost as much as $1.5 million over the lifetime of a soldier, and he urged staff to be good stewards of taxpayer dollars.

Keppler is a forensic psychiatrist whose work had helped Madigan gain a national reputation for innovative screening for PTSD before questions were raised about the accuracy of his team’s diagnoses.

Soldiers evaluated by the screening team often took the Minnesota Multiphasic Personality Test, which consists of more than 500 true-or-false questions. Some are relatively straightforward, such as questions about sleep and anxiety. Others are designed to detect patterns of exaggeration, such as answers that reflect what people think mental illness is like rather than what it is actually like.

Most of the screenings also included patient interviews. But some of the soldiers who went through the process told The Seattle Times the interviews often felt confrontational, at times hostile.

More than 300 patients screened by Keppler’s team are now being offered re-evaluations by new screening teams established at Madigan. The results of the new examinations have not been announced.

All this has spurred plenty of debate at Madigan and in the broader Army medical community.

One forensic team member, Dr. Juliana Ellis-Billingsley, quit in February, and in a letter of resignation blasted the Madigan investigations as a charade.

The surgeon general’s policy memorandum notes that many soldiers have become wary of the Army’s mental-heath care providers. It calls for a “culture of trust” that will give more soldiers confidence to seek help.

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Recruitment ads by for-profit colleges targeted

JUSTIN POPE

WASHINGTON

Where do for-profit colleges get the money they spend on all those highway billboards and television and radio ads?

Mostly from the government, at least indirectly. Federal money, most of it through the financial aid that students get, accounts for up to 90 percent of for-profit colleges’ revenue — even more in some cases if veterans attend the school on the GI bill.

And while figures vary, some institutions spend a quarter or more of their revenue on recruiting, far more than traditional colleges. In some cases, recruiting expenses approach what these institutions spend on instruction.

A recent Senate report on 15 large, publicly traded for-profit education companies said they got 86 percent of their revenue from taxpayers and have spent a combined $3.7 billion annually on marketing and recruiting.

Sen. Tom Harkin, D-Iowa, says the connection is clear: “Their marketing budgets are funded by taxpayers.”

On Wednesday, Harkin and Kay Hagan, D-N.C., introduced a bill to try to check the flood of advertising, which has particularly targeted Iraq and Afghanistan veterans for the benefits they receive under the new GI Bill. The measure would prohibit colleges of all kinds from using dollars from federal student assistance programs, including the GI Bill, to pay for advertising and recruiting.

The bill would extend a current rule that prohibits federal dollars from being used for lobbying — though the lobbying budgets of for-profit colleges are tiny compared to what they spend on advertising.

“Today we are sending a strong message to colleges that choose to spend federal dollars on advertising at a time that middle-class students and families are struggling to get ahead: Find the money for marketing elsewhere, not from taxpayers,” said Harkin, chairman of the Senate Committee on Health, Education, Labor and Pensions.

The bill faces daunting odds in Congress. But it represents a new tactic in recent efforts by some in Washington to curb aggressive marketing tactics by for-profit schools, particularly toward veterans. Military veterans are particularly attractive recruiting targets because they come with generous federal tuition support and also don’t count toward a limit called the “90/10″ rule, which requires colleges to get at least 10 percent of their revenue from non-federal sources.

The proposal would forbid GI Bill dollars from being used in marketing, along with funds from other forms of federal student aid such as Pell Grants.

The rule would apply to colleges of all kinds but would mostly affect for-profits. While not-for-profit colleges do more and more advertising and recruiting, Senate backers cited a study showing such expenses typically total no more than 1 percent or revenue. Those colleges also typically get much lower proportions of their revenue from federal student aid, so they wouldn’t be constrained.

However, colleges generally resist any efforts from Washington to tell them how to spend their money — so opposition from traditional universities will make the bill even more of a longshot.

While some smaller higher education groups such as the American Association of Collegiate Registrars and Admissions Officers expressed support for the bill, the American Council on Education — a main group representing all of higher education — did not. Terry W. Hartle, the senior vice president at the Council, said in a statement Wednesday that the proposal contributes to an important conversation about how to ensure students are not overwhelmed by aggressive marketing tactics but would impose a “very complex set of requirements of all institutions because of a handful of bad actors.” He said it was unlikely to be enacted this year.

The Association of Private Sector Colleges and Universities, which represents for-profits, called the bill misguided at a time when the country will depend on such schools to help get millions more workers college-level training.

“Legislative proposals like this only create more burdensome regulations affecting our ability to ensure that all Americans have access to a high-quality education,” it said.

Another concern: definitions such as “marketing” are so slippery such a law would be hard to apply fairly, said BMO Capital Markets managing director Jeff Silber. He noted, for example, that the Ohio State University football team doesn’t get counted as a marketing expense but clearly promotes the school as effectively as any advertising campaign.

Wall Street appeared to agree the bill stood little chance of passing, with stocks of leading for-profit companies such as Apollo Group (parent of the University of Phoenix), Corinthian Colleges Inc., and DeVry Inc. all lower in mid-day trading but not substantially on a day when the market overall was down.

In fact, Silber said most for-profits have been cutting back in recent years on advertising and recruiting budgets. Still, the business model relies heavily on Web and broadcast ads, billboards and well-staffed call centers to drive enrollment.

“Yes, this would be an issue for everybody (in the sector),” Silber said. “Advertising and selling is a fairly sizable component of the business model,” and if spending were limited, “it would limit their growth.”

Figures compiled by BMO show that at the largest for-profits marketing expenses average around 22 percent of revenue but range as high as 29 percent at Bridgepoint Education. Bridgepoint’s Ashford University got only about 20 percent of its revenue from non-federal sources, so conceivably could have to cut back on half its advertising and recruiting under the proposal.

Harkin emphasized the proposal would leave schools free to advertise — just from a separate pot of money that hasn’t come from taxpayers.

Even critics acknowledge that quality at for-profit colleges varies widely, and many are a good fit for students, particularly adult learners looking for flexible scheduling and specialized career training that often requires a certificate but not a degree.

But while comparing graduation rates can be misleading for those reasons, for-profit schools on average have lower success rates than traditional colleges on a variety of measures. A report from Harkin’s Senate committee found that almost 2 million students withdrew from large for-profit colleges over a three year period. Among those who enrolled at 10 large chains in 2008-2009, 54 percent had withdrawn by the summer of 2010.

Meanwhile, the latest figures from the Education Department put the default rate on federal student loans for students at for-profit colleges at 15 percent, compared to 7.2 percent at public nonprofit universities and 4.6 percent at private nonprofit colleges. The industry points out that’s partly because its schools tend to serve lower-income students. But difficulties transferring credits, and having credentials from for-profit colleges rewarded in the job market, also play a role.

 

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Pressure to reduce VA disability claims may cause more delays, advocates warn

By Steve Vogel From the Washington Post With the Department of Veterans Affairs facing a growing backlog of more than 900,000 disability claims, advocates for veterans warned Wednesday that pressure by the VA to reduce the numbers will increase the number of mistakes it makes.The number of pending claims before the VA stood at 903,000 this week, up 50,000 from January and an increase of about one-half million from three years ago, numbers driven by veterans returning from Iraq and Afghanistan with complex injuries, and a policy change making it easier for Vietnam veterans to file Agent Orange-related claims.

“The tidal wave of claims coming in on VA is putting unprecedented demand on VA,” Paul Sullivan, representing the National Organization of Veterans’ Advocates, told the House Veterans Affairs Committee at a hearing on the disability claims process.

“When VA focuses attention on expediting new claims, VA exacerbates the already bad situation by increasing the error rate, leading to even more appeals and even longer delays,” Sullivan added.

Speaking at the hearing, Rep. Silvestre Reyes, (D-Tx.) expressed concern that the VA “culture overemphasizes quantity over quality.”

Sullivan said the VA headquarters in Washington is putting pressure on regional offices to quickly resolve cases. “What that causes is the VA to take the easiest way to resolve a claim, not the best way,” he added.

But Thomas J. Murphy, director of compensation service for the VA’s Veterans Benefits Administration, testified that the VBA is implementing a series of of training, process and technological improvements aimed to meet the department’s goal of processing all claims within 125 days with 98 percent accuracy by 2015.

“We are confident that we are on the right path to deliver more timely and accurate benefits decisions to our nation’s veterans,” Murphy said.

Representatives of veterans service organizations said they welcomed VA’s efforts to reduce the numbers, but cautioned that meeting the goals would not guarantee that veterans are better served.

“It is essential that Congress provide careful and continuing oversight of this transformation to ensure that the VBA achieves true reform and not just arithmetic milestones, such as lowered backlogs or decreased cycle times,” Jeffrey C. Hall, assistant national legislative director of Disabled American Veterans, told the committee.

The House veterans committee will maintain “vigorous oversight,” according to the chairman, Rep. Jeff Miller (R-Fla.).

“With two wars winding down and an increasingly aging veteran population, it is imperative that the much-touted technological and training improvements are set up correctly and used efficiently,” Miller said.

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