Army: PTSD treatable; some diagnosed return to war

Posted on March 23, 2012 by Team VCS

It is still not known if the soldier accused of killing 17 Afghans was ever diagnosed with post-traumatic stress disorder – but even if he had been, that alone would not have prevented him from being sent back to war.

By JULIE WATSON

Associated Press

It is still not known if the soldier accused of killing 17 Afghans was ever diagnosed with post-traumatic stress disorder – but even if he had been, that alone would not have prevented him from being sent back to war.

The Army diagnosed 76,176 soldiers with PTSD between 2000 and 2011. Of those, 65,236 soldiers were diagnosed at some stage of their deployment.

Many returned to the battlefield after mental health providers determined their treatment worked and their symptoms had gone into remission, Army officials and mental health professionals who treat troops say. The Army does not track the exact number in combat diagnosed with PTSD nor those who are in combat and taking medicine for PTSD.

The case of Sgt. Robert Bales has sparked debate about whether the Army failed in detecting a soldier’s mental instability or pushed him too far. The Army is reviewing all its mental health programs and its screening process in light of the March 11 shooting spree in two slumbering Afghan villages that killed families, including nine children.

For some Americans, Bales is the epitome of a soldier inflicted by war’s psychological wounds, pushed by the Army beyond his limits.

Bales’ attorney says he does not know if his client suffered from PTSD but his initial statements appear to be building a possible defense around the argument that the horrific crime was the result of a 10-year military veteran sent back to a war zone for a fourth time after being traumatized.

Mental health professionals say it’s reasonable to consider PTSD but it was likely not the sole factor that sent the 38-year-old father from Washington state over the edge. Still, there is much that is not known about the psychological wounds of war and how they can manifest themselves, and even less is known about the impact of multiple deployments.

Military officials say they have to rely on their mental health experts to decide whether someone is mentally fit to go back into war, and they cannot make a blanket policy of not redeploying troops diagnosed with PTSD. The provider makes a recommendation, but the ultimate decision to deploy a soldier rests with the unit commander.

Army Secretary John McHugh told Congress this week that “we have in the military writ large over 50,000 folks in uniform who have had at least four deployments.” Some have served double-digit deployments, where they witnessed traumatic events.

“People do not understand that you can be treated for PTSD,” said Dr. Heidi Kraft, who cared for Marines in Iraq in 2004 as a Navy combat psychologist. “It’s a matter of turning a traumatic memory into just that – a memory rather than something that haunts you.

“You can’t say the person hasn’t live through trauma, but symptoms can go completely into remission, where a person is very functional and in fact emerges from treatment better or more resilient. There is the misconception out there that if you have this diagnosis, you will always be disabled, and that’s just not true.”

It also depends on the severity of the PTSD, which can last anywhere from months to years.

Some troops treated for PTSD yearn to return to the battlefield where they feel more comfortable surrounded by their fellow troops and on a mission than in the unsettling quiet of their home life, mental health professionals say.

But Bales’ attorney said that was not the case with his client.

John Henry Browne of Seattle said Bales had suffered injuries during his deployments, including a serious foot injury and head trauma and did not want to go on a fourth tour.

Military officials insist that Bales had been properly screened and declared fit for combat.

Army officials say soldiers sent to war may be checked up to five times, including before being deployed, during combat, once they return home and six months and a year later. The Army screens soldiers for depression and PTSD, asking questions to find out about any social stressors, sleep disruption and other problems. Those who are detected as having problems go on to a second phase of screening.

Officials say, however, that no test is considered diagnostically definitive for mental illness in general or PTSD in particular.

Critics say the Army has a history of bandaging the problem and rushing troops back into combat by loading them up on prescription drugs. Military courts also do not recognize PTSD as a legitimate defense, said attorney Geoffrey Nathan who has represented a number of court martialed troops.

“They’re still in a state of denial as to what combat soldiers go through in the field of battle,” Nathan said.

The Army says it’s committed to the health of the force, pointing out it has invested $710 million in behavioral health care and doubled the number of mental health workers since 2007.

“The Army has a robust policy to return soldiers who are fit for duty to combat units as soon as possible,” said Army spokesman George Wright. “If a soldier has a broken leg, and he is healed, and fully capable of conducting the mission, he’s eligible to return to duty. It’s the same when qualified medical doctors, psychologists or psychiatrists determine a soldier suffering from a behavioral health disorder is healed. If he displays the signs that he’s fully capable of accomplishing the mission as a solider, he’ll be returned to duty.”

Treatment can result in cure for some patients with PTSD, but more often results in improvement in symptoms and functioning, not a complete cure, according to the Army. PTSD can recur after treatment on exposure to other traumatic events or stressors. According to some studies, up to 80 percent of people with PTSD also suffer from another psychiatric disorder, making it challenging to make an accurate diagnosis.

The Army says its doctors look at a soldier’s current clinical condition and rely heavily on the soldier telling the provider whether symptoms have subsided. The Army says it recognizes that deploying a soldier who is not medically ready puts both the individual and unit at risk.

PTSD is a condition that results from experiencing or seeing a traumatic event, whether it’s being in a car crash or witnessing a battlefield casualty.

Browne said a fellow soldier’s leg had been blown off days before the rampage and Bales had seen the wounds. A U.S. defense official said it is likely that a soldier from Bales’ unit suffered a leg wound a day or two before the March 11 shootings, but military officials have no evidence that this has any connection to the massacre.

Bales also remembers very little or nothing from the time the military believes he went on the rampage, according to his attorney.

Not remembering a traumatic event or avoiding the memory is a classic symptom of PTSD, along with recurrent nightmares, flashbacks, irritability and feeling distant from other people.

But mental health experts believe other factors were at play. Bales’ personal history shows he had a past assault charge against a former girlfriend that required anger management classes, and also financial troubles.

Those who suffer from PTSD are prone to acting out, according to the Department of Veterans Affairs National Center for PTSD. But the violent behavior is usually against family members or fellow troops, not strangers, mental health professionals say.

Dr. Harry Croft, a San Antonio, Texas psychiatrist who has diagnosed 7,000 veterans with PTSD for the Veterans Affairs Department and written the book “I Always Sit With My Back to The Wall” about PTSD said the case has set back years of work to erase the perception that veterans are walking time bombs who can go off without warning. Veteran advocates point to one tabloid headline labeling the then-unidentified suspect “Sergeant Psycho.”

That stereotype, they say, has caused employers to shy away from hiring veterans returning from war and steered singles away from getting involved in relationships with them.

“Even the most severe cases of PTSD alone would not have caused such a heinous act like this,” said Croft. “Something else was definitely going on, most probably severe depression, psychosis, substance abuse or he received some terrible news from home that pushed him over the edge.

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Researchers Wrestle with How Many Deployments are Too Many

Posted on March 23, 2012 by Team VCS

 Big take away over 100,000 have deployed 3 times or more. Without incident. According to our statistics about half went at least twice. —————————————

By Gregg Zoroya, USA TODAY

After nearly 11 years of war and hundreds of millions of dollars in research on the mental health of troops, the military is no closer to understanding how many deployments are too many for individual servicemembers, researchers say.

Military leaders have said the nation has never fought wars this long with this small of a military, deploying troops over and over. Yet questions about how many times a soldier can recycle into combat without psychological harm remain unanswered, reseachers say.

“I think it’s definitely disappointing that we don’t know. I wish we did,” says retired Navy Capt. William Nash, a psychiatrist studying resiliency within Marine battalions.

The issue of multiple deployments was one of many raised following the March 11 massacre of 16 civilians in Afghanistan, allegedly by U.S. Army Staff Sgt. Robert Bales. Bales, 38, was on his fourth combat deployment when the shootings occurred.

Many of the issues reported about Bales — repeated combat exposure, physical injuries and personal finance and career problems — are common stresses on troops, scientists say. Yet 107,000 service members have deployed three or more times without incident. Advisors Alliance Singapore gives us detail idea about how can a person who is uninitiated in investing start investing with these robo-advisors and what is the catch behind them and what are the risks.

“The question we don’t have answered is how do we get precision about picking out the people who are really going to be in trouble,” says Shelley MacDermid Wadsworth, director of the Military Family Research Institute at Purdue University.

Scores of studies have looked at the wars’ impact on behavior and mental health. But the work has been done “in piecemeal fashion,” offering a snapshot analysis of a group of servicemembers at one point in time, says Terri Tanielian, a senior research analyst at RAND Corp.

The Pentagon may have missed a chance to follow large numbers of combat troops through the war in what is called a longitudinal study to better understand how behavioral problems develop, say Tanielian, Wadsworth and Nash.

Col. Paul Bliese, an Army scientist, agrees about the lack of a longitudinal study. But he and the others say there is important ongoing analysis.

The Army and National Institute of Mental Health launched a five-year longitudinal study of 9,000 soldiers in 2011 to better understand suicide.

A series of Army field studies of troops in combat co-led by Bliese, known as Mental Health Advisory Team Reports, produced waves of data underscoring a link between deployments and post-traumatic stress disorder.

Most promising, researchers say, is a massive, 21-year longitudinal study begun by the Navy before the war looking at how military life impacts mental and physical health. While not tailored specifically to the conflicts to come, 80,000 troops enrolled in the study have deployed and key findings are emerging, says Nancy Crum-Cianflone, the director of the study.

New research published in The British Journal of Psychiatry found 85{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of Iraq and Afghanistan veterans showed little or no PTSD symptoms over a decade. The 4.5{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} with “worsening-chronic” PTSD signs were mostly soldiers with severe combat experience

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Veteran Unemployment: Jobless Rate Drops

Posted on March 23, 2012 by Team VCS

Good news on veterans employment. The rate for veterans under 25 is still  far and away above the national average. It is great to see the policies promoted by federal leadership aimed at promoting the hiring of veterans having an effect. Thank you to POTUS and First Lady and members of congress who took action to begin  reversing this trend.

—————-

AP-Kevin Frecking

 

WASHINGTON — The unemployment rate for military veterans of Iraq and Afghanistan has dipped recently after months of riding higher than the national average, but some analysts caution it’s too early to tell if the progress is real or a blip.

The monthly snapshot provided by the federal government’s February jobs report showed that the unemployment rate for veterans of the two wars had dropped significantly, to 7.6 percent. That followed a decline in January, and last month’s number was also lower than the rate of 8.3 percent for the population as a whole, a significant shift because joblessness among veterans who served in the Gulf had run higher than the general rate in recent years.

“We tend to call a trend a trend and we are starting to see what seems like a trend, but we don’t want to overstate it and say the problem is solved,” said James Borbely, an economist at the Department of Labor.

Some analysts say there’s good reason for the caution. Ted Daywalt, the chief executive officer of a jobs board called VetJobs, said he expected the unemployment rate in early 2012 to drop because fewer guardsmen and reservists were returning from the Gulf.

“They aren’t flooding the market as much,” Daywalt said. “It’s a blip.”

The federal government also undertakes a longer-term review of unemployment among veterans. That report came out Tuesday and presented a more sobering picture of the jobs scene for veterans. The report said the unemployment rate for those who served in Iraq and Afghanistan averaged 12.1 percent during 2011, versus 8.7 percent for the overall population and up from 11.5 percent for veterans the year before.

Kevin Schmiegel, who is leading the U.S. Chamber of Commerce efforts to find jobs for veterans, said the monthly drops cited for January and February seem so different from past results that he’s skeptical that the jobs picture has improved that much. He’s putting more stock in the latter report, even if the information is more dated.

“If you look at a whole year, you’re going to get a more accurate picture than if you look at an individual month,” Schmiegel said. “I think the data reflect that the picture hasn’t gotten better.”

Sen. Patty Murray, D-Wash., and chairman of the Senate Committee on Veterans’ Affairs, said that a 30 percent unemployment rate in 2011 for the youngest veterans – those ages 18 to 24 – was particularly startling.

“Clearly, there’s significant work ahead, she said. “I think getting our veterans jobs has to remain a top priority.”

Congress has already taken some steps to try to help veterans find work. It passed a new tax credit worth up to $5,600 for employers that hired unemployed veterans. It doubled the tax credit for employers that hired disabled veterans out of work at least six months, moving it to $9,600. Federal agencies have also stepped up the hiring of veterans and partnered with the private sector in conducting job fairs.

Jordan Diminich, 28, a former operations specialist with the U.S. Navy, said he appreciates the focus on helping vets find work and likens it to fulfilling an obligation. He knows that he’s the one responsible for whether he gets a job or not, but part of the sales pitch that military recruiters made to him was that his service would be a “game-changer” when it came time to get a job outside the military. That hasn’t happened. Diminich graduated from New York City’s Hunter College in January and has been looking for a job in advertising or marketing.

“The government and other organizations should help, but most of it falls on you,” Diminich said. “I have to be a hard-charger and make the most out of my interviews.”

Murray said she expects the Obama administration in the coming weeks to reveal more details about plans to create a new conservation program that would put veterans to work rebuilding trails, roads and levees on public lands. Obama also called for targeting federal grant money toward those local agencies who hire more veterans as police officers and firefighters. It’s been about six weeks since he announced the proposal, but there has been little movement since then on Capitol Hill. At a recent hearing, Sen. John Boozman, R-Ark., said he was concerned that spending $1 billion to hire veterans to tend to federal lands would be a waste of money.

“I’ve never heard a veteran express to me that’s the route they would like to go,” Boozman said.

Murray said the report looking at veterans’ unemployment for all of 2011 shows that no option should be taken off the table at this stage of the debate.

Over the years, veterans have generally had more success finding work than non-veterans, but that has not been the case for many of those who served in Iraq and Afghanistan.

Marvin Wells, who helps connect employers with returning guardsmen and reservists in Tennessee, said the unemployment rate is still high among the returning soldiers that he works with.

“I haven’t seen a change for our returning solders. Two years, we had 3,000 come back and it was 25 percent (unemployment,)” Wells said. “Today we have 300 come back and it’s still 25 percent.”

Some analysts say that lengthy deployments for members of the National Guard and Reserves have made some employers wary of hiring veterans who are still active members.

“You really have to have dedicated employers who see the value in hiring a reservist and know what they bring to the table and say, `yeah, they may be gone for 6 to 9 or 12 months, but I’m willing to bring someone in temporarily to fill for them because I know the quality of person that military experience brings to my company,’” Wells said.

Schmiegel said that the Chamber of Commerce would continue to hold job fairs around the county and encourage businesses to hire veterans. While some large companies, such as Walt Disney Co. and General Electric, have made commitments to hire more veterans, he said that it’s critical to get small businesses more involved in hiring vets.

Federal agencies are also looking to fill more positions with veterans. Veterans make up about 30 percent of the workforce at the Department of Veterans Affairs. Secretary Eric Shinseki has set a goal to increase that total to 40 percent. The Agriculture Department is also looking to hire veterans, mostly to fill firefighting and forest management positions. The department set a goal of veterans filling at least 17 percent of job openings, and it’s exceeding that goal, said Secretary Tom Vilsack.

Vilsack said his department also has low-interest loans and grants available to veterans who want to start their own business or farm.

“If veterans don’t want to work necessarily work for the government, they want to work for themselves, we have programs at the USDA designed to help folks who are dreaming those big dreams,” Vilsack said.

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Important Claims Resources

Posted on March 23, 2012 by Team VCS

We wanted to take a moment to share important information about claims applications. There are two relatively new options available.

VA Releases Disability Benefits Questionnaires

With Disability Benefits Questionnaires (DBQs) Veterans now have more control over the disability claims process. Veterans have the option of visiting a private health care provider instead of a VA facility to complete their disability evaluation form. Learn more

                                    Fully Developed Claims

The Fully Developed Claims (FDC) Program is the fastest way of getting your compensation or pension claim processed. Participation in the FDC Program allows for faster claims processing while preserving great quality of service and your right to appeal a decision. Learn more at http://benefits.va.gov/transformation/fastclaims/

——-

We hope this helps

VCS Staff

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40{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of PTSD diagnoses at Madigan were reversed

Posted on March 22, 2012 by Team VCS

 

By Hal Bernton

Seattle Times staff reporter

A Madigan Army Medical Center screening team reversed more than 40 percent of the post-traumatic stress disorder diagnoses of patients under consideration for medical retirement since 2007, according to information released by U.S. Sen. Patty Murray.

The statistics were compiled as part of an ongoing Army Medical Command investigation into the screening team’s practices. The team has been suspended from PTSD evaluations, and the Army Medical Command is offering new evaluations to patients whose diagnoses were reversed.

Citing a need to “protect the integrity of the process” during ongoing investigations, the Western Regional Medical Command, in a statement released to The Seattle Times, declined to comment on the statistics released by Murray.

The investigation was triggered, in part, by soldiers who were concerned by the decision to take away their PTSD diagnoses and, in some cases, tag them as possible malingerers.

Originally diagnosed by other Army or Department of Veterans Affairs doctors, some had been receiving extensive treatment for months or years when the screening team evaluated them.

A PTSD diagnosis can qualify a soldier for the considerable financial benefits of a medical retirement. Those include a pension, health insurance for spouse and dependents and commissary privileges.

In a lecture to colleagues, a Madigan forensic psychiatrist stated that a PTSD diagnosis can cost taxpayers $1.5 million over the lifetime of a soldier who medically retires, according to a memo by an Army Medical Command ombudsman.

Investigators so far have checked the medical evaluations of more than 1,680 patients screened. Of those patients, more than 690 had a PTSD diagnosis. The team reversed more than 290 of those diagnoses, Murray told The Seattle Times this week.

Murray, a Washington Democrat who chairs the Senate Committee on Veterans Affairs, received the statistical breakdown from the Army surgeon general, Lt. Gen. Patricia Horoho.

Those statistics are not yet final and could change as more patients who went through the screening process are identified.

“What we know is that since 2007 over 40 percent of those service members went in the door with a PTSD diagnosis and that diagnosis changed to something else or was overturned entirely,” Murray said. “I worry that there are other service members that didn’t seek help because of what they have seen their fellow soldiers go through.”

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.

Madigan Army Medical Center is located at Joint Base Lewis-McChord south of Tacoma and is one of the largest military installations in the country.

The special screening effort there was different from how medical-retirement evaluations were handled at other Army medical centers, sparking considerable controversy and a broader Pentagon review of how the military services diagnose PTSD.

The Army Medical Command already has begun re-evaluating patients whose diagnoses were changed by the Madigan screening team. Initial reviews earlier this year of 14 patients at Walter Reed National Military Medical Center resulted in six patients having PTSD diagnoses reinstated.

The Army Medical Command has assembled a larger team of mental-health specialists at Madigan to offer re-evaluations to more than 280 other patients.

The Army Medical Command investigation also is examining why an intensive outpatient treatment program for PTSD at Madigan was closed down in 2010, the year that some 18,000 soldiers returned to Lewis-McChord from tours of duty in Iraq and Afghanistan.

The investigation began earlier this year, weeks before a Lewis-McChord soldier, Staff Sgt. Robert Bales, was detained for allegedly killing 16 Afghan civilians, including nine children, during a nighttime rampage through two rural villages March 11.

Bales’ case has increased the scrutiny of mental-health resources offered to base soldiers.

Bales, who was on his fourth tour in a combat zone, received a mental-health check as part of a 2008 certification to qualify as a sniper. He also went through routine physical- and mental-health checks before deploying and after he returned from overseas duty.

Bales’ attorney, John Henry Browne, said he expect to argue that this client suffered from “diminished capacity,” such as an emotional breakdown. Brown and co-counsel Emma Scanlan are trying to understand more about their client’s mental health through a review of medical records, and interviewing Bales and family members.

They say there is no indication that Bales or his family sought mental-health counseling for the soldier at Lewis-McChord or Madigan.

He was deemed fit for deployment, and not under consideration for a retirement due to PTSD or other mental-health conditions. So Bales would not appear to be among those screened by the forensic psychiatric team.

The Army has been waging a campaign to reduce the stigma that some soldiers feel if they want to seek mental-health treatment.

Many soldiers are wary of coming forward for fear it could damage their career.

Meanwhile, there remains considerable dispute among health professionals about how to diagnose PTSD. Some believe it is overdiagnosed.

For the military, the financial stakes of PTSD screening dramatically increased after Congress in 2008 authorized a 50 percent disability rating for anyone leaving military service with that diagnosis.

That rating is well above the threshold required for an Army medical retirement.

After the law changed, several soldiers attempted to make false or exaggerated claims of PTSD for personal financial gain, according to a Feb. 16 memorandum by Dr. Paul Whittaker, a Madigan physician who serves on the medical board that examines soldiers under consideration for medical retirement.

Whittaker wrote that Madigan psychiatrists used objective testing to determine which soldiers had “significant mental illness that was compensable.”

One of those tests the Madigan forensic team used is called the Minnesota Multiphasic Personality Inventory (MMPI).

In one patient file reviewed by The Seattle Times, a forensic-team member said the validity of the MMPI has been confirmed by multiple studies and has “shown the best resolution” in separating “PTSD simulators from actual patients.”

But the Army Surgeon General’s Office, in a paper about the condition, said while the test might help evaluate some behaviors, it is “not one of the gold standards measures for PTSD” and is not recommended for routine clinical evaluation of PTSD.

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Sgt. Robert Bales-PTSD Link at Odds With Research

Posted on March 22, 2012 by Team VCS

 

From KABC Talk Radio

US Army(NEW YORK) — When Army Staff Sgt. Robert Bales was arrested last week for allegedly killing 16 men, women and children in Kandahar, Afghanistan, speculation swirled that post-traumatic stress disorder, or PTSD, had caused him to snap.

The disorder, which plagues thousands of soldiers and veterans returning from combat, triggers episodes of intense anxiety, anger and disturbing behavioral changes. Bales’ lawyers, led by John Henry Browne of Seattle, have reportedly considered that Bales suffered from PTSD, in addition to his history with a traumatic brain injury.

In truth, however, there’s no evidence to indicate that people afflicted with the condition are more likely than anyone else to commit crimes and acts of mass violence. They are more inclined, instead, to turn their aggression on themselves and their families to devastating effect, research shows.

The knee-jerk linking of Bales and PTSD also exposes troops to prejudice that might discourage them from seeking the treatment they so desperately need, advocates say.

Army Capt. Ross Maybee, 30, a West Point graduate now serving at Fort Hood in Texas, believes the automatic linking of Bales’ alleged rampage and PTSD is unfair. Maybee was diagnosed with PTSD after four tours in Iraq and Afghanistan left him with severe panic attacks, difficulty concentrating and an inability to complete assignments for his job. He said he doesn’t buy the notion that the disorder caused Bales to commit the alleged crime.

“I feel they’re using it as an excuse for other underlying behavioral problems,” Maybee said of the allegations. “People with PTSD rarely experience actual violent outbursts like that.”

Travis Martin, 27, of Richmond, Ky., is familiar with the disorder’s undercurrents of anger and aggression. He was diagnosed with PTSD after two tours as an Army sergeant in Iraq, and underwent treatment to keep his aggression, violent dreams and heavy drinking at bay. He said he can’t discount that PTSD played a possible role in the Kandahar killings.

“But I don’t know for certain that it’s a result of one condition,” Martin said of the allegations. “I don’t know if we can ever really know just what went through his head.”

When shocking crimes are connected with soldiers who have endured the strain of combat, PTSD is often an automatic diagnosis for people searching for an explanation. But experts and survivors dispute the notion that PTSD turns soldiers into ticking time bombs.

“I really hate that people are going to think that,” Martin, who’s no longer in the military, said.

PTSD affects about 8 percent of men and 20 percent of women who have experienced at least one traumatic event in their lives, according to the U.S. Department of Veterans Affairs (VA). About 20 to 30 percent of the servicemen and women returning from Iraq and Afghanistan have the disorder. Nearly 100,000 of those veterans received treatment for PTSD at VA medical centers in 2011 alone.

There’s no denying the troubling mental health consequences of PTSD and that it causes some sufferers to act out. Several studies have documented that people with PTSD are more likely to express anger and aggression, which for some turns into violence toward their partners, children or others.

Dr. Matthew Friedman, executive director of the National Center for PTSD in White River Junction, Vt., said it’s a mistake to automatically attribute crimes like Bales’ alleged killing spree to PTSD.

“I’m not saying that PTSD couldn’t have been contributory, but the emphasis that PTSD and it alone can account for the event is just not borne out by the data,” Friedman said.

Research suggests that people with PTSD are more likely to harm themselves. Soldiers and veterans have a much higher suicide rate than the general population, and the National Center for PTSD notes that studies have found that PTSD is strongly associated with suicidal thoughts or attempts, more so than other psychiatric conditions.

“Damage to individual veterans is so much greater than their damage to other people,” said Dr. Joan Anzia, associate professor in psychiatry at Northwestern University Feinberg School of Medicine in Chicago. “As tragic as those killings [in Afghanistan] are, those are few and far between compared to what our soldiers, veterans and their families suffer.”

The effects of PTSD are widespread and often devastating for people who suffer. But the condition is vastly underreported in the military. Of the servicemen and women who return from war with PTSD, only about half receive any kind of treatment. Many fear that a diagnosis will damage their career prospects or relationships with their comrades.

Some advocates worry that characterizing people with PTSD as violent potential criminals might further stigmatize the disorder and prevent soldiers and veterans from seeking treatment.

“Creating a link without really knowing what causes a crime stigmatizes hundreds of thousands of people who have such a diagnosis who are contributing members to society and are no harm to anybody,” said Dr. Israel Liberzon, an associate professor of psychiatry at the University of Michigan in Ann Arbor.

Capt. Maybee said he chose to speak candidly with his family and fellow soldiers to fight stereotypes about the condition. He hopes that others will not suffer from an association with rare cases of violent crimes.

“A handful of people make major news stories,” Maybee said, “and you don’t hear about that person who’s suffering silently, abusing drugs and alcohol, or is confronting their issues and moving on with their lives.”

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Army reviewing traumatic stress diagnostic practices

Posted on March 22, 2012 by Team VCS

From Reuters

By David Alexander

WASHINGTON | Thu Mar 22, 2012 3:18am EDT

WASHINGTON (Reuters) – The Army has started a system-wide review to ensure its mental healthcare facilities are not engaging in the “unacceptable” practice of considering treatment costs in making a diagnosis, Army Secretary John McHugh told a U.S. Senate hearing on Wednesday.

Lieutenant General Patricia Horoho, the Army surgeon general, initiated the review in response to the discovery that hundreds of soldiers being treated for post-traumatic stress disorder had their diagnoses reversed after being seen by psychiatrists at the Madigan Army Medical Center in Washington state.

The medical center is located at Joint Base Lewis McChord, the home base of Staff Sergeant Robert Bales, who is suspected of killing 16 people, including nine children, in a shooting rampage in Afghanistan this month.

Bales was on his fourth deployment to a war zone in the past 10 years. His civilian lawyer told Reuters last week that PTSD would likely be part of the defense.

PTSD is a huge issue for the Defense Department. A recent Army study estimated as many as 20 percent of the more than 2 million U.S. troops who served in Iraq and Afghanistan could suffer from post-traumatic stress disorder. Cost of care could range between $4 billion and $6.2 billion, it said.

The Army is looking at whether doctors at the medical center were influenced by the cost of PTSD diagnosis in terms of pensions and other benefits. One psychiatrist said the cost to taxpayers was $1.5 million over the lifetime of a soldier on medical retirement, the Seattle Times reported.

The review being carried out by the Army inspector general aims to ensure that standardized diagnostic procedures are followed by all psychiatrists “and equally important that fiscal considerations are not in any way a part of the evaluations,” McHugh said. “It’s simply unacceptable.”

Referring to Bales, Representative Bill Pascrell, founder of a U.S. congressional task force on brain injuries, told reporters he wanted to “cradle this soldier in our arms” while condemning his actions until it could be determined what happened to him and whether he was properly tested and treated.

Bales had received a traumatic head injury and lost part of a foot during previous deployments in Iraq. The incident raised questions about the stress of repeated deployments, but McHugh said four was not uncommon.

“We have in the military writ large over 50,000 folks in uniform who have had at least four deployments,” McHugh told members of the defense panel of the Senate Appropriations Committee.

‘VERY CONCERNING’

Patty Murray, a U.S. senator from Washington state, told McHugh it was “very concerning” that 40 percent of the service members with PTSD who were seen by psychiatrists at Madigan “had their diagnosis changed to something else or overturned entirely.”

“What it says is that over four in 10 of our service members – many of whom were already being treated for PTSD – and were due the benefits and care that comes with that diagnosis had it taken away by this unit,” she said. “They were then sent back into the force or the local community.”

General Ray Odierno, the Army chief of staff, said the Army wanted doctors and psychiatrists to have the attitude they were “patient advocates.”

“That’s the mindset that we’re going to work on changing – to make sure that everybody understands that,” Odierno said. “We are patient advocates. We are trying to get the best for what is right for our soldiers.”

But Murray said senior military leaders had been saying that since the start of the war a decade ago.

“It’s really disconcerting after 10 years to find now that that has not been the case,” she said.

Murray said it was important to focus on the issue system-wide to make clear that “it isn’t the cost of PTSD or any mental health evaluation that is of concern to the Army. … It is making sure that those men and women get the care.”

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P.T.S.D. Can Yield Positive, Yet Sometimes Deadly, Results

Posted on March 22, 2012 by Team VCS

By JIM RENDON From http://6thfloor.blogs.nytimes.com/2012/03/22/p-t-s-d-can-yield-positive-yet-sometimes-deadly-results/

Just as my story about the Army’s program designed to help boost resilience in soldiers was approaching its final edit for The Times Magazine, news broke of the killing of 16 Afghan civilians by an American soldier. As details emerged, and Staff Sgt. Robert Bales was accused of committing this atrocity, I was stuck by the similarities between him and many of the soldiers I interviewed for this article.

Bales is a 38-year-old father of two who was on his fourth combat tour. He suffered multiple injuries, including mild traumatic brain injury and, possibly, according to his lawyer, P.T.S.D, yet he was sent back to combat. Soldiers going on their third and fourth deployments are not uncommon because these wars began a decade ago. Sgt. Jeffrey Beltran, who is featured in the story, was severely wounded in Iraq (he too suffered a mild, traumatic brain injury) and was on many medications when he was sent to Afghanistan. He was later diagnosed with P.T.S.D. Bales’s experience — the stresses, the multiple tours, the injuries — is not very different from that of so many men and women in uniform.

George Bonnano, a professor at Columbia University, whom I interviewed for the story, has found that soldiers are more resilient than the rest of the population — more of them recover from traumatic experiences without incident than in the general population. That may be because those who choose to join the military are more resilient to start with. Those who stay, like Beltran did, are most likely even more resilient. Yet, these men and women are not indestructible.

In the course of reporting this story I spoke with dozens of soldiers who served in combat zones, many of them multiple times. They all told me that no matter the number of tours, leaving for combat and returning home is always hard. In addition to the combat-zone stress, soldiers are also connected to home in ways they never were before: Skyping with spouses and children, for instance. For some, it is a source of strength, for others, a source of stress, for most it is likely both — a way to connect with loved ones, a reminder of what they are missing at home and a way for the daily stresses of bills, child care, the ups and downs of marriage — to seep into their challenging lives in a war zone.

And, when soldiers return home, their world is again turned upside down. Many soldiers who consider themselves healthy talked to me about struggles at home. Nearly everyone slept poorly. Some were unwilling to open up emotionally, even years later. During one conversation, several soldiers all laughed when they simultaneously referred to the massive, crowded aisles of Wal-Mart as Trauma-Mart.

It is not clear how to identify those who will be able to cope well with these stresses and those who will not. The Army’s Comprehensive Soldier Fitness Program, discussed in depth in the story, is an institutionwide effort to help soldiers handle these stresses better. The idea is to try improve everyone with the hope that those most susceptible to the stress will be a little less susceptible; those already somewhat resilient will be more so. The most seasoned soldiers I spoke with applaud the program’s goals. Many wished there had been something like it for them before they deployed three or four times. Instead they had to figure it out on their own.

Nothing excuses the cold-blooded slaughter of civilians that Bales is accused of. And we do not yet know what was going through his mind. The soldiers I met and hundreds of thousands of others, have served, been wounded and struggled with the aftermath of their experience, and all of them handle the stress one way or another. Most do the best they can on their own, riding out the bumps until they start to connect again here at home. Some develop P.T.S.D. and, as is discussed in the story, many soldiers feel that they change for the better as well, precisely because of the struggles they face.

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Some go extra mile to hire growing pool of jobless veterans

Posted on March 20, 2012 by Team VCS

Thomas Garlic and Steve Castillo found that their time in combat in Iraq and their service in the Army added up to little or nothing when they became civilians looking for work.

By John Smierciak, for USA TODAY

“It was very depressing,” says Garlic, 26, who lives with his wife and 5-year-old son outside Chicago. He was discharged in 2008 with post-traumatic stress disorder and has been largely jobless ever since. “Every time I would go up to bat, I would just strike out.”

“When I first got out (in 2008),” says Castillo, 31, from Biloxi, Miss., a medically retired Army staff sergeant, “I had a lot of motivation, a lot of high self-esteem and everything was good.”

But steady work eluded him as well. He lives today on temporary, often menial labor and an $1,800-per-month government disability check for his combat injuries. “We’re barely scratching by,” Castillo says.

As the nation grapples with finding work for its newest generation of combat veterans, job experts say that basic roadblocks persist for those willing to hire them — how to find these veterans and how to train them in new, non-military skills.

“We’ve just got to be very, very creative about this,” says Michele Deverich, executive director for a consortium of nearly two dozen health care companies committed to hiring veterans. “There’s got to be an extra mile that we walk here to do this. And it’s absolutely worthwhile.”

Nearly 30{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of male veterans ages 18 to 24 were out of work last year, compared with a 17.6{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} rate among civilian peers, according to a Bureau of Labor Statistics report released Tuesday. Unemployment last year was 12{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} for men who served during Iraq and Afghanistan compared with 9.3{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} among civilian males. Women were even worse off with 36{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of young female veterans jobless in 2011 compared with a 14.5{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} rate among young women 18 to 24.

As the economy improves, President Obama has launched an initiative for hiring veterans and there have been some encouraging signs with unemployment rates among veterans trending down so far this year.

“We’re cautiously optimistic,” says Jim Borbely, an economist with the Bureau of Labor Statistics.

The Obama administration has a campaign that includes tax credits for employers, corporate hiring pledges, job fairs and new initiatives by the Pentagon and Departments of Veterans Affairs and Labor to help ex-servicemembers prepare for and find work.

A survey of employers in January by the Society for Human Resource Management, the largest association of personnel officials with 260,000 members, also found positive signs with 64{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of companies hiring veterans in the previous 36 months, up from 53{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} in 2010.

Still, there were 154,000 Iraq and Afghanistan veterans out of work last month.

“We’re basically at the beginning stages of this,” says VA spokesman Steve Westerfeld. “Now we’re trying to find a way to put all the pieces together to make sure (veterans) are getting the jobs that they need.”

Time is not on their side.

The Iraq War is over, and the Afghanistan conflict is winding down. The military plans to shed troops — 80,000 in the Army alone, over the next few years — and more veterans will need work.

Meanwhile, says Michael Aitken, a vice president with the Society for Human Resource Management, “they’re getting buffeted by a lot of résumés from (non-veteran) folks that are unemployed, that have the skills and everything else.”

Two-thirds of employers say they are “not all familiar” with key Department of Labor programs aimed at making those linkages, while another 20{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} say they are aware, but do not use them.

Aitkens says aggressive outreach is required. “The Field of Dreams approach that government does, you build it and they’ll come, doesn’t always work,” he says.

At least a third of employers also worry that a veteran may have post-traumatic stress disorder or some other mental illness, the January employers survey shows.

Federal officials offered mixed reactions.

Ismael “Junior” Ortiz, head of the Department of Labor’s veterans programs, rejected any suggestion that companies aren’t familiar with the many programs for veterans the government funds. “We are successfully connecting with employers,” he says.

Curtis Coy, a VA official, said outreach could always improve, but employers often expect too much from the government. “There are companies that would love us to be their headhunter,” he says.

Best efforts at linking veterans with jobs can be at the community level, he says.

In Elk Grove, Ill., USA Cares, a non-profit that provides financial and advocacy assistance to post-9/11 veterans, and the Illinois chapter of the Association of Builders and Contractors, linked seven veterans, including Garlic, with careers as electricians.

The vets already have jobs promised by Professional Labor Support, a contractor based in Champaign, Ill., and $10-an-hour income while in class to help them support their families.

Their $4,000 apprentice tuition is being fronted by USA Cares until GI Bill vocational coverage comes through, says Bill Nelson, head of the non-profit.

After injuries from roadside bomb explosions in Iraq, Garlic eventually abused pain medication, a common problem in the military. The abuse led to a general discharge, what many employers took a red flag, he says.

Past that hurdle now, Garlic says his life is turning around. “Personally, I’m lifted. My wife has seen a change. I’m happy,” he says. “I’m getting good grades.”

A few weeks ago, the Army brought several unemployed disabled veterans, Castillo among them, to a jobs conference in Washington, D.C.

Castillo, back in Biloxi, says he’s hoping the contacts developed will produce a job.

“There are a lot of promising things,” says Castillo, who earlier this month made extra cash unloading Sheetrock for a construction supply company.

“Right now, it’s a waiting game,” he says.

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Six months after repeal, military says DADT died quietly

Posted on March 20, 2012 by Team VCS

WASHINGTON — Sgt. Pepe Johnson was surprised by the reaction he received when his fellow soldiers learned that he is gay.

“They’ve pretty much shrugged it off,” said Johnson, who rejoined the Army last fall after nearly a decade away. “Most of them were wondering why I had a nine-year gap in service. When I told them it was because of ‘don’t ask, don’t tell,’ they shrugged it off.

“That was a pleasant surprise.”

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Six months after the military dropped the controversial “don’t ask, don’t tell” law barring gays from serving openly, Pentagon officials and gay rights advocates say the policy change has largely been a non-issue, with few complaints and no major headaches resulting from the new rules.

Pentagon spokeswoman Eileen Lainez said the repeal is “proceeding smoothly across the Department of Defense,” which officials there credit to the “enforcement of standards by our military leaders” and “servicemembers’ adherence to core values that include discipline and respect.”

Officials at the Servicemembers Legal Defense Network, a pro-repeal group which offers free legal assistance to troops on discrimination issues, said they’ve heard only a few minor complaints from military members about the implementation of the repeal.

“We had thought this would be largely a non-event, and that has been the case,” said Aubrey Sarvis, executive director of the group. “I think the new regulations permitting gays and lesbians to serve are unambiguous, and the commands have all made it abundantly clear that this is the direction the force is going.”

Military leaders have seen pushback from conservative groups on some high-profile post-repeal stories — such as a picture of a gay Marine kissing his boyfriend which circulated earlier this month — but haven’t faced any lawsuits or mass resignations predicted by some opponents.

Last month’s White House dinner honoring Iraq War veterans included several same-sex couples among the invitees, but in their remarks military leaders didn’t even note that such a public display would have resulted in those troops’ dismissal just a few months earlier.

Johnson was booted out of the Army in 2003 under “don’t ask, don’t tell.” After he shared his secret with some friends, others in his unit started grilling them about his sexual orientation. Feeling pressure from both his friends and others, Johnson eventually came clean to his superiors.

As the political winds changed last year, Johnson said he was speaking with recruiters about returning even before the repeal went into effect last September.

“Their biggest issue was asking when I could start, not worrying about my personal life,” he said. “There has been no backlash, nothing to worry about.”

Repeal opponents remain skeptical. Elaine Donnelly, president of the conservative Center for Military Readiness, said plenty of troops remain opposed to serving with openly gay colleagues, but fear they’ll lose their job if they object to the military’s new pro-gay agenda.

“The entire administration … has imposed ‘zero tolerance’ policies against persons who are not enthusiastic supporters of LGBT law,” she said. “This is what we predicted, but the effects will not be seen quickly, especially in an election year.”

Much of the repeal fight has already shifted to the next rights battlefield, whether same-sex couples should receive the same housing and medical benefits as their straight peers.

Sarvis said the current benefits rules create two different classes of servicemembers. Opponents argue that the rights groups are trying to use the military to force radical social changes.

Meanwhile, Donnelly said that she has heard from a number of troops unhappy with the changes, who are simply waiting for their contracts to expire before leaving the service. That could cause major problems in coming months and years, she said.

Petty Officer 1st Class Jeremy Johnson, a member of active-duty gay-rights group OutServe, said he anticipates more problems in the future, although nothing to the extent of Donnelly’s predictions. Many of the gay troops he knows have not yet talked about their personal lives with their work colleagues, somewhat delaying the cultural impact of the repeal.

“This was never about having people come flying out of the closet,” he said. “It was about knowing you can’t be fired for being found out. There’s going to be a natural transition as more people become comfortable with the idea.”

Johnson, who was forced from the military in 2007, became the first openly gay person to re-enlist after the repeal was finalized. He said his commanders have warned him that he could be singled out for his public role, but so far it hasn’t caused any real conflicts.

“I anticipate that this isn’t over, but I don’t anticipate major problems, either,” he said.

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