Recruiting Stand-Down Ordered

January 27, 2009 – Army Secretary Pete Geren has ordered a stand-down of the Army’s entire recruiting force and a review of almost every aspect of the job is underway in the wake of a wide-ranging investigation of four suicides in the Houston Recruiting Battalion.

Poor command climate, failing personal relationships and long, stressful work days were factors in the suicides, the investigation found. The investigating officer noted a “threatening” environment in the battalion and that leaders may have tried to influence statements from witnesses.

“There were some things found that are disturbing,” said Brig. Gen. Del Turner, deputy commanding general for Accessions Command and the officer who conducted the investigation.

While he declined to discuss what action might be taken, Turner has recommended disciplinary action against battalion- and brigade-level commanders. He declined to discuss what action might be taken.

The report was not made public, with officials citing extensive personal information contained in the report.

The four recruiters who killed themselves were all combat veterans of Iraq or Afghanistan. The Army did not identify them.

The Army Inspector General’s office has been asked to conduct a command-wide assessment of Recruiting Command to determine if conditions uncovered in Houston exist elsewhere.

The one-day stand-down of all 7,000 active Army and 1,400 Army Reserve recruiters will be Feb. 13.

The soldiers will receive training on leadership, a review of the expectations of Recruiting Command’s leaders, suicide prevention and resiliency training, coping skills and recruiter wellness, Turner said.

“It’s significant,” Turner said about the stand-down. “It is not routinely scheduled. It normally occurs after some sort of major event like this.”

Turner was appointed to conduct the investigation on Oct. 14 by Lt. Gen. Benjamin Freakley, commanding general of Accessions Command. The investigation was sought by Sen. John Cornyn, R-Texas, who heard from soldiers and family members after the Houston Chronicle in 2008 reported the suicides.

“I think that when you have something like this happen that’s this serious and has such a huge impact on families and loved ones, of course people will ask what’s going on,” Freakley said.

Recruiters and soldiers who are going to be recruiters, their families and the public are going to want to know what’s happening and what’s being done, he said.

“We’re very aware of our soldiers’ concerns and we want to make it better,” Freakley said.

USAREC is a strong command with good leaders and exceptional soldiers, Freakley said.

“I do not believe for a minute that this is endemic of the entire command whatsoever, but I do believe that one [suicide] is too many, and we had four,” he said. “So let’s fix this and move forward and grow from this in a positive way. It’s hard work, but the whole Army has hard work right now.”

Turner’s investigation was completed Dec. 23, and Turner said his work revolved around the four suicides that occurred between January 2005 and September. Findings from the investigation were released Jan. 21.

“It’s a very tough and very tragic thing,” he said. “But I’m focused on what good can come out of this and that’s where our focus is right now.”

There were 17 suicides within Recruiting Command between fiscal years 2001 and 2008, said Col. Michael Negard, a Training and Doctrine Command spokesman.

There were more than 500 suicides by active-duty soldiers across the Army from Jan. 1, 2003, through Aug. 31, according to data from the Army G-1. Another 31 cases were pending final determination, as of Aug. 31.

The Army’s suicide rate increased from 12.4 for every 100,000 soldiers in 2003 to 18.1 in 2007, an all-time high for the service. Nationwide, the suicide rate for every 100,000 people was 19.5 in 2005, according to the Centers for Disease Control and Prevention.

Gen. Pete Chiarelli, vice chief of staff of the Army, voiced his concern in a Jan. 23 interview with Army Times.

“We need to move out as quickly as we can to do those things that are going to lower the numbers,” Chiarelli said. “That’s the best we can do. We can’t eliminate suicide.”

“I believe there are certain things leaders can do in the short run to reverse the trend and I’m going to talk about those next week,” Chiarelli said.

Turner said he examined the four soldiers’ personal lives, from their financial and medical histories to their performance at work. He also studied organizational factors such as command climate, leadership within the battalion, brigade and Recruiting Command. He looked at screening soldiers for recruiting duty, the impact of assigning soldiers directly to that duty after they return from combat tours, the adequacy of the Army’s suicide prevention training, and soldiers’ access to mental health care.

Here is what Turner said he found:

• There was poor command climate in the recruiting battalion, one of 38 in the Army.

Morale was low among the unit’s 200-plus recruiters, who routinely worked 12- to 14-hour days. They had unpredictable work schedules, frequently working on weekends. There was a “threatening type of environment” established by certain leaders throughout the battalion’s chain of command.

Monthly missions assigned by USAREC were bumped up, violating Army regulations and adding stress. For example, in July 2008, the battalion’s 205 recruiters each had to recruit two new soldiers a month, even though the battalion’s mission was 360 contracts, which is roughly the equivalent of 1.5 or 1.6 new contracts each.

“I don’t think it was malicious necessarily,” Turner said, “but what that does is it artificially ups their work load.”

• All four soldiers who killed themselves suffered from “troubled” or “failing” personal relationships.

Turner said he did not find any common thread of significant financial stress among the four men and none had been diagnosed with PTSD.

At least seven months had passed between the time each man returned from combat to the U.S. and when they were assigned to USAREC.

• Regarding witness statements, Turner noted “inappropriate comments by leaders before investigations were done and before mine started.” He added: “It may have been construed by recruiters as attempts to influence their statements.”

Recruiters who felt their commanders may have been trying to influence their statements were given the opportunity to change their statements during Turner’s investigation.

• There were no inherent problems with assigning soldiers to recruiting duty after they returned from combat, but the assignment process must be improved.

Soldiers now can get approval from the first lieutenant colonel in their chain of command to waive the 90-day stabilization period required of them after returning from a deployment. Sometimes, problems stemming from a soldier’s experience in the war zone may not present themselves immediately, so the Army G-1 is reworking the waiver policy so that soldiers must now get approval from a general officer.

• Almost 50 percent of prospective recruiters were not fully vetted by their chain of command, as required by USAREC.

Soldiers who are nominated for recruiting duty must complete financial disclosure forms and statements declaring that they understand that recruiting is sensitive duty, they may be assigned to remote locations and they must be able to work independently.

They also must complete a mental health evaluation and be interviewed by their current battalion commander, command sergeant major and company commander, who must determine whether the soldier would be a successful recruiter. Input from this command team must include comments on the prospective recruiter’s leadership ability and potential, physical fitness, character, integrity, ability to perform in stressful situations and any incidents of abuse. All negative evaluations must include a full explanation.

Turner said he found that almost half the soldiers who went on to be recruiters did not have a complete nomination packet, and that soldiers were not taking a standardized mental health evaluation.

To correct that, HRC on Jan. 13 sent a message reinforcing the need for a complete nomination packet and instituted a policy that prohibits soldiers from being assigned to recruiting battalions until their completed packet has been reviewed, Turner said.

Also, the Army surgeon general, G-1 and USAREC are creating a mental health evaluation form specific to recruiters, Turner said, and officials are working on a catalog to track the adequacy of medical and mental health care and the access soldiers have, regardless of where they are stationed, to that care.

Turner said “the Army is moving in a very quick way in taking concrete action” and to “improve the climate and leadership inside that battalion and other organizational, institutional factors that will improve recruiting operations.”

Freakley said the Army is listening to Turner’s advice and taking immediate and long-term steps to correct any problems.

“I want to ensure we have a climate where our recruiters know how important they are, are well led in a positive command climate, are well supported by the systems that we put in place to help them in their very important mission of recruiting an all-volunteer force – and that we learn and really grow from this experience,” he said.

Recruiting is a very stressful job, said Bret Moore, a former captain and clinical psychologist who served twice in Iraq.

“I know that recruiting duty is one of the most stressful jobs, alongside drill sergeants,” he said. “They have quotas to meet and there’s a lot of pressure.”

Turner, who briefed the four soldiers’ families and Cornyn before releasing the findings of his investigation, said “all these [deaths] are tragic, but the one thing the Army does extremely well is learn from itself,” he said.

Maj. Gen. Thomas Bostick, commanding general of USAREC, will send a team to Houston this summer to conduct a follow-on assessment of the command, Turner said.

There also is a move to balance suicide prevention training with resiliency training and coping skills, he said.

“[Instead] of trying to recognize that [a soldier] is exhibiting risk factors, this is more toward helping [a soldier] cope with the stresses in his life,” he said.

Bostick is calling for a review of the current USAREC policies on duty hours for each of the five recruiting brigades and their 38 battalions.

For example, the Houston battalion’s policy called for a maximum work day of 13 hours, and recruiters had to seek approval from their chain of command if they worked beyond that, Turner said. However, the 13-hour maximum was interpreted as the expected norm, and the policy could have been written more clearly, Turner said.

Bostick also is directing a review of how missions are assigned to recruiters, so what happened in Houston, where commanders were assigning a higher mission to recruiters, would not be repeated, Turner said.

What is critical in all of this is leadership, Turner said.

“It requires compassionate leaders caring for their soldiers, hitting that sweet spot between accomplishing the mission and caring for soldiers.”

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Obama to Hear Advice of Service Chiefs on Iraq

January 28, 2009 – Barack Obama often has said he will issue orders to swiftly close down the Iraq war. Now military leaders are getting a chance to tell the new commander in chief how they could comply, and why he might want to wait.

Obama was to hear the opinions of the four U.S. military service chiefs on Wednesday in a meeting the White House called one more step toward fulfilling his promise of withdrawing all combat troops from Iraq. The Joint Chiefs of Staff will be ready with a rough sketch of what would be required to fulfill the president’s timetable for a 16-month withdrawal.

Defense officials have said they can meet Obama’s campaign pledge, but several officials have signaled that a fast withdrawal could upset the fragile security that currently holds in Iraq.

“We are developing other options as well,” Defense Secretary Robert Gates said Tuesday. “We are laying out, with each of the options we will present to him, our view – each of the commander’s – of the risks associated with that timeline.”

In preparing those, Obama has asked for more information behind assumptions and for additional analysis, Gates said. “I think that the president will listen to the commanders,” he said.

Adm. Mike Mullen, chairman of the Joint Chiefs of Staff, told reporters Tuesday that all the scenarios will meet the president’s “desire for a responsible drawdown that preserves the security gains we have made in Iraq and protects our forces.”

Mullen said he hopes to give Obama that menu “in the very near future,” but Pentagon spokesman Geoff Morrell said there will be no decisions made at Wednesday’s meeting.

The Joint Chiefs are among those in the Pentagon hierarchy who have expressed concerns about the impact that long, repeated war tours in Iraq have had on the U.S. military.

Much of the discussion is also expected to look ahead to the building fight in Afghanistan and how Obama’s plans to add forces and resources there will depend in part on the success of the Iraq exit. The Pentagon is nearing an announcement of new troop deployments in Afghanistan, with forces arriving in numbers in the spring and summer.

Obama pledged during his presidential campaign to immediately order the withdrawal of all combat troops from Iraq by May 2010. He said he would call in the Joint Chiefs and tell them so on his first day in office, a bit of campaign hyperbole that has evolved in practice into a series of consultations with military leaders, including commanders in Iraq and Afghanistan.

The new president also has said he would adjust his timeline if it would risk the safety of U.S. troops remaining behind to train Iraqis and fight al-Qaida or if it would cause backsliding in Iraqi stability.

“Ultimately the commander in chief will decide which option he prefers and how much risk he can accept,” Morrell said.

Obama has not said when he plans to announce a new Iraq plan. Iraqi leaders already have said they want to stick to terms of an agreement negotiated with the United States last year that would leave some fighting forces in place longer.

“The president has laid down the test of ensuring that he hears specifically from both those on the ground and in the region before he makes decisions on our force posture going forward,” White House press secretary Robert Gibbs said Tuesday.

Obama has not changed his determination that the war must end, his spokesman said.

“There will be a new mission in Iraq,” Gibbs said.

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Groups Urge Faster Action to Help Veterans

January 27, 2009 – A roundtable discussion, aimed at creating a consensus among military and veterans groups about top priorities for the year ahead, focused on how solving some longstanding problems might be especially important today to veterans and their families who are being hurt by the national economic crisis.

The discussion involving 36 organizations representing current and former service members was sponsored by the House Veterans’ Affairs Committee, which has responsibility over some, but not all, veterans programs.

In comparing the views of the groups, committee staff came up with five shared priorities: advance appropriations for veterans’ programs, fixing disability compensation, improving mental health treatment, implementing the new Post-9/11 GI Bill in August and smoothing the transition from military to civilian life.

None of those issues are new, and the problems have proven difficult to fix. Rep. Bob Filner, D-Calif., the veterans’ committee chairman, said Congress has tried to eliminate a backlog of disability claims that have forced veterans to wait, on average, more than 180 days for a simple claim to be approved and years of delay if the claim is complicated. Congress boosted VA staff so that more people are processing claims, which may be a long-term solution – but while new employees are being found and trained, “the backlog is growing,” Filner said.

Congress has faced similar problems in trying to improve job training and rehabilitation programs, creating programs that reduce homelessness and expanding access to veterans’ health care.

John Rowan, president of Vietnam Veterans of America, and representatives from the Non Commissioned Officers Association and Veterans of Foreign Wars all backed the idea of making quick improvements in veterans programs to help people who have lost jobs or health insurance because of the economic slump.

Rowan had the most ambitious idea, proposing to create a new VA division for economic independence that would oversee small business, job training, vocational rehabilitation programs and reintegration efforts for injured and disabled veterans. Rowan said the idea would be to take programs spread throughout the government, where they are the “step-children of some other agency,” and make them into veterans’ programs.

Cutting the processing time for disability checks would be of immediate help to veterans who have lost jobs and also might reduce homelessness among veterans, said Richard Schneider of the Non Commissioned Officers Association. “This nation is in an unemployment crisis,” he said. “We need to fix the claims backlog. It will help the homeless issue. It will help the unemployment issue. It is a tragedy that people have waited years to be paid.”

Chris Needham of Veterans of Foreign Wars said veterans programs also could help people who lose health insurance when they lose their jobs if VA uses existing waiver authority that would consider current income – and not income over the previous 12 months – when deciding whether they qualify as low-income veterans, which allows them to qualify for health care even if they do not have service-connected medical problems.

A smaller group of six veterans’ organizations will testify Wednesday before the Senate Veterans Affairs Committee about their priorities for the 2010 VA budget.

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Gates: Afghan War is ‘Greatest Military Challenge’

January 27, 2009 – Afghanistan is America’s “greatest military challenge” and coordination of the fight against the insurgency has been “less than stellar,” Defense Secretary Robert Gates is telling Congress.

In testimony prepared for delivery to Congress Tuesday, Gates said it will take a long and difficult fight to rout militants and help develop a nation that rejects the Islamic fundamentalist Taliban and backs its own elected government.

“There is little doubt that our greatest military challenge right now is Afghanistan,” Gates said in testimony prepared for the Senate Armed Services Committee and obtained in advance by The Associated Press.

And in the other war involving the United States, he said that although violence has remained low in Iraq, “there is still the potential for setbacks – and there may be hard days ahead for our troops.”

Gates repeated the oft-heard assessment by field commanders that: “As in Iraq, there is no purely military solution in Afghanistan.”

But, he added, “it is also clear that we have not had enough troops to provide a baseline level of security in some of the most dangerous areas – a vacuum that increasingly has been filled by the Taliban.”

Gates said that although there are more than 40 nations involved in the Afghan campaign: “Coordination of these international efforts has been less than stellar, and too often the whole of these activities has added up to less than the sum of the parts.”

Congress is eager to hear from Gates on how the Obama administration plans to salvage the war in Afghanistan and hold a relative peace in Iraq – all the while reducing the stress on a force stretched thin by years of combat.

Lawmakers, set to question Gates on Tuesday, also want to hear details on the closing of the Guantanamo Bay prison, with some members of Congress concerned that their state might become the next location to house the nation’s most dangerous terrorist suspects.

“There are a lot of questions as to what victory and the redeployment out of Iraq means,” as well as plans to bolster forces in Afghanistan, said Rep. John McHugh of New York, the top Republican on the House Armed Services Committee.

President Barack Obama has vowed to shift military resources away from Iraq and move them toward Afghanistan and Pakistan, which he says is the central front in the struggle against terrorism and extremism. In a plan initiated during the Bush administration and endorsed by Obama, the Pentagon is planning to double the 34,000 contingent of U.S. forces in Afghanistan.

But expectations in the troubled region may have to be tempered as top military advisers focus on showing even small security gains and development progress quickly.

“That’s clearly the message I’m getting is, `what are the near-term goals going to be?’ ” Adm. Mike Mullen, chairman of the Joint Chiefs of Staff, said when asked about Obama’s agenda for Afghanistan.

While lawmakers mostly support the plan to send more troops, several Democrats have expressed the need for a clearer strategy.

Without an idea of when the commitment would end, “we tend to end up staying in different places and not necessarily resolving problems in a way that fits our national interest,” said Sen. Jim Webb, D-Va., a Senate Armed Services Committee member.

Gates, the only Republican Cabinet member asked by Obama to stay on, oversaw the same buildup of military forces in Iraq in 2006 and 2007 that Obama opposed. Gates also at one point urged caution against setting a firm timeline for troop withdrawals as Obama campaigned on the promise to bring U.S. forces home within 16 months.

But in recent months, the two are believed to have found much common ground, including Obama’s desire to step up diplomatic efforts

Last week, in a meeting with Gates and other national security advisers, Obama reiterated his plans to execute a “responsible military drawdown from Iraq,” according to a White House statement.

There was no mention in the statement of the 16-month deadline Obama frequently cited while campaigning for president. A current U.S.-Iraq agreement calls for U.S. troops to leave Iraqi cities by the end of June, with all troops gone by 2012.

Also in his first week in office, Obama ordered the eventual closure of Guantanamo Bay prison. With many of the details yet to be worked out, lawmakers are wondering where the detainees will go and how they will be tried. Mostly, members of Congress want to know if they’ll be consulted before the administration makes any decisions.

“These perplexing questions confounded the previous administration and will also test the new administration, but our duty calls us to set policies which keep America safe and conform to American values,” said Rep. Ike Skelton, D-Mo., chairman of the House Armed Services Committee.

Another issue likely to arise at Tuesday’s hearing is defense spending and whether Gates expects the Pentagon budget to decline considering Obama’s increased focus on domestic spending.

The Obama administration is not expected to complete its review of the defense budget until this spring. Meanwhile, Gates has already estimated that the Pentagon needs another $70 billion in war costs to continue operations through September.

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Mesothelioma Cases Remain High for Military Veterans Exposed to Asbestos

January 26, 2009 – The U.S. Department of Veterans Affairs stated that out of the millions of veterans who have served the country, hundreds of thousands have been exposed to asbestos during their service. Regarded as one of many coverups jointly executed by corporations and government, it appears that the asbestos scandal still has not reached its climax.

Widely used by every military branch in the United States, over 300 products containing asbestos were used by the Navy and other military sectors from the 1930s through the 1970s. This has led to asbestos exposure among hundreds of thousands of military personnel.

Although not everyone who is exposed to asbestos will develop an asbestos-related illness, long-term exposure does increase the possibility. Asbestos exposure can cause severe ailments such as asbestosis and malignant mesothelioma, a highly aggressive cancer caused almost exclusively by asbestos exposure. Approximately 2,000 to 3,000 new mesothelioma cases are reported every year in the United States alone.

Due to an intense latency period associated with mesothelioma, many soldiers will not experience related symptoms until 20 to 50 years after exposure, when the disease has already progressed to its later stages. Many symptoms of mesothelioma are ones found with other less serious conditions, making early diagnosis a significant challenge for physicians.

Around the turn of the 20th century, asbestos business grew into a major corporate industry with large profits and thousands of employees. By 1922, the Navy issued a medical checklist that placed asbestos in a list of hazardous occupations and recommended the use of respirators.

The U.S. Navy was not ignorant of the dangers of asbestos and evidence shows the hazardous qualities of asbestos was swiftly covered up by asbestos manufacturers. Any asbestos concerns were silenced in the race to build the U.S. Navy fleet prior to World War II.

Working in shipyards during WWII became almost as dangerous as fighting in the war itself. As many as four million service men and women worked in shipyards repairing and building giant vessels. Thousands of tons of asbestos were used as piping and boiler insulation aboard navigation rooms, sleeping quarters and mess halls in ships.

The Navy issued a ban on asbestos-contaminated materials on new ships in 1973, but then violated its own ban for the next five years.

In 1983, the Navy Asbestos Control Program was created to help facilitate compliance with asbestos-related regulations set by the U.S. Department of Labor’s Occupational Safety and Health Administration. Despite these actions, many veterans continued to be exposed to high levels of asbestos even after the Navy began to replace contaminated ships.

The majority of veteran asbestos exposure continues to occur when veterans work on naval vessels where asbestos-contaminated products were heavily used. Many of these older ships are decommissioned and sent for overhaul to third world countries that have limited regulations or little knowledge of the dangers of asbestos.

This phase of exposure began in the 1990s when the U.S. Navy began to sell obsolete ships for scrap materials where workers have no prior knowledge of the dangers involved in handling asbestos. Usually these workers are not given any protective equipment to prevent potential exposure.

Since March 2003, United States combat troops have been stationed in Iraq where they face many dangers while performing military operations. Many are unaware of the potential threat of asbestos exposure. Documents from 2003 reveal that over $194,000 worth of asbestos was imported into Iraq. This presents a significant hazard for all soldiers stationed in the country because intense winds and desert sands can carry asbestos dust for long distances.

Veterans with asbestos-related disease unfortunately find themselves in a tough situation because they experience difficulty in obtaining assistance and benefits for their illness. Currently, mesothelioma is not readily recognized as a service-related medical ailment. However, veterans can apply for Veteran Affairs (VA) benefits for asbestos-related illness and must provide proof that their exposure occurred at the time of their military service.

Some naval vessels and public facilities may still contain asbestos-laden materials, such as clutches, brakes, gaskets or older construction materials. Thus, the potential remains for yet another generation of veterans and civilians to be exposed to asbestos on a global scale.

For more information on veteran asbestos exposure and mesothelioma, please visit the  Mesothelioma Cancer Center.

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Washington Post Speculates on More Potential VA Leaders

Veterans Affairs Secretary Eric K. Shinseki, a retired four-star Army general, appears to be stacking his sub-Cabinet with fellow veterans. We’re hearing buzz that Shinseki will name W. Scott Gould, who served in Iraq as a naval intelligence reservist, as his deputy secretary. Gould, a former assistant secretary of commerce who once served in the Clinton White House, is a vice president at IBM Global Business Services.

Meanwhile, Shinseki is eyeing disabled Iraq war veteran Tammy Duckworth as assistant secretary for public and intergovernmental affairs. Duckworth, whom Obama had considered for the top VA post, currently runs the Illinois Department of Veterans Affairs. A former congressional candidate, Duckworth had been mentioned as a candidate for the Senate seat Obama vacated. After losing both her legs in combat, Duckworth was an outspoken critic of President George W. Bush’s Iraq war policy.

Sources say Shinseki also could tap Roger Baker, who served on Obama’s transition team and is a longtime information technology executive in government and private industry, for a top VA post, perhaps as chief innovation officer.

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GAO: VA Not Budgeting for Full Cost of Long-Term Care

January 26, 2009 – U.S. Senator Daniel K. Akaka (D-HI), Chairman of the Veterans’ Affairs Committee, issued the following statement today in response to a report issued by the Government Accountability Office (GAO) which found that the Department of Veterans Affairs (VA) is under-projecting the increase in funding and staff it will need to provide veterans with adequate long-term care in the coming years:

“GAO has found yet another example of VA providing incomplete and inaccurate estimates of veterans’ needs. This investigation is timely, with the Obama Administration now developing a budget for veterans’ health care and other services. I hope that Secretary Shinseki will direct his Department to make the necessary corrections in time for VA to give an accurate assessment of its long-term care needs, and that he will make it a priority to improve the Department’s overall budget and planning process.

“Members of Congress, the President, and Secretary Shinseki have called for veterans’ health care to be funded one-year in advance of the regular budget process. For this to work, projections of veterans’ health care needs must be accurate,” said Akaka.

Last year, Chairman Akaka introduced S. 3527, the Veterans Health Care Budget Reform Act of 2008, to provide advance funding for VA, and require the Comptroller General to conduct a study on the adequacy and accuracy of VA health care projections. Currently, the Veterans Health Administration (VHA) is funded one-year at a time, and is too often the victim of delays and short-term budgets.

Jesse Broder Van Dyke is the Press Secretary for United States Senator Daniel K. Akaka (D-HI)

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Charity Appeal: How Brain Scans Show the Trauma of War

January 26, 2009 – For the Ancient Greeks, it was a “divine madness” that infected the minds of soldiers. During the US Civil War, it became known as “soldier’s heart”. By the First World War it was called shell shock. Today, the condition is known as Post-Traumatic Stress Disorder.

The idea that war can inflict deep and lasting psychological wounds is not new. In Sophocles’s tragedies, former soldiers descend into a state of mind that would be all too familiar to modern military psychiatrists. Yet despite the passage of more than 2,400 years, our understanding of PTSD has remained surprisingly unsophisticated: not only are the underlying biological and psychological causes poorly understood, but it is almost impossible to predict which soldiers are the most susceptible.

Now, however, new research from America – triggered by the soaring incidence of PTSD among troops returning from Iraq and Afghanistan – has found striking differences in the brain patterns of those suffering from combat stress, raising hopes that we will be able to identify and treat sufferers much more effectively.

At the most basic level, PTSD is the result of a breakdown in the defence system that copes with traumatic and frightening experiences. After such events, most people will suffer what is known as Acute Stress Disorder, which involves symptoms of anxiety and depression. The majority will recover, but a minority go on to develop the chronic mental health problems that characterise PTSD.

“They get stuck in a cycle whereby recollections of a traumatic event are triggered by a particular situation they encounter,” explains Professor Simon Wessely, director of the King’s Centre for Military Health Research at the Institute of Psychiatry, King’s College London. “This triggers the symptoms, and they then try to avoid the situation that triggered the recollections – but that just means that the symptoms get worse the next time they encounter the same situation.”

“Those who develop PTSD are not necessarily the most vulnerable,” adds Professor Roberto Rona, a lecturer at King’s Psychological Medicine and Psychiatry Division. “Ideally, we would want to start treatment as soon as possible by separating those who are going to recover normally and those who will have a problem after a traumatic event.”

One way to find them might be to scan the brains of those affected. In 2007, as fighting intensified in Afghanistan and Iraq, cases of PTSD among American military personnel increased by more than 50 per cent. The Pentagon poured money into research – the latest instalment of which has revealed that there are differences in parts of the brains of those with PTSD.

Older studies had linked PTSD to changes in the activity of the amygdala, the area of the brain involved in emotional memory. But Dr Norbert Schuff, of the Veterans Affairs Medical Centre in San Francisco, found using MRI scans that the hippocampus of sufferers, which plays a major role in short-term memory and emotions, had decreased in size. There was also increased blood flow in the prefrontal cortex, the region responsible for decision-making – hyperactivity here is thought to be involved in the excessive reaction to fear. Most strikingly, there was a loss of up to 10 per cent of the grey matter – the nerve cells and blood vessels that make up much of the brain.

What is unclear is exactly why these changes have come about – and whether they are the cause of combat stress, or its consequence. “It is hard to say which comes first,” explains Professor Wessely. “Do the changes in the brain cause the symptoms? Or do they occur as an effect of prolonged stress – or is it a result of alcohol abuse or head injuries?”

One possible explanation comes from research which found a link between PTSD and mild brain trauma, suggesting that the condition could in some cases be triggered by mild brain injuries resulting from nearby explosions. But there is another curious piece of the puzzle. While cases of PTSD are common outside the Armed Forces, soldiers should be particularly vulnerable: their jobs place them in frightening situations where they are more likely to encounter the kind of events that can spark psychological problems.

But while around 20 per cent of ex-combatants in the British Armed Forces do suffer some sort of psychological disturbance – hence the need for the work of Combat Stress, one of the three charities involved in the Telegraph’s annual appeal, which ends this week – PTSD is only one of a number of conditions. According to official figures – which some campaigners dispute – just 3 per cent of the British troops sent to Iraq or Afghanistan on active duty develop PTSD. The single biggest mental health problem is alcoholism: according to recent studies, 27 per cent of soldiers are heavy drinkers, and 15 per cent are problem drinkers.

This does not make PTSD any less of a problem. Sufferers are plagued with recurring nightmares, insomnia and depression, experiencing high anxiety, mood swings and relationship difficulties. Divorces, unemployment, homelessness and violence become common; vivid flashbacks can lead to panic attacks; and veterans often sink into a cycle of alcohol or drug abuse as they attempt to deal with their symptoms.

But Prof Wessely has found that the very thing that exposes soldiers to PTSD might also help them deal with it: their job. According to his research at King’s, group cohesion and firm leadership are critical in reducing the impact of psychological distress.

“You have to remember we are talking about professional soldiers who have been highly trained,” he says. “Their training is designed to harden them against the unpleasant nature of war. The military is actually very effective at reducing the risk of PTSD with their training, their professionalism, esprit de corps and morale. War is a stressful business and this all prepares soldiers for that.”

The flip side is that the memories that provoke trauma are not necessarily those of gruesome battles or injuries. “The kind of events that affect them are not simply seeing bad things and coming under fire – it is when the rules they have come to expect are somehow broken. It is when errors of omission or commission lead to the feeling they have been let down, or that they have let their comrades down, that mental health problems occur. This is why ‘friendly fire’ incidents are so psychologically damaging – it violates the soldiers’ rules of who is supposed to be shooting at them. They will feel anger at those responsible.”

That was certainly the case for James Saunders, a veteran of the Gulf War interviewed by The Daily Telegraph last month. As a 21-year-old in the Royal Artillery, he experienced “friendly fire” from Challenger tanks. No one was killed, but six months later he began to suffer from anxiety and depression, developed a drug habit and ended up in prison. “For years,” he says, “I blamed myself for being a poor soldier and weak-minded.” Having sought help from Combat Stress, and been diagnosed with PTSD, Saunders recovered, although he still suffers from occasional depression. On Thursday, he will speak about his battle against PTSD alongside Professor Wessely at the Dana Centre in London.

In addition to the research into the causes of PTSD, new treatment is being developed, drawing on neurolinguistic programming, relaxation techniques and even Eye Movement Desensitisation Therapy, which involves following a moving light or object with the eyes, to work through the bad memories. But there are no simple solutions.

“I don’t think there are many people who believe PTSD will be solved by simply giving people a drug,” says Wessely. “With soldiers, the only really effective way of preventing it would be to not go to war in the first place.”

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Jan 26, VCS Urges VA Secretary Shinseki to Grant Presumption of PTSD Benefits Based on Scientific Research

Here is our VCS letter to Secretary Shinseki urging him to use his rule-making authority to promulgate a regulation establishing a presumption of service connection for Gulf War, Iraq War, and Afghanistan war veterans diagnosed with post traumatic stress disorder (PTSD) based on the recent Institute of Medicine report linking PTSD with deployment to a war zone.

January 26, 2009

The Honorable Eric K. Shinseki
Secretary of Veterans Affairs
Department of Veterans Affairs
810 Vermont Ave., NW
Washington, DC 20420

Dear Secretary Shinseki:

On behalf of our 14,400 members, Veterans for Common Sense (VCS) congratulates you for becoming our new Secretary of Veterans Affairs.  VCS strongly supports your goal of transforming and improving the Department of Veterans Affairs (VA).

As of September 30, 2008, more than 105,000 Iraq and Afghanistan war veterans were diagnosed with post traumatic stress disorder (PTSD) by VA.  However, as of August 31, 2008, only 42,000 were granted service-connected disability for PTSD by VA.   We believe this discrepancy is an outrage that can be addressed with a new regulation.

VCS has long promoted the use of your rule-making authority to promulgate a regulation establishing a presumption of service connection for PTSD.  A new PTSD regulation deserves your urgent attention because it will significantly reduce the disability claim backlog crisis now facing VA.  The backlog crisis will only worsen as the Iraq and Afghanistan wars continue.

In 2008, VA made progress on this issue by accepting the recommendation of Senator Daniel Akaka, Chairman of the Veterans’ Affairs Committee, to accept military diagnoses of PTSD for claims purposes.  If an Iraq or Afghanistan war service member being discharged has a diagnosis of PTSD from the military, then VA shall grant a 50 percent disability rating. 

VCS believes the “Persian Gulf Veterans Act of 1998” and new scientific research should prompt regulations for conditions associated with deployment to Southwest Asia.

A scientific literature review conducted by the Institute of Medicine (IOM) titled “Gulf War and Health (2008)” concluded, “The epidemiologic literature on deployed vs nondeployed veterans yielded sufficient evidence of an association between deployment to a war zone and psychiatric disorders, including posttraumatic stress disorder (PTSD), other anxiety disorders, and depression; alcohol abuse; accidental death and suicide in the first few years after return from deployment; and marital and family conflict, including interpersonal violence.”

The definition of the Gulf War dates under 38 USC 101(33) and the definition of the Gulf War locations under 38 CFR 3.317 provide you with broad authority to provide disability compensation to veterans deployed to the Southwest Asia Theater of Operations on or after August 2, 1990.

In order to clarify the population covered by a new regulation, VA may want to revise 38 CFR 3.317 to include all of the nations and bodies of water ever identified by the Department of Defense (DoD) for the Gulf War, Iraq War, and Afghanistan War.

Preparing a new regulation for PTSD begins the process of transforming VA by reversing the prior Administration’s pattern and practice of opposing PTSD benefits. During 2005, VA took four improper steps to block and otherwise hinder access to healthcare and disability compensation for veterans diagnosed with PTSD.

First, VA attempted to re-examine more than 70,000 veterans’ previously granted PTSD disability compensation.  After reviewing more than 1,000 claims, VA investigators found no fraud cases.  Congress blocked VA’s review after a distraught veteran in New Mexico completed suicide after hearing news of VA’s new policy.

Second, VA issued a Fast Letter that required two signatures to grant a disability compensation claim for PTSD – denials and other conditions were excluded.  After a public outcry, VA suspended (but did not rescind) the Fast Letter.

Third, VA issued another Fast Letter that mandated a review by VA Central Office for all large retroactive disability compensation awards.  VCS viewed the new VA policy as another attempt to block PTSD awards since PTSD claims take, on average, longer than six months to process, and several more years to resolve under an appeal, often resulting in large retroactive awards.  VCS asks you to rescind both Fast Letters.

Fourth, VA also entered into two contracts with IOM to review the legitimacy of the PTSD diagnosis and the adequacy of disability compensation for PTSD.  The IOM validated the diagnosis of PTSD and called for greater disability compensation for veterans diagnosed with PTSD.

Again, we offer our sincere congratulations on your confirmation as America’s top veterans’ advocate.  We look forward to working with you to transform VA and put our veterans first.

Sincerely,
Paul Sullivan
Executive Director

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Afghanistan Roadside Bombs Hit Record in 2008, up 45 Percent to 3,300 Blasts

January 25, 2009 –  Roadside bomb attacks against coalition forces in Afghanistan hit an all-time high last year, killing more troops than ever and highlighting an “emboldened” insurgency there, according to figures released by the Pentagon.

Last year, 3,276 improvised explosive devices (IEDs) detonated or were detected before blowing up in Afghanistan, a 45{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} increase compared with 2007. The number of troops in the U.S.-led coalition killed by bombs more than doubled in 2008 from 75 to 161. The Pentagon data did not break down the casualties by nationality.

Roadside bombs in Afghanistan wounded an additional 722 coalition troops last year, setting another record.

In Afghanistan, “an emboldened, increasingly aggressive enemy has increased the use of IEDs,” Irene Smith, a spokeswoman for the Joint IED Defeat Organization, the Pentagon’s lead agency for combating roadside bombs, said in an e-mail.

“The trajectory of trends in 2008 has been in the wrong direction,” Michael O’Hanlon, a military analyst at the Brookings Institution, said Sunday of the IED records. “We’re losing the war. This shows a greater capacity on the part of the Taliban and other insurgents to cause more death, destruction and challenges to the legitimacy of the Afghan government.”

Army Gen. David McKiernan, the top commander of U.S. and NATO troops in Afghanistan, said in an interview last month that Taliban and other militants use roadside bombs to kill troops, terrorize civilians and sow disorder.

“It’s part of a change in tactics by the insurgency to go into more complex, smaller-scale, more asymmetric ambushes that attack softer targets,” McKiernan told USA TODAY. “IEDs don’t discriminate between civilian and military so it’s the single biggest killer in Afghanistan — civilian and security forces.”

President Obama has pledged to devote more resources to Afghanistan. McKiernan has asked to nearly double the size of the U.S. forces — the largest group in the international coalition — to 60,000 troops. Combat engineers who clear roads and defuse bombs are among the forces that U.S. and NATO commanders need, McKiernan says.

Vice President Biden warned Sunday on CBS’ Face the Nation that fighting in Afghanistan will intensify and that “there will be an uptick” in casualties.

Meanwhile, the Pentagon plans to rush as many as 10,000 new armored vehicles to Afghanistan to counter roadside bombs. Commanders there have issued an urgent request for a lighter, more maneuverable version of the Mine Resistant Ambush Protected vehicle, known as MRAPs. Few paved roads and rugged mountain terrain prevent the use of MRAPs in parts of Afghanistan.

Devices useful in Iraq to counter roadside bombs may have to be “ruggedized” to work in parts of Afghanistan, Navy Capt. Vincent Martinez, deputy commander of Task Force Paladin, said in an interview at Bagram Air Base last month. The task force combats IEDs in Afghanistan.

“We’ve got a fight on our hands,” he said. “This is not just affecting the future of Afghanistan. It’s for the future of the entire region. We cannot allow terrorists to have safe havens.”

O’Hanlon, who says he supports McKiernan’s goal of providing better security for the Afghan people, said reversing the trend in roadside bomb attacks is critical to success there.

“People in Afghanistan need a reason to join the army and not the Taliban,” O’Hanlon said. “They need some sense of hope.”

In Iraq, where roadside bomb attacks are far more prevalent, the number of IED attacks continues to fall. There were 8,999 such attacks in 2008. The all-time high was 24,302 in 2006.

Better security in Iraq has prompted civilians there to provide coalition forces with more tips on where bombs are planted and who is making them, Smith said.

Since the two wars began, 570 U.S. troops have died in Afghanistan and 4,220 in Iraq.

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