Veterans for Common Sense

November 30, 2008 – Air Force veteran David Chini has lost track of all the times the Department of Veterans Affairs lost records he sent to it.

Registered mail? A VA worker signed, and the paperwork vanished. By fax? Chini, 69, of St. Petersburg said the VA claimed it never arrived. Regular mail? Don’t even ask.

And if something doesn’t arrive, the agency threatens to discontinue his medical benefits because Chini isn’t sending the papers it needs.

“It’s just totally demoralizing,” he said.

Recent revelations that workers in 41 of 57 VA regional benefits offices, including St. Petersburg, improperly set aside hundreds of claims records for shredding came as no surprise to veterans.

The VA, critics say, has long operated in a veritable culture of lost paper and was losing records many years before this latest scandal. Lost paperwork sometimes leads to delayed, denied or abandoned claims for medical or financial assistance.

And it leaves some questioning if workers lose it deliberately to ease workloads. At least two VA employees outside Florida are being investigated for just that.

“I remain angry that a culture of dishonesty has led to an increased mistrust of the VA within the veteran community,” said Rep. Bob Filner, D-Calif., chairman of the House Committee on Veterans Affairs.

The VA notes it is the most paper-intensive federal bureaucracy, sifting through 162-million pages of claims documents a year.

And while the VA hopes to have largely paperless claims filing by 2012, the size of the agency makes computerization a challenge.

“Until we get out of the paper business, lost documents are something we’re going to have to contend with,” said Mike Walcoff, the VA’s deputy undersecretary for benefits in Washington.

Walcoff said it is unfair to criticize thousands of dedicated VA employees for the failures of a small minority, and said the VA is working hard to improve its performance.

Others remain skeptical, and question why it has taken so long for the agency to move toward digitized records.

“It’s ludicrous that we have the most highly technologically advanced army in the history of the world and still come back home to an antiquated system that is all on paper,” said Rick Weidman, director of governmental relations at Vietnam Veterans of America.

Take a look at one measure of the problem: the Board of Veterans Appeals in Washington, where veterans appeal the denial of claims.

Searching an online database of appeals decisions for “destroyed records” reveals 20,000 cases where those words appear. “Missing files” locates 33,000 cases.

Disappearing files

Through VA history, confidential claims papers have been found in some odd places: above ceiling tiles, inside closets, in curbside trash at a VA lawyer’s home, and in one case at the bottom of an elevator shaft.

“It’s a corporate culture of disappearing records,” Weidman said. “It’s just generally a disdain for the individual veteran that needs to be changed.”

But Weidman applauds the VA for moving quickly to suspend shredding nationally after discovering the latest problem and then implementing new policies.

Now it will take the approval of three VA employees before any document is shredded. Records czars are being appointed in all 57 regional offices.

The agency also said it has reminded employees that claims records can’t be stowed in unauthorized areas. Workers who do so can be fired.

And the VA has announced a temporary policy (see accompanying box) allowing, in some cases, veterans to refile crucial paperwork if they think the VA lost it.

“We’re taking the steps that we need to do to get the trust of the veteran community again,” Walcoff said.

He said moving to digital records too quickly would only lead to more problems, though Walcoff noted that much of VA operations are already computerized.

But the VA wants to integrate all its activities in five separate business lines, including insurance, loan programs and medical, an enormously complicated process. That takes time, Walcoff said.

Filner remains wary about any proposed fixes.

“We have heard promises from the VA before,” he said after a Nov. 19 meeting in Washington on shredding with members of his committee, the VA and veteran advocates.

Filner was particularly displeased that he and other members of the veterans committee found out about the shredding problem in news reports, not from the VA.

“The way to build confidence is to tell people about it before it appears in the paper,” Filner said.

Many critics point to one thing as the biggest incentive for workers to “lose” records: incentive bonuses to quickly resolve claims and improve their numbers.

The VA’s Walcoff denied that the agency believes there is any link between bonuses and misplaced paperwork.

Weidman at Vietnam Veterans of America said the VA needs to enforce employee accountability and offer better training and competency tests for anyone deciding a claim.

“Unless the VA changes how it measures work, we will be back here again in eight years doing the same thing,” said Ron Abrams, joint executive director of the National Veterans Legal Services Program.

November 29, 2008, East St. Louis, IL – A widow whose husband died at a Veterans Affairs hospital under fire for substandard care has agreed to settle her lawsuit against the government for $975,000, her attorney said.

Katrina Shank had sought $12 million in her federal wrongful-death lawsuit. Her husband, 50-year-old Robert Shank III of Murray, Ky., bled to death in August 2007, a day after undergoing gallbladder surgery at the VA hospital in Marion, Ill.

Shank’s widow claimed the government failed to sufficiently check the background of her husband’s surgeon, Dr. Jose Veizaga-Mendez, before hiring him in January 2006.

Veizaga-Mendez resigned three days after Robert Shank’s death, and major surgeries were ordered halted there after inspectors attributed several patient deaths to questionable surgical care.

Terms involving Katrina Shank’s settlement were not disclosed in court documents, but one of her attorneys, Stan Heller, put the amount at $975,000. He said the sum amounts to an admission of responsibility, because “the government doesn’t toss money like that around easily.”

A VA spokesman, Paul Sherbo, said only that “the VA has no information to offer on this case, pending a review by the court.” According to the order by U.S. District Judge J. Phil Gilbert, the settlement becomes final after 90 days unless it hits a snag.

The VA found at least nine deaths between October 2006 and March 2007 were “directly attributable” to substandard care at the hospital. Those deaths did not include Robert Shank, who died months later.

The VA’s findings do not put the sole blame on Veizaga-Mendez, but Shank’s lawsuit said many or all of those who died were his patients.

At least one other lawsuit involving care by Veizaga-Mendez at the hospital is pending. James Marshall, 61, of Benton, Ky., died of a blood infection in July 2007, six days after Veizaga-Mendez performed a lymph node biopsy. His widow, Darla Marshall, is seeking $10 million in damages.

Veizaga-Mendez, who is not listed as a defendant in the lawsuits, has no listed telephone number and has not responded to repeated messages left by the AP at a Massachusetts home listed as an address for his wife.

November 28, 2008, New Delhi – Afghan President Hamid Karzai blasted the U.S. and its NATO allies for failing to defeat the Taliban, insisting for the first time that Afghans need a firm deadline to end the war.

Setting such a deadline seems unlikely with President-elect Barack Obama seeking to boost the number of U.S. soldiers in Afghanistan. But without one, Mr. Karzai said, his government had no choice but to explore a negotiated settlement with the Taliban.

“This war has gone on for seven years; the Afghans don’t understand any more how come a little force like the Taliban can continue to exist, can continue to flourish, can continue to launch attacks,” Mr. Karzai told a visiting United Nations delegation Tuesday. His office released a transcript Wednesday.

After the Taliban fell from power in Afghanistan in late 2001, the U.S. backed Mr. Karzai’s rise to power, and he has enjoyed Washington’s support since then. But with elections set for next year, Mr. Karzai has stepped up his criticism of the international role in Afghanistan in an apparent bid to shore up his support among conservative — and increasingly disaffected — Afghan tribes, and to deflect mounting criticism at home and abroad from people who say his government is weak and corrupt.

Neither the U.S. Embassy nor spokesmen for North Atlantic Treaty Organization forces in Afghanistan responded to requests for comment about Mr. Karzai’s remarks.

Mr. Karzai’s strident tone adds another layer to the challenges facing Mr. Obama, who has said Afghanistan will be among his top foreign-policy priorities. Among plans being considered by Mr. Obama is one to send as many as 20,000 U.S. soldiers to Afghanistan next year to reinforce the 32,000 already there.

In his remarks, Mr. Karzai said for the first time that Afghans needed a clear timeline for the war and couldn’t tolerate an open-ended campaign. “If there is no deadline we have the right to another solution for peace and security, which is negotiations,” he said.

The Afghan president has repeatedly called for negotiations, last week going so far as to offer Taliban leader Mullah Omar safe passage to attend talks — an offer that was promptly rejected by the Taliban.

U.S. and other Western policy makers have said that talks with some elements of the Taliban are needed. But they are looking to engage relatively moderate Pashtun tribes that form the Taliban’s grassroots support. Few in the U.S. or Europe want to make any sort of deal with the group’s leadership, or believe such an agreement can be struck.

To the U.N. group, Mr. Karzai criticized everything from what he called a “parallel” government being created by foreign security and aid agencies to the number of civilians killed by U.S. and NATO forces. He said those forces have taken the fight “to the villages of Afghanistan where there were no terrorists.”

U.S. and NATO commanders say the Taliban is using villagers as human shields.

Mr. Karzai also blamed Afghanistan’s endemic corruption in part on foreign contractors who “contract, then subcontract, and then another subcontract and then perhaps another subcontract.” The process “means immense possibilities of major corruption.”

In one of the few positive notes, Mr. Karzai said relations with Pakistan, where the Taliban and al Qaeda have taken over wide swaths of territory in Pakistan’s Northwest, have improved considerably since President Asif Ali Zardari took office in September.

Mr. Zardari’s predecessor, Pervez Musharraf, a former general who came to power in a 1999 coup, won Washington’s backing after the Sept. 11, 2001, attacks but was frequently accused by Afghanistan and Western governments of not doing enough to combat Islamic militants.

November 26, 2008, Fort Campbell, KY – Some 15,000 U.S. soldiers are heading home to this sprawling base after spending more than a year at war in Iraq and Afghanistan, and military health officials are bracing for a surge in brain injuries and psychological problems among those troops.

Facing prospects that one in five of the 101st Airborne Division soldiers will suffer from stress-related disorders, the base has nearly doubled its psychological health staff. Army leaders are hoping to use the base’s experiences to assess the long-term impact of repeated deployments.

The three 101st Airborne combat brigades, which have begun arriving home, have gone through at least three tours in Iraq. The 3rd Brigade also served seven months in Afghanistan, early in the war. Next spring, the 4th Brigade will return from a 15-month tour in Afghanistan. So far, roughly 10,000 soldiers have come back; the remainder are expected by the end of January.

Army leaders say they will closely watch Fort Campbell to determine the proper medical staffing levels needed to aid soldiers who have endured repeated rotations in the two war zones.

“I don’t know what to expect. I don’t think anybody knows,” said Gen. Peter Chiarelli, vice chief of staff of the Army, as he flew back to Washington from a recent tour of the base’s medical facilities. “That’s why I want to see numbers from the 101st’s third deployment.”

What happens with the 101st Airborne, he said, will let the Army help other bases ready for similar homecomings in the next year or two, when multiple brigades from the 4th Infantry Division and the 1st Cavalry Division return.

Noting that some soldiers in the 101st Airborne units have been to war four or five times, Chiarelli said he is most worried the military will not be able to find enough health care providers to deal effectively with the troops needing assistance.

Many of the military bases are near small or remote communities that do not have access to the number of health professionals who might be needed as a great many soldiers return home.

More than 63,600 active duty Army soldiers have done three or more tours in Iraq or Afghanistan. That is nearly 12 per cent of the total number of soldiers who have deployed at least once. Roughly four in 10 soldiers who have gone to war have served more than one deployment – and that number is growing steadily.

One solution under discussion is the formation of mobile medical and psychological teams that can go to Army bases when they are expecting a surge in activity from returning units.

At Fort Campbell, the director of health services, Col. Richard Thomas, has roughly doubled his authorized staff of psychologists and behavioural specialists to 55 and is trying to hire a few more.

“I think we have enough staff to meet the demands of the soldiers here, but I could use more, and I’ll hire more if I can,” said Thomas. “I’ll hire them until they tell me to stop.”

He said he expects the increased staffing levels to last at least through next year.

For the first time, Thomas said, every soldier returning home will have an individual meeting with a behavioural health specialist and then go through a second such session 90 days to 120 days later.

The second one is generally the time when indications of stress surface, after the initial euphoria of the homecoming wears off and sleeplessness, nightmares, and other symptoms show up.

“We’re seeing a lot of soldiers with stress-related issues,” he said. “They’re not bipolar or schizophrenic. But they’re deploying three and four times and the stress is tremendous. They’re having relationship issues, financial issues, marital problems – all stress-related.”

According to Dr. Bret Logan, deputy commander for managed care at the base, extended war zone stints that have lasted as long as 38 months over the course of the wars in Afghanistan and Iraq have taken a severe toll.

More than 3,000 of the 15,000 troops returning home, Logan estimated, probably will experience headaches, sleep disorders, irritability, memory loss, relationship strains or other symptoms linked to stress disorders.

Medical staff at Fort Campbell say they also worry that there will be a new surge of suicides – an escalating problem in recent years, largely related to the stresses of war.

Jon Soltz, an Iraq war veteran and chair of VoteVets.org, said more soldiers will have stress-related problems, and the military must be vigilant in diagnosing and treating post-traumatic stress disorder to head off more serious issues.

“The longer you are there (at war), the more PTSD you’re going to see. You wonder when it’s going to be your time,” he said.

Each returning soldier is evaluated through a seven-day reintegration program. It includes medical checkups, tests, lectures on suicide prevention and relationships, and other sessions to help them transition back into life at the base and with their families.

During his visit to Campbell, Chiarelli took a spin on one of the base’s simulators, which are used for soldiers having neurological or stress problems. The simulator can be used to test soldiers’ reflexes or as a way to work someone back into everyday situations.

With occupational therapist Eileen Hayes watching over his shoulder, Chiarelli adeptly negotiated the city streets, sudden turns and other obstacles moving at him on the small screen.

The simulators, said Logan, put patients in high stress scenarios to test their decision-making ability while under duress.

While soldiers have been routinely deploying for 15-month tours, most Marines serve about seven months and pilots deploy for about four months, although some may serve for tours of six months or longer.

Late this past summer, Pentagon leaders ordered a change, saying any soldier who deployed in August or after would serve 12-month tours. Army leaders say they want to reduce that to nine months, but doing so will be difficult considering the strains of fighting two wars at once.

Logan said that some 85 per cent of those soldiers with stress disorder symptoms will recover with the help of some treatment or medication. But the other 15 per cent will require more intensive help.

November 26, 2008 –   As the strains of war push the Army’s suicide rate up to an all-time high, the service is turning to a fictional soldier named Spc. Kyle Norton to encourage soldiers to seek help faster.

Suicides among soldiers have increased dramatically in the last several years, up by 46 percent since the US invaded Iraq in 2003. Senior service officials recognize that the wars have affected soldiers in the form of post traumatic stress disorder and other manifestations of mental depression, but still haven’t completely figured out how to address the issue.

The Army is conducting new training, handing out “buddy cards” to alert soldiers to problems among their friends, and recently announced a new five-year study to be undertaken with the National Institute of Mental Health.

But one of the more novel solutions is an interactive game called “Beyond the Front,” starring Specialist Norton, a character in a kind of modern-day military morality play. The service plans to send out thousands of copies of the game – part of an Army suicide prevention program costing almost $1 million – to educate soldiers about the dangers of not seeking help when they most need it.

Role playing for real life problems

Users of the interactive video watch a drama unfold on screen and then make decisions that affect the outcome for the characters. In one scenario, Norton receives a “Dear John” letter, and then a roadside bomb kills a buddy, setting off a chain of events that require players to make decisions for the main character. Players who repeatedly choose to reach out to fellow soldiers and family members within the scenario get a happy ending. Players who opt – in their character – not to tell anyone about their problems will steer the game to a sad end.

Another scenario focuses on a soldier’s role in preventing a buddy’s suicide.

“People are drawn into it, they see themselves because [the situations in the movie] are very realistic,” says Sharon Sloane, president and chief executive officer of WILL Interactive, which made the film and has produced such training films for more than a decade. “The problems resonate, and they feel the emotions of the characters because they look like and sound like and behave like them, so it becomes a first-person experience.”

Ms. Sloane says the video gives soldiers a chance for players to walk in someone else’s shoes.

“It’s an opportunity to play it out before you live it out,” she says.

The emergence of this relatively untested approach illustrates the difficulty the Army has in combating the effects of depression on a service exhausted by war.

Army suicides have increased from 79 in 2003 to 115 last year, not including attempts. About two-thirds were deployed or had deployed when they committed suicide. Senior Army officials expect this year’s rate to be even higher. If so, the Army suicide rate could surpass that of the general US population of 19.5 per 100,000 people.

“One suicide is too many,” says Col. Thomas Languirand, chief of Command Policies and Programs Division for the Army. He says the Army is not yet sure how exactly it will use the “Beyond the Front” video and won’t say how many copies it plans to buy. It’s just one “tool in the toolbox” for suicide prevention, says Colonel Languirand.

Ultimately, it’s not about videos or pocket cards or any other programs, but about educating soldiers to look out for each other, he adds.

“If we can have soldiers understand what those behaviors are that may lead to suicidal behavior, we believe we can have them intervene and that is where we can have the most payoff.”

The Marine Corps has its own problems. That service saw a high of 34 suicides in 2004, or 17.5 suicides per 100,000 marines, not including attempts. The number dropped to 25 in 2006 but has begun to increase again.

Persuading soldiers to get help

The key to suicide prevention lies in overcoming the stigma of seeking help. Individuals typically find it difficult to seek help for a mental disorder or even mild post-traumatic stress disorder in a military environment that stresses toughness and derring-do.

Earlier this year, Defense Secretary Robert Gates changed Question 21 on a Defense Department survey required for security clearance, exempting soldiers from reporting mental-health treatment related to combat injuries or family issues. The move was seen as a major step in recognizing that professional counseling is a positive step, not a negative one.

“It’s time we made everyone in uniform aware that the act of reaching out for help is one of the most courageous acts – and one of the first steps – to reclaiming your career and future,” said Adm. Mike Mullen, in announcing the change in May.

Soldiers or marines who return from war with mental disorders may be predisposed to having them. But the severity of the trauma they encounter there can also turn a healthy soldier or marine into a sick one, says Dr. Jan Fawcett, a psychiatrist who has consulted for both military and police departments.

“You can take people who look pretty healthy and run them through the … grinder and they will come out in shards,” he says.