Veterans for Common Sense

November 30, 2008 – It’s not how Air Force enlistee Joseph Weston pictured either his military service or his country.

Not long after he began basic training May 31 at Lackland Air Force Base in Texas, Weston figured something was wrong. He was weak and dehydrated. His heart rate soared. He collapsed on his way to Sunday morning church service. On June 9, doctors diagnosed the Cadillac native with leukemia. But his battles were just beginning.

From an isolated room in a wing at the base, he is engaged in a bitter fight with the Air Force over his discharge and health care. That comes on top of ongoing chemotherapy aimed at saving his life. The conflict pits Weston, his family and even his military doctor against an Air Force seeking to discharge him without benefits.

“I feel like I am in a never-ending prison. I’m just trying to get through one day at a time right now,” Weston said.  The military’s contention: Weston’s leukemia preceded the start of his service. It is a critical finding, because it means he will not be eligible for medical benefits upon discharge.

An Air Force review board issued that finding on July 21. An appeal board affirmed it in October.

Weston is appealing that ruling, a decision to be made by a Maryland-based board of the Secretary of the Air Force. He is backed by an Air Force doctor who is his primary physician.

In an appeal letter, cancer specialist Della Howell stated that doctors “would not have been able to make the diagnosis” of leukemia when his military service began.

Leukemia is a potentially fatal condition in which the bone marrow overproduces white blood cells and they crowd out normal cells. Howell based her finding on the typical multiplication rate of leukemia cells. She concluded that a marrow test taken the day he arrived for basic training would have been read as normal.

Weston, 21, spends much of his time alone in a spare, windowless room. At times depressed, Weston says the tension of the legal battle is the last thing he needs as he faces cancer.

“It’s made it 10 times harder,” he said.

Air Force officials would not speak to the specifics of his case.  But in an Oct. 29 decision, a three-member board found there is evidence his leukemia “existed prior to his military service.”

It cited his June 9 emergency room admission with a complaint of fatigue, shortness of breath for two weeks and medical history in which Weston reported dizziness for four weeks.

The board concluded “the preponderance of medical evidence indicates (Weston’s) condition manifested prior to” his military service. It rated Weston “unfit” for duty because of physical disability.

Limbo is tough to take

Cadillac resident Jim Weston said his respect for the military is gone, the result of his son’s ordeal.

“I’m as patriotic as the next guy,” he said. “I’m red, white and blue and support the country. But not any more. It is very, very disappointing.”

Should his son lose, Weston is uncertain how the family could afford future medical expenses. He fears they could amount to hundreds of thousands of dollars and wipe out family finances.

“We don’t have those answers,” said Weston, 49, superintendent for a Cadillac casting factory. His wife, JoAnn, 51, is an appointment coordinator in a dental office.

“It would be devastating for all of us,” JoAnn Weston said.

He sought a career

Joseph Weston’s mother recalled his excitement when he signed early enlistment papers in October 2007, months after graduating from Cadillac High School.

In a state where good-paying jobs are hard to find, he saw the Air Force as a chance to serve his country and earn benefits.

“His plan was to remain and make it a career,” she said. “He really, truly, had a passion for it.”

Weston traveled to Lansing to complete his medical testing, undergoing a thorough physical examination.

On May 26, he went to the Air Force recruiting office in Cadillac and was transported to Lansing, given a blood test and transported the following day to Lackland.

He began boot camp on May 31, exercising with other recruits in 90-degree temperatures.

On June 5, he found himself unable to run. He was examined the next day by Air Force medical personnel after he developed a racing heart.

Two days later, he collapsed as he made his way to Sunday church services. He was admitted the day after to the base hospital, Wilford Hall Medical Center. The diagnosis: leukemia.

Experts take his side

A bone marrow test on June 10 found Weston had 90 percent leukemia cells.

Working backward from that date, cancer specialist Howell calculated Weston would have had 2 percent leukemia cells on May 27. A bone marrow test at that level would have judged Weston normal, Howell said.

“Therefore, there is no way that I can support the classification of this illness as a pre-existing condition,” Howell stated in her letter.

An expert in military disability cases said enlistees enjoy a “presumption of soundness” when they join the military, based on the physical examination required for entry.

According to Arizona lawyer Theodore Jarvi, the Air Force must provide “clear and unmistakable” evidence Weston was diagnosed prior to boot camp to prove its case.

Jarvi, 67, has 27 years of experience in the Air Force Guard and Reserves, including 20 years as a judge advocate, charged with the defense and prosecution of military law. He is past president of the National Organization of Veterans Advocates, a nonprofit group that promotes legal representation for veterans claims.

If he loses, Weston could take his case to the Veterans Administration, Jarvi said.

“He would probably have to fight with the VA five years,” Jarvi said.

Broken bureaucracy?

Paul Sullivan, executive director of Veterans for Common Sense, a veterans advocacy group, says the military faces ongoing pressure to keep down the cost of medical cases.

“It has a lot to do with the money. The military is essentially broke,” Sullivan said.

“The (military) doctors are doing great work. It’s the bureaucracy behind the medicine that is not working.”

But Sullivan said he also is concerned the military has shunned Weston while it contests his case.

“The military should be stepping up to the plate to see that he gets good care,” he said. “It sounds like this person is being railroaded out.”

Encouraging signs

Weston is in the fourth round of treatment that began the day after he was diagnosed, under the direction of cancer specialist Howell.

“He has had a great response to chemotherapy so far,” Howell said.

She expects treatments to continue for three years.

Based on Weston’s age at the onset of leukemia, Howell placed his long-term survival rate at about 65 percent.

Once a week, he enters the hospital for outpatient treatment in which medication is put into a catheter in his chest, with a line that moves it directly to the top of his heart.

His family is encouraged by his response to treatment.

But as he fights a disease for which stress can be one more handicap, they worry his isolated routine is hardly the medicine he needs. He is housed in a wing of the base dedicated to recruits who flunk their drug tests or develop medical issues during training.

He ‘feels like he’s the enemy’

Weston is expected to awake at 4:45 a.m., dress and remain in his room. He is allowed to leave three times a day for meals. He gets one hour a day to use the phone and shower. Lights out at 9 p.m.

Air Force spokesman Kirk Frady said trainees such as Weston “are expected to maintain professionalism” and live by Air Force “core values.”

“Trainees are allowed bed rest if prescribed by the trainee’s doctor,” Frady said.

Asked about the possible physical toll of his predicament, physician Howell said: “I would much prefer to have somebody in an environment where they have family and support around him.”

The National Cancer Institute points to studies that show stress can increase tumor growth and psychological factors like feelings of helplessness can help spread cancer.

“All I can do is provide the best medical treatment possible,” Howell said. “We do what we can for him here.”

His father worries that is not enough.

“The cancer battle has now become almost secondary to winning this fight. My son feels like he’s the enemy within the boundaries of a U.S. military base.”

Added his mother: “We keep telling him to be strong. This kid needs to be around people who love him.”

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 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.