Veterans for Common Sense

November 10, 2008, El Paso, TX – Post-traumatic stress disorder (PTSD) has received a significant amount of attention as a result of recent reports outlining the increasing number of men and women returning from war zones with PTSD.

PTSD is an anxiety disorder associated with a dramatic event in which the person experiences the threat of death or serious injury.

In spring 2007, the RAND Center for Military Health Policy Research reported that of the 1.64 million military service members deployed to war zones, 14 percent have screened positive for PTSD and another 14 percent for major depression.

However, the disorder is not limited to soldiers in war zones. In the United States, the most common cause for PTSD exposure is automobile accidents. According to the National Highway Traffic Safety Administration, about 2.5 million people are injured in automobile accidents annually. It is estimated that about 20 percent of those in automobile accidents suffer from the disorder.

PTSD is a biological disorder which can be manifested from exposure to excessive levels of stress. Basically, the body’s stress response system is overloaded.

Symptoms of PTSD include insomnia, nightmares, flashbacks of the traumatic event, startling easily, avoiding a situation that reminds the individual of the traumatic episode, difficulty in concentrating, emotional withdrawal, aggression and irritability.

According to a recent study by the Geisinger Health Systems, Vietnam veterans with a history of PTSD had a Post-traumatic stress disorder (PTSD) has received a significant amount of attention as a result of recent reports outlining the increasing number of men and women returning from war zones with PTSD.

PTSD is an anxiety disorder associated with a dramatic event in which the person experiences the threat of death or serious injury.

In spring 2007, the RAND Center for Military Health Policy Research reported that of the 1.64 million military service members deployed to war zones, 14 percent have screened positive for PTSD and another 14 percent for major depression.

However, the disorder is not limited to soldiers in war zones. In the United States, the most common cause for PTSD exposure is automobile accidents. According to the National Highway Traffic Safety Administration, about 2.5 million people are injured in automobile accidents annually. It is estimated that about 20 percent of those in automobile accidents suffer from the disorder.

PTSD is a biological disorder which can be manifested from exposure to excessive levels of stress. Basically, the body’s stress response system is overloaded.

Symptoms of PTSD include insomnia, nightmares, flashbacks of the traumatic event, startling easily, avoiding a situation that reminds the individual of the traumatic episode, difficulty in concentrating, emotional withdrawal, aggression and irritability.

According to a recent study by the Geisinger Health Systems, Vietnam veterans with a history of PTSD had a 50 percent chance of dying from heart disease in their 50s compared to those veterans without the disorder. Many individuals with PTSD delay treatment and thus may manage their symptoms with drugs and/or alcohol.
Treatment of PTSD includes exposure therapy, stress inoculation training, cognitive therapy, eye- movement decentralization and reprocessing, psychodynamic and group therapy. Some doctors may prescribe psychiatric medication, such as Zoloft and other selective serotonin re-uptake inhibitors.

All of these treatment procedures have a level A of effectiveness, meaning the treatments have been shown to be successful in randomized clinical trials.

To help its returning war-zone veterans overcome PTSD, the Department of Defense has earmarked more than $300 million for research on the disorder and brain injuries. The Veterans Administration also has designated significant resources to the treatment of former service members who may have suffered these conditions.

The key to a more successful outcome is early recognition and treatment. In El Paso, the military has treatment programs available for active-duty personnel.

Dependents and retirees are eligible to receive care under the Tri-Care insurance program. Retirees also can receive care at the Veterans Administration facility.

PTSD should be considered a stress injury and care should be sought as soon as symptoms begin to emerge.

“Opening a larger facility in Austin is very good for our veterans and their families,” Sullivan said, “especially given the increase in demand for care due to patients from all wars flooding into VA.”  

November 11, 2008 – As he leaned against a pillar in front of Austin’s veterans clinic, Larry Martino needed maybe a second to absorb news that a new clinic is in the works.

“Good,” said Martino, a 60-year-old Vietnam War veteran with thick glasses, a University of Texas T-shirt and a cane that helps him walk on a recently replaced knee. “I’ve been coming here two years now, and I’ve seen a huge increase in the number of patients. They don’t have enough space; even the doctors don’t have enough space.”

Other patients reacted similarly to word that the federal Department of Veterans Affairs , which runs the Austin clinic, is planning to build a new facility to deal with the area’s growing population of veterans, whose contributions will be celebrated today, Veterans Day.

About 21,000 veterans from 10 counties now seek medical care at the Southeast Austin clinic, a one-story building that sits where East Oltorf Street dead-ends at Montopolis Drive.

By 2025, that number is expected to reach 30,000.

The VA has set aside $18.5 million for a new clinic, which local officials said was secured by Rep. Lloyd Doggett, D-Austin. The new clinic will be about three times as large as the Montopolis building, which will still be used by the VA. The new clinic is scheduled to open in 2012.

The VA is deciding between two Austin locations. Local officials said they could not release specifics until one is selected in December; regardless, plans call for it to be the largest VA clinic in the nation.

Most surgeries and overnight stays will still be handled 68 miles north of Austin, at the VA hospital in Temple, which is the hub of the VA’s Central Texas arm because of its proximity to Fort Hood. But the new Austin clinic will allow the addition of some new services, VA officials say.

The Montopolis facility is crowded. Cars sometimes park in the grass, and before some building renovations freed up space, patients at times had to circle for 45 minutes in the morning looking for a spot. Tandy Kinard, one of the clinic’s patient advocates, said the scramble among staff to find work space is sometimes resolved by time sharing.

The clinic is also seeing a range of new issues. The World War II veterans are dying, but a wave of Iraq and Afghanistan war vets now rely on the VA. As of May, about 837,000 troops who had left the military had served in the Iraq and Afghanistan wars, and 39 percent had already sought VA care, according to a VA report obtained by advocacy group Veterans for Common Sense.

The report concluded those numbers will rise, although no one can say with certainty by how much.

Ryan Crunk, a 26-year-old Iraq war veteran from Kerrville, is among those who could be seeking VA care for decades. Now an Austin Community College student with plans to attend Texas A&M University, Crunk registered with the Austin clinic Friday, talking as a nurse wrapped an elastic band around his arm and began drawing blood.

“They got me in quick,” said Crunk, who spoke in a deep voice and shook hands with a vise-like grip. He wore a trim red-brown beard, camo shorts and sandals, one of which was strapped to the plastic foot at the end of his prosthetic right leg. He chose the prosthetic after doctors could not repair the damage caused by a nail-covered grenade that tore into his leg on the day of Iraq’s first post-Saddam Hussein election, in 2005 .

“I have zero complaints with the health care I’ve received,” Crunk said, including the year he went to the VA’s Kerrville clinic. “Everything I’ve needed, from psychological help to physical pain relief, I’ve gotten.”

Paul Sullivan, a VA critic and head of Veterans for Common Sense, said the new clinic is a needed step.

“Opening a larger facility in Austin is very good for our veterans and their families,” Sullivan said, “especially given the increase in demand for care due to patients from all wars flooding into VA.”

Austin clinic director Greg Vrentas could not say what the average wait time is at the Austin clinic. But Vrentas, a retired Special Forces operative who oversaw the rebuilding of medical facilities in Afghanistan, said every patient gets an appointment within 30 days , as the VA requires. He said the new facility will help cut wait times and expand services.

“Whatever way a vet needs help,” Vrentas said, “we try to provide it.”

To free up space, Vrentas had the clinic’s mental health unit moved recently to the Southgate building, at Oltorf Street and Interstate 35. The move created room for a women’s clinic, which is scheduled to open in a few weeks.

Women now make up about 15 percent of the fighting force and 14 percent of the veteran population. Minnie Bowie-Garcia , the Austin clinic’s women’s program coordinator, said 1,800 women in Austin have enrolled with the VA.

The VA has also started a home care program that tends to patients across Central Texas who are too frail or otherwise incapable of regular clinic visits. It cares for 34 patients now and should have about 800 in two years, said Tim Reese, the program coordinator.

“This is not your father’s VA,” said Reese, a retired colonel who served 24 years in the Army Nurse Corps .

The Central Texas arm of the VA has had ups and downs proving that point. A recent study of VA regions ranked Central Texas 118th out of 139 in patient satisfaction. Norma Perez, a post-traumatic stress disorder coordinator in Temple, also drew a congressional inquiry after advising mental health workers in a memo to “refrain from giving a diagnosis of PTSD straight out” because “we really don’t have time to do the extensive testing that should be done to determine PTSD.” And the Central Texas VA still has not determined what to do with Dr. Robert Van Boven , a VA researcher working at the University of Texas who alleges that the VA wasted millions of brain injury research dollars and says his superiors are trying to fire him for petty reasons.

But by some measures the Central Texas system’s care has improved dramatically. In 2006, it opened a world-class hospital in Waco that specializes in treating patients who suffer from post-traumatic stress disorder. Four years ago , the VA ranked Central Texas 126th in overall care. Last year, despite low patient satisfaction numbers, Central Texas ranked 31st in overall care and first in accessibility.

The disparity was evident in the reactions of Callie Bradford, 54, and her father, Frank Walker, 91, who had just been prescribed medicine to lower his blood pressure.

“It’s wonderful” that the VA is planning a larger clinic, Bradford said. She said the staff is sometimes impolite, possibly as a result of the cramped quarters, and added that “maybe with a larger building, you won’t have people so crowded there’s nowhere to sit.”

“Don’t focus on the negative,” said Walker, a retired pastor and World War II veteran, patting his daughter gently on the hand. “I’m leaving (the clinic) with great joy in my heart. My health has been meticulously cared for.”

November 10. 2008 – The War in Iraq has disappeared from the headlines. The ongoing economic crisis has Americans looking inward, wondering if they can keep their homes and their jobs, with little interest in death and destruction half a world away. According to the Pew Research Center, media coverage of the war has plummeted from an average of 15 percent of stories in July 2007, to 3 percent this February, to just 2 percent of stories during the last week of October.

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The war also disappeared as an issue in the presidential campaign. Both Barack Obama and John McCain barely mentioned the war in Iraq in their final debate. In his historic victory speech, Obama said “Iraq” only once. Some say the election results show Americans demanding a “change,” and in many ways they do. But they also show a collective desire to forget.

Most Americans want to put the war behind them, but this feeling is based not on a coherent critique but on a kind of collective exhaustion. In many ways, we as a country find ourselves in a mood like the one towards the end of the Vietnam War: we are tired and simply want to move on and forget the conflict ever happened.

Yet this feeling can come at a great cost, because it is this same dynamic that led to the betrayal of more than three million Vietnam veterans.

“When I go through airports I see soldiers just sitting up against a wall…by themselves,” says therapist and Vietnam veteran Shad Meshad, who heads up the National Veterans Foundation. “No one goes up to them; that positive energy toward them has faded. No one is spitting or shouting, but they’re still left with the fact that they’re responsible for what they did or didn’t do, and they’re supposed to think about that alone.”

Given the experience of Vietnam vets, Meshad believes that the American people ignore their veterans at their own peril. According to the Department of Veterans Affairs, eighteen veterans commit suicide every day and 200,000 sleep homeless on the streets on any given night. By 1986, the National Vietnam Veterans Readjustment Survey reported that almost half of all male Vietnam veterans suffering from post-traumatic-stress disorder had been arrested or jailed at least once–34.2 percent had been jailed more than once, and 11.5 percent had been convicted of a felony.

“We’re going to repeat that same thing, I can sense it,” Meshad says, “if we don’t take action and Congress doesn’t create services to help these folks over the next ten or fifteen years.”

Indeed, there are already many signs that history is repeating itself. Consider the implications of an April 2008 survey by the Rand Corporation; it found that a majority of the 300,000 Iraq and Afghanistan veterans suffering from post-traumatic-stress disorder and of the 320,000 with traumatic brain injury are not receiving help from the Pentagon and VA medical systems. In its study, Rand noted that the federal government fails to care for war veterans at its own peril–noting PTSD and TBI “can have far-reaching and damaging consequences.”

“Individuals afflicted with these conditions face higher risks for other psychological problems and for attempting suicide. They have higher rates of unhealthy behaviors–such as smoking, overeating, and unsafe sex–and higher rates of physical health problems and mortality. Individuals with these conditions also tend to miss more work or report being less productive,” the report said. “These conditions can impair relationships, disrupt marriages, aggravate the difficulties of parenting, and cause problems in children that may extend the consequences of combat trauma across generations.”

“These consequences can have a high economic toll,” the report continued. “However, most attempts to measure the costs of these conditions focus only on medical costs to the government. Yet, direct costs of treatment are only a fraction of the total costs related to mental health and cognitive conditions. Far higher are the long-term individual and societal costs stemming from lost productivity, reduced quality of life, homelessness, domestic violence, the strain on families, and suicide. Delivering effective care and restoring veterans to full mental health have the potential to reduce these longer-term costs significantly.”

There is hope in this story, though.

When Barack Obama takes the oath of office on January 20, America will have a President who has shown an interest in and commitment to caring for America’s veterans. As a senator, Obama supported increased funding for the VA and an expanded GI Bill. His campaign platform sounded all the right notes about increasing the number of mental health providers, reforming the government’s bureaucratic disability-claims system, and increasing the number of Vet Centers, where returning veterans can find community as they make the difficult transition from war to civilian life.

But taking those steps will require hard work and support from the public that amounts to more than just lip service to “supporting the troops.” We must stay engaged on the issue of Iraq and our government’s treatment of its veterans and create an atmosphere where a repeat of the tragedy that followed the Vietnam War will not be tolerated. If we don’t, Barack Obama may follow our lead and rush quickly past the veteran who’s sleeping homeless on the street.