Friday, July 09, 2010

PTSD and the VA

Ed O'Keefe (Washington Post)reports on the VA's change for PTSD claims. The change will replace paperwork with medical screenings to determine PTSD. O'Keefe notes that, under the system being replaced, women had a difficult time having their PTSD recognized. From the article:

Women often face more skepticism about PTSD claims during visits to male-dominated VA medical centers, said retired Army Sgt. Carolyn Schapper.
"If you happen to go once and the first person you speak to questions the authenticity of your story, you're less likely to go back," she said. "That's true for men and women, but women are more likely to be questioned than men."

April 23, 2009, US House Rep John Hall chaired the House Armed Services Subcommittee on Disability Assistance and Memorial Affairs hearing. John Wilson (Disabled American Veterans) explained the struggle women in the military have as a result of the notion that they aren't 'in combat.' From his opening statement:

The female soldiers who accompany male troops on patrols to conduct house-to-house searches are known as Team Lioness, and have proved to be invaluable. Their presence not only helps calm women and children, but Team Lioness troops are also able to conduct searches of the women, without violating cultural strictures. Against official policy, and at that time without the training given to their male counterparts, and with a firm commitment to serve as needed, these dedicated young women have been drawn onto the frontlines in some of the most violent counterinsurgency battles in Iraq.
Independent Lens, an Emmy award-winning independent film series on PBS, documented their work in a film titled Lioness which profiled five women who saw action in Iraq's Sunni Triangle during 2003 and 2004. As members of the US Army's 1st Engineer Battalion, Shannon Morgan, Rebecca Nava, Kate Pendry Guttormsen, Anastasia Breslow and Ranie Ruthig were sent to Iraq to provide supplies and logistical support to their male colleagues. Not trained for combat duty, the women unexpectedly became involved with fighting in the streets of Ramadi. These women were part of a unit, made up of approsimately 20 women, who went out on combat missions in Iraq. Female soldiers in the Army and Marines continue to perform Lioness work in Iraq and Afghanistan.
I would like to highlight the issues faced by Rebecca Nava as she seeks recognition of her combat experience and subsequent benefits for resulting disabilities. Then US Army Specialist Nava was the Supply Clerk for the 1st Engineering Battalion in Iraq. In conversations with her and as seen in the film Lioness, she recounts several incidents. Two of those incidents are noted in my testimony today.
The first is the roll-over accident of a 5-ton truck that was part of a convoy to Baghdad. In this accident, the driver was attempting to catcuh up with the rest of the convoy but in doing so lost control of the vehicle. The five ton truck swerved off the road and rolled over, killing a Sergeant who was sitting next to her, and severely injuring several others. Specialist Nava was caught in the wreckage. She had to pulled through the fractured windshield of the vehicle. While not severly injured in the accident, she did suffer a permanent spinal injury.
Another incident occurred wherein she was temporarily attached to a Marine unit and her job for this mission was to provide Lioness support for any Iraqi women and children the unit contacted. It was a routine mission patrolling the streets of Ramadi. Before she knew it, the situation erupted into chaos as they came under enemy fire. She had no choice but to fight alongside her male counterparts to suppress the enemy. No one cared that she was a female -- nor did they care that she had a Supply MOS -- their lives were all on the line -- she opened fire. The enemy was taken out. During this fire fight she also made use of her combat lifesaver skills and provided medical aid to several injured personnel.
This and other missions resonate with her to this day. When she filed a claim with the VA, she was confronted with disbelief about her combat role in Iraq as part of Team Lioness. Specialist Nava filed a claim for service connection for hearing loss and tinnitus but was told that she did not qualify because of her logistics career field. Since she does not have a Combat Action Badge, she cannot easily prove that the combat missions occurred which impacted her hearing.

When you can't prove the service connection -- under the system set to be phased out on Monday -- you've got a disability or condition that the VA isn't going to rate you for. In the hearing last year, US House Rep Ann Kirkpatrick discussed the struggle veterans were forced into as they attempted to prove service connection:

Ann Kirkpatrick: I just spent two weeks in my district meeting with veterans and there's so much anger about how they're being treated by the administration and specifically with regard to PTSD. I've met with veterans who said that -- how difficult it was to show the service connection. One veteran in particular was a Vietnam veteran and he told me how painful it was to try to track down his patrol finding out that so many of them had died since their days in the service. I finally was able to locate someone across the country who was able to validate the service connection. The other problem is also the lack of trained mental health care professionals specific to PTSD in some of these communities. And again they said, 'Please take back to your community our request that we have trained mental health counselors in PTSD in the Veterans Administration' and how specific that is to their treatment in those who qualify. My concern, and my question is for you Mr. Wilson, for a veteran who has PTSD or thinks they have it and can't show the service connection, where do they go for treatment? What services are there for them?

John Wilson: It's a good question. While I was in the field, I also had veterans come through with the same issues -- Vietnam in particular, some WWII -- their entire team wiped out. So who did they go to for support for their particular claim? No letters -- as we were talking about here -- and the distinguished gentleman was providing letters still postmarked from someone overseas at the time, excellent evidence typically. Why that claim was denied, I am not sure. It would, I think normally, I hope, it would be granted. It's difficult circumstances as I say and I have encouraged those people to go back and meet with their reunion websites for people who may be part of that unit, who may be able to provide, perhaps, some other story of 'Yes, I saw Johnny there on that -- on that truck going to that combat zone all geared up.' Those kind of things may all be of benefit. But it is nonetheless very difficult and the fog of war? How is it that you're going to appoint a stenographer or a court reporter, a videographer to accompany each person on that combat? You cannot. It's very difficult circumstance. I would contend that the VA does have the means before it in order to grant those benefits by looking at the lay evidence that a veteran submits and looking at the times, places and circumstances of that particular event, they should in fact be able to grant the service connection. But it nonetheless is a problematic condition.

Ann Kirkpatrick: And for those people who can't -- can't show the connection, are there other places they can go for help?

John Wilson: Ma'am, I wish I could find those. None that I'm aware of.

Ann Kirkpatrick: Mr. Chairman, let me just make one other comment. I asked the veterans I was meeting with if they were concerned about people applying for PTSD treatment who may not really qualify and they said "No." No. The risk really is that those who need treatment are not going to seek it out because of the current system and they emphasized over and over again that they were promised medical treatment for life when they enlisted and that that promise has been broken.

Service Women's Action Network's Anuradha K. Bhagwati notes:

Part of this ignorance results from male bias, but the rest is due to the Combat Exclusion Rule that precludes women from direct ground combat — even though commanders are knowingly violating this policy overseas. It's a policy that needs to be revised immediately, in part because it's too easy for a claims officer from Veterans Affairs to assume a woman is presenting a fraudulent claim for a combat-related wound or injury.

She also points to serious flaws in the changes and does so as part of variety of views the New York Times offers on this topic.

Bhagwait has regularly appeared before Congress to address the discrimination in veterans care. July 16th, she testified at a hearing chaired by US House Rep John Hall and we'll note this exchange:

Chair John Hall: Thank you. And Ms. Bhagwati, is the lack of legal representation more determental to women when their claims are the result of a crime?

Anuradha Bhagwati: I'm sorry, sir, the lack of legal work?

Chair John Hall: Legal represenation.

Anuradha Bhagwati: Absolutely, sir. I'm finding that, without the assistance of an attorney, many of those legal claims would be left behind. It takes a lot of courage, stamina, finacial assistance for a veteran -- either male or female -- to pursue an appeal or reconsideration of a claim. A lot of pride and a lot of issues wrapped around a veteran's identity go into the claim process and when a claim is rejected by the VA -- even when the claim is deemed to be sort of sufficient to get an awarding of compensation -- when that denial happens, it can be life shattering. And many veterans, both male and female, just fall off the map.

Chair John Hall: I understand more all the time as we have these hearings about the issues surrounding reproting problems with MST, but what about domestic violence that takes place while the wife is on active duty? How are those instances of PTSD or other disabilities resulting from those injuries adjucated by the VA?

Anuradha Bhagwati: Sir, that remains to be seen. I think a lot of data as both the congressman and Ms. Halfaker pointed out has not been collected on domestic violence in particular. Right now, I can tell you anecdotally, we're working on a case in the marine corps with a -- an NCO who's going through through a commissioning program whose partner spent five days in jail for attempting to kill her and that partner who spent five days in jail is now at Officer Candidate School. So that shock factor -- it's almost unbelieveable that that can happen but there are ways around the system. And DoD needs to explore that.

Kat also covered that hearing and noted, "Anuradha Bhagwati explained that some of these facilities require two months of intensive therapy and while that's astounding therapy that's being provided, it's also true that some working women can't take two months off and it's also true that some female veterans have children and are the only one who can take care of them. They can't afford to leave their kids for two months and head off for treatment."

The following community sites updated last night and this morning:

We'll close with Sian Ruddick's "Exclusive: the story of the British soldier jailed for turning against the Iraq war" (Great Britian's Socialist Worker):

Ross Williams is 22 and from Neath in South Wales. He joined the army in 2007 and was sent to Iraq in 2008. Ross went absent without leave (Awol) for one and a half years and was sentenced to nine months in Colchester military prison. He was released last week and spoke to Siân Ruddick.

“I think the wars in Iraq and Afghanistan are wrong. These wars are illegal and we shouldn’t be out there,” says Ross.

“The people at the top are risking the lives of others when we shouldn’t even be there.

“Troops are coming back destroyed and devastated. The military and the government just use people up.

“Soldiers’ careers and lives are ruined by what they have seen and what they’ve been put through.


“I joined the army because there is nothing here in Neath, no jobs and no future.”

“It seemed like a very tempting offer. I went down to the careers office and they sold me the world. But it was a load of bollocks.

“In the recruitment office, they get bonuses for recruiting people to their department, even if it’s not suitable.

“The guy who was in there when I went was from the artillery, so that’s what I got signed up to.

“I was operating an AS90 155mm self-propelled gun in Basra. The training before I went was appalling. On the plane there were a few of us on our first tour and I began to realise we were not prepared. There are loads of boys out there who don’t know what they’re doing.

“Attacks and live rounds were common place.

“At the base in Basra, where most of the British soldiers were based, there was ammunition being fired into the camp. We’d have to jump up and take cover.

“I injured my knee when we were on patrol. We came under live fire and I was jumping down from the vehicle because you’re supposed to just get down.

“The guy behind me was scared and untrained—he pushed me off and I landed on my knee.

“This was early December 2008. I’d hurt my knee before and wasn’t really fit for Iraq but the army didn’t care.

“I spent two weeks in hospital and it was the worst time of my life.

“One day two Gurkhas was brought in with shrapnel wounds. They couldn’t move from their beds.

“An attack began and every­one got under their beds. I could tell the rounds were landing very close. I looked up and could see that the Gurkhas couldn’t move. So I got up and took my body armour and lay it on one of them.

“I got back under my bed and could see an officer under the table. I shouted across to him, ‘do the same, give someone your jacket’. He said, ‘No, you have to look after number one.’

“He didn’t care about anyone but himself. I was there, trying my best and this officer just didn’t care.

“I lost all my confidence at that moment, with the army.

“We were supposed to be helping people in Iraq but we were just making a mess.

“I was sent home when I came out of hospital and was flown into Brize Norton RAF airbase.

“I should have been met by an army official and be checked out in a military hospital.

“But no one met me. It was 3am and I had to call my parents to pick me up. They had to drive for over four hours to get me. The army abandoned me.

“My head was messed up, I’d just come out of a fight zone into civilian life with no support whatsoever.

“They were supposed to set up physiotherapy for me. But I ended up having to drive myself to my first appointment with an injured knee.

“I crashed the car that day because I couldn’t press the brake.


“That’s when I hit my limit, my breaking point and went Awol. I thought, ‘I can’t risk my life for this shower of shit.’

“It’s always in the back of my mind, I get nightmares and have flashbacks to Iraq. I keep questioning why I did it, why I put myself through it.

“When I was Awol, it drove me to money problems and all sorts. In the end the past caught up with me.

“I had a court martial and served four and a half months in prison. There were other young guys in the court that day for going Awol.

“The outside world doesn’t always get to hear about them but there are quite a few soldiers going Awol.

“Before sentencing I was told by an army CPN [community psychiatric nurse] that I might have Post Traumatic Stress Disorder.

“In prison I tried to get seen by the nurse but they cancelled the appointments. They said they were treating me the best they could, but it was a nightmare.

“I felt totally alone and had no one to turn to. One day the medic came around and gave me someone else’s medication.

“I didn’t feel safe in there. No one had a clue or cared.

“I couldn’t believe this was what I got in return, after I’d given them everything. I want to do meetings and stand up against the army. Now I’m out I want to ruin them.

“After I served my sentence I was just thrown back onto the street.

“I feel so distant, I’m not Ross any more. I can’t stop thinking about it all.

“When I was getting on the train back from prison some guy stopped me and asked me if I’d been in MCTC [Military Corrective Training Centre].

“He said people like me should be shot for being cowards. I just said, ‘You don’t know what you’re talking about, you get all this from the media but the truth is different.’

“Now I want to clear my head and get a job and move on.

“I’m not getting any help or treatment from the army, they don’t give you any back up. I’ve just got to carry on with my life.

“I’ve been betrayed by the army—and it’s certainly not what is advertised to the public.

“When people die they get talked up, but these generals and government ministers don’t give a shit about us. It’s not their kids being killed.”

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thomas friedman is a great man

oh boy it never ends