Friday, June 22, 2012. Chaos and violence continue as Iraq is slammed with bombings, Moqtada's bloc doubts Nouri al-Maliki has a long range plan for Iraq, Secretary of Defense Leon Panetta makes some important remarks, the VA's fiduciary system gets some attention, and more.
March 21st, Iraq War veteran Captain Ian Morrison called the military suicide hotline and
waited for over one hour to speak to someone before killing himself. Steve Vogel (Washington Post) reports his widow Rebecca Morrison joined with other surviving spouses to share their stories of loss at a VA and Defense Dept cofnerence in DC following the record number of military suicides so far this year (in 2012's first 155 days, 154 active-duty service members have taken their own lives. His wife Rebecca Morrison shares his story with Steve Vogel (Washington Post) who also quotes Secretary of the VA Eric Shinseki wondering, "Are we asking the right questions about sucides?" He notes that, in 2009, 'experts' were saying "mental illness was the leading cause of homelessness, and we have since learned that it is, more specifically, substance abuse." Secretary of Defense Leon Panetta spoke on the issue (link is video). His remarks on the concluding day of the conference included:
First of all, this is always critical when it comes to an operation like the Defense Department and to our military forces…leadership responsibility. We are directing military leaders to take this issue head on. Like almost every issue in our military, progress on suicide prevention depends on leadership.
I have made that clear, that this issue is first and foremost a leadership responsibility.
All those in command and leadership positions – particularly junior officers and NCOs who have day-to-day responsibility for troops – need to be sensitive, need to be aware, need to be open, to signs of stress in the ranks, and they need to be aggressive, aggressive, in encouraging those who serve under them to seek help if needed. They also must set an example by seeking help themselves if necessary.
As part of their leadership responsibilities, junior officers and NCOs must foster the kind of cohesion and togetherness that is a fundamental part of our military culture and can do so much to improve mental health. My wife was a nurse, worked on mental health care issues, and she said to me time and time again, this is a human issue, a human problem. You've got to look in people's eyes, you've got to be sensitive to their emotions, you've got to be sensitive to the challenges that they're facing, you've got to be aware, you've got to have your eyes open, and the more we can see those problems, the more we can do to try to help people in need. To that end, we have to make clear that we will not tolerate, we will not tolerate actions that belittle, that haze, that ostracize any individual, particularly those who have made the decision to seek professional help.
Leaders throughout the Department must make it understood that seeking help is a sign of strength, not a sign of weakness, it is a sign of strength and courage. We've got to do all we can to remove the stigma that still too often surrounds mental health care issues. Outreach efforts such as the Real Warriors Campaign, which work to increase awareness and the use of resources such as the Military and Veterans Crisis Lines, are also a very important part of these efforts.
Secondly, we've got to do everything we can to improve the quality and access to health care. This is the second pillar of the suicide prevention strategy – improving the quality of behavioral health care, expanding access to that care.
We now have more than 9,000 psychiatrists, psychologists, social workers, mental health nurses, counselors working in military hospitals and in military clinics. That number has increased more than 35 percent over the last three years. Behavioral health experts are now being embedded into line units, and the Department has worked to place mental health providers in primary care clinics in order to facilitate access.
Guardsmen and Reservists often do not have ready access to the same support network as the active duty force. We've got to do what we can to increase initiatives like the Yellow Ribbon Reintegration Program that's working to address this kind of problem.
And going forward, I want to make sure that all service members and their family members have the quality mental and behavioral health care that they need, the kind of care that must be delivered by the best health care professionals in the world. Thanks to the efforts of so many of you in this audience, we are improving our ability to identify and treat mental health care conditions, and we are working to better equip our system to deal with the unique challenges that these conditions can present. For example, I have been very concerned about reports of problems with the screening process for post-traumatic stress in the military disability evaluation system. For that reason, I have directed a review of this process across all of the uniformed services. This review will help ensure that we are delivering on our commitment to provide the best care for our service members. We've got to do everything we can to make sure that the system itself is working to help soldiers, not to hide this issue, not to make the wrong judgments about this issue, but to face facts and deal with the problems upfront, and make sure that we provide the right diagnosis and that we follow up on that kind of diagnosis.
Thirdly, we've got to elevate the whole issue of mental fitness. A third pillar of suicide prevention is better equipping service members with training and coping skills that they need to avoid or bounce back from stress.
To that end, all of the Services, all of the Services – under the leadership of General Dempsey and his Senior Enlisted Advisor, Sergeant Major Bryan Battaglia – are working to elevate mental fitness to the same level of importance, we've got to elevate mental fitness to the same level of importance that DoD has always placed on physical fitness.
Separately, a whole of government effort that has been led by the President and Mrs. Obama to combat veterans' unemployment and boost hiring of military spouses is aimed at helping to reduce the financial stress faced by military families and veterans.
Finally, fourthly, we've got to increase research in suicide prevention. In partnership across government and with the private sector, the fourth pillar of our approach is to improve our understanding of suicide, to improve our understanding of related mental health care issues through better and more improved scientific research. I'd like to note the leadership of Health and Human Services Secretary Kathleen Sibelius on this issue and thank her for coming to address this conference earlier.
I think it's an important speech and hopes the press will pay attention to it. (Click here to read it in full.) I know Leon and I like Leon so he doesn't get a fair shake here. This morning we called him out with regards to statements he made and I don't have a problem with that but he made some historic and important remarks (click here for video) last week and we were too busy to note it. Anyone else would have gotten their deserved attention for those remarks but I always want to be sure that I'm fair with regards to him because I do like him and I've known him for years. And factor in all of that because what he said in the speech today needed to be said. But no one in leadership has wanted to say it. If words are followed up by the brass immediately below Panetta, this should be a historic shift regarding suicide and mental health issues in the military. As with his remarks earlier this year on sexual assault within the military (click here for January 19th snapshot if you missed it), he said was needed and should have been said long before. But he's the first Secretary of Defense to say these things. The National Suicide Prevention Lifeline is 1-800-273-TALK.
P.T.S.D. is an anxiety disorder that can occur after a traumatic event. Given that troops deployed to Afghanistan and Iraq see fallen comrades, experience combat, or survive horrific events, the likelihood of a veteran being diagnosed with P.T.S.D. is high. According to the Department of Veterans Affairs, someone with P.T.S.D. is at least twice as likely to commit or attempt suicide, or experience substance abuse. Tens of thousands, if not hundreds of thousands, are suffering from alcoholism and drug abuse, depression or mood disorders, according to a 2010 report by the Coalition for Iraq and Afghanistan Veterans.
The Center for a New American Security discusses the stigma in the service associated with mental health treatment. In a study on the rising suicide rate in the military, the organization found that troops were two to four times more interested in receiving care than reported but were afraid of repercussions from their superiors. That same fear initially kept me from getting treatment. But I finally sought help. My superiors met me with neither resistance nor support. It felt like I lost their respect, that they forgot who I was and what I had done for the Marine Corps during my tours in Iraq and Afghanistan.
P.T.S.D. is something that some in the military do not accept or understand. Unlike physical wounds, it is invisible, intangible. I once heard a senior Marine say P.T.S.D. was "fake." In a way this makes sense for a military institution that prides itself on toughness and resilience in the face of adversity. But the time has come to realize that all battlefield wounds must be healed.
And Senator Patty Murray, who is the Chair of the Senate Veterans Affairs Committee, has been calling for answers as to how some service members and veterans were diagnosed with PTSD but then were given new diagnoses and suddenly they didn't have PTSD -- except most of them still did. So who ordered the change and was someone trying to cut out needed treatment to save a few bucks? As she gets more answer on what recently happened, she's now insisting that the scope be expanded to see who else was effected. Wednesday her office issued the following:
(Washington, D.C.) – Today, U.S. Senator Patty Murray (D-WA), Chairman of the Senate Veterans' Affairs Committee sent a letter to Defense Secretary Leon Panetta to request details on how the Department of Defense will conduct amajor review of mental health diagnoses made since 2001. The review, which Secretary Panetta announced last week at a hearing with Senator Murray, comes after Murray has repeatedly pointed to inconsistencies in the Pentagon's mental health evaluation system. In Washington state, those inconsistencies have led to hundreds of service members having their proper diagnosis of PTSD restored after being accused of lying about their symptoms.
"The Department of Defense and the Department of Veterans Affairs are losing the war against mental and behavioral health conditions," Murray wrote. "As you acknowledged, huge gaps remain in how both the Departments of Defense and Veterans Affairs approach, diagnose and deal with these cases. A review across each service is a necessary step forward in addressing concerns I have been raising about both the disability evaluation system and the diagnosis and treatment of behavioral health conditions."
In the letter Murray outlines four key issues the Pentagon must consider in proceeding with the review, including one about the timeline for this massive review. Murray also calls on Secretary Panetta to "clearly communicate the scope of the review as well as the impact on individual servicemembers and veterans."
The full text of Senator Murray's letter follows:
June 20, 2012
The Honorable Leon E. Panetta
Secretary of Defense
1000 Defense Pentagon
Washington, DC 20301
Dear Secretary Panetta:
As I stated during the Senate Defense Appropriations Subcommittee hearing on the Department of Defense FY 2013 Budget Request, the Department of Defense and the Department of Veterans Affairs are losing the war against mental and behavioral health conditions. The recent events at Madigan Army Medical Center, where hundreds of soldiers have had their proper diagnosis of PTSD restored after being told they were exaggerating their symptoms, lying, and being labeled malingers, demonstrate the weaknesses within the Department of Defense in properly evaluating and diagnosing behavioral health conditions.
As you acknowledged, huge gaps remain in how both the Departments of Defense and Veterans Affairs approach, diagnose and deal with these cases. I was pleased to see you share my belief that a review of behavioral health evaluations and diagnoses in support of the disability evaluation system needs to be a Department led effort. A review across each service is a necessary step forward in addressing concerns I have been raising about both the disability evaluation system and the diagnosis and treatment of behavioral health conditions. I applaud your commitment to undertake this comprehensive review, however, I have questions about how the Department will proceed.
·Has the Department developed or provided guidance to the services in order to accomplish this review? If so, I would request copies of any guidance that has been developed or issued.
·What is the timeline for execution of this review? When do you expect the other services to begin this review and when do you expect findings and recommendations from each of the services?
·Which senior leaders at the Department and each service will be responsible for conducting this review and the development and implementation of recommendations?
·How will the Army's current review be incorporated into this broader effort?
As the review begins, the Department of Defense must clearly communicate the scope of the review as well as the impact on individual servicemembers and veterans. Appropriate steps must also be taken to ensure the performance of this review does not adversely impact the timeliness of cases currently processing through the disability evaluation system.
Ensuring greater consistency in the evaluation and diagnosis of behavioral health conditions is not the only challenge currently confronting the Integrated Disability Evaluation System (IDES). As highlighted by a recent Senate Veterans' Affairs Committee hearing I held on IDES, the number of men and women enrolled in this system continues to climb, the number of servicemembers cases meeting both of the Departments' timeliness goals is unacceptably low, and the amount of time it takes to provide benefits to a servicemember transitioning through the system has risen each year since inception. Both Departments must take immediate action to reverse these trends.
Following a recent discussion with Deputy Secretary Carter on these issues, I outlined a series of recommendations to improve the disability evaluation system. The letter to Deputy Secretary Carter dated June 6, 2012 outlining these recommendations is enclosed, and I urge you to act quickly to implement these solutions. I appreciate the opportunity, which you offered at the Defense Appropriations Subcommittee hearing, to discuss these issues with Secretary Shinseki and you in the near future, and I look forward to hearing your recommendations about how we can improve this system.
I appreciate your attention to this request and I remain committed to working with you to address these very serious issues.
That was released on Wednesday and we're staying on Wednesday for a moment.
Chair Bill Johnson: H.R. 3730, the Veterans Data Breach Timely Notification Act, was introduced by our Subcommittee's Ranking Member, Congressman Donnelly of Indianana. His bill would require the VA to notify Congress and directly affected individuals, within 10 business days or less, of a data breach that compromises sensitive personal information. This imporved transparency and responsiveness would be a boost to the VA's efforts at improving its information security image. As the system currently works today, the lapse of time between the VA knowing of a data breach and a veteran knowing his or her information has been compromised and may be floating around is entirely too long. In discussions with staff, Assistant Secretary Baker acknowledged that the current duration between the VA learning of a data breach and a veteran being notified that his or her personally identifiable information, or "PII," may have been compromised could be shortened, and this legislation is a good measure toward that end. I am proud to co-sponsor this bill. I urge my colleagues to consider adding their support and look forward to Ranking Member Donnelly's further remarks on it.
Wednesday the House Veterans Affairs Subcommittee on Oversight and Investigations held a hearing on proposed legislation. (Yesterday the House Veterans Affairsl Subcommittee on Economic Opportunity and a section of it was covered in yesterday's snapshot.) That was one of four important bills that were addressed. Another important one was H.R.5948. This is the fiduciary bill. On February 9th, this same Subcommittee held a hearing on VA's fiduciary system. We coverd aspects of that in that day's snapshot and I had no idea it was as big an issue as it was. That snapshot resulted in a ton of e-mail then and since and we still get e-mails asking, "Has anyone mentioned fiduciary again?" I'm hardly the smartest person in the room so I'm not surprised that I had no clue on this one's importance. But I think it's also true that this isn't necessarily an issue that you're going to have veterans showing up at hearings to talk about because if they have someone overseeing their benefits, there's usually a reason for that. So this is a veteran's issue but it's one that's more likely to catch attention from veterans' families. Chair Johnson did raise the issue while questioning the VA's Director of Pension and Fiduciary Service Dave McLenachen and we'll include some of that exchange.
Chair Bill Johnson: I find it interesting that you used the term working constructively together on the fiduciary program because at our hearing on the VA's fidcuiary program in February, you said you intended to look at the statutes governing the fiduciary program and make recommendations that might improve it. Outside of the testimony that you've given today, four months later we haven't heard anything from you or your Dept. Currently, our bill addresses a number of issues we brought to your attention and yet you're against these. After the issues raised at the February hearing and the recent media coverage of fiduciary issues, I would think that you would have some ideas on how to improve the program. Can you provide for us improvements in the fiduciary program that you've made since our February hearing?
Dave McLenachen: Well sir, in addition to the -- the policy and procedures that we've issued even since the February hearing, as I mentioned, we've completed our proposed fiduciary recommendations. Now as we were working on those recommendations, we determined that there was different authority that we needed from Congress, we would certainly develop a legislative proposal for that purpose. But I have to say, having worked on those regulations and looking at the authority that we have, we believe we have the authority we need to correct the program. And all of the things that we do support in the bill are things that we have implemented ourselves, like I said, over the last seven months. I believe we are making real progress.
Chair Bill Johnson: You mentioned that you've completed the regs and that you have the authority to implement the program, but you didn't really answer my question. Can you describe some specific improvements that you've made in the fiduciary program since February?
Dave McLenachen: Yes, sir. One of the concerns of the Committee was the independence of the fiduciary. We had a policy in place that required a fiduciary to check with VA, as you mentioned the form. Well it wasn't just the form, we had a policy in place that required a fiduciary to check with VA for any expenditure over $1,000. I rescinded that policy. That was since the hearing. In addition to that, there's concern about transparency in the program. We have never provided veterans with copies of audited accounting by VA. I changed that policy. Every -- every fiduciary is instructed to provide a copy an audited true accounting by VA to the beneficiary. Criminal background checks. We have contracts in place to do a criminal background check on every fidicuiary we appoint. There's a number of other developments, sir, that I could go through with you but we are making progress in this program.
Chair Bill Johnson: That would have been great. We would have liked to have gotten that information before today. But that's good. Based on recent articles about nationwide problems in the fiduciary program, it seems that there's been little improvement other than the things that you mentioned today. Do you have any further response to the media reports of the numerous and horrific stories in those stories?
Dave McLenachen: Yes, sir. I disagree with the view that the fidcuariy program is plagued with fraud. I am aware of those articles and it is our position that any misuse of VA benefits is unacceptable. That's our position. And we work hard to prevent that type of misuse. That's the reason why we do over 30,000 accounting audits every single year. That's the reason why we do 70,000 or more field examinations every year. So we work hard to prevent misuse and we've been very successful. I testified in February that our misuse rate during Fiscal Year 2011 was less than one-half of one-percent. Looking at the articles, sir, I think, in reality, the articles are about a broader problem and that is general abuse of veterans. We looked at the cases that were mentioned. In the state of Texas, 6.5% of our beneficiary population in our program live in Texas. Yet the misuse rate in Texas is only 4.4% compared to all of the cases. So while the articles may have been reporting the broader problem of misuse, I don't think that we've been able to confirm that it points out a specific problem about the fiduciary program. And, that said, that doesn't mean we're going to ease up on misuse of benefits.
Chair Bill Johnson: The VA opposes the provision that would authorize the VA to limit the appointment of a fiduciary to management of VA funds. The VA contends that the purpose of this provision is unclear and probably unnecessary because the VA appoints fiduciaries only for the limited purpose of receiving VA benefits on behalf of a beneficiary. However, I have VA e-mails that direct a VA representative to take control of non-VA funds. Why the difference between your actions and your comments on the legislation?
Dave McLenachen: Mr. Chairman, I'd be interested to see -- to see the information that you have about that. Congress has authorized us to appoint fiduciaries for the purpose of VA benefit funds under management. That's what we have authority to do. Now there may be some disconnect about the accounting process. When we do an accounting, we need to see all income and expenses in accounts and sometimes in those accounts there is other income such as, for example, Social Security benefits.
Chair Bill Johnson: So you would find it inappropriate for a VA representative to take control of non-VA funds?
Dave McLenachen: Yes, sir. Without knowing more about the facts of the case, I would say, yes, I would.
Chair Bill Johnson: We will provide you with that information.
Dave McLenachen: Thank you.
Chair Bill Johnson: You discuss the provision concerning appeals and the removal of fiduciaries as limiting a beneficiary's ability to have his or her competency restored. Can you describe how a veteran currently has his or her competency restored and subsequently can get out of the fiduciary program?
Dave McLenachen: Yes, thanks for that question because this is an area that I've really been interested in addressing and we are doing that in our regulations, just to let you know, that's one thing that we are addressing. Currently, if an individual has been rated as being unable to manage their VA benefits. They can be taken out of the program by having a medical evidence such as a doctor's opinion that they can in fact, based on their disability or regardless of their disability, manage their own VA funds. In addition to that, there might -- if there was a legal process -- uh -- where a court held that a person was incompetent to manage their own affairs and a court concludes otherwise, that would be evidence considered.
The past week has been a deadly one for Iraqis. A wave of coordinated attacks around the country targeted Shiite Muslim pilgrims and others observing a week of holy days. The results, according to Iraqi Body Count, an organization that analyses reports of deadly incidents in Iraq from around the world and from Iraq, saw 92 killed on the deadliest day, Wednesday June 16, and a further 121 killed over the following week. Many hundreds more were wounded with around 300 injured on Wednesday. This was one of the deadliest weeks in Iraq following the withdrawal of US troops late last year and Iraqi Body Count estimates that 315 civilians had been killed up in Iraq up until June 19.
Mohammed Tawfeeq (CNN) adds, "Also, in a separate incident, gunmen opened fire at a police checkpoint near an outdoor market in a southwest Baghdad neighborhood leaving three police officers dead, police said." Margaret Griffis (Antiwar.com) counts 23 dead in today's violence and 170 injured and among the dead: a girl, 4 years-old, who had been kidnapped but was found beheaded in Ishaqi. Kidnappings appear to be on the rise in Iraq although it just may be that the reporting on them has increased. As noted on Tuesday: " Into the continued violence of Iraq where Alsumaria reports that the son of a local council member was kidnapped in Ramadi today and that security forces quickly secured the area and began searching for clues. While kidnappings have not been uncommon throughout the Iraq War, today's may end up getting attention due to the fact that is it one of two kidnappings. Al Rafidayn reports two young girls were kidnapped yesterday in Tikrit and that one is the daughter of a a member of Tikrit's security council."
In Iraq, the political crisis continues and Nouri al-Maliki and his sycophants insist he's incredibly popular. Alusmaria reports Moqtada al-Sadr's response: Saddam Hussein used to claim 100% of Iraqis stood behind him. Meanwhile Al Sabaah reports the head of the Islamic Supreme Council of Iraq, Ammar al-Hakim, is stating that he's putting together a meeting between Nouri and Moqtada. Not stated is that all this work doesn't endear him to the elders of ISCI who, like Ammar's late father, do not care for Nouri al-Maliki. Ammar might want to consider that when you only got your position because your father died, when you never earned it yourself, you might want to be careful about cozying up to your father's enemies because if the elders feel you're not honoring your father, they will work to remove you.
Iraqiya's Hadi al-Dalemi is dismissive of al-Hakim's efforts, Raman Brusk (AK News)reports, noting that his alleged 'ideas' were proposed by Iraqiya earlier but were blown off. He states further that "the time for this step [dialog] is over and the political blocs are now trying to take the step of interrogating [the PM] . . . which is more serious and through which the differences can be settled." As Lara Jakes (AP) reported yesterday, Speaker of Parliament Osama al-Nujaifi declared Nouri would be summoned before the Parliament shortly to answer questions and they are prepared to move towards a vote as to whether confidence remains in Nouri's ability to lead. This is how Moqtada's explained it, Alsumaria notes.
Yesterday Maliki called for the urgent session to discuss the violation and authorities of the executive and legislative bodies and the areas of overlap between the authorities of the two bodies. The demand to convene an urgent session is only an effort "to gain more time and affect the efforts for withdrawing confidence from government" said Muayyad Tayyeb who leads the Kurdistan Blocs Coalition.
Dia al-Asadi is the parlimentary head of Moqtada al-Sadr's bloc and he tells UPI that, "Our main concern is that Maliki doesn't have a plan to administer the country. And if he ahs, then we want to know about it. If he hasn't, then there's a big problem because we are living in a country that needs comprehensive, fast and integrated development."