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september/october 2007

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PTSD/SUBSTANCE ABUSE COMMITTEE REPORT

BY TOM BERGER, CHAIR
In late July, House Veterans’ Affairs Chair Bob Filner (D-Calif.) held a hearing to examine how the Department of Veterans Affairs addresses the military diagnosis of Personality Disorder. In the last six years, the military has discharged more than 22,500 service members due to Personality Disorders. The Committee found that once service members are diagnosed with a Personality Disorder, they have a much more difficult time receiving benefits and treatment from the VA.

Service members discharged due to a Personality Disorder—rather than PTSD or some other mental health condition—generally are not provided military disability benefits because the military classifies Personality Disorders as existing prior to entry into military service. The service member must show that his or her prior existing condition was aggravated or worsened by military service, which is difficult to do. Service members may seek veterans’ disability benefits, but, again, they must show that their condition was aggravated by military service.

In related matters, the Government Accountability Office (GAO) announced in late July that it will study whether the Departments of Defense and Veterans Affairs are providing proper mental health care for veterans returning from Iraq and Afghanistan. In May, nine members of Congress asked the GAO to conduct such a study; this was followed by letters from Colorado Sens. Wayne Allard (R) and Ken Salazar (D), which broadened the scope of the study and asked the GAO to provide recommendations for legislation to improve mental health care and to capitalize on best practices in the military. The GAO said it would assess the VA’s treatment of veterans with mild traumatic brain injury; the Department of Defense’s pre- and post-deployment screenings for mental health conditions and mild traumatic brain injury; and whether policies pertaining to Personality Disorder discharges have been followed.

The studies are to be completed by the end of the year. Note that prior to the National Convention in July, VVA President John Rowan sent a letter to Secretary of Defense Gates calling for a moratorium on the issuance of Personality Disorder discharges until such an investigation can be conducted.

Figures released in August by the Army’s Office of the Surgeon General show that a total of 23,788 soldiers, most of them deployed to Iraq or Afghanistan, have been diagnosed by the military with PTSD in the past four years. Only about 3 percent of soldiers who have served in combat since 2003 have been diagnosed by the Army with Post-traumatic Stress Disorder—far fewer than the numbers of those who have screened positive for PTSD symptoms in recent Army studies, suggesting that the disorder is being under-reported and under-diagnosed. The Army figures do not account for all cases of PTSD among soldiers who have served in Iraq and Afghanistan, but instead represent only diagnoses made while soldiers were on active duty. Other diagnoses are made by the VA, after soldiers are discharged.

But even the combined total of Army and VA diagnoses of PTSD—about 76,000 to date—represents only about 5 percent of the more than 1.5 million troops who have served in Iraq or Afghanistan. The Army figures show active-duty diagnoses of PTSD have nearly doubled in the last two years, from 3,867 in the 2004 fiscal year, to 7,352 in the fiscal year that ended last September. In the first half of this year 4,477 new cases were diagnosed. Army spokespersons attribute the relatively low numbers to the stigma surrounding mental health issues. On the other hand, in May the Pentagon’s Mental Health Task Force found that 49 percent of National Guard members, 38 percent of soldiers, and 31 percent of Marines have experienced mental health issues after serving in Iraq or Afghanistan.

The VA has treated about 52,000 Iraq and Afghanistan veterans for PTSD, according to the report by the President’s Commission on Care for America’s Returning Wounded Warriors. That figure represents about 7 percent of the more than 720,000 troops—including Marines, sailors, and airmen—who have separated from the armed forces since returning from Iraq or Afghanistan. The VA numbers do not include veterans who might seek mental health care from private doctors or other sources.

SUICIDE PREVENTION
According to an internal May 2007 VA report, veteran suicides account for almost one in five of suicide attempts in the entire country. Five thousand veterans commit suicide every year and more than 50,000 have been diagnosed with Post-traumatic Stress Disorder.

Another finding is that too many veterans are being turned away from treatment because patients are required to demonstrate “sustained sobriety” before they receive any type of treatment. The report also made a number of recommendations for helping these at-risk veterans, such as more qualified staff, extra mental-health screening, as well as tracking patients more accurately by storing a list of suicidal patients in a database accessible to all VA clinics and hospitals. The report cited a lack of funding to help suicidal veterans and was released days after VA Secretary Jim Nicholson reported that he and other VA officials had received almost $4 million in bonuses last year.

But in a sudden turnaround, the Department of Veterans Affairs announced plans in June to hire suicide-prevention counselors at each of its 153 medical centers across the country. This announcement came after national media reports of the death of Marine Pvt. Jonathan Schulze, a combat veteran who killed himself after his parents said he repeatedly sought help at the VA Medical Center in Minneapolis, but was put on a waiting list.

In addition, on August 1 the Department of Veterans Affairs began operating a national suicide prevention hotline for veterans. The toll-free hot-line number is 800-273-TALK (8255). According to the press release, VA’s hot line will be staffed by mental health professionals in Canandaigua, N.Y. They will take calls from across the country and work closely with local VA mental health providers to help callers. To operate the national hot line, VA is working with the Substance Abuse and Mental Health Services Administration of the Department of Health and Human Services. The Vet Centers also will be part of the referral network.

Speaking of the Vet Centers, VVA was very pleased to learn that in 2007 the VA plans to open new Vet Center facilities in Grand Junction, Colo.; Orlando, Fla.; Cape Cod, Mass.; Iron Mountain, Mich.; Berlin, N.H.; and Watertown, N.Y. (with others located in Montgomery, Ala.; Fayetteville, Ark.; Modesto, Calif.; Fort Myers and Gainesville, Fla.; Macon, Ga.; Manhattan, Kans.; Baton Rouge, La.; Saginaw, Mich.; Las Cruces, N.M.; Binghamton, Middletown, and Nassau County, N.Y.; Toledo, Ohio; Du Bois, Pa.; Killeen, Tex.; and Everett, Wash. scheduled for opening in 2008).

While VVA is grateful that new centers will offer access to veterans, it is not just the new centers that require staff. VVA has called on the VA to increase staff at existing centers for the past three years. VVA would like to see more family services, including bereavement counseling and counseling for military sexual trauma, available at every Vet Center. Ideally, each Vet Center would be able to provide round-the-clock crisis-intervention services.

Congratulations to VVA’s newly elected Board members, re-elected officers, and Board members. Thanks also to the National Convention Planning Committee, the Illinois State Council, and VVA staff for making the 2007 Convention a great success.

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