Saturday, June 26, 2010

Barack's pal heads to the slammer






This Sunday is PTSD Awareness Day. US Senator Kent Conrad's office issued the following:

Washington -- In an effort to bring greater attention to Post Traumatic Stress Disorder (PTSD), the United States Senate last night passed a resolution authored by Senator Kent Conrad designating June 27 as National PTSD Awareness Day.

"The stress of war can take a toll on one's heart, mind and soul. While these wounds may be less visible than others, they are no less real," Senator Conrad said. "All too many of our service men and women are returning from battle with PTSD symptoms like anxiety, anger, and depression. More must be done to educate our troops, veterans, families and communities about this illness and the resources and treatments available to them."

The Senator developed the idea for a National PTSD Awareness Day after learning of the efforts of North Dakota National Guardsmen to draw attention to PTSD and pay tribute to Staff Sgt. Joe Biel, a friend and member of the 164th Engineer Combat Battalion. Biel suffered from PTSD and took his life in April 2007 after returning to North Dakota following his second tour in Iraq.

Earlier this month, Senator Conrad visited the Fargo VA Medical Center and met with physicians and social workers to discuss their capabilities for helping those suffering from PTSD. He also met with friends of Sgt. Biel and presented them a copy of the resolution designating June 27 -- Biel's birthday -- as National PTSD Awareness Day.

According to the National Institute for Mental Health, PTSD is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, accidents, and military combat. From 2000 to 2009, approximately 76,000 Department of Defense patients were diagnosed with PTSD.

"This effort is about awareness, assuring our troops -- past and present -- that it's okay to come forward and say they need help. We want to erase any stigma associated with PTSD. Our troops need to know it's a sign of strength, not weakness, to seek assistance," Senator Conrad said.

To learn more about PTSD and locate facilities offering assistance, visit the U.S. Department of Veterans Affairs' National Center for PTSD at

Veterans in need of immediate assistance can call the VHA Suicide Hotline at 1-800-273-8255 and press 1.

That is this Sunday, June 27th. Toady, on The Diane Rehm Show (NPR), second hour, the caller did what the host and guests couldn't: Raise the issue of Iraq. Henry from Florida was the only one aware that Iraq was the locale of an ongoing war. Others were aware of it as a 'fixed' reference point for Afghanistan.
Henry: Yes, thank you for taking my call. I have a simple question. Did George [W.] Bush not ask his generals when we would be getting out of these stupid wars in Iraq and Afghanistan? Or did the generals not ask him, "Sir, when will we be getting out of this war that you started?" Because essentially that Republicans find it okay for us to be spending whole millions and billions on this war but it's not okay with them to spend on our poor people in this country.
Diane Rehm: Lots of folks have raised those kinds of issues.
Elise Labot: Well Henry raises an issue that's felt about a lot of Americans around the world about how much money we're spending on wars in Iraq, in Afghanistan. We look at the world economy. A lot of the US economy is in the toilet and we're continuing to spend on both these wars. However, both President Bush and President Obama spent many weeks and months talking with the generals about how to win the strategy in Iraq, in Afghanistan. The problem is that these wars might not be winnable. The US can leave the situation in a better place than it found it but maybe not win.
That was Elise Labot from CNN. That was all that was worth hearing. And sometimes, when it's pointed out how pathetic it is that Iraq's not covered on Diane's show, a little whiner will show up in the e-mails. (Friends with that show know not to. I'm not in the mood for this show right now.) And it will be, boo hoo, they have so many topics and they're winging it and blah blah blah. Since the Idiot Kevin Whitelaw outed Diane today, let me as well. On air, he says, "I forgot what you wanted me to say, Diane," in reference to what he was supposed to say. Diane curtly called on Moises Naim to take over. Point? That show's worked out in advance. Only real surprises are the calls -- and they generally know what the call's about before it goes on air (though some callers don't stick to the topic they say they're calling in about). Here's reality on how the show works on Fridays. Diane divies up topics and the guests begin searching (the web) for the topic. Then they speak into the mike on air and act like they did something wonderful. Ask any guest -- ask Roy Gutman -- and they'll tell you that's how it goes. Diane determines the topics ahead of time, assigns aspects of the topics ahead of time, and then the 'non-scripted' conversation takes place. And if you missed it Sunday, read "Only 30% of Diane Rehm's guests are women (Ava and C.I.)." And any whine Diane freaks, grasp that while Iraq was not a topic during the international news hour, Diane WASTED the international news hour with approximately seven minutes of talk about tennis. Apparently, Diane is hoping to move to ESPN in her tarnished years. No time for Iraq. 7 US service members have died there so far this month but Diane's not interested. Tennis? She's mad for it. It's all about priorities.
Priorities was the question. And isn't it curious that no one -- not the host, not her guests -- while talking about the money spent on the wars -- bothered to mention the numbers? Isn't that rather telling. Diane says a lot of people are talking about this. But apparently not on her show. Not even today. From Monday's snapshot:
Moving over to the finanical cost of war, at the start of this month, the Institute for Public Accuracy offered a dollar amount for the financial costs of the Iraq and Afghanistan Wars: $1 trillion dollars. BBC notes that the costs for the UK government in fighting the two wars has surpassed the 20 billion pound mark -- which would be approximately 29.7 billion US dollars. They go on to note, "Critics questioned why the UK was spending so much on conflict when public finances were in a dire state." The US has spent much, much more than that but ask yourself when you ever heard the anchor of the ABC, CBS or NBC news note that anyone might wonder why, when the US' economy is "in a dire state," the government was spending so much money on war? Carl Ramey (North Carolina's Pilot) notes, "Amazing, isn't it? We can talk endlessly about the nation's debt crisis and rampant spending, but nary a word about two wars that are costing us more than $12 billion every single month, and whose cumulative costs, over the past eight years, have already surpassed $1 trillion."
One trillion dollars. The dollar amount that was ignored by Diane and company today.
At McClatchy's Inside Iraq, an Iraqi correspondent remembers Yasser Slaihee, "In June 2005 there was supposed to be a sovereign government on June 30, Yasser's birthday, but Yasser didn't live long enough to see the date changed to June 28, they deprived Yasser from a wish that didn't come true even after his death, off course I blame no one for it doesn't matter, the ceremony and the announcement was everything but true on the ground." Yaseer was shot dead by a US sniper June 24, 2005. NPR's Jacki Lyden noted of the journalist, "Yasser was hip: blue eyes, wire rims and a buzz cut, average height, endless smile. He invited me for coffee to meet his wife and baby daughter, and our coffee klatch never ended. When NPR producer Tom Bullock turned ashen, feverish and couldn't get out of bed, Yasser hooked him up to an IV bag hoisted on a camera tripod before he even told Tom who he was." In real time, Ron Brynaert (at Why Are We Back In Iraq) blogged about Yasser's death and, in the excerpt below, he's citing a report by McClatchy's Tom Lasseter:

Once again, the Pentagon initially lied about the murder of a journalist in Iraq.

"An early report said Salihee was shot by a passing U.S. convoy when he failed to heed hand signals or shouts from soldiers. That later turned out to be untrue."

But there are conflicting accounts.

"Most of the witnesses told another Knight Ridder Iraqi special correspondent that no warning shots were fired. But the front right tire of Salihee's car, a white Daewoo Espero, was pierced by a bullet, presumably meant to stop him from advancing."

FYI, Ron's now with Raw Story. Yesterday's violence included assaults on Sahwa with four members of one family kidnapped in a home invasion and later found dead. Lourdes Garcia-Navarro (NPR's All Things Considered) reported yesterday that the month of June has seen a minimum of 19 Sahwa killed. Sahwa, also known as "Awakenings" and "Sons Of Iraq" are largely Sunni fighters that the US put on the payroll to stop them from attacking US military equipment and US service members, numbered over 91,000 and Nouri al-Maliki agreed to take them and fold them into government jobs, putting them on the Iraqi payroll. That really didn't happen. Targeting has happened, repeatedly. These are Iraqi citizens. Nouri has an obligation to protect them. His refusal to do so goes to the fact that he's not a leader. He can't protect the people and he has refused to call out the killings. Doing so wouldn't violate his attempts to continue sectarian tensions. Nouri's caught in the past and Iraq will never be able to move forward with him as prime minister. Back to Lourdes Garcia-Navarro who reports:

Now, the exit of American troops is under way. In 2009, the fate of the Sons of Iraq was left in the hands of Iraq's Shiite-dominated coalition government, which agreed to pay the men and eventually either integrate them into the armed forces or give them civilian jobs.
But scores have been arrested over the past year by the government, says Hussam, while others have fled the country, leaving a sense of bitterness among the remaining Sons of Iraq.

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Thursday, June 24, 2010

Tanks for the memories






Today Megan McCloskey (Stars and Stripes) reported that the National Intrepid Center of Excellence opened today at Bethesda. The military and assorted generals are attempting to claim credit for it but McCloskey points out, "The $65 million to build the center came from 125,000 Americans, including donations as small as $10. The project broke ground in December 2008. When the Intrepid fund was in danger of missing its fundraising mark this spring, Bob Barker of The Price is Right fame stepped in and donated $3 million." So the government didn't shoulder the cost, no military weapons went unpurchased in order to put the wounded first. And that's not the only problem with the center. TBI and PTSD were discussed on the first hour of The Diane Rehm Show today and we'll note this on the new center.
Daniel Zwerdling: The troubling questions I have about this center include these, there are -- my investigations at NPR and with T. Christian Miller of ProPublica showed that there are tens of thousands of troops who have -- perhaps more -- who have had Traumatic Brain Injuries who have not been diagnosed, many of them have not had proper treatment so when you talk about sending only 500 a year to this center, that's only a drop in the bucket. Second of all, this new center is not going to treat these folks. It's going to evaluate them over two weeks and then it's going to send them back to the military bases from which they came. And one thing we found in our investigation which is quite troubling is that many of these bases do not have adequate staff to treat Traumatic Brain Injury, they don't have staff occupation therapists or doctors who have really been trained to treat Traumatic Brain Injury so, the center is going to send troops back to the bases where they've been having problems. So, yes, it's a great step but a lot of questions still.
With T. Christian Miller, Zwerdling is the author of the joint-investigative reporting by NPR and ProPublica. Click here for one audio report at NPR and, on that page, there are links for other reports in the series. You can click here for ProPublica's folder for the (text) reports from the investigation. Since generals are not doctors and since they couldn't stop spinning and lying to the Senate Armed Services Committee this week (See Tuesday's snapshot and Wednesday's snapshot), let's note this section where Diane's speaking to Dr. Gergory O'Shanick, Zwerdling and Dr. S. Ward Casscells.
Diane Rehm: Dr. O'Shanick, let me ask you brain injuries and how they actually occur.
Dr. Gregory O'Shanick: Diane, good to be back with you.
Diane Rehm: Thank you.
Dr. Gregory O'Shanick: And I appreciate the comments of Mr. Zwerdling and Dr. Casscells'. Brain injuries occur whenever there is a force imparted to the head or body that results in either a direct blow to the head or what we call an acceleration-deceleration injury to the brain -- that is, if you think about the brain being about the consistency of Jello, if you shake a bowl of Jello, you'll see the motion bounce -- the force wave bounce across the bowl. That process involves straining the appendages if you will, the arms of the brain cells called axons and can cause a tearing of those in terms of the function or, in the case of mild Traumatic Brain Injury, causes a series of changes in terms of how the brain cell handles sugar and oxygen -- the two things that it uses -- which then results in a disolving -- fairly similar to what happens to a tadpole's tail. A disolving of that appendage over time. These two processes then result in what is called Diffuse Accidental Injury which is really the hallmark of Traumatic Brain Injuries -- mild, moderate or severe. .
Diane Rehm: And --
Dr. Gregory O'Shanick: In addition --
Diane Rehm: I'm sorry, go right ahead.
Dr. Gregory O'Shanick: Yeah, in addition, you can have focal contusions or bruises to the brain from the brain bouncing inside. We also know the pressure wave associated with blast inury creates a change in terms of whenever there's different densities -- whether it's liver, whether it's lung, even within the brain, we'll see a change in terms of the tissue in those areas as well.
Diane Rehm: And I gather, Dr. Oshanick and Daniel Zwerdling, that many of these brain injuries are caused by the explosion of IEDs.
Daniel Zwerdling: Well the extraordinary thing is, I never knew before I undertook this investigation, is that a blast wave -- First of all, you can see it. Troops have told me they saw the wave coming almost like something in a horror film. These ripples coming through the air and through the soil. And those blast waves go through metal, they go through your helmets, they go through skulls, they go through the brain. And here's what this means for the soldiers who come home based on the soldiers we've met around the country and at Fort Bliss where we talked with more than a dozen soldiers: A soldier named Victor Medina comes home. This is a guy who was in a blast a year ago. He, uh, speech is slurred. He stutters terribly which is not a terribly common side effect but is a side effect of Traumatic Brain Injury. He goes to the supermarket with his wife. He suddenly disappears. She goes looking all over the supermarket for him and when she finds him, he says, "Hey, when did you get here?" He has totally forgotten that they came together. He used to devour novels, now he reads a page -- struggles to read a page -- and then forgets what he said. Or Brandon Sanford who was in two blasts in Iraq. He had a dog that sniffed out bombs. He used to help his little boy with his homework. Now his son is ten, he cannot comprehend his son's homework. Or William Frost who got a Bronze Star With Valor, who helped save a bunch of Iraqi troops and his major. He now -- He was driving one day and realized, "Oh my God, I can't drive anymore." He just couldn't put it together. He couldn't wrap his brain around what it means to drive so he gave his keys to his wife. So these -- Even when you call these injuries mild Traumatic Brain Injuries, you know, you can't see blood, there's no broken bones, this can cause a huge problem for years or for the rest of the person's life.
Diane and her panel spoke of how the thrust of care is forced off onto the service member or veteran and/or his/her family. That's The Wounded Veterans and Service Members Story This Decade, isn't? Attend any Congressional hearing where veteran and service member advocates testify, speak to any number of veterans and you find that receiving care is a full time job and that hasn't changed, the system hasn't streamlined. You can throw as many generals before the public as you want -- with so many bars and stripes they look like human Christmas trees -- and they can spin like crazy but they cannot change reality. For the second half of the first hour, Diane opened up the phone lines to her listeners. We'll note Marlene from Ohio.

Marlene: My son was in Iraq for 15 months and directly effected by two IED explosions -- with shrapnel to his head. He continues -- my son continues to say everything is fine. But two weeks ago, the bank repossed his car. He had been faithfully paying on this car prior to his diagnosis of PTSD. Now, as the Mom and the next of kin, I was not able to assist in any way. The bank would not work with my son other than to demand the total payment of the balance. There was no bailout for this soldier. Now I as the Mom had no right to advocate on his behalf. I called my Congressman, the military and who ever else I thought could help. My question is: Who does advocate for these soldiers?
"Of the nearly eight million veterans who are enrolled in the VA health care system, about three million are from rural areas," declared US House Rep Michael Michaud as he brought the House Veterans Affairs Subcommittee on Health's hearing to order this morning. "This means that rural veterans make up about 40% of all enrolled veterans. For the 3 million veterans living in rural areas, access to health care remains a key barrier, as they simply live too far away from the nearest VA medical center."
Chair Michaud and the Subcommittee were exploring the barriers to providing health care to rural veterans. There were four panels. The first panel was composed of West Wireless Health Institute's Dr. Joseph Smith, the Brookings Institution's Darrell West and The Healthy Applachia Institute's David Cattell-Gordon. AirStrip Technologies' Dr. Wililam Cameron Powell, Continua Health Alliance's Rick Cnossen, MedApps, Inc's Kent Dicks, Cogon Systems Inc's Dr. Huy Nguyen, Three Wire System's Dan Frank and LifeWatch Service's John Mize composed the second panel. The third panel was FCC's Kerry McDermott, DoD's Col Ronald Poropatich, VA's Gail Graham. Lincoln Smith, of the Altarum Institute, was the fourth panel.
The rural health care, it is argued, will be improved through telecommunication systems via computers and telephones and various monitors attached to the body. We'll note this exchange from the first panel.
Chair Michael Michaud: I have a quick question, actually, for all three. I assume that all three of you, from your testimony, believe that there is a great opportunity for the VA to move forward in this wireless health solution. So my question is, is what steps should the VA, FCC and FDA take to clear the way for this new type of technology? We'll start with Dr. Smith -- keeping in mind that some states like Maine and other states are very rural and we might not have the broadband that we need for this type of technology. So start with Dr. Smith.
Dr. Joseph Smith: So I think it starts with assuring the wireless infrastructure is present. I think that to the extent that we can avoid the health care delivery system being centered in hospitals and clinics and move it to being centered in patient's homes where they can be appropriately monitored with- with relatively low sophistication devices and that information be liberated from their homes and their bedsides to caregivers independent of their location, I think that's critical. I think for the -- To achieve the great value, that you speak of and the opportunity that's in front of us, we have to make sure that the regulatory and the reimbursment path for the innovators who are on the front door making these things is quite clear to them. And, at the moment, it is clearly not clear. At the moment, there is great concern that aspects of the system including the handsets, you know, the wireless handsets or, in fact, the telecommunications companies can be part of an FDA regulated concept of a medical device or that they can be the target for the plantiff's bar in the event of some untoward event. And that those concerns are chilling the engine of innovation that could deliver the techonologies that matter so much. And then I think lastly, we need to incentivize the appropriate use of this technology once it's available and that's not so simple as to say, "They are available." It is to provide the appropriate incentives for appropriate use. Because I think, as the VA program has demonstrated, there's dramatic cost savings in quality improvement and satisfaction of the patients' waiting -- and they are waiting. And what we need to do is make sure that we incentivize the use. You know, the Institute of Medicine has told us it can take 16 years from the time novel technology has proven to be useful to the time it's fully adopted and patients are waiting.
Darrell West: Mr. Chairman, I'd like to address the Food and Drug Administration part of your question because I think, in general, the VA has made tremendous progress on encorporating new technology. There's still work to be done, but they are ahead of many of their parts of society but the FDA, I think, has a problem in the sense that the policy and regulatory regime is way behind the technology. The FDA plays a role in certifying new devices that come on the market and I think, especially, the pace of technology and innovation has been very intense and very rapid in recent years -- the remote monitoring devices that I've been talking about, some of the new apps that have been developed for smart phones. The FDA needs to revamp it's regulatory review process to speed up the approval of these new innovations because there are tremendous new devices that are coming on to market but it's been a slow process to get approval of many of those things so if there is one specific thing that I would recommend, it would be taking a close look at the FDA and encouraging it do all that it can to speed up its certification and review process.
David Cattell-Gordon: I would very much agree with the points my colleagues have made concerning this and further say that the VA is the leader. You guys wear that mantle of leadership in the nation and you need now, because now is the time, I think for us to continue to debate this subject as to whether or not this is an effective capability, we're way beyond that. The data is overwhelming whether you look at what we do with Traumatic Brian Injury and reminders for appointments, whether we look at how we monitor a veteran with diabetes to lower that A1C and prevent blindness and follow their care or whether it's a weight loss program, the evidence is overwhelming. So we know that that's true. So now it is about adoption and we have to push that across the government at a lot of levels -- whether it's the defintions of rurality, whether it's encouraging and incentivizing investments by health systems to use this, rural veterans use a variety of health systems so we have to integrate that, we have to intergrate their VA records into health care. There are a lot of things we need to do and I would just encourage that the most important thing we can do is act now.
Let's take a breath.
Woman beaters
and Huck Finn shucksters
hopping parking meters
I never loved a man
I trusted
as far as I could pitch my shoe
-- "Lucky Girl," written by Joni Mitchell, first appears on her Dog Eat Dog album
Huck Finn shucksters. That's what the panel had. With the Gulf Disaster continuing, who the hell really wants to advocate for loosening regulations? And to do it on something as important as health care?
We're told by the panel that diabetes can be monitored via these 'new' devices. Uh, it is already. Anyone who knows a diabetic knows all about the test strips and checking blood sugar. What are a few body monitors going to do? And weight loss? Are we confusing Jenny Craig with actual health care?
'Things must move and must move quickly!!!!' That was the message. Did you notice that -- doctor or not -- everyone testifying (plus VA stooges) was testifying on behalf of . . . their own financial interests. There were no doctors present testifying on the value of this or the ethical issues that might arise. It was just a bunch of Huck Finn shucksters who want to make a buck and they're offended that the FDA makes them do this and that and -- Well everything the FDA has always made people do to get approval.
There was nothing listed in the hearing that was, for example, a cure for cancer. Meaning, nothing was earth shattering. There was nothing that couldn't go through a traditional FDA process. The FDA exists, at least allegedly, to ensure the public good. Things need to be checked out by the FDA. Again, no one's promising a cure for cancer. Just a few mobile devices that they hope to market. Basically, they've got this decades beepers and they want to bypass the normal process because they're hungry to make a fast buck.
This hearing pointed out a very real flaw in Congress' hearings. They need to bring in people, doctors, on health issues to be witnesses. Not doctors who have a company on the side that wants to sell this or that. An objective doctor who can say, "Wait, why are we whining about the FDA? Of course we want to prove that these devices are safe and that they actually do what they're portrayed as doing." Hucksters. They may honestly believe in their product -- I have no reason to doubt that they do -- but what does it do? What does it actually do? How does this improve anything for veterans health care?
US House Rep Tom Perriello raised the issue of suicides and drug addiction concerns -- "to what extent does the telemedicine and some of the techonology run the risk that we're not seeing some of the signs or screenings from people being physically present or is this an opportunity because we're going to be able to monitor -- what kind of a dynamic do you see between the technology and that particular problem?"
That's a fairly straightforward question. Let's make it real simple: Will telemedicine cut out the face-to-face factor that would normally allow a greater chance of telling if a veteran needed help with a drug problem or with suicidal thoughts/actions?
Try to find the answer in the pitch that's delivered -- and I'm including every word that was supposedly a reply to a direct question -- and Perriello asked this question directly to -- and only of -- Cattell-Gordon.
David Cattell-Gordon: I'm very proud of the fact that we have psychologists at U VA, Dr. Larry Merkle who has done extensive review of rural issues and suicide. The numbers are overwhelming. You look at the Virginia Dept of Health, you look at rural areas -- in particular, you look at the coal fields of Virginia, the suicide rate is twice that of what it is of the state as a whole. And then you look at issues like fatal, unintentional overdoses from addiction to pain medications the mortality rate in the coal fields of Virginia is 40 deaths per 100,000 adjusted as opposed to 8.3 deaths for the rest of the state. These are huge problems. The level of disability. The lack of access to care. Uhm, the isolation that people experience in rural areas create a perfect storm of problems for mental health issues. Then you add to that the absence of practitioners, there are just way too few practitioners and they are going to be even greater shortages in primary care and mental health care folk for this region and for our vets and everyone else. So telehealth and the use of wireless capabilities become a key tool to reduce isolation to send reminders -- Just the appointment reminders alone -- and this has been a VA study -- to look at folks with Traumatic Brain Injury and reminders over the cell phone for their appointments and daily contacts has dramatically changed the number of people who show for their appointments. Those small things will add up to the large indicators about how we can address mental health issues in rural areas.
That doesn't address the question. And why he's bringing in non-military rural populations? Because he doesn't know the answer. So he's at length and never answers the damn question. Never. Wow. An alarm clock will help many wake up in the morning. And apps on a cell phone can be used as reminders for appointments. What does this have to do with health care? Gizmos aren't health care.
And Dr. Merkel? I don't know him. I asked around to find out about his expertise on veterans issues and was told repeatedly -- by medical doctors who study and treat veterans -- that he has none. He's apparently very big on adolescent health (an important issue) but he's not an expert on veterans issues. Why is he being name checked? Oh, that's right, it's a sales pitch. It's not about veterans issues, it's about making a sales pitch. Got it.
Senator Kent Conrad has issued a statement (which Senator Daniel Akaka's office kindly passed along):

Washington -- In an effort to bring greater attention to Post Traumatic Stress Disorder (PTSD), the United States Senate last night passed a resolution authored by Senator Kent Conrad designating June 27 as National PTSD Awareness Day.

"The stress of war can take a toll on one's heart, mind and soul. While these wounds may be less visible than others, they are no less real," Senator Conrad said. "All too many of our service men and women are returning from battle with PTSD symptoms like anxiety, anger, and depression. More must be done to educate our troops, veterans, families and communities about this illness and the resources and treatments available to them."

The Senator developed the idea for a National PTSD Awareness Day after learning of the efforts of North Dakota National Guardsmen to draw attention to PTSD and pay tribute to Staff Sgt. Joe Biel, a friend and member of the 164th Engineer Combat Battalion. Biel suffered from PTSD and took his life in April 2007 after returning to North Dakota following his second tour in Iraq.

Earlier this month, Senator Conrad visited the Fargo VA Medical Center and met with physicians and social workers to discuss their capabilities for helping those suffering from PTSD. He also met with friends of Sgt. Biel and presented them a copy of the resolution designating June 27 -- Biel's birthday -- as National PTSD Awareness Day.

According to the National Institute for Mental Health, PTSD is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, accidents, and military combat. From 2000 to 2009, approximately 76,000 Department of Defense patients were diagnosed with PTSD.

"This effort is about awareness, assuring our troops -- past and present -- that it's okay to come forward and say they need help. We want to erase any stigma associated with PTSD. Our troops need to know it's a sign of strength, not weakness, to seek assistance," Senator Conrad said.

To learn more about PTSD and locate facilities offering assistance, visit the U.S. Department of Veterans Affairs' National Center for PTSD at

Veterans in need of immediate assistance can call the VHA Suicide Hotline at 1-800-273-8255 and press 1.

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Wednesday, June 23, 2010













"On September 11, 2001," declared US House Rep Harry Mitchell this morning, "we witnessed one of the greatest tragedies in American history. Still today, we all remember the horrific scenes of these terrorist attacks. Four years later, in 2005, the Gulf Coast was hit by one of the biggest natural disasters the region has ever seen, as Hurricane Katrina swept through the region killing thousands and leaving many homeless and displaced. And sadly, again today, we see Gulf states struggling with yet another major disaster, as the oil continues to spill. These types of events highlight the critical need for federal agencies to proactively prepare to effectively execute their federal obligations -- especially when called upon during emergencies." Whether a national disaster, international or regional, how does the VA intend to ensure that veterans needs are met regardless?
Chair Mitchell was opening the House Committee on Veterans Affairs' Subcommittee on Oversight and Investigations. (He also recognized veteran Terry Araman for his work in Arizona with homeless veterans, Araman is the program director of the Madison Street Veterans Association.) There were three panels. The American Red Cross' Neal Denton, the Healthcare Coalition's Darrell Henry, the American Legion's Barry A. Searle and BT Marketing's John Hennigan composed the first panel. The second panel was Capt D.W. Chen of the DoD, Christy Music (DoD), Kevin Yeskey (HHS) and Steven Woodard (Homeland Security). Panel three was VA's Jose Riojas with the VA's Kevin Hanretta and Gregg Parker. We'll note this exchange.
Chair Harry Mitchell: I have a question for anybody who would like to answer this. In reviewing the National Response plan, there's a myriad of federal resources called upon in response to a crisis. How do we determine if the agencies will be able to work together? Yes, just go ahead in any [order].
John N. Hennigan: Thank you, Mr. Chairman. I can -- I can speak from experience in Montgomery County [Texas] when we had [Hurricane] Ike occur. We first had [Hurricane] Rita hit the Gulf Coast and it was truly total confusion. And what we found Contra[-Flow] Lanes in the freeway to try to - to try to evacuate people on the Gulf Coast was a disaster. It was done too late. Communications between EMS, fire stations, police, sheriff, state police was uh, was inappropriate. Since that time, prior to Ike, we all went on same frequencies. We developed a program where Contra-Flow Lanes were done well in advance versus-versus a uh 24 hour mandate, get-out-of-town. So I think a lot of it is, can-can communities -- in this case with the VA -- can the community officials communicate to the VAs and vice-versa on the same frequency -- whether it's radio, whether there's a set plan or one organization that coordinates all the entities as we're doing in Montgomery County right now. Can that happen? And when that happens, it just makes life a lot easier for everybody because you only have one source to go to and they'll do the -- they'll delegate the appropriate things to do.
Chair Harry Mitchell: You know there's a -- again -- a myriad of agencies involved in all of the emergency preparedness. And, again, let me just ask others, how do we determine if these agencies are able to work together? Sometimes I think there's miscommunication of who has what role to play. How can we determine that? Do we determine that?
Barry A. Searle: Well, sir, as far as the DoD - VA interaction, one of the things that we see as very positive is on a day-to-day basis now in the attempt to develop the lifetime virtual records has established communications between DoD, VA and the public sector actually as far as transferring public information on veterans. The hope by the American Legion is that that will have started the -- a crack in the dyke, if you will. There's no question that stove piping exists and it has to be broken down. Through the-the-the national framework -- response framework -- and people have assigned positions, jobs and responsibilities -- For example, American Legion is not telling VA how to do that but it would be reasonable that they would be under the ESF8 as a support function, that they would not be an elite function in this case. But there is a framework there for telling people what they should be doing and feeding into it. But I think that VA has taken some serious steps into making a coordination with other entities -- be it DoD and civilian doctors, for example -- which will eventually help with the system. It's not going to solve the whole thing, but at least it's a starting point.
Neal Denton: Mr. Chairman, if you don't mind, I'd like to say something to this too. So much of this builds on exercises -- the national level exercises -- that take place in the country where we bring these groups together and have a table-top exercise in advance so that we get to know who the players are and what their capacities are, what it is, they're going to bring to the table, what it is that they thought we were going to be bringing in and we discover, "Oh, no, that's actually something we need to resolve somewhere else." So much of this really happens on a local level. You know, I mentioned in my testimony, that the event we just had at we had out at Fort Belvoir where we had a preparedness event. At that parking lot there in the PX, all of the players who would respond to a disaster in Fort Belvoir were there. It was a bright sunny day and we were handing out preparedness kits but the other thing that was going on was we were who'd be responding to a disaster if something were to happen there. Having a chance to talk to each other, connect with other and talk a little about what our roles and responsibilities are if something were to happen. The more of these that happen on a local level, I think the more success that we're going to have.
Chair Harry Mitchell: I just was looking at the federal response plan and the VA has a support role with four different agencies that have the primary response. We have a support role with DoD. There's one with the American Red Cross. There's one with the GSA also HHS. And I just hope, that's what part of this hearing is about, is to make sure that everybody understands their role -- in a support or a primary role.
Does anyone feel like there's a plan? How about a plan to have plan? We're not wasting time on the second panel. For example, Capt Chen was and Chair Mitchell stopped him and informed him of the law -- actually made it clear (nicely) that he knew the law Chen was talking around -- and how it worked and asked specifically -- again -- what VA and DoD were coordinating on and instead of a direct answer, Chen wasted several more minutes offering a historical overview. An overview that it was very clear that the Subcommittee didn't need. (And, again, hadn't asked for.) "I understand about the wartime, again, but I'm asking about the natural disasters where DoD is part of the response team," Chair Mitchell attempted for a third time with Chen. Whether DoD didn't want the issue addressed or whether Chen didn't have the information is an unknown. But it was a waste of time and Mitchell's attempts to redirect were repeatedly ignored. Christy Music noted she'd grab it -- to everyone else on the panel before she made the statement to the Chair -- and she then ignored the question to offer yet another historical overview. Chair Mitchell wanted to know when the last time the two department -- VA and DoD -- cooridnated and no one could or would answer the very clear question. Over three minutes after she began 'answering' the Chair's question, Music stated, "So to answer your question more specifically, we coordinate with them daily, certainly two to three times a week." And, no, that didn't answer his question. Coordinate with them on what? On what Mitchell was asking about? Yesterday we heard about DoD and VA coordination on health care, for example (and we'll go back to that in a moment). That's not what the Chair was asking and his question was never answered. If the plan was to run out the clock, the witnesses were successful in that.
We're going to drop back to yesterday to note Tuesday's Senate Armed Services Committee Hearing. Committee Chair Carl Levin's initial questions were noted in yesterday's snapshot. Today we'll note Senator Daniel Akaka's. Appearing before the Committee was Gen Peter Chiarelli (Army), Adm Jonathan Greenert (Navy), Gen James Amos (Marine Corps), Gen Carrol Chandler (Air Force), and the VA's Dr. Robert Jesse.
Senator Daniel Akaka: In continuing to work with you and my colleagues we can refine efforts to prevent military suicides and to look for better ways to treat the -- to detect and treat and care for those suffering from invisible wounds of war. General Chiarelli and General Amos, suicide prevention is difficult and challenging -- and for all of you on our panel, this has come about, of course, because of what we call combat stress. And as was mentioned, this includes PTSD, TBI and behavioral health issues that we are facing here. As was previously stated, the services have experienced a rise in the numbers of suicides since the wars in Afghanistan and Iraq started. And there is a need to understand suicide, look at the causes so we can understand it and prevent it. Generals Chiarelli and Amos and also Dr. Jesse, how can the VA and DoD better collaborate in the area of suicide research and prevention? This has been mentioned by General Chiarelli as a great need here and I'd like to have the three of you give your perspectives on this.
Gen Peter Chiarelli: Well I would argue --
Senator Daniel Akaka: General Chiarelli?
Gen Peter Chiarelli: -- the cooperation between the VA and the services, I believe, has never been better. I think the disability evaluation pilot that we're running at different installations is proving to be a great success for the United States Army. And the wonderful thing about this is is that when a soldier goes through the DES uh we ensure that if they're leaving the service that they're in the VA system. And this is something that has never happened before as far as I know. It is a wonderful benefit of this that when a soldier makes a decision to leave the service, he is in that VA system. Before we would in fact have soldiers separate and it would be their responsibility to work their way through the process to get in to receive both their medical benefits and other benefits through the VA system. I think that you've hit upon a key piece here and that is stressors but it's not only combat stress, it's individual soldier stress and family stress and when we look at those across a continuum. what we're seeing in the army with the high ops tempo that we're on today, that a soldier in the first six years that he or she spends in the United States Army has the cumulative stressors of an average American throughout their entire life. And that's when you combine high ops tempo, individual soldier stressors and family stressors. So this is an area we're looking at very, very hard. And when you realize that 79% of our suicides last year were soldiers in-in-in 60% in their first term, 79% one deployment or no deployment, I think it points to doing everything we possibly can to mitigate those stressors whenever possible and as we're working so hard to do in the Army, work to increase the resiliency of our soldiers -- particularly in their younger years.
Senator Daniel Akaka: Thank you. General Amos?
Gen James Amos: Senator, I'll be happy to talk about not only the relationship but the hand off between the military -- in my backyard, the Marine Corps -- and the Veterans Association. Like General Chiarelli, I have never seen it better. The entire organization is well led from the top down, from VA. They are compassionate, they are passionate about the care of our young men and women that enter their system. I've never seen it better. I'm fortunate to get to travel around and visit a lot of our VA hospitals and a lot of our wounded and I come away just completely wowed by what I see. There is a systematic handoff . In the Marine Corps, this is done by what we call our recovery care coordinators. We take some Marines -- we have them around the nation. They are not part of the federal recovery, but they are linked to it. They are US marines whose job it is in life to know everything they can about the VA system and so when a Marine transitions -- especially one of our wounded Marines -- transitions out into -- heading to VA Land, after his disability board and he's moving on to the next half of his life, that recovery care coordinator contacts the federal recovery care coordinator, the District Entrance Support Marines we have out there, our network of Marines for life, put our arms around this guy. But I've seen it first hand where the actual hand off for a needy Marine, in some cases two years after the injury, after the initial injury -- I just saw this last -- about last month down in Corpus Christie, Texas. A young Marine, TBI two years ago his life is unraveled right now and through the federal recovery coordinator and the VA in San Antonio and our care coordinator we were able to plug this Marine, get him back into a hospital right away for further care. So, I've never seen it better, Senator.
Senator Daniel Akaka: Let me ask Admiral Greenert for your comments as well as General Chandler after you.
Admiral Jonathan Greenert: Thank you, Senator. I think General Chiarelli and Amos hit the nail on the head. Cooperation is very good. In fact, we meet monthly-- with leadership of the VA and the leadership of the Dept of Defense to streamline the Defense -- the Disability -- excuse me -- Evaluation System. I would say that what we are finding in our study of suicides, the transitional period seems to be a spike in stressors and this is an area we need to watch very closely -- this transition period -- and be sure that our Sailors have the social support network that they've had as they've moved through their career in the Navy as long as it is. It's also a focus area to watch out for those stressors. Thank you.
Senator Daniel Akaka: General Chandler?
Gen Carrol Chandler: Senator, we have approximately 700 Airman in our wounded warrior program. These are young men and women whose lives have been changed forever and that we are dedicated to taking care of from the time they've been wounded until they no longer need our services in the Air Force and we make the transition to the federal system if, in fact, that's required and we're not able to bring them back to the Air Force. We use much the same system that General Amos described with recovery care coordinators that allow us to do that around the nation, to service the men and women that require that kind of treatment and that kind of handling. We're very comfortable with our relationship with the VA and the way that's working.
Senator Daniel Akaka: Well I'm glad that we've been working on what we call seemless transition and it appears that we're moving along in that. Dr. Jesse?
Dr. Robert Jesse: Thank you, sir. So as not to reiterate things that have already been said. I'd just like to point out a couple of areas where this level of integration has really become manifest. The first is in the post-deployment and health reassessment exercises. Uh, the VA generally has a presence at the exercises -- not to administer the exams but to be present to make sure that those service members are uh-uh aware of all of their benefits that the VA can provide. But also if there are immediate health and particularly mental health issues that arise, that they are there and can literally make an appointment on the spot. They can get them enrolled in VA, make an appointment and, if we need to take them into our care, we can do that. So that we participate in that -- The second is the poly-trauma networks uhm which really are while the VA has four going on five now poly-trauma centers of care those are really tightly integrated into the wounded war -- wounded warrior programs at Walter Reed and Bethesda. In fact, I had the real honor to accompany [VA] Deputy Secretary [W. Scott] Gould and Dr. Stanley on a tour of Walter Reed and them come directly down to Richmond and look at the seemless way that both patients and their information moved back and forth through those networks including the fact that VA represenatives stationed in the DoD facilities and DoD clinicians in the poly-trauma centers so that they ensure that any movement of a patient is a warm hand-off and not just being sent to another place. Finally, in the mental health area, I think there has just been an extraordinary collaboration uhm-uhm going on for some time now. There was a joint-conference in the fall of '09 that led to an integrated VA - DoD strategic plan and the real goal is to make sure that when, for instance, the -- there are evidence-based therapies for Post Traumatic Stress -- treatment of Post Traumatic Stress, the VA and the uh -- Dep -- the uh, services uh agree on how we treat those patients so that this treatment begins in the services and then transitions to the VA, we're not abruptly stopping one form of therapy and then herding them into another. And I think that is a hugely important point of collaboration that we've gotten that far.
How wonderful. There are no problems. Everyone said it worked wonderfully. So everything's perfect. And the service members have stopped taking their own lives, right? Suicide is now a thing of the past, right? Surely, it must be when it's being so wonderfully praised in a Senate hearing. Or maybe a lot of people just wanted to spin? Suicides didn't stop. And nothing raised in the above exchange really addresses the issue. Akaka clearly asked about military suicides and look at the responses. Kat offered her impressions of this hearing last night.

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Tuesday, June 22, 2010

Frat boys pissing on the White House











"The Committee meets today to recieve testimony on the status of our efforts to prevent military suicides and the challenge in detection, treatment and management of the so-called invisible wounds of war which we consider to include Traumatic Brain Injury, concussive events, Post Traumatic Stress and other combat-related psychological health concerns A hearing on military suicides was requested by Senator [James] Inhofe several weeks ago and we all appreciate that request," Senator Carl Levin declared today bring the Senate Armed Services Committee Hearing to order. Appearing before the Committee was Gen Peter Chiarelli (Army), Adm Jonathan Greenert (Navy), Gen James Amos (Marine Corps), Gen Carrol Chandler (Air Force), and the VA's Dr. Robert Jesse.
Chair Carl Levin: The increase in suicides by military personnel in the last few years is alarming. In 2007, 115 Army soldiers committed suicide; in 2008 the number increased to 140, and to 162 in 2009. Similarly, 33 Marines committed suicides in 2007; 42 in 2008, and 52 in 2009. I understand that there are a number of additional cases where the Armed Forces Medical Examiner has not yet concluded whether the deaths are by suicide, so the 2009 numbers will likely be even higher. These increases indicate that despite the services' efforts, there is still much work to be done. We must improve our suicide prevention efforts to reverse the number of services members taking their own lives. I am greatly concerned about the increasing numbers of troops returning from combat with post traumatic stress and traumatic brain injuries and the number of those troops who may have experienced concussive injuries that were never diagnosed. Studies indicate that mild traumatic brain injury -- or concussion -- is associated with PTSD, depression and anxiety. These conditions, in turn, may contribute to the increase in the number of suicides. Key to suicide prevention is to make greater efforts to end the stigma that too many perceive attaches when they receive mental health care. Another key, of course, is the proper and timely diagnosis and treatment of Traumatic Brain Injury and Post Traumatic Stress and increasing awareness of and access to mental health care resources as well as leadership support for those seeking such care. We hope to hear from our witnesses today the approach that each service and the Department of Veterans Affairs is taking to help detect, treat and manage psychological health problems to include Post Traumatic Stress and Traumatic Brain Injury. The numbers of suicides have increased in every service, but significantly more so in the Army and Marine Corps, the two services most heavily engaged in ground combat in Iraq and Afghanistan. Congress has recognized the strain on these ground forces and has over the past several years authorized significant increases in the active duty end strengths for the Army and the Marine Corps.
"The burdens of our missions in Iraq and Afghanistan are tremendous and so are the consequences for those who serve," Ranking Member John McCain stated. "Many of our service members have answered their country's call with multiple deployments to combat and little time for rest and recovery at home."
Chair Carl Levin: A couple of weeks ago, National Public Radio reported that the military is failing to diagnose brain injuries in troops who served in Iraq and Afghanistan, that the injuries were not documented on the battlefield, that soldiers with TBI don't always get the best medical treatment and interviews with soldiers at Fort Bliss revealed that some soldiers with TBI were crying out for help still had to wait more than a month to see a neurologist. Also they reported that many military doctors have failed to accurately diagnose TBI. Can you give us your response to those reports?
Gen Peter Chiarelli: Mr. Chairman, I prepared a complete response to National Public Radio in which I detailed my problem with the report. I've got three basic problems with the report. Number one, it criticizes the leadership for not caring or not doing anything about it. I think that's far from the truth. I took great exception with the report stating that our doctors seemed to [not] care and are not properly diagnosing these injuries without explaining the real issue here. And you cannot isolate Traumatic Brain Injury without talking about PTS. As I mentioned in my opening statement, the comorbidity of symptoms between these two make it very, very difficult for doctors to make that diagnosis. Of my Army wounded warrior population, this is the most severlyly wounded population I have, with a single disqualify injury of 30% or greater, 60% have either TBI or PTS. 43% PTS, 17% TBI. And I really believe that when you fail to talk about both PTS and TBI and this issue of comorbidity, you're doing a great disservice because to state it flatly: Our science for -- on -- the brain is just not as great as it is in other parts of the body. And researchers are struggling today to-to find the linkages and to learn everything they can about the brain. And because of this, we're going to see some misdiagnosis. I-I can tell you of the folks that the National Public Radio talked about, they had over 200 appointments a piece, uhm, and there's no doubt you could go to anyone of our posts and find soldiers who are struggling because of our inability to nail down and to diagnos exactly what treatment they need for these behavioral health issues but, I promise you, it is not for a lack of trying or real care on the part of our doctors and our leadership is totally committed to working these issues.
Chair Carl Levin: In terms of the wait that one of the soldiers, I guess, claimed of a month or more to see a neurologist?
Gen Peter Chiarelli: I will tell you that a neurologist is not the answer necessarily to these soldiers' issues. I have a total of 52 neurologists in the United States Army. 40 of them are currently practicing. 40. And that's when I include my child neurologist. The team that will work with somebody on any behavioral health issue is -- is a team of a neurologist, possibly a psychatrist, nearest case manager who will look at the entire file or medical record of care given to that-that soldier and work to provide them the best that they can. The -- One of the problems we have here, and I get this from talking to doctors, is even the medications for PTS and TBI are totally different. So if we misdiagnose at the beginning and provide diagnosis of PTS when in reality it's TBI, the medications we're going to put that soldier on are going to be different than what the real problem is and maybe different from another behavioral issue that a soldier may have. Because it's not all TBI and PTS. There's anxiety issues, depression issues, other issues that are the product of the-this-these wars that are causing us so much difficulty in this area. I've got 79% of the psychiatrists currently assigned to the United States based on my authorization prior to 2001. And I know that that authorization is lacking but I only have 79%. And it's not just an Army problem. This, I think you will all agree, is a national problem in a shortage of behavioral health specialists.
Chair Carl Levin: So there are some areas of professional need where we are short. Is this a matter of funding, is this a matter of finding people or what is it?
Gen Peter Chiarelli: No-no, I don't believe it's a matter of funding at all. I think it's a matter of finding folks. Of getting them to move to some of the places where the Army is stationed. When you have shortages, it's much -- You know, I think a psychiatrist might prefer to be in Nashville than in Clarksville, Tennessee. So we have to rely on that TriCare network many times to provide some of the behavioral specialists that we need.
Chair Carl Levin: And in terms of this delay issue, is the delay the result of the lack of resources in the cases that were talked about on NPR or is that a matter of the complexity which you just described.
Gen Peter Chiarelli: I-I-I'd argue it's a case of the complexity. I really would. And I'm not saying in every instance that we're getting soldiers in exactly when we want them to be but when soldiers are assigned to our WTU, they have a primary care manager of a rate of one to two hundred, a primary care manager -- where you or I would have a primary care manager at a ratio of 1 to 12,000 to 15,000. They have a nurse case manager at a ratio of one to twenty. They have a squad leader at a ratio of one to ten or less. So we've done everything we can to focus our resources, our limited resources, in this area but I will tell you, we are short behavioral specialists.
Chair Carl Levin: But again, that's not a funding issue?
Gen Peter Chiarelli: It is not a funding issue.
The general seemed sincere in his first reply to Levin (quoted above). He seemed sincere in his second. But there's a contradiction in the two. In the first, it's concern for the well being of the soldier. In the second, it's woah-ways-me. "A team" of two people? And one is a neurologist that the soldier can't get to see, all he or she is seeing is a case worker and that's supposed to be acceptable? In what world? There's also a shift from the notion that the soldiers deserve the best care (lip service, I know) to 'the best that these overworked doctors and caseworkers can give.' That's a world of difference.
In the second, 'It's woah-ways-me, I only have 40 neurologists.' I'm not seeing and I'm not hearing that supposed real committment to the issue. I'm hear justifications and insults. And that's especially clear when the general decides to speak of "other behavioral issues."
PTSD and TBI are not behavioral issues (I am aware some treat them as if they were, I'm also aware those treatments do not have longterm success rates) and that, after all this time and all this supposed education, a United States general doesn't know that, doesn't grasp that, it's rather telling. And it goes a long way towards explaining the manner in which the second response was delivered which was in a between-you-and-me kind of way and seemed to mock the illnesses. Not behavior issues, illnesses. And the Army would do well to get away from that term as well as to get away from calling medical providers "behavioral specialists." In addition, the 'squad leader' is not part of a medical team. Nor is the 'nurse case manager' that the general blurred all lines of reality on. Yes, he or she has a one to twenty ratio . . . for the designated time that they're responsible for a certain squad (such as an hour each day or a portion of a day). There's a world of difference between that reality and what the general was implying or impLYING. No, for every 20 soldiers on a base, you will not find that there is one nurse case manager. That's not how it works and he knows that. The reality is that a general physician of some sort (and that may be increasing the qualifications of the man or woman) is responsible for all care. And if there are misdiagnosis as the general wants to state, that's all the more reason the soldiers need to be seeing a specialist and not some general practitioner.
As for being 'caused so much difficulty in this area,' the general's 'suffering' is of no concern to most Americans and he needs to climb down from his cross and grasp he has a job to do, one he's paid handsomely for by US tax payers. He's not paid to whine. He's paid to ensure the safety and well being of all those serving under him. That's what he was there to talk about but instead he wanted to play Drama Queen. As his voice rose and rose, what it really came down is he refused to answer direct questions and if you tried to piece together the answer from his many words, what you got was: "I'm offended NPR and ProPublica reported what they did but, yes, it is accurate."
And it's probably a good time to remember Adrienne Kinne's testimony at Winter Soldier in 2008 (see March 25, 2008 snapshot for an overview of all her testimony), specifically her testimony on Friday March 14th at the panel on veterans healthcare. Kinne spoke of after leaving the military and pursuing her education further. She did some college internships at VA hospitals and then was an assistant on a research study. The study was on PTSD and TBI -- Post Traumatic Stress Disorder and Traumatic Brain Injury. The group devised a way to screen for TBI, hammered down the details and were ready to proceed.
Adrienne Kinne: And then they went to go to the next step, to actually make this happen. And I was actually on a conference call when someone said, "Wait a second. We can't start this screening process. Do you know that if we start screening for TBI there will be tens of thousands of soldiers who will screen positive and we do not have the resources available that would allow us to take care of these people so we cannot do the screening." And their rationale was that medically, medical ethics say if you know someone has a problem, you have to treat them. So since they didn't have the resources to treat them, they didn't want to know about the problem.
Has a lot really changed? Doesn't appear so from the general's testimony. Picking immediately back up with Levin's questions.
Chair Car Levin: Alright, now, Dr. Jesse, the VA, as I think you've testified, screens all of our Iraq and Afghanistan veterans who receive care from the VA for TBI. Does that screening for TBI indicate that there is a routine failure in the military to properly diagnose TBI before you see that veteran, while they're still on active duty?
Dr. Robert Jesse: No-no, sir, I don't -- I don't think we can say that. The problem with TBI is that there-there's no hard, fast diagnostic test. There's not a lab test that you can send off and get an answer back. And the other thing is that of temporal issues -- is that often it takes time to manifest some of the -- some of the effects that would have to show up. So I don't think think that it's a -- it's a failure on the Department of Defense to find these people. I think it's uh, uh, may just be, uh, the complexity of the disease.
Good to know it's no one fault, right? Who pays you, Dr. Jesse? Oh, yeah, perfectly clear now. Tomorrow we may note Senator Daniel Akaka's questioning. He focused on suicides and it's worth noting but, if you can't tell, the general and the doctor disgusted me. And I'm not really big on people attacking the press with bluster with non-specifics. When, for example, Senator Mark Udall spoke to the general (the only one focused on in this snapshot) about a doctor who didn't think it mattered -- put this in writing -- whether or not TBI was properly diagnosed, he did a song and dance and refused to answer. I don't have time to quote his multitude of lies. The NPR and ProPublica report stands. Click here to refer to those reports. Instead of the general's diversions, we'll note this from Senator Akaka's office:


WASHINGTON, D.C. – Senate Veterans' Affairs Committee Chairman Daniel K. Akaka (D-Hawaii) introduced legislation today to make much-needed improvements to VA's disability claims processing. VA provides disability compensation to approximately 3.1 million veterans across the nation.

"VA's system to provide veterans with disability compensation is well intended, but it is broken. This bill will move the Department closer to fulfilling its obligation to provide every eligible veteran with timely and accurate disability compensation," said Akaka.

As Chairman, Akaka has held a series of hearings on improving the veterans' disability compensation system (to view the Committee's hearings click here). The Committee will hold a hearing to review disability claims processing on July 1, at which time witnesses will testify about Akaka's legislation.

The Claims Processing Improvement Act of 2010 (S.3517) would make various changes to the way VA processes disability compensation claims, including provisions to:

  • Set up a process to fast-track claims that have been fully developed;
  • Help veterans with multiple disability claims by allowing VA to provide partial disability ratings; and
  • Provide that the Department give equal deference to the medical opinions of a veteran's non-VA doctor.

The bill would also establish a test program at several Regional Offices replacing VA's method for identifying musculoskeletal disabilities. Compensation under the pilot would be based on a functional assessment of limitations due to the disability, such as standing, walking or lifting, and would take into account the severity, frequency and duration of symptoms of the disability. To identify disabilities, the pilot would use the common language of the International Classification of Diseases, rather than VA's current Rating Schedule.

To read Senator Akaka's statement in the Congressional Record introducing the bill, click here: LINK


Kawika Riley

Communications Director

U.S. Senate Committee on Veterans' Affairs

Senator Daniel K. Akaka (D-Hawaii), Chairman

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