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  • Better MH Services


    In our nation's history, more than 1 million American servicemembers have been killed in U.S. wars. For the past 151 years on the fourth Monday of May, we have honored the great soldiers, sailors, Marines and airmen who have fallen.

    Much has changed, but the generations of brave men and women willing to make the ultimate sacrifice in the name of freedom have endured, and the sanctity with which we regard these individuals has remained.

    There are many millions of Veterans, however, who returned home from war to find a country unable to provide them access to basic human rights such as quality civilian employment opportunities, health care and education. In recent years alone, 20.4 million men and women risked their lives for their country and, in return, many were refused fundamental care by the Department of Veterans Affairs (VA). President Trump has renewed the fight for these Veterans.

    The VA fell into disarray under the Obama administration. President Obama tried to establish reform with initiatives such as the Veterans Choice Program to expand health care options and reduce wait time for medical appointments to a maximum of 30 days. This policy was great in theory, but in practice the Government Accountability Office found that some Veterans waited up to 70 days for care and many died as a result.

    Why was this happening? Some VA personnel neglected their duties by falsifying wait times for medical care and ignoring major systemic issues in the medical network with no accountability.

    When President Trump took office in 2017, he pledged that the men and women who uphold our country's freedoms no longer would be ignored by their government. In June 2017, he signed the Department of Veterans Affairs Office of Accountability and Whistleblower Protection Act. This legislation resulted in the removal, demotion or suspension of more than 4,000 employees who exhibited substandard performance. By weeding out the under-performers, Veterans have been left with a better-functioning VA.

    The Trump administration continues to move forward with efforts to expand VA accountability like the implementation of the "Access and Quality Tool," a platform that allows Veterans to view wait times and assess quality-of-care data when choosing health care providers. As a result, wait times have improved and are comparable to the private sector.

    There is a prevalence of mental illness in the Veteran community that was not effectively addressed under Obama. Thirty one percent of active duty and reserve military personnel who were deployed to Iraq or Afghanistan have experienced some form of mental illness or have reported experiencing a traumatic brain injury, but only 30 percent of those servicemembers will get treatment. The 70 percent who go untreated are forced to cope and, sadly, 22 Veterans die by suicide every day in the United States, on average. Substance abuse precedes approximately 30 percent of all Veteran suicides and about 20 percent of high-risk behavior deaths.

    The stigma surrounding mental health treatment has created a substantial access gap in coverage, meaning many people who need to be receiving treatment may not be. In an effort to create more accessible options, President Trump secured $73.1 billion in funding for VA mental health services, opioid abuse prevention, suicide prevention and rural Veterans' health initiatives.

    Veterans' choices and access to medical care have expanded with the VA Mission act, making it easier for Veterans to find treatment in their own communities and providing access to walk-in clinics for immediate care.

    The president also signed an executive order requiring Homeland Security, Defense and Veterans Affairs secretaries to construct a joint plan that affords Veterans access to mental health treatment.

    The transition from a uniformed life to a civilian one is not easy, but President Trump has worked to ensure that Veterans have access to quality job opportunities. The jobless rate for all Veterans fell to an 18-year low of 3.5 percent in 2018, from its peak at 9.9 percent in 2011.

    President Obama once said, "Our nation owes a debt to its fallen heroes that we can never fully repay." Although that is true, it is with gratitude that we honor the fallen heroes whose bravery and sacrifice has ensured our freedom. Not just this day but every day, we must choose to honor their memory by caring for those soldiers who did return home. As President Trump said, "We will not rest until all of America's great Veterans receive the care they've earned through their incredible service and sacrifice to our country."


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  • Life Can Turn Around


    Maybe it’s the moment when you realize that things could be better or the moment when you decide you need to reach out for help. Or, maybe it’s the moment when you know that help is working — that your life has changed for the better.

    This Mental Health Month, the Department of Veterans Affairs (VA) Office of Mental Health and Suicide Prevention is highlighting the many moments — big and small — that can make up a Veteran’s mental health recovery.

    For La Wanda, a U.S. Navy Veteran, it was the moment when a friend bluntly said what she needed to hear: “You know there’s help out there available — and you need to get it.”

    For Joseph, a U.S. Navy Veteran, it was the moment when he reconnected with an old teacher. That meeting spurred him to see a counselor, which changed his life. “All of a sudden,” he says, “I wasn’t alone anymore.

    For Richard, a Vietnam Veteran, it was the moment when he began to feel rejuvenated by his mental health treatment. He had tried to deal with feelings of anger and depression on his own. But now, with treatment, he thought: “This is helping. This is working.”

    A run-in with the law, a divorce, or the loss of a career could be the wake up call that sparks a change. But many other times, it could be a small thing, the moments that happen on a routine Wednesday afternoon. The one conversation. The one question. Someone noticing. Someone reaching out.

    These moments can be a turning point.

    This May and all year round, we recognize the moments that can spark a recovery. This is the perfect time to start a conversation about mental health, to lend your support, to encourage others to take a positive action. Or, to reach out yourself.

    Visit to watch Veterans share their stories about the many different moments of their mental health journeys, from the little victories to the major turning points.


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  • Disabled Vets


    What's Not Talked About?

    Throughout the history of warfare, service members have been placed in unimaginable situations, often situations in which they have to make difficult decisions. Frequently, decisions made during deployment have lifelong consequences. Many Veterans have expressed a desire to be the person they were before they experienced trauma, and they often try to suppress or avoid memories of the trauma they have lived through. However, the use of avoidant coping strategies has been found to be counterproductive in the long run. By attempting to avoid the traumatic events service members have experienced, they end up exacerbating the intensity and frequency of their trauma memories and the sequelae and symptoms of those memories over time.

    Some Veterans are able to move past trauma with minimal dysfunction in their lives; however, for others, the traumatic event creates havoc and chaos. Trauma symptoms can become so problematic that they result in family discord, divorce, social dysfunction, significant substance use, employment difficulty, physical health difficulties, legal problems, and more. And the disruption of service members’ lives as a result of trauma symptoms is hardly uncommon. Due to the dysfunction and negative impact of trauma and its symptoms in the lives of service members, the VA has recognized and developed the VA disability rating system. The disability rating system considers both physical and mental health-related conditions. The more areas of a Veteran’s life that are impacted (i.e. social and occupational difficulty or physical limitation and/or pain), the more financial compensation that Veteran potentially could be warranted. I am a firm believer that Veterans are entitled to every dollar that they are afforded and then some...Many can argue that the lifelong implications and symptoms that Veterans have to endure cannot be quantified or compensated with a dollar amount. The VA does its best to equitably compensate Veterans based on their level of dysfunction. However, if the Veteran could eliminate the disabling experience that initiated their impairing symptoms, it is possible that they could exceed the amount of their VA compensation by functioning optimally in the civilian sector. Essentially, they would be able to have a greater positive economic impact and earn a higher living wage if they did not experience disabling symptoms. Given the high level of training military members receive, the values, discipline, and structure instilled by military training and service often lead most Veterans to make dependable, hard-working, and effective employees.

    Disability Rating System

    According to the VA Disability Rating System, in the year 2000, the average compensation provided to Veterans through the disability rating system was about $20 billion for 2.3 million Veterans. In 2013, that number rose to 3.5 million Veterans receiving $54 billion in compensation. This number has continued to rise over the last several years and will hopefully continue to do so, enabling Veterans to receive the compensation they deserve. A major reason for the spike in Veterans receiving compensation is the continued 14-year wars in Iraq and Afghanistan. When service members are sent to war and later return home, there are often significant consequences to service—economics being one of them. Unfortunately, many Veterans who are still in need of services and compensation for VA benefits have not taken advantage of the services offered. Many factors impact Veterans’ decisions not to seek care— a main one being stigma. Two examples of stigma are: one, a Veterans’ hesitation to seek mental health services due to being perceived as “weak” or “vulnerable;” and, two, the possibility of having negative career or job implications as the result of potentially impairing symptoms. As I have said in a previous blog, it takes a nation to build a military and go to war. And, it takes a nation to welcome them home. Compensating our Veterans for their service is the first of many steps that should be afforded to Veterans for their sacrifice. If we send people to war, it is a fundamental imperative that we take care of them when they come home. The tide is changing, and the VA has gone to great lengths to decrease wait times for compensation and pension evaluations so that Veterans are streamlined through the process. There is no perfect system, and the pendulum has and is continuing to shift in the right direction so that our brothers and sisters in arms are taken care of.

    To specify the rating system with an example, if a Veteran diagnosed with PTSD has a 50 percent service-connected disability rating and they have a spouse and one child, they would receive $978.64 each month. Yearly, that is roughly $11,745. The pay for a Veteran that is 100 percent serviced-connected increases significantly. They would approximately $3200 monthly. Although this money is not taxed, many Veterans still struggle to make ends meet. Anecdotally, there is a misconception that if a Veteran receives a 100 percent service connection, they will be able to live a “lavish” lifestyle. That is simply not true. This money can definitely help decrease financial distress, however, many Veterans still struggle to pay for things they and their families need.

    Once a Veteran receives a disability rating and compensation is provided, there can be fear that the disability rating might be decreased or taken away if the VA finds evidence the Veteran’s symptoms have improved to a more manageable level. Once Veterans receive a service-connected percentage of disability, it is not a fixed rate for life—although it could be. The VA has the right to decrease the compensation rate if the Veteran shows material improvement in their ability to function in daily life whether that be in relation to a physical or mental health-related condition. According to the Department of Veteran’s Affairs Service Connected Disability website (2017), if a Veteran has less than a 100 percent disability rating, has been receiving compensation for less than five years, and has shown medical and social improvement, the VA can reduce the percentage of disability and compensation based on the evidence found. However, if a Veteran has been receiving benefits for longer than 20 years, it is considered a continuous rating and the VA cannot lawfully reduce the rating. At 10 years, a Veteran’s rating cannot be terminated, but it can be reduced. If a Veteran’s disability rating is reduced, a Veteran has the option of requesting a reexamination, and they should contact a Veterans’ Service Organization representative to advocate on their behalf.

    The VA provides great and well-needed services, and they save lives every day. Unfortunately, some Veterans walk away from the VA dissatisfied and displeased. There is no perfect mental health and medical system, and the disability rating scale is not perfect either. There is no one program that provides a “fix all” solution. What it will take is public and private partnerships moving forward in order to maximize reach and expand access, frequency, and quality of care.

    Many Veterans who receive benefits fear their benefits may be taken away at any point in time. Unfortunately, this fear of disability ratings potentially being lowered if there is substantial evidence that the Veteran has made improvement deters people from seeking and fully engaging in well-needed treatment. For instance, if a service-connected Veteran engages in an evidenced-based trauma-focused treatment for PTSD that has been shown to reduce symptoms upon full completion, and as a result of that treatment their overall dysfunction decreases, that Veteran could be at risk of decreased disability ratings if that improvement is documented and gathered during a medical evaluation. Veterans who know the disability rating system may be deterred from seeking care at the VA because of that potential. The more dysfunction one has, the more money they receive; so increased symptomology is incentivized and reinforced. If Veterans struggle with employment and optimal functioning, it makes sense that those Veterans may not want to show improvement. This is one lens to look through.

    Unfortunately, there is no perfect solution to this problem. However, there has been plenty of debate about possible solutions. One solution discussed would be to extend the time period between the rating system from the initial evaluation and reevaluation. This solution could assist with decreasing stigma and reducing the fear of losing a percentage rating with the potential benefit of encouraging people to fully engage in well-needed treatment. This would allow Veterans to seek a high standard of care, receive benefits, and practice their skill-sets learned with a longer time to adjust for life stressors that may continue to exacerbate symptoms. If there is no reoccurrence of symptoms, then one may experience a reduction in compensation. If there continues to be notable impairment, then the percentage of disability rating could stay the same or increase. Another potential solution is to continue the private-public partnership so that Veterans can receive care outside of the VA. If Veterans fear that making progress would jeopardize their disability rating when seeking care at the VA, those concerns are potentially lessened with treatment in the private sector. These issues about disability ratings and improvement in functioning are only a few of the many issues debated in the current Veterans’ issues climate. Although they are hotly debated, the pendulum is moving in the right direction by placing our Veterans first.


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  • Low Ball


    The day was just like any other day. Until you checked your mail. The big brown envelope was in it, with the VA logo in the upper left corner. You knew it was your VA PTSD Rating Decision. It’s about time – you filed yourPTSD service-connection claim18 months ago. “Why does the VA take so long,” you think. “It shouldn’t be that hard for the VA to service connect PTSD.”

    You tear off the envelope open expecting to see a 70%, or 100% rating. That dude in your unit who was there that day – and saw the same things you did – got a 70%, and he seems to be having an easier go of life than you.

    Part of you is excited. That extra compensation is going to make a difference. You are struggling to make ends meet as it is. You got fired from the last job for getting upset with your boss. The job before that you quit because all the people moving around that place wanting to talk made you jumpy and anxious.

    When you read the letter, your heart sinks. Then, a wave of anger and frustration.

    10%. That’s what they gave you. The same rating they give to every Veteran with tinnitus.

    Where do you go? What do you do?

    First, it is important to know that you are not alone – the VA is not out to get you, and didn’t do this as retaliation against you.

    I’m serious about that: the VA is just plain incompetent when it comes to rating most medical conditions. Most of their raters try to do a good job – many are Veterans themselves – but the VA doesn’t give them training. VA management has created a culture of hostility and back-stabbing where all problems are blamed on the “unions.”  Don’t let me go down THAT rabbit hole.

    A lot of Veterans – some worse off than you, some better off than you – have a diagnosis of service-connected PTSD and find themselves “low-balled” with a rating that is much lower than that of their peers and that does not reflect the severity of their medical condition and the affect it is having on their lives.

    When it comes time to appeal that low rating though, most Veterans have something else in common: they don’t have the tools to adequately challenge the low VA PTSD rating and don’t know where to start even if they did.

    I’m going to give you some ideas to deal with the lowball VA PTSD rating.

    The #1 thing to consider when your VA PTSD Rating is low-balled.

    There is nothing wrong with getting a professional to help you.

    VA PTSD claims can be really tough, even on straightforward facts. Recently, I talked to a Vet who witnessed some horrible, horrible things during the invasion ofPanama that messed him for a long time and put him on a path to opioid abuse and homelessness. The VA denied him service connection for PTSD.

    At my own firm, I’ve gone to theVeterans Court many times to straighten theBVA out on low-balled VA PTSD ratings. I’vestopped them from symptom hunting. I’ve seen ratings so bad that the Veterans Court found the BVA’s actions “disconcerting.” And we stopped the BVA from an absurd decision that gave a 30% PTSD rating to a Veteran who had regular hallucinations due to his trauma.

    These cases are hard to fight – there are so many traps for the unwary that just add stress and anxiety to a situation that probably already has too much.

    And I’m here to tell you, if I was fighting the VA on my own PTSD claim, there is only one attorney I would get to help me:Matt Hill.

    I don’t recommend people very often on the Veterans Law Blog® – it’s not what we are trying to do here. I”m trying to educate Veterans, not shill for other businesses. I’ll tell you about lawyers, and experts, but I rarely make suggestions.

    I’ve known Matt for almost 10 years now, and he knows his stuff when it comes to PTSD claims.Click here to watch a quick interview with him a couple years back– use the form on that page and it will email him your info and ask for a consultation. And you can absolutely tell him that Chris Attig said he was the best.

    But don’t let me pressure you: if you want to handle your own VA PTSD rating appeal – and many, many Veterans do so successfully without having to pay an attorney or stress out over a non-responsive VSO – the rest of this post is a good place to start figuring things out.

    So, I’m going to walk you through 9 Things that might help you get the VA PTSD rating you are entitled to.

    These are  not the ONLY 9 things, and every case is different. Let’s get started.

    Understand where your VA PTSD rating fits in the 4 Pillars.

    When we talk about a VA Claim, we talk about simplifying it bybuilding the 4 Pillars.

    The 4 Pillars are the 4 things that every Veteran, in every VA claim, needs to prove before they will recover service-connected disability compensation.

    Impairment ratings – or the way that the symptoms of your service-connected condition are equated to a percentage and a dollar value – are the 3rd Pillar.

    The VA PTSD rating table is a little intimidating at first. It’s a jumble of sentence fragments, a massive list of symptoms, written by government bureaucrats that have long since forgotten how to communicate with earth people. Take a look:

    Low Ball 02

    That right there, my friends, is the definition of “impenetrable jargon.”

    Here are 9 pointers to help you evaluate the rating in yourVA PTSD claim.

    #9: Did you File your VA Claim – theRight Way?

    The 2 biggest errors that Veterans make in their VA Claims – and the 2 errors that cause them to get stuck in the VA backlog for longer and longer periods of time, are these:

    1. They filed their claim and expected the VA to do the work – or to do the RIGHT work – in developing the claim.
    2. They didn’t “connect the dots” for the VA in a simple straightforward way that made the VA Rater WANT to grant the claim.

    What does that mean in the context of a VA PTSD rating? Usually, it means the Veteran dumped 3, 5, or 10 years of mental health treatment records, and a couple handwritten statements on a VA Form 21-4138, on the VA and hoped the rater would see how bad things were.

    Remember, they don’t get training. And they see so darn many claims that they aren’t going to spend but a few minutes deciding your VA PTSD rating.

    You can avoid those solutions byFiling Your VA Claim – the Right Way – from the very start.

    It’s a simple fact that if you put the RIGHT evidence into your claim, and explain in a very clean and basic way how that evidence shows your sleep apnea is service connected, your claim will go quicker.

    And you will probably get better results.

    When you are ready to start learning How to File Your VA Claim the right way, click here & read this  post.

    #8:  The best-kept secret in a VA PTSD Rating are the Bankhead and the Mauerhan cases.

    The Code of Federal Regulations – before listing the PTSD rating criteria in DC 9411 – says that when rating PTS, the VA should consider symptoms “such as” those listed.

    That’s key language – as the Courts told us in Mauerhan.

    You don’t have to find  ALL the factors on the list to qualify for a particular rating.  You just have to make a case for your symptoms being similar to the symptoms listed at the rating level you believe you are entitled to.

    And what the Courts told us in Bankhead is that the VA is supposed to look HOLISTICALLY at your medical condition when assigning a rating for PTSD. I’m not going to get into Bankhead in too much detail here. I write a blog to help lawyers learn Veterans law, and have written about Bankhead.

    #7: Occupational Impairment factors are more important for VA PTSD Rating purposes.

    I’ve reviewed hundreds, if not thousands of Veterans C-Files.

    When the VA PTSD rating is too low, a common reason I have seen is that the Veteran focused on the social impairment factors, and not the occupational impairment factors.

    Take a look at all the factors in the 50% category for PTSD.

    In addition to equating those symptoms to your social life (home, family, friends and social interactions), relate them to your ability or inability to get or keep a job.

    #6:  The VA PTSD rating criteria is NOT a complete list of PTSD symptoms.

    Remember that the list of symptoms on this list are not meant to be every possible symptom.

    If you have symptoms, or manifestations of symptoms of your PTSD that are not on this list (and there are plenty), see which ones on the list are similar to yours. And then make that argument – that your symptom is like such-and-such a symptom of the 70% rating.

    The list of symptoms in the table above is not as a comprehensive listing of PTSD symptomatology. Think of it as an objective tool that was supposed to help make sure Veterans get rated as consistently as possible when PTSD affects them in similar ways.

    #5: Did the VA examiner consider the frequency, severity and chronicity of PTSD symptomatology?

    This is one thing that C&P Examiners overlook the most often. They hunt-and-peck through your medical records for a symptom that matches the one on the rating list, and if they don’t find it, they move on and give you a 10% rating. This is called “symptom-hunting” and it misses the whole point of Bankhead, discussed above.

    To make a “holistic analysis” of your mental health condition’s impact on your life, the VA rater must consider the frequency, chronicity and severity of your PTSD in work and social settings.

    Rarely do C&P exams for Veterans with a PTSD claim discuss how long the symptoms last or the length of any periods of “remission”. Sometimes, they discount the resilience/remission factors so much so that they change the Veteran’s diagnosis altogether.

    For example, we were able to get one Veteran a higher PTSD rating by showing that her “resilience” was not as high as one might thing from frequent periods of remission: because of the nature of her symptoms, she still had significant social and occupational impairment limitations during the “remission” period.

    #4:  Did the VA considerALL of the evidence in the record?

    Far too often, VA C&P examiners focus on the most recent symptomatology.   The doctor has to look at the whole of the evidence of the record.

    One thing you can consider doing is making a copy of any medical recordrelating to your PTSDout of your C-File.

    Organize those documents from your C-File in chronological order, and type up an EASY to read outline of the chronology of your symptoms – keep it to 1 page, double spaced, so it’s easy to read.

    Share it with your C&P Doc, and ask them to put the chronology in your C-File when they are done.

    Don’t argue your position, just hand it to the doc and say “Here’s the chronology of my condition, if it helps you, use it.  If not, just put it in my C-File.”

    This is really hard to do if you don’t have your C-File – here’show to get a copy of your C-File.

    #3:  What is theGAF scale?

    TheGAF scale is a subjective rating, on a scale of 0 to 100, for a doctor to “evaluate” a Veteran’s overall psychological, social and occupational functioning.  The higher the score, the more ability the Veteran has – in theory – to function in a wide range of activities.

    Problem is,GAF scores are nonsense. Seriously, ask a psychiatrist or psychologist how they come up with aGAF score. They pick a number out of thin air that “feels right.” One doctor could give you aGAF score of 30 (low functioning). Another could give you aGAF score of 60 (reasonably high functioning). For the same symptoms.

    So, in DSM-V, the medical profession threwGAF scoring to the crap-pile.

    Even still, I see many, many PTSD ratings that give heavy consideration toGAF scores over actualobjective medical and lay evidence of PTSD symptomatology.

    In current claims, theGAF score is no longer used – however, many VA Raters still wrongly use theGAF score and in some claims, the appeal is based on the law at the time of the denial, which may have involved use of theGAF Score.

    This is CRITICAL: if you have a claim or appeal filed afterAugust 14, 2014, and the VA orBVA is usingGAF scores, they are very likely rating your claim wrong.

    #2:  Don’t let the VA rate you based on the ABSENCE of factors for a particular level.

    I really think that if the VA wouldget away from using “negative evidence”, 80% of the backlog would be cleared out.

    Seriously – I think I see this error in nearly every case I look at.  The VA cannot usually consider the absence of evidence as proof of anything.

    If your VA PTSD rating talks about how youDON’T have certain symptoms or problems, you need toget in touch with a lawyer ASAP.The way to fix this is a legal argument, coupled with a long-term appeal strategy.

    Find out how tochoose the best attorney for your VA appeal in this free eBook.

    #1:  Did you downplay your symptomatology at the C&P Exam?

    Many Veterans get dressed up in their “Sunday best” for their Comp & Pen exam, believing that they are more persuasive when they “present” well.

    Other Veterans refuse to shower, shave, or wear clean clothes, based on the suggestion of some random Veteran in a facebook group.

    BOTH approaches are wrong.

    Remember, doctors can assess the symptoms in your records –AND the symptoms they observe.  When itcomes to your appearance at the C&P exam, BE your symptoms.

    More importantly, don’t downplay your situation.

    Let the doctor see, and hear, how bad your PTSD is affecting you.

    Vietnam Veterans out there tend to be serious hard-asses, and refuse to tell people when they are hurting.

    I’m not judging at all – I am saying that the time to downplay your symptomatology is NOT during your PTSD C&P exam. (By contrast, you don’t want to exaggerate your symptoms either).

    The Veterans I see with PTSD ratings that are too low (or that later face ratings reduction problems because they were over-rated) all have one thing in common – they failed to follow the Golden Rule of PTSD C&P Exams: Just be yourself.

    Here are some more tips for getting through a VA PTSD C&P exam – or any C&P exam for that matter.


    These tips for evaluating your VA PTSD Rating are worthless unless you have your C-File.

    Without your C-File, youcan’t know how much weight the VA is wrongly putting on arbitrary GAF scoresfrom 10 years ago, whether all of your medical records made it into the VA’s hands, or whether there is something really damaging in your file (like some VA C&P examiner down in Florida who finds every Veteran is malingering, over-reporting, or under-reporting symptoms without explaining what those terms mean, medically).

    Here’s where I show youmy Firm gets C-Files from the VA.

    I hope these tips helped – let me know if you have any thoughts or questions.


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  • Moral Injury


    Fear for one’s life is considered a normal reaction to a traumatic event, nonetheless it is far from being the only common reaction observed in response to trauma.

    In a recent study, Center of Excellence Investigators, doctors: Sheila Frankfurt, Bryann DeBeer, and Eric Meyer, and their colleagues explored the effects of another typical reaction to trauma that has been largely understudied: moral injury.

    Moral injury refers to a psychological harm resulting from either (1) acting, failing to prevent, or witnessing actions that violate an individual’s deepest values and principles or from (2) betrayal by a trusted authority figure in a high stakes situation. These actions and events are called “morally injurious events.”

    When memories of these morally injurious events are incompatible with Veterans’ own views of who they are and what they stand for, they may experience intense feelings of guilt, shame and rage. If this inner conflict is unresolved, it may lead to a moral injury syndrome characterized by depression, re-experiencing and avoidance trauma symptoms, substance abuse, spiritual/religious decline, and suicide.

    Although the typical focus of moral injury research are “perpetration-based” events, Frankfurt and colleagues’ study tested whether the definition of morally injurious events should include military sexual trauma (MST), as this may be experienced as a betrayal-based morally injurious event.

    In their study, Frankfurt and colleagues sought to understand the pathways through which military traumas, like combat exposure and MST, ultimately lead to a moral injury syndrome, characterized by concomitant PTSD and depression.

    Analyzing data from more than 300 post- 9/11 Veterans, the study found that whether traumatic events were appraised as betrayal- or perpetration-based, explained the presence of PTSD-depression symptoms. For instance, in MST, betrayal explained the association between traumatic events and PTSD-depression symptoms, while in combat exposure events, it was perpetration that accounted for this relationship.

    Additionally, Frankfurt and colleagues found some evidence suggesting that the self-focused experience of shame, but not the behavior-focused experience of guilt, further links combat exposure to PTSD-depression symptoms.

    Overall the results suggest that moral injury can develop through different pathways following military traumas. Given that in recent years moral injury has been identified as a unique source of distress in Veterans, the results of this study are a promising early step in helping identify modifiable factors that can be used to develop targeted treatments to relieve the burden of moral injury.

    For more information about research taking place at the VISN 17 Center of Excellence for Research on Returning War Veterans, visit here.


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  • Justice 006


    ROCHESTER, N.Y. U.S. Attorney James P. Kennedy, Jr. announced that Michael Pecka, 33 of Fairport, NY, pleaded guilty before U.S. District Court Judge Charles J. Siragusa to making a false official statement. The charge carries a maximum penalty of five years in prison, a fine of up to $250,000, or both.

    Assistant U.S. Attorney Craig R. Gestring, who is handling the case, stated that Pecka filed a claim for VA Disability Benefits in 2011 claiming that he had Post Traumatic Stress Disorder (PTSD) from witnessing the suicide of two fellow soldiers while deployed to Kuwait in 2004-2005 with the Army Reserve. In support of his claim for PTSD, the defendant described in detail the two suicides that he claimed to have witnessed to include his distance from the soldiers, the manner in which they each committed suicide, his observation of the bodies, and his role in the investigations. As a result of this claim, Pecka received a high disability rating and was awarded tax free disability benefits of $3,167 per month. The defendant filed the initial claim while he was an inmate in federal prison for an unrelated bank fraud conviction.

    Pecka repeated his false claims about observing the suicides on Official VA Forms, signed under penalty of perjury, in 2011 and 2014. However, an investigation by Special Agents of the VA Office of Inspector General determined that the defendant lied about being present for either suicide, lied about observing either suicide, lied about being involved in the investigation of either suicide, and in the case of one of the soldiers, was not even in the same country at the time he committed suicide. Pecka repeatedly stated under oath that he watched this soldier commit suicide, when in fact, the defendant was stationed over 6,000 miles away in Kuwait when the soldier committed suicide near Ft. Drum, NY.

    On May 24, 2018, Pecka provided statements to an undercover VA Office of Inspector General Special Agent whom the defendant believed to be a VA Field Examiner conducting a routine file update for his compensation claim. During that meeting, Pecka falsely told the agent that he personally witnessed the suicide of one of the soldier, now claiming that it happened while they were “on a mission” together. Pecka described the incident stating that soldier shot himself with his pistol without warning, and that he reported the incident to his First Sergeant. None of that was true. Regarding the second suicide, the defendant falsely claimed that he saw the muzzle fire from the discharge of that soldier’s rifle, discovered that victim in his vehicle, and then reported the suicide to Military Police. This too was a lie.

    After making these statements to the undercover VA-OIG Special Agent, Pecka completed a new VA Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder Form, in his own hand. In that statement, the defendant again falsely claimed that he saw both soldiers shoot themselves.

    As a result of his false statements to the VA, Pecka received over $92,000 in tax free VA Disability benefits to which he was not legally entitled.

    According to the National Center for PTSD, Post-Traumatic Stress Disorder is a mental health condition that some people develop after experiencing or witnessing a life-threatening event, like combat. The condition may last months or years, with triggers that can bring back memories of the trauma accompanied by intense emotional and physical reactions. Symptoms may include nightmares or unwanted memories of the trauma, avoidance of situations that bring back memories of the trauma, heightened reactions, anxiety, or depressed mood. For further information on PTSD, treatment options, and how to obtain help from the Department of Veterans Affairs, please go to

    The plea is the result of an investigation by the United States Department of Veterans Affairs, Office of Inspector General, Criminal Investigations Division, Northeast Field Office, under the direction of Special Agent-in-Charge Sean J. Smith.

    Pecka also has a pending violation of his supervised release conditions from the prior federal bank fraud conviction.

    The defendant was ordered detained pending sentencing on both cases, which is scheduled for January 24, 2019, at 10:00 a.m. before Judge Siragusa.


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  • PTSD Key


    Veterans who have symptoms of PTSD often ask us for help, as do their families. The National Center for PTSD provides education and conducts research on trauma and PTSD. We do not provide diagnosis or treatment of PTSD.

    For direct care, see both of the following:

    Below are the answers to some questions about PTSD that are often asked by Veterans and their families.

    Do I have PTSD?

    A natural first question is whether your symptoms might be due to PTSD. A good place to start learning about PTSD is the PTSD Basics page on our website. You should know, though, that having symptoms does not always mean that you have PTSD. Some reactions to stress and trauma are normal. Since many common reactions look like the symptoms of PTSD, a doctor must decide if you have PTSD

    Also, stressors other than trauma may cause symptoms that are like those of PTSD. For example, work or money problems can lead to symptoms. Medical problems such as heart disease or diabetes, or mental health problems such as depression or anxiety, can have symptoms that look like PTSD. That is why you should see a provider who is trained to know which of your symptoms might be PTSD.

    If I have other problems, can I also have PTSD?

    Veterans with PTSD often have other types of problems. They might have other stress, medical, or mental health problems. Sometimes PTSD is overlooked when other problems seem very pressing. If you have questions, ask your doctor if PTSD also needs to be treated.

    Am I eligible for VA services?

    All Veterans could possibly be eligible. Here is a brief list of factors that make up whether you are eligible:

    • You completed active military service in the Army, Navy, Air Force, Marines, or Coast Guard (or Merchant Marines during WW II).
    • You were discharged under other than dishonorable conditions.
    • You are a National Guard member or Reservist who has completed a federal deployment to a combat zone.

    You should also be aware that:

    • Health care eligibility is not just for those who served in combat.
    • Other groups may be eligible for some health benefits.
    • Veteran's health care is not just for service-connected injuries or medical conditions.
    • Signing up for health care is separate from signing up for other benefits at VA.
    • Veteran's health care facilities are for both women and men. VA offers full-service health care to women Veterans.

    For Veterans who served in a theater of combat operations after November 11, 1998, some benefits have been added. In January, 2008, the period of eligibility for free health care was extended from two to five years.

    VA operates a yearly enrollment system that helps make sure that Veterans who are eligible can get care. For information, see VA Health Care Eligibility & Enrollment. Your DD 214 is used to enroll for VA services. If you have trouble locating this form, VA Enrollment can still assist you.

    What help is there for me (or my Veteran family member)?

    PTSD is treatable. Many places within VA provide PTSD treatment. General programs that provide mental health services include VA medical centers, community-based outpatient clinics (CBOCs), and Vet Centers. Use the VA Facilities Locator to find the closest VA facility.

    An extra note about Vet Centers

    Offered through the Readjustment Counseling Service, Vet Centers are located in the community. They provide information, assessment, and counseling to any Veteran who served in a war zone. This includes conflicts such as in Somalia, Iraq, or Afghanistan.

    Vet Centers also offer services to families of Veterans for military-related issues. There are no fees or charges for Vet Center services, and services are confidential. That means no information will be given to any person or agency (including the VA) without your consent. Most of the staff are Veterans themselves.

    During normal business hours, you can call 1-800-905-4675 (Eastern) or 1-866-496-8838 (Pacific). The Vet Center program also has a 24/7 hotline, with all calls answered by combat Veterans: 1-877-WAR-VETS (1-877-927-8387).

    VA special PTSD clinics and programs

    VA also has special PTSD clinics and programs that can help eligible Veterans. For more on these programs, see our fact sheet PTSD Treatment Programs in the U.S. Department of Veterans Affairs.

    What to expect when you see a VA provider

    When you see a VA provider, he or she will first assess whether or not you have PTSD. If you do have PTSD, remember that it can be treated. Several types of education and treatment are helpful to Veterans and their family members. These include:

    • Classes on dealing with stress, anger, sleep, relationships, and PTSD symptoms
    • One-to-one, group, and family counseling
    • Medications

    For more information, please see Treatment.

    I think I am disabled due to PTSD caused by military service. What can I do?

    Service-connected disability for PTSD is determined by the Compensation and Pension Service. C&P is an arm of VA's Veterans Benefits Administration:

    Compensation. This decision is not made by the providers who care for you in VA's PTSD clinics and Vet Centers. The process for making the decision involves several steps:

    • A formal request (claim) must be filed using forms provided by the VA's Veterans Benefits Administration.
    • After all the forms are submitted, you must complete interviews about your:
    • social history (a review of family, work, and education before, during, and after military service).
    • psychiatric status (a review of past and current mental health symptoms and of traumas gone through while in the military).

    The forms and information about the application process can be obtained from Benefits Officers at any VA medical center, outpatient clinic, or regional office.

    The process of applying for a VA disability for PTSD can take several months. It can be confusing and quite stressful. Veterans Service Organizations (VSOs) can help Veterans and family members with VA disability claims. VSOs provide Service Officers at no cost. Service Officers know all about every step in the application and interview process. They can provide practical help and moral support. Some Service Officers are experts in helping Veterans with PTSD disability claims.

    Even if you have not been a member of a given VSO, you still can ask for help from a Service Officer of that VSO. To find a Service Officer to represent you, just contact the local office of any VSO. You may also wish to ask other Veterans who have applied for VA disability what they would suggest. A mental health provider at a VA PTSD clinic or a Vet Center may also have some tips.

    My claim for a VA PTSD disability has been turned down by the Benefits Office, but I believe I have PTSD due to military service. What can I do?

    A Veterans Service Officer can explain how to file an appeal. The Service Officer may be able to help you gather the information you need to make a successful appeal. You may want to contact a Service Officer who is an expert in helping Veterans who have PTSD-related claims.

    I can't get records from the military that I need for my disability claim. What can I do?

    Veterans Service Officers can help you file the paperwork needed to get your military records. If your Service Officer is not able to help you get needed records, ask him or her to direct you to another Service Officer who has more experience in getting records.


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  • Chronic Pain


    Virtual reality program provides real results

    A double amputee Veteran looks through his special headset and suddenly is scuba diving under the sea, and sees fish swimming all around. Another Veteran in a wheelchair is mountain climbing and can see trails and wild animals along the way. And another Veteran suffering from chronic pain is fishing and can be seen casting his lines in the water.

    These are a few examples of how Veterans dealing with various injuries are experiencing a special virtual reality rehabilitation therapy program that is proving to be successful in helping them cope with their physical, cognitive and psychosocial issues.

    “These therapies build confidence and develop coping skills.”

    In the photo above, Jamie Kaplan, a recreation therapist who oversees the virtual program at the James Haley Tampa VA Medical Center, helps guide Veteran Geoff Hopkins through his chosen virtual reality scenario.

    The special program provides Veterans with varied medical issues resulting from traumatic brain jury, spinal cord injury, stroke, amputees, ALS or other similar areas with an alternative to the use of drugs such as opioids. They use a virtual reality headset or can watch on a large monitor screen to experience virtual scenic settings with music and narration individualized to each patient’s interests.

    “Virtual reality is able to take the user someplace else they’d rather be,” said Kaplan. “For example, virtual games and activities can allow the wheelchair user to experience freedom from the limitations they face in everyday life.”

    Special apps and computer programs are utilized through virtual reality headsets in the Virtual Reality Clinic and at the patient’s bedside. Veterans can choose from 20 scenarios, ranging from mountains and oceans. Veterans can fish, ski, go scuba diving or even play golf.

    One of the main goals is to help Veterans who suffer from chronic pain reduce their reliance on medications, such as opioids. Relaxation and guided imagery programs are also used to address stress, anxiety, frustration, anger, and pain. Heart rate and self-reporting from the Veteran are used to determine effectiveness. The measures, taken at the beginning and end of each session, have proven to reduce an average of 5 to 7 heart beats per minute while pain levels dropped 2-3 levels during the 10-minute use.

    “What is truly exciting is that it is showing measurable results in helping reduce chronic pain while using the program,” Kaplan said. Kaplan said the idea came about through his interest in computer-based video games. He extended the idea based on video games to develop the virtual reality scenarios.

    At first, virtual reality was targeted for use by younger Veterans who are more proficient in the use of technology and social media. However, older Veterans are embracing its use as well. About 200 Veterans, both inpatient and outpatient, have gone through the program.

    The Virtual Reality program at James A. Haley VAMC is recognized as part of February as National Therapeutic Recreation Month. VHA has more than 900 recreation therapists and creative arts therapists serving Veterans.

    “Recreation therapy and creative arts therapy provide a spectrum of services, opportunities, and choice for Veterans to maximize their rehabilitation potential, increase independence and sustain a healthy and meaningful leisure lifestyle,” said Lucille Beck, Ph.D., VHA’s Deputy Under Secretary for Health for Policy and Services. “These therapies provide opportunities to build confidence, develop coping skills, and integrate the skills learned in treatment settings into community settings.”

    Guided imagery, meditation, and relaxation programs promote decreased muscle tension, stress, anxiety and blood pressures. This, in turn, can increase function abilities, decrease pain behaviors and increase activity.


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  • X Box Gaming


    For active duty military members, playing video games can help release stress, build camaraderie and offer comforting familiarity in foreign environments. For Veterans returning from combat, gaming can reduce isolation, renew connections with fellow service members and provide therapeutic benefits.

    Recognizing the unique value of gaming for the military community, Microsoft is partnering with the U.S. Department of Veterans Affairs to provide Xbox Adaptive Controller units to 22 initial VA rehab centers across the U.S.

    Launched in 2018, the Xbox Adaptive Controller was created to make gaming accessible to players with limited mobility by enabling them to customize their setups and connect with external devices like buttons, switches and joysticks that accommodate their playing. The controller, which can be used to play Xbox One and Windows 10 PC games, was developed after extensive consultation with gamers, accessibility advocates and nonprofits that work with gamers with limited mobility, including Veterans.

    Ken Jones, the founder of Warfighter Engaged, a New Jersey-based nonprofit organization that provides gaming devices to wounded Vets, says the Xbox Adaptive Controller makes gaming accessible to a broader range of Veterans.

    “People just want to participate, and it’s going to allow them to do that,” he says. “It allows for a much bigger population of people to be included in gaming.”

    Gaming is a popular activity among the military community, but navigating a traditional controller can be difficult or impossible for injured Veterans. The inability to game can mean the loss of connection to Veterans’ military communities and to an activity that was a significant part of their lives during service.

    The partnership with Microsoft aims to give Veterans with limited mobility the opportunity to game again, get them more involved with their rehabilitation and increase social interaction, says Dr. Leif Nelson, director of National Veterans Sports Programs & Special Events for the VA.

    “We’re looking for platforms for Veterans to interact with each other, and the Xbox Adaptive Controller can be that access point to get involved in this world and in the gaming community,” Nelson says. “Gaming is now everywhere in the world, and while people tend to think of it as isolating, we’re finding that it actually has the opposite effect and can increase interactions with other Veterans and folks who are non-Veterans. I think this can be a tool in the rehabilitation process to achieve a lot of different goals.”

    For Jeff Holguin, gaming was a way to cope with the depression and post-traumatic stress disorder he experienced after being discharged from the U.S. Coast Guard in 2003 following an injury. He’d planned on a career in the military, but that identity was suddenly gone. Facing a series of surgeries and feeling adrift in the civilian world, Holguin isolated himself. He turned to gaming, an activity he’d enjoyed since childhood, and found the sense of inclusion he was craving.

    “It gave me an outlet, a virtual efficacy within a world that I didn’t feel like I had a place in anymore,” says Holguin. “I made a lot of social connections and friends through that virtual space.”

    Holguin went back to school, studying clinical psychology with a focus on trauma and PTSD. He has designed research for Microsoft around mixed-reality devices and learning outcomes and is also a clinical psychology doctoral intern at the Northern Arizona VA Health Care System in Prescott, Arizona. For Holguin, gaming provided a space where he could gradually reintegrate into post-military life.

    “It was a sense of belonging and a sense of safety,” he says. “When you have trauma and you’re depressed, sometimes even just a little bit of stimulation is too much and you just don’t have the cognitive or emotional resources to deal with other people’s well-meaning interactivity.

    “Gaming gives you what we might call exposure therapy, meaning you get a little bit of socialization, but when you’re ready to turn it off you can turn it off,” Holguin says. “Gaming provided some significant therapeutic value for me.”

    Jamie Kaplan, a recreation therapist at James A. Haley Veterans’ Hospital in Tampa, Florida, has been using gaming as therapy with his patients — about 25 percent of whom have had traumatic spinal injuries — for seven years.

    Kaplan, himself an avid gamer, says gaming provides a range of therapeutic benefits. Manipulating a controller and pressing buttons, for example, can help with motor skills. Decisions made throughout a game, from choosing which character to play to which moves to make, requires cognitive processing and visual processing, he says.

    “It’s fine motor skills, gross motor skills, decision-making ability, information processing, cognitive processing,” Kaplan says. “We can assign a number of therapeutic values to gaming.”

    Kaplan used various gaming systems and consoles with patients before getting an Xbox Adaptive Controller last fall. He particularly likes the Copilot feature, which was developed for Xbox One and links two controllers as if they were one, allowing players to team up on a game and share controls. The feature quickly became one of Xbox’s most popular ones and was built into the Xbox Adaptive Controller.

    One of his patients, Kaplan says, was able to play with his brother for the first time in three years by using Copilot. “It’s amazing,” Kaplan says. “It allows me as the therapist to make up for whatever deficit the patient has in utilizing a regular controller or the adaptive controller.”

    Kaplan uses games ranging from sports and racing games to virtual reality games and programs that allow Veterans with limited mobility to try activities such as scuba diving, fishing or hiking. VR is useful for helping amputees work on balance, Kaplan says, and VR guided relaxation and meditation programs can help Veterans reduce stress and anxiety — and potentially reduce reliance on pain medications such as opioids.

    “I see chronic pain patients every day and tell them, ‘I’m not going to cure your pain; we’re just hoping to trick it for a little while,’” he says. “You’re distracting them from the pain by engaging them in gaming.”

    Gaming has been part of Mike Monthervil’s life since his childhood growing up in Carrefour, Haiti, a suburban area southwest of Port-au-Prince. Monthervil’s family was one of the only ones in the neighborhood with a gaming system, but electricity was only available for part of each day. When the lights would come back on, Monthervil recalls, “every kid would be banging on our door to come and play a game.”

    For Monthervil, gaming was a passion that also provided an escape from a challenging environment. “It was a very tough place to live. Kids don’t have a lot to do there,” he says. “Gaming made my childhood better. It took a lot of stress out for me.

    “To this day, I still talk to the guys who are over there that I grew up with, that are still going through the hardship of being there,” he says.

    Monthervil continued gaming after moving to the United States and later enlisting in the U.S. Army. Stationed in Afghanistan, he passed time playing games with his fellow soldiers between missions. But in July 2014, Monthervil sustained a serious spinal cord injury after falling backward into a ditch during a training session, leaving him unable to use his legs. He underwent surgery and spent nine months at James A. Haley Veterans’ Hospital in Tampa, Florida. There he met Kaplan, who helped him adapt his gaming to accommodate the dexterity limitations caused by his accident.

    Kaplan gave Monthervil an adaptive controller to try several years ago, but it was cumbersome and difficult for him to use. After getting an Xbox Adaptive Controller, Kaplan created a custom set-up for Monthervil by adding a few additional buttons. Monthervil recently got one of the controllers at home and says it works better for him than any device he’s tried since his injury.

    “Of all the adaptive stuff I’ve tried, it’s by far the best one,” says Monthervil, who’s 26.

    The Xbox collaboration is part of a strategic partnership between Microsoft and the U.S. Department of Veterans Affairs dating back more than 20 years. Recent efforts under the partnership have focused on equipping VA employees with productivity and collaboration technologies, migrating VA legacy systems to the cloud and using advanced analytics in VA call centers to give Veterans better information to make decisions about their benefits and medical care.

    Toni Townes-Whitley, president of U.S. Regulated Industries at Microsoft, says the Xbox Adaptive Controller collaboration is part of a broader effort to improve therapeutic and clinical care for Veterans. But its fundamental goal is to harness technology to improve Veterans’ lives, she says.

    “It’s an example of using technology as a means to a much more significant end, which is a sense of belonging, being part of a team, a sense of reconnection, a sense of family,” she says.

    Phil Spencer, executive vice president of gaming at Microsoft, sees the collaboration as an ideal pairing of Microsoft’s efforts to increase diversity and inclusion in gaming with the vast reach of the VA, which serves more than 9 million Veterans nationwide in its health care system.

    “Everyone can play games, and we really focus on that as an organization,” he says. “With the VA being the largest integrated health care provider in the U.S., we thought it was a perfect opportunity to bring our focus on gaming and the great work that the VA is doing together.”

    Microsoft will use feedback and data collected by the VA centers to determine how effective the Xbox Adaptive Controller is in serving Veterans and how the device might be improved going forward, Townes-Whitley says. Nelson believes the initiative will serve not just existing gamers, but also Veterans who weren’t previously into gaming.

    “If we do our job well and we’re able to expose Veterans to (the Xbox Adaptive Controller) as a possible tool or intervention in their rehab process, I expect to find successes even in those folks who have never gamed before in their lives,” he says.

    A 2018 study found that gaming can relieve stress for Veterans, help them cope with moods and provide a way to connect. Kaplan also sees the Xbox Adaptive Controller as an equalizer for Veterans and others with disabilities.

    “One of the biggest things kids and adults with disabilities face is the stigma of being different. Online, we’re all the same,” he says. “I could be missing my arms or my legs and you wouldn’t know it. Gaming really helps to promote that feeling of normalcy and feeling of belonging.

    “I have a lot of respect for Xbox seeing and filling a need for making something that allows military members and anyone who has a disability to be able to game,” Kaplan says.

    “I think it’s great for a mainstream company like Microsoft to be the one to take the first step. I hope it encourages other companies to do that.”


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  • Ntl PTSD Treatment


    If you have been through a traumatic event, you may find it hard to talk about your experiences. But, it can be helpful to tell your doctor or a counselor about any symptoms you have. Witnessing or going through a trauma can lead to both emotional and physical problems.

    The checklist below can be a good start to talking about your symptoms following a trauma. You can print this page, complete the checklist, and show it to your doctor, therapist, or someone who can help you find care.

    Sharing this information will help a health care provider know you better and plan the best treatment for you. Not everyone who goes through trauma will get PTSD, but keep in mind that good treatments are available even if you only have some PTSD symptoms.

    Brief checklist of trauma symptoms

    Check the symptoms below that you experience. Include symptoms you have even if you are not sure they are related to a traumatic event.

    I experienced or witnessed a traumatic event during which I felt extreme fear, helplessness, or horror.

    The event happened on (day/month/year) _______________.

    What happened? ________________________________________.

    1. I have symptoms of re-experiencing or reliving the traumatic event:
    • Have bad dreams or nightmares about the event or something similar to it
    • Behave or feel as if the event were happening all over again (this is known as having flashbacks)
    • Have a lot of strong or intense feelings when I am reminded of the event
    • Have a lot of physical sensations when I am reminded of the event (for example, my heart races or pounds, I sweat, find it hard to breathe, feel faint, feel like I'm going to lose control)
    1. I have symptoms of avoiding reminders of the traumatic event:
    • Avoid thoughts, feelings, or talking about things that remind me of the event
    • Avoid people, places, or activities that remind me of the event
    • Have trouble remembering some important part of the event
    1. I have noticed these symptoms since the event happened:
    • Have lost interest in, or just don't do, things that used to be important to me
    • Feel detached from people; find it hard to trust people
    • Feel emotionally "numb" or find it hard to have loving feelings even toward those who are emotionally close to me
    • Have a hard time falling or staying asleep
    • Am irritable and have problems with my anger
    • Have a hard time focusing or concentrating
    • Think I may not live very long and feel there's no point in planning for the future
    • Am jumpy and get startled or surprised easily
    • Am always "on guard"
    1. I experience these medical or emotional problems:
    • Stomach problems
    • Intestinal (bowel) problems
    • Gynecological (female) problems
    • Weight gain or loss
    • Pain, for example, in back, neck, or pelvic area
    • Headaches
    • Skin rashes and other skin problems
    • Lack of energy; feel tired all the time
    • Alcohol, drug, or other substance use problems
    • Depression or feeling down
    • Anxiety or worry
    • Panic attacks
    • Other symptoms such as: ______________________________

    Summing it up

    If you checked off some of the symptoms above, it is important for you to let your health care provider know. This information helps providers plan your medical treatment. It can also help them connect you with services you may need.

    If you think you may have PTSD, print this checklist, fill it out, and take it to a health care provider, or someone you trust.


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  • Mental Health 001


    Just one year after President Trump signed Executive Order 13822, VA has made significant strides forward in its mission to provide mental health care to transitioning service members and Veterans during the first 12 months after separation from service, a critical period marked by a high risk for suicide.

    The executive order mandated the creation of a Joint Action Plan by the departments of Defense, Homeland Security and VA. The plan was accepted by the White House in May 2018 and has been underway since that time.

    According to Dr. Keita Franklin, executive director, suicide prevention for VA’s Office of Mental Health and Suicide Prevention, all 16 tasks outlined in the Joint Action Plan are on target for full implementation by their projected completion dates, seven out of the 16 items are complete and early data collection efforts are showing positive results.

    Transitioning service members can now register for VA health care early

    Partnerships within the Veterans Health Administration and the Veterans Benefits Administration’s Office of Transition and Economic Development, are actively providing, through the Joint Action Plan, transitioning service members with the opportunity to register for VA health care pre-transition during the Transition Assistance Program. This is a new option for service members, who before were provided with information for independent registration, however, were not provided with the opportunity for facilitated registration.

    “In a single month, more than 34 percent of the nearly 8,000 transitioning service members who attended the TAP modules in person registered for VA health care before, during or after their class attendance date,” Franklin said. “One of the joint goals of this effort is to reduce barriers to care. By getting transitioning service members registered into the VA health care system earlier, we are able to get them the mental health care they need much quicker.”

    The TAP curriculum is also modified to incorporate a new military lifecycle module on community integration resources. This module informs transitioning service members about community organizations as well as how to identify and check them.

    “Because of the updates to TAP, 81 percent of the transitioning service members in TAP during the fourth quarter of fiscal year 2018 said they felt informed about the mental health services available to them,” Franklin said. “This modification reinforces the important role of community partners, such as Veteran Service Organizations.

    Emergent mental health care available to more service members than ever before

    Through the coordinated efforts of DoD, DHS, and VA, certain former service members may receive emergent mental health care from VA. Additionally, any newly transitioned Veteran who is eligible can go to a VA medical center, Vet Center, or community provider and start receiving health care right away.

    As part of the effort to provide mental and behavioral health care, VA is using telemental health technology to reach those service members who may not have easy access to a VA facility and implementing eligibility training for employees at the field level.

    “Mental health care is something that we want to make available as widely as possible,” said Dr. David Carroll, executive director, Office of Mental Health and Suicide Prevention. “The efforts under this executive order are one way that we can make that happen. We have the greatest respect for the men and women who have served in our nation’s armed forces, and we will not relent in our efforts to connect those who are experiencing an emotional or mental health crisis with lifesaving support.”

    Looking ahead: Early contact and predictive analytics

    While proud of how far the program has come since May, Franklin acknowledged that there is still some time before all of the Joint Action Plan goals will be fully implemented. However, there are several goals underway that will be complete in the coming months, including:

    • Within the next six months, the Veterans Benefits Administration will establish caring messaging and reach to all transitioning service members and Veterans to inform them about a variety of resources including health care enrollment, education benefits, and more.
    • By April 2019, DoD, DHS and VA will establish a way forward for an integrated data environment and inter-agency analytical platform that can support development of a joint approach to predictive modeling.

    “This executive order was established to assist in preventing suicide during a critical period – the first-year post-separation from military service. However, the completed and ongoing work of the executive order and Joint Action Plan will likely impact suicide prevention efforts far beyond the first year,” Franklin said. “We are working diligently to increase coordinated outreach, increase access to care and focus our efforts beyond just the first-year post-separation. We are working to promote wellness, increase protective factors, reduce mental health risks, and promote effective treatment and recovery as part of a holistic approach to suicide prevention.”

    The efforts created under Executive Order 13822 and the Joint Action Plan are all key components of VA’s public health approach to suicide prevention. Combined with VA’s other suicide prevention programs, these efforts will provide a full continuum of evidence-based mental health care that can help prevent a suicidal crisis before it occurs. Using a public health approach to suicide prevention, VA continues to focus care on high-risk individuals in health care settings, while also encouraging comprehensive collaboration with communities to reach service members and Veterans where they live, work, and thrive.

    “Just as there is no single cause of suicide, no single organization can end suicide alone,” Franklin said. “We’ve been able accomplish and implement some great things from the executive order and Joint Action Plan in the last year, but there other important and valuable efforts ongoing and in our future, too. That’s why VA is working to educate partners, other government agencies, employers, community organizations, and more, on the available mental health and suicide prevention resources available – both inside and outside of VA.”


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  • Health Technician


    The Deployment Health Clinical Center (DHCC) is pleased to announce the formation of the Behavioral Health Technician (BHT) Work Group (BHTWG). Chartered as a sub-workgroup to the Military Health System (MHS) Mental Health Work Group (MHWG), this collaborative, expert-led group will enable the MHS to gauge how BHTs are currently being used throughout the system, and more importantly, develop and implement actionable recommendations to improve the quality of care for our service members.

    Work group membership includes both clinician and technician leaders from the Army, Navy, Air Force, National Capital Region Behavioral Health, and the Marine Corps Operational Stress Control and Readiness (OSCAR) program and Fleet Marine Force. The group will also invite other behavioral health leaders to share insights, provide recommendations and deliver subject matter expertise.

    What are behavioral health technicians?

    BHTs, also called mental health technicians, psychiatric technicians, or behavioral health specialists, support mental health services in psychiatry, psychology, social work, and substance abuse prevention and rehabilitation. These enlisted service members from the Army, Navy and Air Force attend approximately 15 weeks of formal, didactic training at the Medical Education & Training Campus (METC) in San Antonio. They learn to conduct intake interviews and individual or group counseling sessions, assist in the administration of psychological testing and brief prevention education, and manage all administrative aspects of a specialty clinic.

    How can this group help you as a clinician?

    A well-trained technician can be the difference between an organized, functional clinic and a disarrayed, overworked facility. BHTs are trained to become provider-extenders, alleviating pressure from their providers while enhancing their own clinical skills. Used properly, BHTs can triage emergent patients, promote therapeutic relationships with enlisted patients, administer psychological screening and test batteries, provide both individual and group psychoeducation, provide outreach services to operational commands, play significant roles in post-disaster mental health services, stimulate rapport with clinic staff, liaise with commands and other medical sections, and improve overall clinical efficacy and efficiency.

    The aim of the BHTWG is to disseminate best practices of BHT implementation and utilization across the services to improve patient care and clinical operations. The group will hold a kick-off meeting Oct. 2. Stay tuned for more information about the BHTWG’s work.

    Are there topics you’d like to see the BHTWG address? Share your thoughts in the comments section below.

    Tech. Sgt. Bradley Blair is an Air Force mental health technician and certified alcohol and drug abuse counselor (CADC). He holds a bachelor’s degree in psychology. Mr. Peter Kelley is a certified project management professional (PMP), with over five years of project management expertise, currently supporting DHCC’s program management processes and procedures.


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  • Marine Col Turner


    Jim Turner was a decorated Marine who served his nation with honor. But the transition to civilian life proved to be too difficult and like 19 other Veterans every day he took his own life.

    ST. PETERSBURG — On Dec. 10, retired Marine Col. Jim Turner put on his dress uniform and medals and drove to the Bay Pines Department of Veterans Affairs complex. He got out of his truck, sat down on top of his military records and took his own life with a rifle.

    Aside from leaving behind grieving family and friends, Turner, 55, of Belleair Bluffs, left behind a suicide note that blasted the VA for what he said was its failure to help him.

    "I bet if you look at the 22 suicides a day you will see VA screwed up in 90%," wrote Turner, who was well-known and well-respected in military circles. "I did 20+ years, had PTSD and still had to pay over $1,000 a month health care."

    Turner’s death marked the fifth time since 2013 that a Veteran has taken his life at Bay Pines. There were more suicides there during those five years than at the rest of the VA hospitals in the state combined. There were none at the James A. Haley VA Medical Center in Tampa.

    It's unclear how many other Veterans killed themselves during that period at VA facilities around the nation. The government’s second-largest bureaucracy declined a federal Freedom of Information Act request by the Tampa Bay Times for that information last year. In an email Friday afternoon, VA spokeswoman Susan Carter said the agency only started collecting the information a month after the denial.

    From October 2017, to November 2018, there have been 19 suicide deaths at VA facilities around the United States, Carter said. The vast majority of Veteran suicides are off campus and 70 percent of those who take their lives hadn’t sought treatment from the VA, according to VA statistics.

    As for why it keeps happening at Bay Pines, officials there say they don’t have an answer.

    Long before he became a statistic — one of 20 Veterans who die by suicide every day — James Flynn Turner IV was a young man from a wealthy Baltimore family who joined the Marine Corps and reveled in his service to the nation.

    “My brother’s identity was being a Marine,” said Jon Turner.

    Jim Turner flew F-18s and then became an infantry officer, taking part in the invasion of Iraq in 2003. He later served in Afghanistan and spent a decade working at U.S. Central Command at MacDill Air Force Base.

    He left “an enduring legacy of professionalism, commitment and superior leadership which served as a guiding force for all service members whose lives he touched,” said Edward Dorman III, a recently retired Army major general who worked with Turner at Central Command for a decade. “That’s a life worth emulating.”

    When Turner retired, he lost his identity and began to struggle, his younger brother said.

    Those problems exacerbated some of the mental health issues Turner was experiencing from his time in the Marines, said his ex-wife, and led to the dissolution of their 27-year marriage,

    “He came home seemingly fine,” said Jennifer Turner. “It was a couple of years later that he just got more aggressive.”

    It was never anything physical, she said. “He just got agitated very easily. He had nightmares, where he would wake up screaming military stuff.”

    The problems reached a crescendo as Turner was retiring in 2015, his ex-wife said.

    The couple decided to separate. In January 2016, while Jennifer Turner was out of town, Turner grew angry at his son and chased him out of the house with a gun. Pinellas County Sheriff’s deputies responded and detained him under the state’s Baker Act.

    Jennifer Turner believes her ex-husband may have taken his life because he was refused treatment at Bay Pines. Both she and Jon Turner say it was quite possible he became frustrated with having to wait and left without being helped.

    The VA did not comment, citing privacy concerns.

    Others who lost a loved one to suicide at Bay Pines have different theories on why they chose to end their lives there.

    Vietnam War Navy Veteran Jerry Reid, 67, may have driven to the VA to take his own life on Feb. 7, 2013, because he lived alone and didn’t want to have his body found weeks or months later, said his friend, Bob Marcus.

    Joseph Jorden, 57, a medically retired Army Green Beret, likely took his life at Bay Pines on March 17, 2017, not because of poor treatment, but because he felt safe there, said his brother, Mark Jorden.

    But Gerhard Reitmann, 66, who served with the Marines in Vietnam and later as a guard for President Richard Nixon at Camp David, “felt like the VA wasn’t really taking care of him” when he ended his life at Bay Pines on Aug. 25, 2015, said his brother, Stephan Reitmann.

    The mother of Esteban Rosario, 24, who ended his life at Bay Pines on May 8, 2013, could not be reached for comment.

    Regardless of why he took his own life, Turner left behind family and friends, many of whom gathered for a memorial service Friday afternoon in Largo, still struggling with the aftermath.

    "Both of his heartbroken children are currently in school and they have lost their main means of financial support,'' his sister-in-law, Katie Turner, wrote on a GoFundme site set up to help them "In lieu of flowers, the family has humbly requested donations for the children's continued educational expenses. "


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  • PTSD Vets Sue


    A federal judge in Connecticut ruled Thursday in favor of thousands of Veterans seeking to sue the federal government alleging they were discharged due to infractions related to untreated mental illnesses and denied Veterans Affairs benefits as a result.

    The Associated Press reports that Senior U.S. District Judge Charles Haight Jr. ruled Thursday that the Veterans, who were given less-than-honorable discharges after service in Iraq and Afghanistan, could move forward with a lawsuit against Navy Secretary Richard Spencer.

    The less-than-honorable discharges, the Veterans allege, made it harder for Veterans who were discharged to receive care for their mental illnesses developed as a result of their service in America's wars.

    The lead plaintiff in the case, Marine Veteran Tyson Manker, sharply criticized the Department of Defense in a statement Thursday following the initial ruling.

    “The fact that the Court has now recognized this class of Veterans is further evidence of the Department of Defense’s disgraceful violation of the legal rights of the men and women who have served their country," Manker said in a statement obtained by the AP.

    “This decision is a victory for the tens of thousands of military Veterans suffering from service-connected PTSD and TBI (traumatic brain injury),” added Manker, who says he was dishonorably discharged after serving in Iraq due to a single use of an illegal drug.

    Students from Yale Law School are reportedly representing the Veterans and have filed a similar suit against the Army, according to the AP.

    Connecticut-based Veterans group National Veterans Council for Legal Redress, another plaintiff in the suit, celebrated the judge's decision in a statement Thursday.

    “We filed this lawsuit to make sure that the Iraq and Afghanistan Veterans with service-connected PTSD do not suffer the same injustices as the Vietnam generation,” group director Garry Monk told the AP.

    “We are thrilled with the court’s decision and look forward to creating a world where it doesn’t take years of wading through unlawful procedures for these Veterans to get relief.”


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  • Outdoors


    Nearly 50 years have passed since Gerry Barker last set foot on a battlefield. But even now, on his farm in Metcalfe County, the sights, sounds and overwhelming feelings of combat return all too easily.

    “I’ll hear an explosion,” he says, something loud, that shakes his whole body, “and nobody else has heard it.” Or he might be driving along the Cumberland Parkway and see 122 mm rockets shooting toward him, the same kind he saw in Southeast Asia when he was a scout with U.S. Army Special Forces.

    “My heart stops,” he says. “All of these are over in a second. I take stock and realize what happened, and go on.”

    And go on he has, enduring symptoms of post-traumatic stress disorder (PTSD) while completing a 22-year Army career, earning a master’s degree, teaching history, working as an administrator, publishing dozens of articles and writing four books.

    All the while, Barker has grappled with hallucinations, nightmares, depression, anxiety and guilt.

    “I just overloaded on war,” says Barker, a consumer-member of Farmers RECC.

    For all the efforts as a society to honor Veterans, the truth is that those of us who’ve never gone into battle for our country have little understanding of the toll it takes on those who have, a toll evidenced by the alarming rate at which American Veterans take their own lives.

    According to the U.S. Department of Veterans Affairs, Veterans (a term that includes active-duty service members) make up only 8 percent of the U.S. adult population, but they account for 14 percent of the suicides. On average, 20 Veterans die by suicide every day.

    The problem is particularly acute in Kentucky, where the VA finds the state’s suicide rate among Veterans is 34 percent higher than the national average.

    The VA has launched a national campaign (#BeThere) to raise awareness and provides a crisis line for Veterans and their loved ones—(800) 273-8255, press 1 or text 838255. The agency provides counseling at its medical centers in Louisville and Lexington and at some of its clinics and other facilities in more than 20 communities around the state.

    The VA also is rolling out video telehealth programs. The Kentucky Department of Veterans Affairs provides social workers to serve Veterans’ mental health needs at its four nursing homes. It also works with organizations like the Disabled American Veterans, American Legion and Veterans of Foreign Wars, and to help Veterans receive all their entitled benefits from the VA.

    And yet, our Veterans’ needs remain greater than all of those efforts put together. At Kentucky Living, we wanted to get a sense of how Veterans across the state are dealing with the suicide crisis. We found that in addition to traditional treatments like psychotherapy and pharmaceuticals, many Kentucky Veterans are taking it upon themselves to find their own paths to healing, both for themselves and their fellow Veterans. In many cases, those paths are leading them to start their own organizations and to get out of doors and into nature.

    Mindful adventures

    Cassie Boblitt earned a scholarship to Purdue University out of high school, but instead left her hometown of Lebanon Junction to join the Army in 2000. “I wanted adventure,” she says. “I wanted to see the world.”

    She says the military gave her that. It also gave her a greater openness to different kinds of people, more awareness of her own strength and resourcefulness, as well as a sense of connection to her fellow soldiers—“my brothers and sisters”—that she says will never be broken. She forged those bonds serving with a Patriot missile air defense artillery unit during the invasion of Iraq in 2003. On those convoys, Boblitt says, “We’d get trapped in towns and people would surround our vehicles. You don’t know who could be a suicide bomber.”

    There’s a psychological impact from the constant vigilance of a war zone and the proximity to combat. “You never feel safe. You never are safe,” she says. “You numb yourself to everything. Stay focused and do what you’re trained to do.”

    She felt lucky when she left the Army seemingly unscarred. Moved on. Played professional basketball. Learned Spanish. Got an MBA and a good job. The symptoms came later.

    Boblitt lives in the Nelson County community of Boston and says sometimes she’s driving on Interstate 65 and suddenly, “I won’t have any idea where I am. Where am I going? This doesn’t look familiar.” She often feels hypervigilant and hyperprotective of those around her. She insists on driving because “I feel trapped if I ride with other people driving.”

    Boblitt’s found multiple ways to cope. She started her own business, Mindful Movement, in 2016, teaching movement and games to children and yoga to combat Veterans from World War II as well as the present. She’s one of the founding members of the performing troupe Shakespeare with Veterans (see sidebar below). But one of the best treatments she’s found for the claustrophobic feelings associated with PTSD is to hit the hiking trails. Her Army training helps, “I can go camping in Yellowstone by myself for a month and a half. My mom says, ‘Anything could happen to you out there by yourself.’ But the way I look at it, nobody’s trying to kill me. So I’ll probably be all right.”

    Boblitt recently started Mindful Adventures, a new business venture in which she helps lead extended wilderness excursions. She’s primarily focused on children, but has plans to offer outings for Veterans.

    Going into the forest and working with kids and Veterans has helped Boblitt feel a sense of purpose and comfort. “It’s through these connections that we heal,” she says.

    The idea of time in nature as a source of healing isn’t new, though the scientific research supporting the idea is. According to a 2016 National Geographic article that surveyed recent studies, “A 15-minute walk in the woods causes measurable changes in physiology.” The article also references a 2015 report published in the journal Psychological Science that says, “Imagine a therapy that had no known side effects, was readily available, and could improve your cognitive functioning at zero cost. Such a therapy has been known to philosophers, writers and laypeople alike: interacting with nature.”

    Boblitt’s passion for the wilderness was kindled by joining a Sierra Club Military Outdoors tour. The Wounded Warrior Project’s website also talks about “using nature and recreation to heal the spirit” through its Project Odyssey program.

    Camp Brown Bear

    Former U.S. Navy SEAL Steve Brown participated in a Project Odyssey outing in 2015. He’d recently retired after a 20-year career and his PTSD hit him especially hard at night. “There were times, my wife was changing our bedding out two-three times a night because I was sweating through the sheets,” he says. He also suffers from traumatic brain injury (TBI), the byproduct of combat, hard falls and proximity to explosions while conducting more than 250 high-risk operations, mostly, he says, “to places I wouldn’t want to go on vacation.”

    TBI, which often affects memory function as well as concentration, sleep and mood, is part of his everyday life. “If there’s something important I need to do tomorrow, I have to write it down today or I won’t remember it,” Brown says. He also doesn’t like crowds, even small ones: “I feel like I’ve got to know who every person is around me. It’s really draining.”

    His wife, Sabrina, says they’ve had to adjust the way they communicate. “It’s very hard for a person with TBI to argue because they can’t remember what’s been said,” she explains. “Sometimes we go to text messaging so he can read over the conversation.” Sabrina Brown is an associate professor of epidemiology at University of Kentucky and is writing a book about their experiences. She says one challenge for Veterans like her husband is that “they’re used to being the hero, leading the command. Now, they can’t remember if they’ve taken their medicine. There’s a self-esteem issue.” In his darkest time, she says, “Sometimes Steve wouldn’t get out of bed for days.”

    Steve found comfort and solace on the Wounded Warrior retreat, both from being in nature and being with fellow Veterans who understood what he was experiencing. He’d had a dream about opening a camp that would serve children, but now he realized he should create a camp for Veterans as well. He found a property for sale north of Frankfort that at one time was home to a church camp. The Browns, consumer-members of Blue Grass Energy, bought it and created Camp Brown Bear, a 501(c)(3) non-profit that’s part of a larger operation, Kodiak Camps and Outfitters.

    He welcomes Veterans’ groups for weekend retreats every three months or so. Their daytime activities include hiking, kayaking and canoeing. Sometimes they hunt with bow and arrow. They journal and share stories around a campfire at night. The Veterans also help renovate the cabins on the 120-acre property so Steve can eventually open the camp to the other population he wants to serve: middle school-aged boys growing up in disadvantaged circumstances. He usually invites a local pastor as well as professionals to lead yoga, meditation and other activities. He’s developing a more robust curriculum for Veterans based on the National Intrepid Center of Excellence at Walter Reed National Military Medical Center.

    Brown tries to keep in touch with alumni of the camp, building a social support network. To his fellow Veterans, Brown says, “Don’t struggle in silence. There are people out there who want to help, and who are dealing with the same things you are.”

    A Soldier’s Heart Bluegrass and Muddy Waters

    One of the most enthusiastic testimonials on the Camp Brown Bear website reads, “By far, this is the best therapy I’ve had over the years of fighting PTSD.”

    Those are the words of Jeremy Wallace, who lives in the Marshall County community of Gilbertsville and is a member of West Kentucky RECC. He’s a former National Guardsman who spent 15 months in Iraq providing convoy security and combat patrol. Wallace says his unit lost only one of about 80 guardsmen to combat. Since coming home, they’ve lost at least three to suicide, and nearly lost a fourth.

    “And I was suicidal,” he says. “Killing myself seemed like the logical answer. It kept running through my head like a CD skipping and repeating itself.”

    What kept him from pulling that trigger?

    “My wife and kids,” he says.

    Wallace has founded his own outdoor retreat and outing non-profit, A Soldier’s Heart Bluegrass and Muddy Waters. The retreats are entirely free and Wallace covers expenses by organizing fundraising concerts and from other private donations. “I was on about 17 different medications,” he says. “Since I started this getting out in nature, now I’m down to three.”

    There are many other examples of Veterans finding healing in Kentucky’s great outdoors. The Kentucky-based charity Active Heroes has a retreat center with cabins in rural Bullitt County. The state’s Veterans Center in Hazard takes residents (some of whom served in World War II) on field trips to nearby Jenny Wiley State Resort Park.

    For some, the interactions with nature focus on animals. The Louisville-based Veteran’s Club is one of several organizations with an equine program. Veteran’s Club was founded by Veteran Jeremy Harrell, who was recently named the male 2018 Kentucky Veteran of the Year by the Epilepsy Foundation of Kentuckiana (Story here). Army National Guard member and Afghanistan Veteran Deborah Sawyer enjoyed one of the club’s recent equine sessions in Shelby County.

    “The horses didn’t need any explanations about who I was or what I could do. They just accepted me,” something she says she doesn’t always feel from civilians who can be “very judgmental and ask a lot of questions.” Overall, Sawyer says, “It was encouraging to watch the trust being developed between my brothers and the other horses.”

    There’s no one answer to addressing the complex mental health challenges like PTSD, TBI and other conditions that contribute to Veterans’ suicide rates. It’s also worth noting that not all Veterans have served in combat and not all experience PTSD or experience it to the same degree. Some Veterans respond well to talk therapy, to pharmaceuticals or some combination of these. Clinical help is still the recommended first stop for anyone struggling with mental health issues, especially thoughts of suicide.

    Still, in a battle as fierce, complicated and necessary as the one our country is fighting against PTSD and suicide, we have to take our victories where we find them and use every tool that gives our Veterans an advantage, no matter how unlikely the form.

    Gerry Barker understands that. He tends to self-medicate too often with bourbon and solitude, he says. But even after all he’s been through, he’s still around, at 74.

    He says one reason for that is the farm where he’s lived for 21 years. There, his companions have included his wife, Maria, as well as a collection of animals that sounds like something between Old McDonald’s farm and Noah’s Ark. “We had 22 horses at one point. 40 ducks. We had oxen. I loved them. I could work oxen all day,” Barker says, lamenting that these days, “We’re down to just 21 goats.”

    Then this man who overloaded on war calls his goats, “great friends.”

    “The other day, one just came over to me and put her head on my lap. They’re a delight. They have a wonderful, calming effect.”

    Seek help here

    Shakespeare with Veterans co-founder Fred Johnson has written about his experiences before, during and after serving in combat in his book Five Wars.

    PTSD information and resources:

    Veterans Crisis Line: (800) 273-8255, press 1, text 838255, or web chat; deaf or hard of hearing call (800) 799-4889,

    Here are the websites of the Veterans’ organizations in the story:


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  • Local Company Donates


    Rochester, N.Y. – A donation delivered Friday aims to help local veterans in need.

    Warrior Salute Veteran Services provides aid to veterans suffering from PTSD and other forms of trauma.

    Friday, Regional Distributors, Inc. presented a check for $11,000 to the organization.

    It’s something that Regional Distributors has done annually for several years. President and CEO Tracy Scalen and Executive Vice President David Scalen have many family members who served our country.

    “My dad was a World War II vet that suffered quite a bit and spent the last few years of his life in a VA hospital,” said Mr. Scalen, “and it was from that we recognized there was additional need for services for vets.”

    The program is run through CDS Life Transitions. President and CEO Sankar Sewnauth says the gift will go a long way to help veterans.

    “We’re able to give them the treatment they need, provide housing, provide food, transportation, and then we send them back into the community at no cost to them," he said. "Warrior Salute is vitally needed in our community right now."


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  • Burpee Record


    Jason Mosel gave it his all. While he didn't break the World Record, he did beat his own personal best at 3,194 burpees. He also raised $6,527 for the Josh Pallotta Fund.

    A local Veteran attempted to break the Guinness World Record for the most burpees done in 12 hours Friday night into Saturday morning. It's all to raise awareness about Veteran suicide prevention and mental health struggles.

    "I hate burpees, hate them. I think they are the worst thing in the world," said Jason Mosel. That's exactly why he's doing 5,000 of the full-body, strength training exercise in just 12 hours. "I'm showing people that if life knocks you down 4,999 times, I can get up 5,000."

    And Mosel says life did knock him down in 2005. After the Marine Corps Veteran served two tours in Iraq, he struggled with depression and PTSD and attempted suicide. "That's where this really hits home for me, because I've lived it. I've done it. And I've seen where you can be in your darkest time and grow to where I am now," he said.

    It's during the darkest times of the day Mosel will be making the record-breaking attempt. He says he wants to connect with the people who battle demons when the world can look and feel darkest, and to show them he's right there battling along with them, live online. "It's not just doing 5,000 burpees, it's doing it during the hardest time, when someone's going to need to see it the most," he said.

    There's many different kinds of burpees, and the one that Mosel is going to be doing is arguably one of the hardest. "So we're going to drop down -- high plank, come down, chest touches the floor, arms come out, and then back in, push up, knees come in, and jump up," Mosel explained.

    As part of the effort, Mosel has also partnered with The Josh Pallotta Fund, which is raising money to build a wellness recreation center for Vermont's Veterans to honor the memory of a Colchester Veteran who suffered from PTSD and took his own life.

    "This is another way of saying, 'Hey, don't give up. Look what I've done. I haven't given up, and I'm going to keep pushing myself and pushing myself and pushing myself,'" said Valerie Pallotta, Josh's mom. She hopes Mosel's message will not only get the nonprofit one step closer to its one-million dollar goal, but also encourage struggling Vets to reach out when they need help. "That one part of your life where you're so down and so depressed and you can't see out of it -- it will get better."

    "Your face is hitting that ground, and you're standing right back up. And I'm going to show you, I ain't going to stay down," said Mosel, describing a burpee.

    And he wants all Veterans to get back up with him.


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  • Female Problems


    From body armor to health care, theUS military has been slow to adapt to women in its ranks. Female service members are paying the price, often with lifelong consequences.

    WASHINGTON — They didn’t want to complain — being a woman in the US military, the last thing you want to be seen as is weak — but the sharp abdominal pain was becoming debilitating. Military doctors dismissed it as “female problems,” period cramps. It was “normal,” they were told. It was said or implied that they were overreacting. They were given painkillers and birth control, and told to report back to duty.

    Those orders landed six of the more than a dozen female service members interviewed by BuzzFeed News in the hospital, fighting for their lives. One was in the ER a few weeks later with a “baseball-sized cyst,” bleeding internally. Another underwent an experimental, highly invasive, and botched surgery by a military doctor. Several had hysterectomies. All now live with infertility; chronic, debilitating pain; and sky-high medical bills. It wasn’t period cramps.

    Interviews with more than a dozen current and former female service members — spanning different branches, decades, and deployments — revealed striking similarities in the way they were brushed off, misdiagnosed, and provided the wrong treatments by US military doctors around the world. In the cases of at least six of the women who spoke to BuzzFeed News, military doctors' inability or unwillingness to properly diagnose women’s health problems put their lives at risk and often created serious new medical issues. For many, it ended their military career. Most said they were properly, quickly, and easily diagnosed by civilian doctors after meeting dead ends with military doctors for years.

    While the Defense Department hasn’t done a comprehensive survey of women’s health issues in 30 years, female service members have long reported receiving inadequate medical care and higher rates of infertility, especially when deployed abroad, in smaller-scale, targeted studies and surveys. More recently, a study released in December by the Service Women’s Action Network (SWAN) found that the roughly 800 current and former female service members surveyed were about 30% more likely to struggle with infertility than civilian women.

    This year, Pentagon-contracted researchers are expected to begin the first comprehensive study of female service members’ health issues since 1989. Experts say it will provide sorely needed data to back up decades of often horrific anecdotal evidence — usually suppressed and only shared among female service members in private — of the real cost of moving too slowly to adapt to women in the ranks.

    At a time when more women are serving in the US military than at any other point in history, military leaders and lawmakers are realizing that not taking the health issues of female soldiers, Marines, sailors, and airmen seriously is impacting military readiness.

    But it's taken women rising to leadership positions — four-star generals, combatant commanders, and lawmakers on armed services committees — for this issue to gain any traction.

    “I laugh when [the Pentagon] says they take care of women in the military,” Rebecca Lipe, a retired Air Force captain who served in Iraq, told BuzzFeed News. “No. Women in the military take care of other women in the military.”

    There is a pervasive problem in the medical community writ large of dismissing women’s pain as false or exaggerated, but it is exacerbated in a mostly male military environment with a lingering resistance to women in their ranks, and a lack of understanding of how military service impacts women differently than men. And there’s evidence the problem hasn’t gotten better as more women have entered the military; the women who spoke to BuzzFeed News described having similar issues in the late 1990s and early 2000s as others did in the past few years.

    “I was treated as if I was in the wrong”

    Lipe was an Air Force captain and deputy staff judge advocate (a senior lawyer) in Iraq in 2011. Only 27 years old at the time, she was in charge of overseeing five bases’ compliance with military and federal law as well as advising local Iraqi criminal courts, a job that required a lot of off-base travel by helicopter and convoy. This meant she was constantly wearing body armor — body armor that was designed for men.

    “Theoretically if you get shot in the side, there’s side panels, but I couldn’t even wear those, because I couldn’t get it to fit or stay on correctly,” she said. “So if I ever were to get hit in the side that would— that would be a bad thing,” she told BuzzFeed News.

    Like many of her female colleagues, Lipe had to adapt the body armor as best she could. The only way it would protect her vital organs the way it was meant to was if she stuck foam rubber under the shoulder straps to lift it up, she said.

    It wasn’t until later that she found out that wearing this ill-fitting equipment weighing more than 40 pounds, while sitting at the 90-degree angles forced by military convoy seats for hours and days on end, likely caused multiple “sports herniations” in her pelvis. When she went to the doctors on base seeking treatment for intense pelvic pain, they insisted it was not a hernia, medical records reviewed by BuzzFeed News show. Instead they became convinced it was symptoms of a sexually transmitted disease, and repeatedly tested Lipe for STDs despite her insistence that there was practically no way she could have one. She was married and faithful to her husband, she told them, but they kept asking her if she was having an extramarital affair.

    “I was treated as if I was in the wrong,” Lipe, now 36, told BuzzFeed News, speaking from her office in Chicago where she works as an attorney after retiring from the Air Force. “Clearly they thought I must have been this adulterous, excuse me, whore who was doing something wrong. And I was like, look, I’m the lawyer here, I’m the one enforcing these rules, you have to be kidding me.”

    All the STD tests came up clean, records show, but the pain got worse. It got so bad that she stopped being able to walk to the dining facility for meals. The doctors told her it was her endometriosis (a common disorder that leads to unusually painful menstruation) but she had knew what that felt like, and this wasn’t it. Within a few days she had to be medically evacuated to the Landstuhl Regional Medical Center in Germany, a trip that only exacerbated her injury, Lipe said. No one believed she was in as much pain as she was. She could barely get up, but they made her walk and carry her own bags to the plane, where the nurses refused to give her the amount of painkillers the doctors had prescribed her for the flight, records reviewed by BuzzFeed News show.

    At first, the military doctors in Germany refused to admit her, saying it was just period cramps, Lipe said, until a higher-ranking officer insisted on her behalf. The records show Lipe was told she had developed a pelvic infection in Iraq from unknown causes (a diagnosis her OB-GYN later wrote in her records, after consulting with nonmilitary specialists, was incorrect and made “without any objective evidence”). Not knowing what else was wrong with her, she was shipped back to the US, to Eglin Air Force Base in Florida for further treatment.

    “I spent the next two years having to advocate for myself to the point of defending my mental health,” Lipe said, echoing a sentiment expressed by every woman who spoke to BuzzFeed News. “I was constantly in pain … I got to the point where I was suicidal because I was literally being told this was all in my head. There’s only so much you can be told that before you start to think you’re going crazy.”

    Finally, almost exactly a year after Lipe first started experiencing the pain, a private, nonmilitary reproductive endocrinologist and general surgeon in Jacksonville, Florida, figured out what was wrong with her — multiple small pelvic hernias caused by the ill-fitting body armor. It took two one-hour appointments, her records show, and they knew exactly how to fix it. After extensive surgery to fix eight areas of her abdominal wall, she began to improve.

    However, due to the delay of proper treatment and the many procedures and medications military doctors prescribed for problems she did not have, Lipe had become hormonally depleted. It caused nerve damage and vaginal atrophy, her medical records show, that prevented her from having sex with her husband, and she had trouble conceiving naturally.

    “I won’t ever go back to a military medical facility,” Lipe said.

    While Lipe’s case was extreme, the military’s own surveys show a widespread problem with women getting access to health care.

    According to a 2006 military study of female soldiers who served in Operation Iraqi Freedom, 44% could not access gynecologic care during their deployment. A later study in 2009 found that 35% of female soldiers had at least one gynecologic problem while they were deployed in Iraq, with 11.5% having to take the risk of traveling by ground convoy and 28% by air to obtain care.

    Many other women described similar ordeals to BuzzFeed News, with misdiagnosis of fairly common medical issues as “female problems” — a term every woman who spoke to BuzzFeed News used to refer to menstruation, saying it was what men in the military said as well — not only interrupting their military careers but causing long-term injuries.

    All the women who spoke to BuzzFeed News said the pressure to “suck it up” and fight the perception of being seen as weak was especially acute as female service members. Many of the men they served with or who treated them saw women as “problem soldiers” — especially if they complained about pain, they said. They all said some of the men made it clear they thought the military was no place for women at all.

    “I can only guess a lot of other women feel this way, but I never want to be perceived as a whiner. I don’t wanna be a complainer,” retired Air Force Maj. Annie Morgan, who experienced similar issues, told BuzzFeed News. “I feel a certain need to be tough, and I don’t know if the military’s telling me that or if I’m imposing this on myself because I know I’m in the minority.”

    If you have to repeatedly tell your superiors and the medics on site that you’re in pain, “it proves their thinking that women shouldn’t serve in certain capacities,” Catherine Harris, who retired last year as a first sergeant in the Army, told BuzzFeed News said. “So you think, OK, I’m gonna keep quiet so I don’t ruin someone else’s chances of doing this.”

    But the pain got so bad for the women who spoke to BuzzFeed News that they couldn’t keep quiet anymore. It was interfering with their jobs, their military service, and their lives. Three of the women were accused of malingering while they were experiencing chronic, debilitating pain. All of them said that this constant denial of their pain took a mental toll on them.

    “We don’t want special care, we want the same level of quality care that the men have,” Harris said.

    A recent analysis of military medical research put out between 2000 and 2015 found that “research on the US military has until recently focused almost exclusively on the health of male service members,” and that gynecological care had the highest percentage of low-quality articles and information available to service members.

    For Harris, 47, her problems started after an accident in the early 2000s in Fort Jackson, South Carolina. She was on duty driving two soldiers when the rear axle of the truck gave out, rolling over several times, she told BuzzFeed News. Harris said she went to the hospital complaining of lower abdominal pain, which continued and got more severe over time. As with five other women who spoke to BuzzFeed News, she said the military doctors dismissed her pain as connected to her period — “female problems” — and prescribed her several different kinds of birth control, none of which worked.

    Harris told BuzzFeed News she had trouble with infertility after that, and lost two pregnancies. During a third pregnancy, she said she was sent to a nonmilitary doctor, because she was considered to have a “high-risk” pregnancy. That doctor discovered large ovarian cysts that endangered her life and her pregnancy, requiring her to undergo a risky operation. Luckily, she and her daughter survived both the procedure and the birth.

    But Harris's pain continued for years, as military doctors continued to insist it was only period cramps, she said. It grew worse in 2013 after she deployed to Afghanistan, where she underwent several physically traumatic experiences, including being in an aircraft that came under fire and being proximate to an explosion, she said. The pain came to its peak in 2015 when she was stationed at the US Army garrison in Vicenza, Italy. Before she deployed, a doctor had installed an IUD in an attempt to help the issues caused by the abdominal trauma, but it had to be removed when it started causing her pain. By the time she left the military, in June 2017, she had to have a hysterectomy, Harris said. She went into early menopause at 45 years old.

    Military doctors and Pentagon officials told BuzzFeed News they could not discuss specific cases, but insisted their priority is to maintain the health and well-being of all service members, men or women, so they can fulfill their mission.

    But the women who spoke to BuzzFeed News said that the “one size fits all” approach, from health care to body armor, simply does not work as the number of female service members continues to rise. For example, 12.3% of female recruits developed hip stress fractures compared to 2.4% of their male counterparts, partly because hip belts and the metal frames for their packs are designed for men’s bodies according to one analysis of US Army recruits. It cites a study — conducted more than 20 years ago — that suggested that female soldiers would not only be able to avoid injury but also close the time gap between them and male soldiers if packs could be designed for the female anatomy.

    Such experiences not only hurt female service members, but also damage the military as a whole in the long term, experts say.

    “The military invests in every single person that enters, man or woman, they lose just as much losing a woman as they do a man, from an investment perspective,” said Sarah Meadows, a senior sociologist at the RAND Corporation, the nonprofit think tank that was commissioned by the Pentagon for the upcoming study on female health issues in the military.

    It was a perspective echoed by more than a dozen US Army, Navy, Air Force, and Pentagon officials questioned by BuzzFeed News.

    “Anything that gets in the way of them being able to serve, just like any other soldier, is bad news for everyone,” one US Army recruiter, who spoke on the condition of anonymity, told BuzzFeed News in January,

    The US Army added eight new sizes of body armor to fit smaller sizes in 2016, and the Marine Corps is adding a helmet that accommodates women’s hair. Gen. Joe Dunford, the chair of the Joint Chiefs of Staff, last year pressed the service branches to move more quickly to get the new body armor to female troops in the field.

    But there are increasing concerns that the lag in adapting to female service members’ medical needs may lead to women leaving military service at a time when the US military is struggling to recruit and retain service members.

    “This is important not just for warfighting but also for retention,” Sen. Tammy Duckworth, a retired Army lieutenant colonel, told BuzzFeed News in an interview. After losing both her legs when her Black Hawk helicopter was shot down in Iraq in 2004, she has been outspoken about the need to extend coverage of fertility treatments for wounded Veterans. She said she hopes the upcoming Pentagon study will provide more data and help fight the stigma around female service members’ health and infertility issues.

    “If we don’t address these issues, women are more likely to leave the military, and taxpayers lose a lot of money when skilled soldiers, airwomen, and sailors leave,” Duckworth said.

    “Girly Problem”

    Even women whose medical issues were not directly caused by their military service told BuzzFeed News they faced dismissiveness and negligence from military medical professionals that worsened their conditions and caused lasting, debilitating medical issues.

    One former Air Force medic, who asked not to be named, had an undiagnosed, rare genetic condition while in the military with symptoms that included pelvic pain. Even though she worked in the medical field, her pain was often dismissed by her colleagues as related to her period.

    “I was the only female officer in a fighter squadron, so it was all officers and all men, and here I was with this girly problem,” she said. Unlike the other servicewomen interviewed for this story, she said her problems weren’t even connected to her reproductive organs, “but if it’s that part of your body, they don’t want to know about it.”

    When the pain was at its peak in the early 2000s, a US military physician at the Royal Air Force Lakenheath base in the UK, which hosts US Air Force personnel, recommended she undergo an invasive surgery. He ended up performing the surgery incorrectly, she told BuzzFeed News, which resulted in lasting problems with urination and pelvic pain.

    “There’s nothing wrong with you. You’re being ridiculous. Tough it out,” she said the doctor told her, assuring her the pain was normal. When she insisted, he refused to keep seeing her. She complained to the head of the hospital as well as the base commander, but is unaware of any action being taken.

    She never fully recovered from the misperformed surgery, and never went back to being active duty again.

    Similarly, Morgan had months of abdominal pain dismissed as menstrual cramps by the military doctors at Lakenheath starting in 2011, according to medical records reviewed by BuzzFeed News. A different OB-GYN at Lakenheath told her she had a “tender cervix” and was told “to take some aspirin,” she said. Weeks later, while on leave back in the US, she ended up doubled over in pain in a civilian ER. Doctors found she had a “baseball-sized cyst” on her ovary that had caused internal bleeding, and performed emergency surgery, according to her records.

    In the following years, as Morgan continued serving in the Air Force as a judge advocate, military doctors performed several exploratory surgeries, her medical records show, including having her right ovary removed. None of them made the pain better.

    “It’s hard not to take this personally and think, Maybe I’m the problem. Maybe I’m being a big baby,” Morgan told BuzzFeed News. “I started to doubt myself. It’s hard when keep having these encounters with medical professionals where they say nothing’s wrong. You start to think, Maybe I’m the crazy one.”

    In a statement, the commander of the 48th Medical Group at Lakenheath told BuzzFeed News that they take the care provided by the base’s OB-GYN clinic “very seriously” and that service members have several options to raise concerns, including patient advocates, email and survey feedback, and filing complaints about doctors and medical staff. Like other military officials contacted by BuzzFeed News, US Air Force Col. Thomas Stamp said he could not respond to questions on individual cases due to privacy laws.

    “Every Airman and civilian staff member working in our hospital is expected to operate at the highest level of professionalism, without exception,” he said. “They trust us to take care of them and in return we are committed to providing world-class healthcare.”

    One servicewoman, who asked to only be referred to by her middle name, YVette, described facing similar experiences with military doctors in the 1990s. She had chronic fibroids (uterine cysts) that caused her a lot of pain, she told BuzzFeed News, but during her time in the military they were repeatedly dismissed as period cramps. Like the others she was prescribed different kinds of birth control and painkillers, and eventually was accused of malingering, she said. By the time she was properly diagnosed by a civilian doctor, nearly 20 years after the pain started, the damage was so bad she had to have a hysterectomy. Another woman, who is currently serving in the Army and asked to remain anonymous, told BuzzFeed News a nearly identical story that happened last year.

    In mid-February the advocacy group SWAN brought Lipe and several other women to Capitol Hill to meet with the staff of 30 members of Congress about the medical and infertility issues facing servicewomen. Two weeks later, staffers for two Senate offices and one House office (who asked to remain anonymous as their offices were not yet ready to go public with this information) told BuzzFeed News there were ongoing discussions about including funding to research the issues brought up by the servicewomen in the next National Defense Authorization Act.

    Duckworth attributed much of the spotlight on the issue in recent years, including legislation and the upcoming study, to more women being in senior leadership roles both in the military and in Congress.

    These women in senior positions “looking out for these issues adds to the momentum that is just now starting to build when it comes to health in the military for women,” she said.

    Lipe and Morgan, both lawyers with prestigious positions in the military, said they were aware of the privilege their positions gave them as they battled for their medical issues and infertility to be taken seriously.

    “If this is my experience, I can’t even imagine what our younger enlisted officers are dealing with,” said Lipe, who had direct access to commanders throughout her infirmity. “I’m worried how many females enlisted who have had similar problems haven’t had a chance to voice them because they’re afraid to speak up, and don’t have the platform to do it.”

    A constant stream of reports have brought to light environmental health hazards service members may have been exposed to — lead poisoning in military base housing, water contaminants, burn pits — but a lack of research into how they might affect women’s health issues down the road, including fertility, means for many there’s nothing to do but wonder.

    “Am I a fluke? I mean, I don’t think I was exposed to a lot of chemicals or equipment or radiation, but I don’t know, a lot of women don’t know,” said Amanda Lurer, a 39-year-old US Navy chaplain who was told there was no medical explanation for her fertility problems when she started trying to conceive in her early thirties. After several expensive rounds of IVF, she was able to have a daughter, who is now 2.

    Like several female service members and lawmakers who spoke to BuzzFeed News, Lurer said she hopes the Pentagon’s upcoming study will provide some scientific data, and finally some answers.

    “It’s good they’re finally doing this, but the military moves at a glacial pace,” Lurer said. “Maybe if my daughter grows up and wants to enlist, there’s hope it’s a better one for her.”


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  • PTSD Key


    Post traumatic stress disorder (PTSD) is a recognized psychiatric disorder that a person may develop after exposure to a traumatic event. For many years, PTSD went widely undiagnosed or was not recognized as the serious condition it is. Thanks to advancements in research and the breakdown of social stigmas, we have more information about the condition than ever before. We know that the majority of people who are exposed to traumatic events do not develop PTSD, and we know that veterans of the U.S. military are disproportionately affected by PTSD when compared to American civilians.

    This blog post is intended to serve as a brief breakdown of the required criteria for a diagnosis of PTSD as defined by the fifth edition of the Diagnostic and Statistics Manual of Mental Disorders (DSM V), published by the American Psychiatric Association.

    Criterion A: Stressor

    In the context of PTSD, the stressor is the traumatic event that leads to the development of PTSD. The precise definition of “traumatic event” is contested, but the DSM V requires exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. This exposure must have occurred in one of the following ways: direct exposure; witnessing the trauma; learning that a relative or close friend was exposed to the trauma; or indirect exposure to details of the trauma, often in the course of professional duties (for example, a paramedic treating victims of a serious motor vehicle accident would be indirectly exposed to the traumatic event of the motor vehicle accident even if she did not witness the accident herself).

    Criterion B: Intrusive symptoms

    Not everyone who is exposed to a traumatic event will develop PTSD. In order for a person to receive a diagnosis of PTSD, the DSM-V requires the person to show at least one intrusive symptom. Intrusive symptoms can manifest in sudden upsetting memories; nightmares or bad dreams; flashbacks to the traumatic event; emotional distress after reminders of the traumatic event; or physical reactivity following reminders of the traumatic event (for example, an increased heart rate after exposure to reminders of the traumatic event).

    Criterion C: Avoidance symptoms

    The third criterion for a PTSD diagnosis is avoidance of reminders of the trauma. This could be an avoidance of thoughts or feelings about the event or avoidance of trauma-related reminders altogether. A person who suffered sexual assault may display avoidance of thoughts and feelings of the assault and do their best to never think about the event. Someone who witnessed a person drowning may avoid trauma-related reminders and stay away from pools or bodies of water. For a diagnosis of PTSD, the presence of at least one of these symptoms is required.

    Criterion D: Negative alterations in cognition and mood

    A person who receives a diagnosis of PTSD must display at least two of the following symptoms following the stressor: inability to recall key features of the stressor; overly negative thoughts or assumptions about oneself or the world; exaggerated blaming of self or of others for causing the trauma; negative affect (having a flat or depressed mood); decreased interest in regular activities; feelings of isolation; or difficulty experiencing a positive effect (having a hard time feeling happy).

    Criterion E: Alterations in arousal and reactivity

    For a diagnosis of PTSD, at least two of the following symptoms that began or worsened after the stressor must be present: Irritability or aggression; risky or destructive behavior (for example, driving recklessly); hypervigilance (for example, not being able to relax for fear that something bad will happen); increased startle reaction; difficulty concentrating; or difficulty sleeping. These alterations in arousal and reactivity are a defense mechanism for preventing further trauma.

    Criterion F: Duration of symptoms

    Even if a person fulfills all the required criteria, a diagnosis of PTSD requires persistence of the symptoms for more than one month. A person may fulfill all criteria immediately following a traumatic event but two weeks after the event may display fewer or none of the required symptoms. Although the criteria were present for a time, the person would not meet the duration requirement.

    Criterion G: Functional significance

    The PTSD symptoms experienced by the person with the diagnosis must create distress or functional impairment in a person’s life. For example, a veteran who suffers from PTSD and currently works in an office setting may find that his job performance is impacted by difficulty concentrating or increased irritability with his coworkers. A college student who experienced sexual assault at a party may find that their friendships are affected by their negative affect, hypervigilance, and their avoidance of other social events.

    Criterion H: Exclusion

    In order to meet the criteria for a PTSD diagnosis, the symptoms must not be caused by medication, substance abuse, or any other illness.

    This is an extremely simplified discussion of PTSD intended to provide clarity to a frequently-discussed condition. Follow-up blogs will address specifications of the diagnosis as well as the issue of PTSD as it relates specifically to veterans seeking service connection.


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  • PTSD and Depression


    Relationship problems stemming from PTSD and depression could have opposite effects on men and women in terms of their seeking mental health treatment, found a VA Boston Healthcare System study. In a study of post-9/11 Veterans, relationship dysfunction was linked to increased rates of mental health care use in women, but lower rates of use for men.

    The results appeared in the January 2019 issue of the journal Psychiatry Research. The findings “underscore the importance of attending to the role of relationship impairment in Veterans’ treatment-seeking,” write the authors.

    PTSD and depression are known to cause functional impairment in Veterans. Functional impairment refers to interference in a person’s ability to effectively manage in various areas of everyday life, such as relationships, family, and work.

    Does that functional impairment affect treatment-seeking differently in male and female Veterans?

    To answer this question, researchers surveyed 363 Veterans of the post-9/11 conflicts. Participants were surveyed five years after their military separation, and then again nine months later. Each participant was assessed for depression, PTSD, and functional impairment.

    Among women, relational problems spur treatment

    The results showed some expected associations. PTSD and depression symptoms were linked to increased use of mental health services in both men and women. Symptoms were also linked to increased relationship and work impairment.

    But when the researchers looked at the connection between functional impairment and treatment-seeking, they found an interesting result: When women had greater relationship impairment, they were more likely to seek mental health treatment. When men had greater relationship impairment, they were less likely to seek treatment.

    Work impairment did not affect treatment-seeking in the same way as did relationship impairment.

    The researchers offer several possible explanations for this difference. According to Dr. Dawne Vogt, the lead investigator for the study: “It could be that for men, the lack of a supportive partner to encourage them to seek treatment could lead to less care use. For women, perhaps the negative impact of their condition on relationships could serve as a signal that help is needed.”

    Gender-based social norms may affect treatment-seeking

    The difference may reflect the different role that relationships play in men’s and women’s lives, say the researchers. Women have been shown to have a greater attunement to and emphasis on relationships than do men, so they may react differently to problems in this area. Social norms that emphasize stoicism and emotional control in men may affect whether they seek treatment.

    The results show the importance of engaging patients on the functional consequences of mental health conditions rather than just focusing on symptom management, says Vogt. Different approaches may be needed to address relationship impairment in men and women. For example, for men, treatment may include bolstering other sources of support beyond intimate relationships to enhance their engagement in treatment. For women, efforts could focus on how treatment may help in preserving relationships.

    The researchers also suggest that it could be helpful for both men and women to be offered PTSD and depression treatment that involves a loved one, which could increase Veterans’ motivation and engagement in treatment.


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  • Marijuana 001


    Researchers at the VA San Diego Healthcare System aim to see whether cannabidiol, or CBD—a compound derived from cannabis plants—can help ease PTSD. The study will give CBD as an add-on to prolonged exposure therapy, a proven psychotherapy for PTSD.

    The $1.3 million VA-funded study will enroll 136 Veterans, from all service eras.

    Dr. Mallory Loflin, a research scientist with VA and assistant professor of psychiatry at the University of California, San Diego, is leading the study. Loflin, with VA’s Center of Excellence for Stress and Mental Health, specializes in studying new mental health treatments that target the body’s endocannabinoid system. CBD and related compounds from cannabis bind with receptors—proteins on the surface of cells—that are part of this system.

    Loflin says past research suggests that CBD can increase extinction learning in PTSD. This has to do with people “unlearning” unhelpful responses and behaviors they’ve developed in the wake of trauma. This, she says, could boost the speed and effectiveness of prolonged exposure therapy, which helps patients gradually work through their traumatic memories. She says CBD could also ease insomnia and over-arousal. Those types of effects are beneficial on their own, but they could also further boost Veterans’ engagement and retention in treatment.

    VA Research Currents interviewed Loflin to learn more about the trial, which plans to start recruiting patients by March 2019.  

    It seems there is a lot of confusion and misinformation floating around on the internet aboutCBD, and cannabis in general. Does that present special challenges for this study?

    I certainly get more questions from prospective participants! In particular, folks have a lot of questions about whether it’s legal for them to participate in the study, and whether they could get in trouble with their work. Because I have a Schedule 1 license, under the Controlled Substances Act our participants are 100-percent legally allowed to receive the study drug. The challenge, though, is with the work question. Just because something is legal doesn’t mean that one’s workplace allows it, so we do have to advise them to do their homework to find out if their employer prohibits use of cannabidiol, even in the context of a research study and for medical treatment. That’s obviously something we wouldn’t have to think about with other medication trials.

    While there has been legitimate research showing health benefits fromCBD, there’s also been hype about how it’s good for virtually anything that ails a person. Is there a concern that this might lead to a stronger-than-usual placebo effect?

    Yes, and this isn’t just an issue for CBD either. This is a common problem for cannabinoid research in general. Folks talk about cannabis and cannabinoids being cure-alls for everything from Alzheimer’s to warts, which creates a huge demand on participants to see improvement when they’re in a “cannabinoid research study.” Unfortunately, what we then see is that even folks in the placebo condition in these trials tend to see greater benefit from the inactive treatment than folks would usually see from an active treatment outside the study! This strong placebo effect creates headaches for researchers because it makes it very difficult for our experimental condition (the study drug) to outperform the placebo, increasing the likelihood that the trial will fail.

    We’ve obviously thought a great deal about this issue and will attempt to measure folks’ expectations about the study drug and attempt to control for that when we analyze the data. Also, I designed this study as an adjunct to psychotherapy because I wanted to test whether the addition of CBD to one of our current frontline treatments for PTSD (prolonged exposure) helps with the process of treatment. But it’s also possible it could impair treatment.

    I’m equally interested in finding out whether taking CBD at the same time as psychotherapy disrupts treatment gains. This is a major question I get from therapists whose patients are self-treating themselves with a cannabinoid during psychotherapy, whether it helps, hurts, or makes no difference. So even if the study “fails” and doesn’t find that CBD outperforms placebo because of too strong of a placebo effect, we should at least be able to see if those in the CBD condition fared worse, which is a very important question.

    Tell me about theCBD product you are using in the study.

    It’s manufactured in a lab to replicate plant-derived CBD. It’s isometrically identical but doesn’t come from cannabis. There was a lot of back and forth on which source to use, but we decided to go with lab-derived for consistency of the drug product. This also helps us test just the effects of CBD alone. Most plant-derived CBD products contain other potentially active compounds that will vary from plant to plant and product type to product type. We could have used plant-derived pure CBD, but at that point it’s just a single molecule. It’s easier to get to that molecule from a synthetic lab-made product than from a plant.

    Would it be correct to use the term “medical marijuana” or “medical cannabis” for this trial?

    Neither is technically correct, since our CBD product doesn’t come from cannabis, although I’d argue that the term medical marijuana isn’t precise in any context, since the scientific term for all is cannabis and “marijuana” is really just a colloquial term, and one with quite a racialized history, too. I guess you’d call our study a “cannabinoid trial.”

    Do naturally derivedCBD products contain various other compounds, even in very small amounts, that may contribute to the therapeutic effect? By using a synthetic and “pure”CBD product, are you possibly sacrificing some therapeutic benefit and effectiveness?

    It’s important to point out that it might not even be CBD that’s responsible for therapeutic effects. It could very well be one of its metabolites [substances that are created when a compound is broken down in the body]. It’s also very likely that a lot of those other compounds in the cannabis plant have therapeutic benefit. However, it’s equally likely that a lot of them also interact with and suppress the effects of CBD, as well. The problem is that we haven’t categorized most of those other compounds in a systematic way, and we know very little about their bioavailability, metabolism, actions, and effects. By studying just one molecule we can at least parse out the direct effect of CBD by itself. We have a very long way to go to understand the effects of everything in the cannabis plant.

    Participants in the trial will receive capsules that contain eitherCBD or a lookalike placebo. Why use capsules as opposed to other forms ofCBD?

    It came down to regulatory process more than anything else. Encapsulating a pharmaceutical product is considered standard pharmacy procedures, but mixing it with sesame oil (for sublingual) or another solid (for inhalation) would be changing the formulary. In the eyes of the Food and Drug Administration (FDA), this would then be considered a different drug product, not pure CBD. We would have had to do all kinds of preliminary studies to demonstrate safety with that new “mixture” before obtaining FDA approval to proceed with the study. Since we don’t have enough data yet to know which method of delivery produces the most consistent effect, oral seemed like a good first start.

    What legal and regulatory processes did your team have to go through to do this trial?

    First, we applied to VA Clinical Science Research and Development for funding. That application was reviewed by a scientific panel of researchers who scored it based on merit of the study design and potential for impact on Veterans’ health. After receiving notice that the study would be funded, we applied for and received approval from the FDA to test oral CBD as an investigational new drug product for the treatment of PTSD. We also received approval from the California Department of Justice to recruit state residents as participants in a controlled-substance research study.

    I also applied for and was granted a Schedule 1 researcher registration, which required a site visit from the federal Drug Enforcement Administration to ensure that we had appropriate facilities and procedures in place to store and administer the drug. Because we decided to purchase CBD as an active pharmaceutical ingredient and encapsulate it in our pharmacy, we did not need National Institute of Drug Abuse approval, though this would be a typical first step for a cannabis-based study. But we did need to get approvals from federal VA contracting for sourcing the drug product from a chemical manufacturer.

    The trial will enroll 136 Vets. Will that be a large enough sample to enable you to stratify the results based on factors like service era, duration of PTSD, gender, or race? In other words, will you be able to learn which subgroups of Veterans with PTSD can potentially benefit most fromCBD?

    We’ll certainly investigate whether those factors impacted outcomes as a secondary follow-up to the study, but you’re correct that the sample size isn’t large enough to test this as a primary outcome.

    Is this the first randomized, controlled trial ofCBD for PTSD in theU.S. or worldwide? Are there any—even small pilot studies—that show up in the medical literature?

    Not at all! Two other cross-over trials that compare different combinations of THC and CBD with placebo for PTSD are underway in British Columbia and Arizona. To my knowledge, though, this is the first cannabinoid trial primarily funded by VA. There is also a double-blind clinical trial preparing to launch at New York University that would test CBD alone as a potential treatment for comorbid PTSD and alcohol use disorder.

    CBD at a glance

    CBD is short for cannabidiol (pronounced kan-a-bih-die-ole). CBD is one of hundreds of chemical compounds found in cannabis plants. One large group of these compounds is known as cannabinoids. Scientists have identified more than 100 cannabinoids, including CBD.

    Besides CBD, another compound found in cannabis is THC, short for tetrahydrocannabinol. THC is “pscychoactive,” meaning it produces a high, a feeling of euphoria. CBD does not have this property.

    Studies and anecdotal experience suggest a variety of possible health benefits from cannabinoids such as CBD and THC—for example, easing chronic pain and anxiety—but researchers are still learning exactly which compound produces which effects, and what the risks are.

    The terms hemp and marijuana are associated with CBD, and there is much confusion as to their precise definitions. See this blog post from the National Institute on Drug Abuse for an explanation.

    What’s important to know is that varieties of the cannabis plant that would be considered marijuana contain far more THC than do varieties that are grown as hemp. According to the 2018 Farm Bill, hemp that is grown legally in the U.S. can contain no more than 0.3 percent of THC.

    CBD products can be derived from either “marijuana” or “hemp” varieties of cannabis—or they can be made synthetically in a lab. CBD can be used in various forms, such as oils, sprays, creams, gummies, and capsules.

    Although CBD does not produce a high, until recently it was considered a Schedule 1 drug—in all its forms—and was subject to tight regulation. The 2018 Farm Bill loosened restrictions on CBD derived directly from hemp, as part of the bill’s legalizing of commercial production of hemp. However, there are currently no hemp-derived CBD products that meet FDA criteria for research. The synthetic version being used in the VA trial and other forms of CBD being used in research are still classified as Schedule 1 drugs. As such, approvals for the research must be obtained from several agencies, including the Drug Enforcement Administration and the FDA.


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  • Wild Tiger


    Energy drinks like Rip-It and Wild Tiger may be essential fuel for hard-charging U.S. service members, but they’re only exacerbating mental health issues and behavioral issues, according to a new study in Military Medicine.

    • The research found that soldiers who consumed at least two energy drinks a day were far more prone to “mental health problems, aggressive behaviors, and fatigue,” with high consumption reported in one out of every six soldiers months after the end of a high-stress deployment.
    • Most alarmingly, however, is the assertion that ongoing energy drink consumption and the resulting aggressive behaviors “are associated with being less responsive to evidence-based treatments for PTSD” — a conclusion that suggests soldiers are mortgaging their long-term health for their short-term performance downrange.
    • This conclusion was based on a survey of 627 male infantry soldiers, mostly junior enlisted between the ages of 18 and 24, seven months after the end of an unnamed combat deployment in order to gauge long-term impact.
    • The problematic behaviors recorded in Military Medicine include extreme irritability (66%), sleep issues (35%), alcohol abuse (29.8%) and depression (9.6%), as well as a higher rate of post-traumatic stress disorder (11.2%), following the end of a deployment.
    • It’s important to note that most of these behaviors aren’t a product of the energy drinks themselves, but a long-term impact of an abnormal sleep cycle: “Interestingly, energy drink use was associated with fatigue,” the authors note. “This relationship suggests that energy drink use may potentially exacerbate, rather than alleviate, fatigue.”


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  • Spiritual Approaches


    Mental-health professionals and military specialists increasingly rely on these tools to combat the after-effects of war.

    As Veterans from the Iraq War and other conflicts continue to face a mental-health crisis that is claiming an average of 20 lives by suicide each day, mental-health professionals and military specialists are increasingly turning to spiritual approaches as a way of combating Post-Traumatic Stress Disorder and other after-effects of war.

    “We welcome our men and women who have served back in airports and in coffee shops. We applaud them. But then we have nothing to do with helping them get back on track,” said Mark Moitoza, the vice chancellor for evangelization for the Archdiocese for the Military Services.

    An estimated one out of every five Iraqi War Veterans has Post-Traumatic Stress Disorder (PTSD). Among Vietnam Veterans, the figure is nearly one in three, according to the National Institutes of Health.

    The need for a faith-based approach is especially clear when it comes to healing from a condition known as “moral injury,” which is related to PTSD but distinct, in that it refers to the wounds to the soul that occur when a soldier in an active battlefield commits acts that go against his values, either on the orders of a commanding officer or on his own accord, according to Moitoza.

    Even if someone acted with justification to kill an enemy combatant, he likely will still have deep misgivings and discomfort with what was done. “Whether the bad guy was bad or not, when you kill, it does something to humans. It’s not natural to kill another person. It’s more justifiable when it’s an extreme terrorist putting a bomb into the school, but it doesn’t change the fact that I killed him. That scars you,” said Damon Friedman, a lieutenant colonel for U.S. Air Force Special Operations and president of SOF Missions.

    SOF Missions is a Florida-based nonprofit that provides a holistic approach — incorporating the body, mind and soul — to helping Veterans cope with PTSD and moral injury. (SOF stands for Shield of Faith.)

    Friedman recently appeared on a panel at a Nov. 29 event on spiritual health and suicide prevention at the Heritage Foundation, a Washington, D.C.-based think tank. The event included a screening of a documentary recently released by SOF Missions, Surrender Only to One.

    The documentary presents Jesus as the one who brings peace and wholeness to Veterans. While they may no longer be engaged in physical combat, the documentary reminds Veterans of their calling to engage in spiritual warfare, Friedman said.

    Wounds Only God Can Heal

    This spiritual approach is aimed at PTSD and moral injury.

    “I would argue that when it comes to moral injury, there’s only certain injuries that God can heal. There’s only certain wounds that God can heal, and that’s why it’s really important to understand the psychological realm and the spiritual realm and how they can work collectively together,” Friedman said.

    The program that SOF Missions offers to Veterans is tailor-made to the needs of individual and includes physical fitness, mental-health care professionals and spiritual counselors. The program also invites participants to identify with the stories of biblical figures like Peter or Elijah.

    Commanders struggling with battlefield decisions might relate to someone like King David, while a soldier dealing with guilt over a particular killing may find comfort in the story of Paul, who presided over the murder of the martyr St. Stephen, according to Friedman.

    Although SOF Missions hails from a conservative evangelical background, its approach is more ecumenical than denominational, and it has team leaders on staff who are Catholic.

    One former military official who is not at the Heritage Foundation says the Department of Defense and Veterans Affairs need to do more to incorporate these spiritual approaches into their treatment for both Veteran and service members.

    Steven Bucci, a former Army special forces officer and now a visiting fellow at the Douglas and Sarah Allison Center for Foreign and National Security Policy at Heritage, says both federal departments need to work with nonprofits like SOF Missions, making their kind of program more widely available. He said the Department of Defense and Veterans Affairs need to better utilize their chaplains, as well.

    “Then we can begin to address this problem and maybe get that darn 21 people a day number down a lot lower than it has been,” Bucci said, citing one estimate for the daily number of Veteran suicides.

    Bucci, who is Catholic, said he can personally attest to the importance of faith in dealing with his experiences in the military. “It’s foundational. I know who my strength comes from, and that’s the Lord Jesus; and I have always been very open with my faith, even with my troops,” Bucci said. “I could not have gone through the things I have and still have my same wife and family and sanity if it had not been for my relationship with the Lord.”

    Chaplain’s Perspective

    For chaplains, one of the first steps is listening to the experiences of Veterans and journeying with them as they process their experiences, according to Father Andrew Sioleti, the chief chaplain at VA New York Harbor Health System in Manhattan.

    Veterans’ chaplains offer the sacrament of reconciliation and retreats as additional aids for Veterans. Another spiritual tool is more active: “One way of healing from your trauma and your pain and your moral injury [is] to start doing good things,” Father Sioleti said.

    He said volunteer work had been particularly helpful to one Veteran haunted by a battlefield killing of a young boy who was the same age as his son. The boy was among a group that was rushing a military position that did not stop when warned to do so. The killing was justifiable, according to military rules of engagement, but the Veteran continued to struggle with that outcome.

    Father Sioleti said the Veteran dealt with his guilt by becoming involved as a fundraiser and public speaker for a charity that ministers to children affected by war and violence.

    Moitoza said there is more that can be done to help Veterans with PTSD and moral injury. In his recently completed dissertation, which focuses on sacramental healing for moral injury, he recommends a communal examination of conscience followed by the administration of the sacrament of confession. He says the anointing of the sick is another remedy that should be applied to both PTSD and moral injury.

    Community Responsibility

    According to Moitoza, the broader Catholic community also has a responsibility to welcome Veterans back into the community. Individual parishes, he said, should reach out directly to Veterans, assisting them even in smaller, mundane tasks, like arranging appointments with therapists.

    “Returning Veterans are frequently hailed for possessing courage and strength as they entered into harm’s way, but some who return feel lost, hopeless and morally conflicted. Those overwhelming feelings contribute toward a sense of being unworthy to approach God or the Church, creating soul wounds,” Moitoza said. “A communal embrace of returning Veterans with moral injury helps to reconnect them with a new sense of courage, allowing them to rise above the images, guilt and shame that endure.”


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  • Prescribed to Vets


    NASHVILLE, Tenn. (WZTV) — A drug treating PTSD in our Veterans could be killing them. Prazosin is a blood pressure medication commonly prescribed to treat PTSD nightmares, according to a WZTV news investigation. Only two drugs are approved by the FDA to treat PTSD, and Prazosin is not one of them.

    Retired Sgt. Allen Chapman said he takes 10 pills a day to treat depression, PTSD, and all the other side effects that come with working in a war zone overseas.

    “I’ve got so many medications, it takes a while to take them all in the morning,” Sgt. Chapman said.

    He served in the 230th Signal Company of the National Guard. He spent time in Afghanistan from 2011-2012.

    “When you get back, you’re used to all that high-speed stuff and then people here, people are just slow,” Sgt. Chapman said.

    It's one of the reasons readjusting is so hard, and why Sgt. Chapman went to the VA for help.

    “I was referred to a psychiatrist and we tried different medication, but it took a while to find the right balance, to find the right medication,” Sgt. Chapman said.

    One of those medications is Prazosin, a blood pressure medication that a VA doctor prescribed him to help with nightmares.

    “I didn’t wanna go to sleep. There are times I didn’t wanna lie down. I just didn’t want to go to sleep,” Sgt. Chapman said.

    Over time, he realized his nightmares weren't getting any better. In fact, he said they got worse.

    “I was killing people, and cutting up body parts, and chopping up their body, and it was always with a knife,” Sgt. Chapman said, describing his nightmares.

    Finally, Sgt. Chapman took himself off the medication, too afraid of the side effects.

    Dr. Vaughn McCall of Augusta University recently did a study on the drug. He found responses like Sgt. Chapman's aren't uncommon.

    "We found that not only did the Prazosin not seem to do much as an advantage to the suicidal ideation, it seemed to reduce the degree of improvement that we see in the nightmares and the general sleep disturbance," Dr. McCall said.

    He said patients who took a placebo saw more of an improvement.

    “It makes me pause and, at a minimum, I would hesitate giving Prazosin to a suicidal patient with PTSD,” Dr. McCall said.

    The VA declined an interview but sent FOX 17 News a statement saying, “Prazosin may not be as effective as we once thought and that it should no longer be routinely prescribed for PTSD nightmares, but that it could still benefit certain patients.”

    The VA responded to Dr. McCall's study by saying, "While it adds to evidence that Prazosin may not be effective for PTSD nightmares, it should not raise any significant safety concerns."

    However for Sgt. Chapman, the idea of increased suicidal thoughts certainly seems like a safely concern.


    Sgt. John Toombs took a video of himself on an early November morning in 2016.

    “I went to the VA for help and they opened up a Pandora's box inside me and just kicked me out the door,” Toombs said in the video.

    The day before, he said the VA kicked him out of a residential drug treatment program for being late to take his medicine.

    “I came for help and they threw me out like a stray dog in the rain,” Toombs said in the video.

    Just moments after recording the video, he hung himself from a construction site on the Murfreesboro VA campus.

    Now his dad is speaking out about his son's struggle leading up to his death.

    “People don’t realize that it’s something you just don’t get over,” his dad, David Toombs said.

    David Toombs thinks about his son every moment of every day.

    “He was extremely smart, and a quick, dry, sense of humor, that would catch you off guard so fast and then he’d answer you so fast,” David said.

    Sgt. Toombs served as the man riding on the back of a convoy in Afghanistan, eyes peeled, looking for suicide bombers or anyone else who posed a threat to his team. His dad says, when he came back home, things were good for a couple years, but when he decided not to reenlist, it became harder and harder to recognize his son.

    “He just wasn’t the same person,” David said. “He said for him, the main thing was being helpless and hopeless. If he was in a position that felt helpless and hopeless that’s when it kicked in the worst.”

    His dad said getting kicked out of the drug rehab program was one of those helpless and hopeless times.

    At the time of his death, Sgt. Toombs had six medications in his system that listed suicidal thoughts as a side effect. It's something his father thinks is a rampant problem in the VA.

    “They’re over medicated and they’re dealing with an over complicated system and they just give up at some point,” David said.

    The VA declined an interview but sent FOX 17 News a statement saying, "Prescribers evaluate a Veteran's response to medication at each encounter including the presence of any side effects.”

    However, Sgt. Allen Chapman, who served with Sgt. Toombs and lives with PTSD himself, says that hasn't been his experience.

    “I can go to the VA and request a certain medication and there’s no questions asked,” Sgt. Chapman said.

    He said his 10 different prescriptions are refilled without any discussion about how they're making him feel.

    “I’m in and out within 10 minutes and I’m like ‘You didn’t ask me anything!’” Sgt. Chapman said.

    According to their website, the Tennessee Valley Healthcare System says they process more than 5,000 prescriptions daily. David Toombs chalks it up as a quick fix when trying to keep up with the thousands of Veterans walking through the VA doors.

    “It’s not a situation where they can just keep filling medication and fix, it sometimes gets worse,” David said.

    Now, he’ll keep fighting for a better outcome for the men and women who fight for our country.

    Here’s the full statement from the VA:

    “Doctors, nurse practitioners, and other medication prescribers at VA Tennessee Valley Healthcare System consider several factors when deciding if a medication is safe and effective for a specific Veteran. Prescribers evaluate a Veteran’s response to medications at each encounter including the presence of any side effects. Medications are discontinued if the risk of continuing treatment due to side effects is thought to outweigh the benefits. Clinical pharmacists with specialty training are available facility-wide to provide medication guidance based on the most current research and expert recommendations.


    The VA/DoD Clinical Practice Guideline for The Management of PTSD and Acute Stress Disorder was updated in 2017 to reflect the most recent literature which shows prazosin may not be as effective for PTSD nightmares as originally found in early studies. While it should no longer be routinely prescribed for PTSD nightmares, experience and research shows it may still be beneficial in certain patients. Results from the study published by McCall and colleagues in December 2018 adds to evidence that prazosin may be not be effective for PTSD nightmares but should not raise significant safety concerns. The study included Veterans with PTSD experiencing suicidal thoughts but there was no evidence that prazosin worsened this particular symptom. Larger studies would be needed to be more certain that prazosin could be responsible for worsening nightmares or insomnia.”-Chris Vadnais,U.S. Department of Veterans Affairs.


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  • DVA Logo 32


    The link between PTSD and substance use may be more common than you think. PTSD and substance use often go together. Many people turn to drugs, alcohol, or nicotine to try to cope with symptoms of PTSD. However, these substances could make existing PTSD symptoms worse or even lead to Substance Use Disorder (SUD) (PDF).

    PTSD and Substance Misuse Can Make Symptoms Worse

    Misusing alcohol and drugs can affect your health, your relationships, and your job or schooling, whether you have PTSD or not. But people with PTSD who turn to alcohol and drugs can make their symptoms worse.

    • Using drugs and alcohol to help you fall asleep can backfire. Instead of helping, drugs and alcohol change the quality of your sleep. You are likely to have a restless night and wake up feeling less refreshed.
    • Drugs and alcohol continue the cycle of avoidance found in PTSD. Avoiding bad memories and dreams or certain people and places can make PTSD last longer. People with PTSD cannot make as much progress in treatment if they continue to avoid what bothers them.

    If you’re living with PTSD and SUD, you’re not alone. More than one in five Veterans with PTSD also have a substance use disorder, and almost one out of every three Veterans seeking treatment for SUD also have PTSD. The good news is, you can treat both PTSD and SUD at the same time.

    How to Get Help for PTSD and SUD

    Dr. Sonya Norman, Director of the PTSD Consultation Program at the National Center for PTSD and an expert on treating SUD in Veterans with PTSD says, "There are two effective ways to do this."

    "One way is to get both problems treated at the same time, but in separate sessions. For example, you could work with a therapist trained in one of the evidence-based trauma-focused psychotherapies for PTSD in one session, and also attend an alcohol and drug treatment program for addiction."

    "Another option is to get both treated at the same time, in the same appointment, with a therapy like COPE, or Concurrent Treatment of Substance Use Disorders Using Prolonged Exposure."

    What is COPE?

    COPE combines two effective treatments---Prolonged Exposure for PTSD and relapse prevention for addiction---in one package. Every session of the 12-week COPE program will address both problems.

    "Veterans have options for how to treat their PTSD and substance use disorder," notes Dr. Norman, "The important thing is to get evidence-based treatment for both."

    Good treatments are available, so don’t wait. Here are some options:

    • Every VA medical center has a SUD-PTSD Specialist who is trained to treat both conditions.
    • You can locate specialized PTSD programs and SUD programs near you with one of the VA's treatment locators.
    • The National Center for PTSD's free mobile app VetChange and self-help courses can also help you and your family cope with PTSD, SUD, and alcohol use.
  • Fewer Male Vet PTSD


    The Department of Veterans Affairs approves claims for post-traumatic stress disorder related to military sexual assault at significantly lower rates for men than women -- a gap the former director of the VA's Center for Women Veterans says shows "systematic discrimination" against men in an era of #MeToo.

    In an editorial published Feb. 11 by The Hill, Kayla Williams, a senior fellow and director of the Military, Veterans and Society Program at the Center for a New American Security, said the Veterans Benefits Administration (VBA) has closed a gap that once existed between approval rates for combat-related PTSD and claims for military sexual trauma (MST), but a disparity still exists between the genders for MST-related claims.

    The grant rate in 2018 for sexual-trauma PTSD claims was 57.7 percent for women and 44.7 percent for men. While those rates represent a large increase from the respective 41 percent and 26.9 percent approval rates in 2011, they show a continued lack of understanding within the VBA of the scope of the problem among men, Williams said in an interview Feb. 14.

    Women in the military, who make up just 15 percent of the total force, do get assaulted at higher rates, statistics show. But more than half of all survivors of sexual assault in the military are men. And male victims are less likely to report sexual assault, often dismissing an incident as hazing or harassment, according to Williams.

    Because they are less likely to report, men don't have a paper trail or proof to back their disability compensation claims for MST-related PTSD, which are subsequently dismissed, she said.

    She added that there is a cultural bias within the VBA that "doesn't think this happens to men."

    "This is thought of as a women's problem," Williams said. "Even when I've talked to senior leaders in the military, I raise certain [hazing] practices -- you've heard of 'tea-bagging' -- and they don't realize it's sexual assault. For someone who has been a victim of sexual assault as a child or anyone who doesn't want someone's genitals pressed onto their face, it is sexual assault."

    In 2011, the VA launched a concerted effort to close the gap between PTSD claims granted for military sexual trauma and those granted for combat and other causes. The effort raised the approval rate for MST claims by 20 percentage points. In 2018, the approval rate was 56.6 percent for MST-related claims while the PTSD grant rate for other traumas was 54 percent.

    Williams said she noticed the gender disparity for MST claims while serving as director of the women's center from 2016 to 2018, adding that she told VBA officials of the difference but "they didn't believe they had a problem."

    She did not raise her concerns with higher-ups, saying that it isn't a secretarial-level concern.

    She believes the VBA could solve the problem by training claims reviewers specifically on male military sexual trauma and bias. She also recommends that supervisors conduct spot checks of claims.

    "If you look at the improvements that VA was able to make in accepting women's claims, I really think this is a solvable problem.... Men deserve equitable disability compensation from VA," she said.

    The VA did not respond to a request for comment.


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  • DVA Logo 39


    In recognition of Mental Health Month in May, the U.S. Department of Veterans Affairs (VA) is launching “The Moment When” campaign, a nationwide effort starting May 1 that will feature Veterans’ personal experiences with mental health treatment and recovery.

    The campaign aims to demystify mental health treatment, build awareness of available mental health resources, and encourage family members and friends to start the conversation with a Veteran going through a hard time.

    “VA continues to be the nation’s vanguard in reshaping the conversation around mental health treatment and recovery,” said VA Secretary Robert Wilkie. “Since May is Mental Health Month, make this the moment you start the conversation with a loved one or reach out for support if you need it.”

    The Moment When campaign will highlight many moments in the broader mental health recovery process: from the moment when a Veteran reached out for support, to the moment when the Veteran realized treatment was working.

    Throughout the month of May and beyond, VA encourages Veterans and their families to visit to explore stories of recovery and find local resources.

    Veterans who are in crisis or having thoughts of suicide, and those who know a Veteran in crisis, can call VCL for confidential support 24 hours a day, seven days a week, 365 days a year. Call 800-273-8255 and press 1, send a text message to 838255 or chat online at


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  • Suicide Data


    The suicide rate among Vets has not improved and remains a deeply disturbing problem, despite work by the VA and others, according to a VA analysis and statistics obtained by Fox News.

    Last week, the VA released findings from a years-long investigation into Veteran suicide data from 2005-2015 in all 50 states and the District of Columbia. The findings are clear: the suicide rate is constant.

    Veterans are more than twice as likely to die by suicide as non-Veterans, according to the VA report. Additionally, VA researchers found the number of Vets who take their own lives each day “remained unchanged at 20.” And even more-recent data obtained by Fox News suggests things may not be much better in 2018.

    Even for the mother of a U.S. Marine who took his own life after battling PTSD, and who has since dedicated her own to preventing Veteran suicides, the numbers are stunning.

    “I had no idea it was that bad,” said Janine Lutz. “That’s really lighting a fire under my butt to work harder."

    The Veterans Crisis Line provides 24/7 support to Veterans in distress, as well as concerned friends and family members. Staffers are available by phone at 800-273-8255 (Press 1), online at, and via text at 838255.

    The volume of phone calls the Crisis Line receives is staggering. The VA told Fox News that since October 31, 2017, the Veterans Crisis Line has fielded approximately 222,000 calls from Veterans who are having thoughts of suicide. That is in addition to the 49,000 calls from family members or friends who are concerned about a Veteran who is considering suicide.

    That breaks down to nearly 950 calls from Veterans (or nearly 40 calls per hour) every day since Halloween, and more than 200 calls a day from friends and family.

    "The mother of all battalions"

    Lutz, who lives in Florida, is affectionately referred to by many in the Veterans' community as “the mother of all battalions” for her efforts to bring Veterans of all stripes together, and prevent more Veteran suicides, via the LCpl Janos V Lutz Live To Tell Foundation.

    Lutz started Live To Tell to honor the memory of her son “Jonny,” a Marine who took his own life while under the influence of a cabinet’s worth of medication for his PTSD. Since then, she has sued the government for her son’s death, eventually winning a settlement out of court, but her work didn’t stop there.

    “About five months after [Jonny’s] death, I woke up one day and I was mad,” Lutz told Fox News. “I was mad knowing that my son wasn't the first to die like this. And I said why didn't somebody tell me… why aren't we doing more as a community? And it was then I decided that I was gonna be the voice, and fight for those who fought for us.”

    It was only a year after her son’s death that Lutz made her first foray into advocacy, organizing a motorcycle rally that brought out an unexpectedly large number of people from across the country. She was excited about the hundreds of supporters who turned out, but unsure of what to do next.

    That was until Lutz’s niece played a song for her that she says “grabbed me by the chest,” and inspired a plan to save the lives of Veterans across the country:

    Buddy Up

    “It’s time to buddy up ‘cause yup, this is wrong.


    Surviving battle, but die when we’re home.

    Yeah it hurts, that’s why I made this song.

    It’s time to see the signs, like the lights when it’s on.”

    Those lyrics are from the song “Red Flags” by Soldier Hard, an artist whose real name is Jeff Barillaro and who also happens to be an Army combat Veteran. Barillaro dedicated himself to creating music that gives a voice to Veterans, and the issues they experience along with their friends and families. When Lutz heard the lyrics to his song, she says she knew immediately what she had to do.

    “He said ‘you all need to buddy up’… and he was talking to the Veterans out there,” Lutz says. “When I heard that, I said that's it. I'm gonna get these guys together, build local communities, facilitate – I don’t know how, but that’s what I’m gonna do.”

    Using Soldier Hard’s song as inspiration, Lutz has since established two “Lutz Buddy Up” social clubs, one in Florida and one in Massachusetts, and this summer she’s touring the country in the hopes of establishing even more. The concept is simple: bringing Veterans together (and even first responders) so they can support one another while sharing a meal, playing a game or two, or just chatting.

    “We welcome our Veterans just as they are, wherever they are,” Lutz says. “Whatever mindset they're in, we welcome them. All we want to do is connect them with their peers, and it's just been a great success. Dozens and dozens of success stories.”

    Lutz says membership has skyrocketed from just a handful back in 2014, to well over 500 in 2018 – including Veterans from every U.S. armed conflict since the Korean War.

    Asked what she would tell Veterans who might be suffering in silence, or friends and family who might be concerned about a Veteran they know, Lutz says to remember that connecting with peers is the key.

    “They need to speak to their peers, someone who has walked in their shoes,” Lutz says, before pointing out that this is the exact philosophy soldiers employ on the battlefield.

    “That's what they fight for, to keep the guy next to them alive… Yeah, they have a mission, but the biggest part is making sure the guy right next to you is alive and well,” Lutz says. “You're watching each other, and that’s what they have to continue when they get home…

    “So if you don’t have any local buddies you know, find some in your community because they're everywhere, and they're looking for help too,” Lutz says. “Reach out to other Veterans in your communities because that is your best medicine - your peer who has walked in your shoes.”

    If you are a Veteran in crisis or having thoughts of suicide, or if you are someone who knows a Veteran in crisis, call the Veterans Crisis Line for confidential support 24 hours a day, seven days a week, 365 days a year at 800-273-8255 and press 1. You can also chat online at, or send a text message to 838255.


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  • Recovery is Working


    Compensated Work Therapy

    Compensated Work Therapy (CWT) is a Veterans Health Administration clinical vocational rehabilitation program offered at every VA medical center. The mission of CWT services is to provide support to Veterans living with mental illness or physical impairment with barriers to employment to secure and maintain community-based competitive employment.

    CWT programs strive to maintain highly responsive long-term quality relationships with business, government agencies, and industry promoting employment opportunities for Veterans with physical and mental health challenges.

    Hundreds of VA employees work hard every day to make these opportunities happen for Veterans. We recognize these employees during CWT Vocational Rehabilitation Recognition Week, which occurs annually during October, National Disability Employment Awareness Month. Every year, the exceptional CWT staff members are honored. As we observe this year’s Recognition Week (October 21-27), let’s take a look back at the Excellence in CWT Award winners from 2017.

    Congratulations to Beverly Maier from the North Chicago Compensated Work Therapy (CWT) program was selected as the 2017 Excellence in CWT Service Delivery award winner.

    Maier would take a fifteen-mile ride to spend an entire day, in below freezing temperatures, to travel about the local community seeking vocational options for a Veteran who had no other means of transportation to support his employment goal.

    She secured employment for 32 Veterans, many of whom have required multiple jobs. Her entire caseload was comprised of those Veterans coping with persistent and serious mental illness.

    In 2015 she was nominated for the Rehabilitation Counselor of the Year Award and was promoted to the position of CWT Coordinator. She immediately revised the CWT discharge follow up survey utilizing statistical software. The goal is to expand this survey into a formal VHA research project to determine which vocational interventions best support sustained employment outcomes.

    Maier is a tireless advocate for mental health recovery and vocational rehabilitation.

    Congratulations to Kenneth Weber, CWT Manager at the Edward Hines, Jr. VA Hospital and Mr. Rodger Woeppel, at the Black Hills Health Care System who were both selected as 2017 Excellence in CWT Leadership award winners.

    Weber is an inspiring leader whose achievements over the last nine years as Hines’ CWT Program Manager have been monumental and include transforming a struggling CWT program into a world-class vocational Rehabilitation system of care, expanding the CWT program from serving only 48 Veterans in 2008 to 1,467 in 2016.

    His CWT office has continued to expand services and access for Veterans to the Veterans Career Center which includes instructions in online job application processes, USA Jobs Account Setup and development of an Internet Cafe concept to allow Veterans to utilize the free patient access Wi-Fi to log in with their own personal devices.

    Weber organized job fairs at Hines attended by as many as 600 Veterans and 27 employers (including FBI, DEA, Comcast, Marriott, and UPS).

    As the Assistant Chief of the Mental Health office noted, “Ken has an impressive list of achievements, but perhaps more remarkable are the ‘little things’ he quietly does every day to encourage staff and Veterans, to handle difficult conversations, and to gently but persistently guideCWT forward.”

    Army Veteran a Licensed Professional Counselor and charismatic presenter

    The Black Hills Health Care System (BHHCS) covers a vast rural area with four reservations, nine Community Based Outpatient Clinics and two hospital facilities at Fort Meade and Hot Springs, S.D.

    As program leader, Rodger Woeppel has made a name for himself in the communities served. An Army Veteran committed to serving Veterans, he is a Licensed Professional Counselor able to provide an array of services.

    He is a charismatic presenter who provides excellent information, integrating recovery-oriented programming in a way that encourages others to do the same. In one presentation he introduced The Seven Bands of the Lakota using Lakota phrases and American translations.

    In addition to his many duties, he manages transitional residence programs located in Sturgis, Rapid City, Hot Springs and Pine Ridge, S.D. He also manages the Domiciliary Care for Homeless Veteran program in Hot Springs and the operation of the Therapeutic and Supported Employment Services programs in McLaughlin, Eagle Butte, Ft. Meade, Rapid City, Hot Springs and Pine Ridge, S.D.

    His presentations include the importance of community involvement and how he successfully created, developed, and manages a Mental Health Advisory Group made up of Veterans in a variety of professional fields and expertise.

    Woeppel has integrated suicide prevention into Therapeutic and Supported Employment Services training and has excellent relations with the Suicide Prevention Team. Rodger recognizes his staff and Veterans for a successful transition to permanent employment and knows this saves lives. His commitment inspires his staff to provide excellent services each day.

    CWT programs are located within all VA medical centers. Review the CWT Locations page to find site specifics.


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  • TBI Vets


    James. A. Haley Veterans’ Hospital (JAHVH) in Tampa, Florida, has been designated a Headache Center of Excellence (CoE) by VA. JAHVH is one of seven facilities throughout the Veterans Health Administration to receive the designation.

    “We’re very lucky because we probably wouldn’t have it if we didn’t have this awesome Polytrauma Center,” Dr. Georgia Kane said. “It means we can offer so much more to our patients. Everybody’s highly excited.”

    Kane, a neurologist and head of the Chronic Headache Management Program (CHAMP), said the designation was due in large part because of the hospital’s Polytrauma program.

    Veterans with a history of polytrauma or traumatic brain injury commonly experience headaches. Headache management for Veterans with TBI and multiple co-morbid conditions is challenging and is best managed by an interdisciplinary team. That’s precisely what CHAMP has been doing for several years.

    “We started an interdisciplinary team about four years ago,” Kane said of the five-week outpatient program. “We noticed that with people with headaches, it’s difficult to treat just the headache, so occupational therapy, psychology and me, we all work together and we meet weekly on patients to maximize their care.”

    Program participants are required to keep a diary, noting the time a headache starts, what they were doing, what they were eating and other aspects of their lives that can be critical to understanding what might be triggering the headaches.

    Options other than medications

    “The number one thing is education. Once you know more about what is affecting your situation, we can then teach options that are other than medications,” Kane said. “Medication will do a certain percentage, but if you only relied on medications to help your situation, then you would be discounting the fact that you’re not sleeping well, or to distract yourself with relaxation techniques or biofeedback that we do to try and get your mind to think of something else.”

    CHAMP participants meet once a week for lectures and other forms of treatment that includes recreation therapy, Botox injections and precise injections in the neck if needed. Botox is used to relax muscles that, when tensed, can cause headaches. The treatment is very effective, Kane said.

    About 60 people are in CHAMP at any given time, including those patients who are followed after discharge.

    While many of the TBI patients with headaches tend to be younger, chronic headaches are non-discriminatory, affecting men and women, young and old, and the additional funding that comes with the Center of Excellence designation will allow the CHAMP staff to add additional treatments for them.

    They hope to work with the lighting in the treatment areas since lighting can affect headache sufferers. Equipment for neck injections, electrical stimulators, and virtual reality equipment are a few of the items Kane said she hopes to procure for the program. Headache treatment is offered to all Veteran patients at all VA medical centers. Patients can get referred to any Center of Excellence but because not all centers offer the same thing Veterans should confirm with their VA health care team and the Center of Excellence that they will receive the specific treatment they need.

    Patients should keep in mind that this is an outpatient program. Patients come once a week for five consecutive weeks – plus the follow-up after they complete the treatment – which is not always easy if referred from a distance.

    “Becoming a Headache Center of Excellence means that we can expand and do more, to be able to offer more things, more physical therapies, recreational therapies, art therapies,” Kane said. “When we were presented with this, it was one of those truly amazing moments.”


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  • Copes with PTSD


    Canandaigua, N.Y. (WHAM)-A local Veteran showcasing what helps him overcome PTSD in Canandaigua.

    Michael Tucker's photography show opened at the Wood Library in Canandaigua on Saturday.

    Tucker served in the Marine Corps and Army National Guard for a combine 21 years.

    He was medically discharged in 2014 with a heart condition, and later diagnosed with PTSD.

    He says photography helps him cope.

    He hopes to inspire other Veterans.

    "I hope that Veterans can see there's other ways. You have PTSD and a lot of times, there's only one solution for that, and there not a way to cope with it. There is a way to get help and there is a way to bring out what you're dealing with. "

    His exhibit will be on display through April 26th.


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  • West LA PTSD


    Dov Simens said he was “playing Rambo” in a homeless camp on Wilshire Boulevard 34 years ago when he stumbled on a therapy group for combat Veterans with post-traumatic stress disorder.

    Through weekly sessions on the West Los Angeles Veterans campus, Simens, 75, a member of the military’s secretive Phoenix interrogation and assassination program in Vietnam, was able to marry, have children and buy a house in Sherman Oaks, he said.

    Buoyed by his success, he took a break. But anger and depression drove him back to the “group of my peers.”

    “I have PTSD and I know that there is no cure,” Simens said. “There is no pill or opioid that will make what I did disappear.”

    Now he and other Veterans say the U.S. Department of Veterans Affairs has soured on long-term therapy and started dismantling the West L.A. PTSD program, which has helped thousands of former service members heal the invisible wounds of war.

    Before August, about 20 groups, each with five to 30 members, had been meeting on the medical campus for a total of 40 hours a week of therapy, said Leslie Martin, the former PTSD therapy program director. The combat Veterans group shut down this fall after refusing the VA’s order to move to cramped quarters with no privacy, she added.

    Two other groups have stopped meeting or relocated since summer; others merged and participation is dropping, Martin said. Martin filed a whistleblower complaint over the service reductions before retiring last month. The complaint accused the VA of reassigning her to work as a clerk as retaliation for her support of Veterans protesting the changes.

    Citing the federal Privacy Act, VA spokeswoman Nikki T. Baker said she couldn’t address Martin’s employment.

    Baker said the number of groups varies depending on demand for therapy. Seven focused on PTSD continue to meet on campus, she added.

    But in a September letter protesting the shift, Rep. Ted Lieu (D-Torrance) said he understood the group therapy program was being replaced by “evidence-based” treatment — 12-week courses of specialized talk therapy that have been shown to be effective for PTSD treatment. Once open-ended, the groups would be available only for the duration of the courses, Lieu said.

    “It is important that we maintain a host of treatment options for our Veterans suffering from PTSD,” he said.

    The secretary of Veterans Affairs, Robert Wilkie, responded that the group therapy program was being “rebranded,” not ended. But he also questioned the effectiveness of group therapy for Veterans with PTSD.

    “Despite the popularity and long history of support groups as routine care for Veterans with PTSD and trauma exposure, there is no strong evidence that this modality is an effective treatment,” Wilkie said in a letter to Lieu.

    The outcry comes at a difficult moment for the Veterans agency, which is experimenting with privatizing mental healthcare while also grappling with staffing shortages and a suicide crisis — 20 former service members a day take their own lives.

    Several former clinicians have complained to the VA about an exodus of as many as 50 psychologists and psychiatrists from the Greater Los Angeles VA Health Care System, which includes the Sepulveda and West L.A. campuses.

    The VA says PTSD affects 8% of Veterans. The agency initially relied on medication to treat the condition, but now is turning to short-term, evidence-based therapies, including cognitive processing, prolonged exposure and eye movement desensitization and reprocessing.

    Cognitive processing helps Veterans recast negative thoughts about their trauma. Prolonged exposure guides Veterans into reliving traumatic events to diminish their fear and anguish, and eye movement desensitization and reprocessing helps Veterans recall their trauma while focusing on external motion or sound.

    Each therapy course generally runs for three months. Martin said VA officials made it clear they like evidence-based treatment because it’s short and saves money. VA leaders called the therapy groups “social clubs” and said Veterans who need more support should take each other’s phone numbers, Martin said.

    Evidence-based therapies can be tough on Veterans, who may have spent years trying to forget the very memories that the sessions dredge up. In his letter, Lieu said only 50% to 60% of Veterans complete evidence-based therapies.

    Peter Erdos, 35, said he tried medication and evidence-based therapies with minimal success after his return from Iraq.

    “Medication is something that the VA was OK with me being on for the rest of my life,” said Erdos, a member of the combat Veterans group. “Coming back in my 20s and hearing that was just soul-crushing. What worked for me was camaraderie with the guys.”

    Research on the effectiveness of group therapy to treat combat Veterans with PTSD is inconclusive. Carl Castro, director of USC’s Center for Innovation and Research on Veterans & Military Families, said the VA should have studied the groups before squeezing them out.

    “The VA has gobs of money to do research,” Castro said. “It was a unilateral decision and goes against patient-centered therapy.”

    “For a lot of Veterans involved in group therapy, just the fact they’re engaging in it is therapeutic for them,” said Paul Brown, adjutant of the American Legion, Department of California. “If it makes a difference in even one Veteran’s life, we’re going to push to have it continued.“

    Members of the PTSD combat support group have continued meeting in a room they rent at a Westside senior center. Martin is volunteering to facilitate.

    Before a gathering last month, a dozen Veterans described the group as a lifeline. The men are black and white, former officers and draftees, and at least one attended West Point. Some spent years battling alcoholism or substance abuse. Some worked as lawyers, company executives or architects.

    Several said they had PTSD symptoms — anger, anxiety, depression — for decades before seeking treatment.

    “It only took me 47 years,” said Steven Goldstein, 71, a U.S. Army infantry Veteran who served in Vietnam. “I had no joy in my life.”

    Randy Kline said he was drafted out of Inglewood in 1967 “to participate in crimes against humanity“ — a moral injury that experts increasingly consider to be as damaging as a gunshot wound or other combat trauma.

    Arnold Hudson said that as a black man from South Los Angeles, he saw no future as a convicted draft dodger. So he reluctantly answered the call to Vietnam, where he saw his friend “incinerated before my eyes.”

    AHudson said the group gave him his life back after years of drug addiction.

    “I’m 69 years old and I lost a whole lot of life,” he said. “When they announced we were disbanding I thought, why in the world is the government who vowed to take care of us cutting us off at the knees?”

    The Veterans said they want to return to the VA campus, where the next person home from Afghanistan or Iraq could wander in and find the support that only comes from shared experience.

    “We’re a band of brothers. We have a duty to all Vets,” Simens said. “We’re just asking for a 400- to 500-square-foot room, for two hours, once a week.”


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  • Veterans Issues


    SANTA FE COUNTY, N.M. - A parade and ceremony Sunday in Santa Fe honored our nation's Veterans.

    KOAT Action 7 News spoke to Veterans about the issues they face today and why more still needs to be done.

    Hundreds braved the cold weather in Santa Fe, marching in the annual Veterans Day parade despite the snow and rain.

    Air Force Veteran James Lamb said events like these are important for Veterans to know how much their service means to people.

    And it's not something that only has to happen once a year.

    “Thank a Veteran. Just come up and say thank you and they'll thank you for your support,” Lamb said.

    Lamb also said Veterans need to take advantage of assistance programs.

    “This state offers a lot of great services for Veterans so take advantage of them, from tax discounts on your housing to healthcare and all kinds of things like that,” Lamb said.

    After the parade was over, everyone gathered at the Bataan Memorial Building for a Veterans Day ceremony.

    Vietnam Veteran Doug Gomez believes availability of care is a big issue Veterans face.

    Because there is not a Veterans Affairs hospital in Santa Fe, he has to drive to Albuquerque for treatment.

    But he said the issue of seeing a VA doctor when you need one is something that is happening across the U.S.

    “It's pretty extraordinary that so many Veterans have to wait for such a long time to get an appointment,” Gomez said.

    Gomez said a lot of promises were made this election season about improving care for Veterans.

    Now he wants to see something done.

    “Politicians, not only in New Mexico, but around the country, who talk about Veterans as a talking point, take it to the next level and actually help us,” Gomez said.


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  • PTSD 002


    With the headlines of U.S. Navy Fleet Commander Scott A. Stearney’s untimely death earlier this month, it is just another tragic reminder of the toll combat takes on these brave men and women even after they come home.

    The numbers are mind-blowing. The Department of Veterans Affairs recently reported that more than 20 Veterans and active duty service members, guardsmen and reservists commit suicide every day in this country. That’s nearly one suicide every hour, and more than 80 percent of them are Veterans.

    There aren’t enough people and systems to help Veterans, and they keep falling through the cracks. I consider these people a vastly underserved and unreached community.

    The effects of combat-related trauma run deep, down to the warrior’s very heart and soul. I know this from personal experience, having served four tours in Iraq and Afghanistan.

    War keeps you running at full speed, always on guard, ready to fight at a moment’s notice. After enduring such extreme conditions for long periods of time, returning to the normality of civilian life is not easy.

    When I came home, nothing felt real to me. Watching TV with my wife didn’t feel real. Walking through the aisles of the grocery store didn’t seem real. My feelings were not easy to identify at first. I just felt “off,” but I didn’t always know why. I didn’t know what was happening to me.

    This is common among Veterans who struggle after returning home. We can’t always draw a straight line from how we feel back to the experience of combat. We don’t want to     believe that the fighting affected us.

    I was in denial. I didn’t want to acknowledge the strange sensations for what they were. But eventually, I couldn’t ignore what was happening. I was struggling with the after-effects of combat.

    Everyone experiences this differently. There are, however, a few classic signs — anger, insomnia, obsessive-compulsive behavior and flashbacks. At one point or another, I have suffered from all of them.

    Eventually, I got help, and there are some wonderful organizations that help Veterans, but many Veterans aren’t as fortunate as I was. Typical interventions such as clinical treatments and group therapies are inadequate and usually ignore the spiritual dimension to trauma. The spiritual dimension to trauma includes topics such as grief, guilt, and shame. It can manifest through things that the warrior has experienced or done on the battlefield.

    Many Veterans dealing with these challenges isolate themselves from friends and family. They don’t think that people understand what they’ve been through. It’s hard for Veterans to communicate to non-Veterans about combat experiences and post-combat struggles. A common complaint from family and friends is, “I can’t reach him or her” or “They won’t talk to me.”

    Veterans do want help. But sometimes they just don’t know how to communicate it. And once they’re able to speak out, they don’t always know how to connect or who to connect with. That’s why it’s very important that when Veterans reach out, especially to a church or nonprofit, the organization is ready to receive them.

    These organizations should have a program to get the Veterans connected with a small group of people who understand and appreciate the Veteran and his or her family. Belonging to a community with a sense of camaraderie is key. It’s something Veterans had while in the service and something they are looking for when they get out.

    It is crucial that when our Veterans return home that they have available to them a support group that will help them walk through everything they have experienced on the battlefield. Even more so, these groups are imperative to helping these brave men and women begin the healing process, pointing them in the right direction to restore broken relationships and begin to knit together the wounds of the heart. Ultimately, that is what will assure a successful transition back into mainstream society.


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  • Website Updates 002 

  • PTSD Treatment


    The only way to know for sure if you have PTSD is to talk to a mental health care provider.

    The provider will ask you about your trauma, your symptoms and any other problems you have.

    Talk to Someone You Trust

    After a traumatic event, it's normal to think, act, and feel differently than usual. Most people will start to feel better after a few weeks. If your symptoms last longer than a few months, are very upsetting, and disrupt your daily life, you should get help. Whether or not you have PTSD, treatment can help if thoughts and feelings from the trauma are bothering you. Talk to:

    • Talk to your family doctor.
    • A mental health professional, such as a therapist.
    • Your local VA facility or Vet Center, if you are a Veteran
    • A close friend or family member who can support you while finding help
    • A clergy member
    • Fill out a PTSD questionnaire or screen (see below).

    Take a Self-Screen for PTSD

    A screen is a brief set of questions to tell you if it is likely you might have PTSD. Below is the Primary Care PTSD Checklist for DSM-5, or the PC-PTSD-5 screen.

    Sometimes things happen to people that are unusually or especially frightening, horrible, or traumatic. For example:

    • a serious accident or fire
    • a physical or sexual assault or abuse
    • an earthquake or flood
    • a war
    • seeing someone be killed or seriously injured
    • having a loved one die through homicide or suicide

    Have you ever experienced this kind of event? YES / NO

    If no, screen total = 0. Please stop here.

    If yes, please answer the questions below:

    In the past month, have you...

    • had nightmares about the event(s) or thought about the event(s) when you did not want to? YES / NO
    • tried hard not to think about the event(s) or went out of your way to avoid situations that reminded you of the event(s)? YES / NO
    • been constantly on guard, watchful, or easily startled? YES / NO
    • felt numb or detached from people, activities, or your surroundings? YES / NO
    • felt guilty or unable to stop blaming yourself or others for the event(s) or any problems the event(s) may have caused? YES / NO

    If you answer "yes" to any three items (items 1 to 5 above), you should talk to a mental health care provider to learn more about PTSD and PTSD treatment.

    Answering "yes" to 3 or more questions on the PC-PTSD-5 does not mean you have PTSD. Only a mental health care provider can tell you for sure. And, if you do not answer "yes" to 3 or more questions, you may still want to talk to a mental health care provider. If you have symptoms that last following a trauma, treatment can help - whether or not you have PTSD.

    Seek Help

    It's common to think that your PTSD symptoms will just go away over time. But this is unlikely, especially if you've had symptoms for longer than a year. Here are some of the reasons why you should seek help.

    Early Treatment Is Better

    Symptoms of PTSD may get worse. Dealing with them now might help stop symptoms from getting worse in the future and lead to a better quality of life for you.

    It's Never Too Late to Get PTSD Treatment

    Treatment can help even if your trauma happened years ago. And treatment for PTSD has gotten much better over the years. If you tried treatment before and you're still having symptoms, it's a good idea to try again.

    PTSD Symptoms Can Affect Those You Love

    PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help improve your relationships.

    PTSD Can Be Related to Other Health Problems

    PTSD symptoms can affect physical health problems. For example, a few studies have shown a relationship between PTSD and heart trouble. By getting help for your PTSD, you could also improve your physical health.

    It May Not Be PTSD

    Having some symptoms of PTSD does not always mean you have PTSD. Some of the symptoms of PTSD are also symptoms of other mental health problems. For example, trouble concentrating or feeling less interested in things you used to enjoy can be symptoms of both depression and PTSD. And, different problems have different treatments.

    When you seek help, your mental health care provider can determine whether you need treatment for PTSD, or another type of treatment.

    Find the Best Treatment for You

    Today, there are several treatment options for PTSD. For some people, these treatments can get rid of symptoms altogether. Others find they have fewer symptoms or feel that their symptoms are less intense.

    You can learn about effective PTSD treatment options using our PTSD Treatment Decision Aid. It includes videos to explain how the treatments work.

    You can also build a chart to compare the treatments you like most. Both psychotherapies (also called talk therapy or counseling) and medications are included in the decision aid.


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    The decision to get care for PTSD symptoms can be difficult. You are not alone if you feel nervous. It is not uncommon for people with mental health conditions like PTSD to want to avoid talking about it. But getting help for your symptoms is the best thing you can do. PTSD treatments can work.

    Why is it important to seek care for PTSD?

    There is no need to suffer with PTSD. There are good treatments that can help. You don't need to let PTSD get in the way of your enjoyment of life, hurt your relationships, or cause problems at work or school. Learn from Veterans who talk about living with PTSD and how treatment turned their lives around: AboutFace.

    "Getting better" means different things for different people, but people who get treatment improve their quality of life. In many cases, PTSD treatment can get rid of your symptoms. For some, symptoms may continue after treatment, but you will have learned skills to cope with them better.

    Treatment can also help you:

    • Make sense of the trauma
    • Learn skills to better handle negative thoughts and feelings
    • Reconnect with people you care about
    • Set goals for activities, like work or school, that you can handle

    What are barriers to care?

    There are many different barriers, or things that might stop you from seeking help for PTSD. Part of PTSD is avoiding thinking about the trauma. So, it makes sense that people with PTSD may want to avoid getting treatment. But there are other reasons people might not seek care right away. Research points out some examples:

    • Believing you will get better on your own
    • Problems getting care, like finding a therapist, transportation, or cost
    • Not knowing that PTSD treatments work
    • Thinking that services are for other people, not you
    • Stigma

    What Is Stigma?

    Stigma is when you feel judged by other people because of some personal quality or trait. You may feel stigma because of negative things people say about you, or because they treat you differently. An example of stigma related to PTSD is a belief that people with PTSD are dangerous or unstable, which is not true.

    Some examples of stigma include:

    • Negative labels or stereotypes that assume all people with PTSD are the same
    • Discrimination at work, at school, or finding housing because of your symptoms
    • Being denied chances to succeed because of a PTSD diagnosis

    Because of concerns about stigma, you may try to hide the problem or not admit you need care. You may start to feel that you deserve to be treated badly because of your symptoms. But PTSD is not something to be ashamed of. The best thing you can do for yourself is to take control and get help.

    Barriers specific to military context

    When you are in the military, there are other things that may get in the way of seeking help. Military members may worry that talking about PTSD with doctors, other soldiers, or commanding officers will hurt their career. You may think if people in your unit learn you have PTSD they will see you as weak, or not trust you to be able to protect them. Or, you may feel that your medical records will be opened for other people to see.

    Being afraid that seeking treatment will damage your career leads you to avoid getting help at a time when you need it most. Many don't get help until their return from deployment, or when their family tells them there is a problem. But you don't have to wait.

    You may think that avoiding your PTSD is critical to keeping your job. But if your PTSD symptoms are getting in the way of doing your duties, it is better to deal with them before they hurt your military career. Getting help for PTSD is problem solving.

    How can I overcome barriers to care?

    There are always reasons for people to put off seeking help, especially with PTSD. It is hard to find a therapist, hard to get time off from work, and hard to find the money to pay for treatment. Facing your problems can be scary. It is even harder if you don't know what to expect.

    But if you learn about PTSD treatments, find social support, and get started in treatment, you can feel more in control. You can't change what others think about PTSD, but you can stop it from getting in your way.

    Here are some steps you can take and resources to get help for PTSD:

    • Learn about PTSD and treatments. Knowing that treatment helps and your options is important.
    • Take the first step and find out where to get help. See our Where to Get Help for PTSD page.
    • Talk to someone you trust. Whether you talk to a family member, doctor, chaplain or clergy, or another service member or Veteran, getting support is key to getting better.


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  • Women and depression


    Imagine having feelings of worthlessness or helplessness. Imagine being unable to sleep, feeling restless and irritable much of the time, or even hiding under the covers afraid to face the day. Many who suffer from depression may not be able to concentrate at work or perhaps even get to work. Those experiencing high- and low-functioning depression know such feelings all too well.

    But for women, there are certain times in their lives when a depression diagnosis is more common. Research has shown that hormonal changes at three stages of life—puberty, post-pregnancy, and during perimenopause—may trigger clinical depression.

    Dr. Nancy Skopp, research psychologist at the Psychological Health Center of Excellence, described clinical depression, or major depressive disorder, as a depressed mood lasting at least two weeks and marked by a loss of interest in things that once were pleasurable. She noted that this period would contain a clear change from previous functioning. If someone isn’t completing work duties, shows up late for work, or experiences profound fatigue and avoids interaction with family and friends, depression could be the cause.

    “Depression symptoms in women often occur around a reproductive event,” said Skopp, adding that there is some evidence that suggests women may have a chronic and recurrent course with longer and more frequent episodes than men.

    Skopp cited statistics from the National Institute of Mental Health showing that 50-80 percent of new mothers may experience the “baby blues,” which usually appear about a week after giving birth and include feeling down, irritability, sleep problems, anxiety, and eating too much or too little. The difference is that the symptoms are mild and usually resolve in a week or two.

    Postpartum depression is much more serious, Skopp said. Between 10 and 20 percent of new mothers experience depression, according to NIMH statistics. Symptoms of extreme sadness, anxiety, and exhaustion may make it difficult to complete daily activities as a new mother.

    During perimenopause, usually between the ages of 40 and 50, when the ovaries gradually begin to make less estrogen, depressive symptoms combine with menopausal symptoms. Women may also experience other life challenges, such as the demands of caring for aging parents, a change in marital status, health problems, or negative attitudes about aging. Skopp said although men may experience similar stresses at midlife, the hormonal changes experienced by women may compound such stresses. “It’s a very challenging time,” she said.

    Approximately 12 million women in the United States experience clinical depression each year, with one in eight experiencing depression in her lifetime, according to NIMH research. This rate of depression corresponds to hormonal changes in women, particularly during these three life stages, suggesting that female hormonal fluctuations may be a trigger for depression. Another trigger may be gender differences between women and men, which may be genetic or involve life stressors and coping styles.

    Skopp says research shows women may have a greater tendency to internalize in the face of depressive symptoms. Men appear to be more likely than women to cope with such symptoms through behavioral distraction, such as doing something that takes the mind off depressive feelings. The result appears to be that more active distraction in men may shorten or prevent a depressive episode whereas internalization in women may prolong it. The Centers for Disease Control and Prevention reports that between 2013 and 2016, 10.4 percent of women experienced depression compared to 5.5 percent of men.

    “Being in the military can magnify the depression triggers one might experience in the general population,” said Navy Cmdr. Paulette Cazares, associate director for mental health at the Naval Medical Center San Diego.

    “The benefit of seeing depression as any other illness allows service members to realize the necessity of early treatment, and the ability to stay focused on career and personal goals,” Cazares said. “Psychotherapy or antidepressant medications are first-line options to treat depression and reduce chances of a relapse. Meditation and yoga as therapy have also been used successfully to alleviate depressive symptoms.”

    If you have symptoms of depression, talk to your health care provider. A loved one showing symptoms should be encouraged to speak to a health care provider as well. Military OneSource also has resources and information available for service members and their families.


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  • Women Veterans Stress


    Despite good food, bright lights, and cheer, the holidays come with stress. The pressures, particularly on women, to cook special meals, give gifts, and decorate can be too much. If you are a woman Veteran who has recently left the service, the strain of it all can be particularly tough.

    Holiday stress and readjusting after deployments and long absences from home can be hard. But VA is here to help. Vet Centers across the U.S. offer readjustment counseling services. Here, there is no shame in getting the help you might need.

    Here are a few VA resources that offer support:

    • Readjustment counseling services are available at Vet Centers nationwide for combat Veterans, service members, and their families. This includes family counseling for military related issues, bereavement counseling for families who experience an active duty death, military sexual trauma counseling, and referrals.
    • VA Self-Help Apps, such as PTSD Coach, PTSD Family Coach, and Mindfulness Coach, can help you cope with symptoms related to PTSD and depression. Visit the VA App Store to learn more:
    • 877-WAR-VETS (877-927-8387) Combat Call Center is a 24/7 confidential service connecting Veterans with combat Veteran staff so you can speak in private with someone who understands your challenges.

    If you need to talk to someone this holiday season, VA is here to help. For additional information about VA’s readjustment services, contact the Women Veterans Call Center at 1-855-VA-WOMEN (1-855-829-6636). To find a Vet center near you, visit


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  • PTSD Women


    There are far more men than women Veterans in the VA system. For this reason, many women Veterans are not aware of resources offered just for them. Many women Veterans prefer treatment with other women.

    Research shows that people often do better in treatment with others that are more like them. As a result, mental health services just for women are offered in many VA’s across the country.

    VA Women Veterans Program Managers

    Every VA Medical Center in the country has a Women Veterans Program Manager. This person is your advocate. She can help you get to VA services and programs, state and federal benefits, and resources in the area where you live.

    If you need help:

    If you have questions about your VA care, you should first go to your Women Veterans Program Manager. During normal business hours, you can also contact:

    • The Department of Veterans Affairs Center for Women Veterans at (202) 273-6193
    • The Veterans Health Administration Women Veterans Health Strategic Health Care Group at (202) 461-1070

    Types of VA programs for women

    The following list describes some of the mental health service programs offered by VA for women Veterans. To find out more, see VA PTSD Treatment Programs. The fact sheet links to a list of VA PTSD treatment programs. The list includes programs for women, with contact information. For other help locating a program or service, you should ask your Women Veterans Program Manager.

    • Women's Stress Disorder Treatment Teams (WSDTTs). WSDTTs are special outpatient (not live-in) mental health programs. They focus on treatment of PTSD and other problems related to trauma.
    • Specialized inpatient and residential programs for women. These are live-in programs for women Veterans who need more intense treatment and support. While in these programs, women live either in the hospital or in a residence with other women. For help locating a program, ask your Women Veterans Program Manager.
    • Cohort treatment or separate wings for women. These programs are like the live-in programs discussed above except these programs accept both men and women. Some programs accept women in groups that start treatment together on a certain date. Sometimes the program has a space set apart for women.
    • Women Veterans Comprehensive Health Centers. Complete health centers for women Veterans are located in many VA's around the country. Many of them provide outpatient mental health services to women Veterans. Check with your local Women Veterans Program Manager to see if there is a women's health center that provides mental health services near you.
    • Women Veterans Homelessness Programs. The Women Veterans Program can help you find shelter if you are homeless or at risk of being homeless. Certain VA locations have programs for homeless women Veterans and homeless women Veterans with children. Contact your Women Veterans Program Manager for resources near you. You can also contact the Social Work Services department at your local VAMC. For more information, go to Homeless Veterans.

    For more information

    To learn more about women and traumatic stress, please see this section of materials Specific to Women.


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