Veterans Day: part four

part one
part two
part three

This is the final part of the speech I wrote in 2002 detailing how the veterans compensation system works. This section deals with official rules and cases that are a matter of public record.

To further draw your attention to how this system works, allow me to quote from the Board of Veterans Appeals publication Understanding the Appeal Process, VA Pamphlet 01-00-1, January 2000, p. 16-17:

IS THERE ANY WAY TO HAVE THE BOARD DECIDE MY CASE MORE QUICKLY?

38U.S.C. 7107(a)(2)
38C.F.R. 20.900(c)

If you believe your appeal should be decided sooner than the appeals of others who filed before you did, you can write directly to the Board explaining why. This is called filing a motion to advance on the docket.

Over the years, BVA has granted fewer than three out of every twenty requests for advancement on the docket. That's because most appeals involve some type of hardship, and the Board wishes to treat everyone fairly. You need to show convincing proof of exceptional circumstances before your case can be advanced. Some examples of exceptional circumstances are terminal illness, danger of bankruptcy or foreclosure, or an error by the VA that caused a significant delay in the docketing of your appeal.

Be sure to send us proof of your exceptional circumstances with your motion. For example, if you are about to lose your home due to foreclosure, send us a copy of the notice you received telling you that. If you have terminal illness, include a statement about that from your doctor.

This pamphlet was prepared by intelligent professionals, so please consider the following:

• Most delays in these cases originate with the VA, not with the veteran. But it is the veteran alone who suffers the consequences.
  
  
• The suggestion to send foreclosure papers to prove financial hardship, as the only listed option to prove that point, is irresponsible at best. By the time a veteran has received foreclosure papers, copied them, filed a motion to advance on the docket, had that motion heard, had their case advanced and heard, they might well be homeless.

Whoever, or whatever team, wrote this pamphlet surely was aware of that. Why is this advice being given to veterans? Is it because the VA truly doesn't care whether a veteran becomes homeless? Why are there no consequences to the VA system when that happens?

Now let's look at p. 29:

WHAT HAPPENS TO AN APPEAL IF THE APPELLANT DIES BEFORE A DECISION IS ISSUED?

38U.S.C. 7104(a)
38 C.F.R. 20.1302

According to the law, the death of an appellant generally ends the appeal. So if an appellant dies, the Board normally dismisses the appeal without issuing a decision. The rights of a deceased appellant's survivors are not affected by this action. Survivors may still file a claim at the Regional Office for any benefits to which they may be entitled.

These claims are processed and decided very slowly. If the veteran dies before the VA completes the processing of their claim, which again the Veteran has no or very little control or influence over, the veteran has suffered without that compensation, and their spouse and children continue to suffer. The claim dies with the veteran.

And again the veteran and the veteran’s family pays the price. There are no consequences to the VA system.

Maybe the taxpaying American public really does want to save money in this way, but I’d like to think not. After all, I volunteered to defend them, and want to believe the best about them. I think the public is totally unaware of how this system actually operates and affects veterans.

Last, I draw your attention to the website of the Department of Veterans Affairs. I began reviewing the archives of Board of Veterans Appeals decisions made earlier in 2002.

I dissociated after reviewing five cases and had to stop reading for now. The cases are heartbreaking, and I believe that all five of these veterans did deserve to be compensated. Here is a brief summary:

Case #1: Citation 0202111
Docket: 99-15 798
Decision date: March 6, 2002

This female veteran served from 1987 to 1992. In 1991, five years into her term of service, she was diagnosed with a situational adjustment disorder. Apparently she required a long time to misadjust to life as a soldier.

After her discharge,she was treated for mental health issues at a VA treatment center from 1993 through 1997. Her symptoms included nightmares, panic and anxiety attacks, depression and suicide attempts. The VA did not diagnose her with a personality disorder; instead she was diagnosed with PTSD and panic disorder. The VA clinician believed the veteran had suffered childhood sexual abuse, although she had evidenced no psychiatric symptoms until she was in the military, and continued to have symptoms after discharge.

In 1999 the veteran admitted that she had been raped. The VA found no record of the rape in her medical records, but did find that she had been treated several times for genitourinary problems while in the service around the time she said the rape occurred.

Incredibly, the BVA used her medical treatment for the condition to discredit her testimony that she was raped by saying that this provided her with additional opportunity to report the rape! This ignores the shame a soldier must endure in having to admit to being incapacitated in such a way, and the symptomology of acute stress disorder and cogntive function of being traumatized.

The veteran stated that she was a virgin at the time of the rape. Because she had been taking oral contraceptives at the timme, the BVA found this statement not to be credible. Of course, whether or not she was a virgin had no bearing on whether or not the rape occurred, but it may have added to her mental anguish.

Again, all I can say is that oral contraceptives are really a very logical medication for a female soldier to take. Why are female veterans being emotionally abused and discredited for taking a medication that makes so much sense for them to be on? Because the VA found no evidence of an in-service stressor. They refused to obtain a medical nexus opinion, and refused to order or review a psychiatric compensation exam.

I understand that the BVA contorted and used the rules of the system to fmd against the veteran. They used their rules very well to that end. But was justice done to this veteran? Was her claim handled fairly and impartially? I don't think so.

Case #2: Citation 02022880
Docket 95-38 932
Decision date: March 27, 2002

This case involves a female veteran who was raped in 1979 during VA hospitalization where she was being treated for a psychiatric disorder. The BVA allowed that the rape occurred during the veteran's hospitalization but concluded that she had not incurred further worsening of her symptoms as a result. Therefore she was not eligible for any compensations.

I am surprised to leam that rape has no negative affect on the mentally disabled. I would think that if a person already has a mental disability that rape would be another injury for them to deal with and recover from. I cannot imagine a rape that would have no consequences to the victim.

This same veteran’s records indicate that she began drinking alcohol while in the service. Also there is no record of this veteran experiencing psychiatric problems before her military service, only afterwards. A VA clinician did, however, link her mental health problems back to her childhood, and to her havingbeing born with a cleft palate! Her symptoms include non-assertiveness, passive/dependent personality traits, substance abuse, free-floating anxiety, and dissociation. She was not diagnosed with PTSD, but her symptoms all cross over to that diagnosis.

Case #3: Citation 0202249
Docket 98-06 477
Decision date: March 8, 2002

This is a case involving a female veteran who was on active duty from 1975 to 1977. She initially filed a claim for a service-connected mental disorder, but her VA health care provider had not diagnosed her with PTSD. In later treatment she was diagnosed with PTSD, and a 50% disability compensation claim was allowed.

Her appeal was to make the effective date of her claim the actual date of her initial claim, which had been denied. Her date of earlier disability was not allowed. Her first diagnosis was not PTSD, but all of her symptomology crosses over to that diagnosis, and she was later diagnosed with PTSD. Again the rules were used to disallow a legitimate claim.

Case #4: Citation 0202159
Docket 98-05 461
Decision date: March 7, 2002

This case involves a female veteran who was on active duty from 1966 to 1968. She was stationed in Saigon, Vietnam, in an administrative position. During her tour of duty she was in a combat area and directly witnessed combat, including explosions and death. She was also raped in service.

According to the military rules of that time, she was not officially categorized as being on combat duty. Consequently, the assumption of PTSD connection due to combat was denied to her. This denial is based on a rule she had no control over, rather than on the reality of her tour of duty.

Moreover, other than her own word, she had no supporting evidence that she was raped. She became pregnant as a result of that rape, and was discharged from the service due to that pregnancy.

Her claim was disallowed. So here is a veteran who served in a combat zone, honorably, without the benefit of combat classification. She was raped by a fellow soldier. The rape led to an unplanned pregnancy which resulted in her discharge from the service.

I can't even imagine her pain and suffering.

I understand the need to follow the rules, but what are we to do when the rules lead to so much injustice and further suffering? This soldier served her country honorably, risked her life, and was dishonored and not supported upon her return.

Case #5: Citation 0202078
Docket 96-15 047
Decision date: March 4, 2002

This case involves a male veteral who served two tours of duty: first from 1969 to 1977, and then from 1980 to 1982. His second tour of duty ended in an administrative discharge, and he has been denied VA benefits.

During his period of active service, he reports that he was beaten and sodomized by at least two soldiers in one attack. His record shows evidence of acute stress disorder, in that after he was attacked, his behaviors changed radically. He became disoriented and began to drink alcohol and use drugs excessively. He attempted to commit suicide while in service, which is documented in his records.

Considering the amount of time this veteran served his county honorably it is clear to me that his problems originated while he was in service. Again, maybe he doesn't present himself to be a very attractive, likeable person to the VA staff, but consider his experience, trauma, and mental disorders. If his behavior was adaptive to civilian life, and his appearance normal, he wouldn't need help, or have a well-grounded claim. How can he improve his quality of life without appropriate medical and mental health treatment, and financial support?

Should all claims be allowed? No. Some claims are not well-grounded or legitimate. But many of them, perhaps most of them, are, and yet all veterans are being treated as frauds, cheats, and fakers. For veterans with mental disorders, this becomes particularly damaging. When our legitimate claims are delayed and denied, we are very vulnerable to further damage, which deteriorates our adaptability even more.

I've discovered that I love my country, my government, its military and its veterans enough to speak up and hope for change. Can you help the veterans receive the care they need and deserve?

Veterans Day: part three

Note: this was originally written on June 9, 2002. I recently decided to revise it somewhat for this blog. Revisions, additions, comments, and updates are indicated by italics.

part one
part two

THE SYSTEM FAILS

1. The VA mental health system fails the veteran by, in many cases, giving a veteran multiple mental health diagnoses. When the symptoms are added up, they equal PTSD. But the PTSD diagnosis is not made.

The VA are the PTSD experts of the world. They deal with PTSD continuously. They wrote most of the research on PTSD. In most cases I do not believe ignorance of PTSD can be an adequate excuse for this error. By diagnosing the veteran with personality disorders, depression, anxiety, panic attacks, etc. the correct diagnosis and treatment are not made. The precipitating event is not recognized. Proper treatment and support are not given and the patient suffers excessively.

2. The VA mental health system fails us by exploring childhoods of veterans excessively, in order to give them pre-service traumas. Everyone has childhood experiences that are maladaptive. Everyone has multiple issues in their lives. PTSD involves a traumatic precipitating event. Anyone in therapy would rather talk about something, anything, other than their major trauma.

Since cognitive dysfunction and memory problems are a major symptom of PTSD, it is extremely easy to victimize a PTSD patient in this way. Trust me, we do not want to get anywhere near that traumatic event again. But if we don't, we can't heal, and interact better in the world. Dealing with the trauma doesn't make our PTSD go away but we're able to recognize and deal with our symptoms easier.

By dealing with us therapeutically in this deceptive way, our healing is delayed, and our pain grows. The client/patient needs help. We come to the VA for that help. And in many cases we are betrayed and hurt again.

3. The Regional Offices and Board of Appeals fail us by ignoring the diagnoses and findings of their own psychiatrists, social workers, and compensation examiners, in order to find against the veterans compensation claim. Many people in the VA system courageously (and probably to their own personal career detriment) do diagnose veterans with PTSD. The psychiatrists carefully and thoroughly interview the veteran, considering their current level of functioning, their service record, and their medical history. In many cases they find that the veteran has PTSD, and based on their professional opinion psychiatrically as well as considering the medical symptoms and treatments at the time of the precipitating traumatic event state that:

• The veteran has PTSD
  
• Based on their interpretation of medical files and events, a traumatic event did occur to the veteran while they were in the service
  
• There is a medical nexus, or link, between the veteran's current chronic disease of PTSD and that traumatic event.

That professional opinion establishes that according to the Department of VA rules, the veteran is entitled to continued free mental health treatment and financial compensation to help them survive financially. PTSD has severe financial repercussions in a veteran's file.

The VA chooses to disregard their own professionals. In my own case, two treating psychiatrists, a compensation examination psychiatrist, and several social workers all agree that I have PTSD due to a rape trauma while I was in the service. The VA chooses to ignore their professionals by saying that they can't prove that what happened really did happen.

But that's not a real requirement for establishing a medical nexus. A medical nexus is a trained professional's most careful interpretation of the entire situation. Either that is a consideration in compensation determination, or it is not. If it isn't a consideration, please be honest and stop saying that it is. If the intention is to never compensate a veteran for service-connected systemic mental disorders, please make that the law. Otherwise, treat us honorably and fairly.

I worry about the honest professionals who tell the truth. I wandered for 24 years without knowing what my problems were. Eventually I found help at a VA treatment center. I was diagnosed with PTSD and helped to understand my symptoms. I went through trauma processing and am in group and private therapy.

I am currently only being seen once a month by a VA counsellor, privately, as I couldn't handle group therapy, and broke down further.

I am grateful to the caring professionals who are helping me. I worry that their being honest to the VA system about my disease will negatively impact their careers. That would break my heart again. These are the people who deserve the best from the VA employment system, the recognition, the raises, the promotions. Because they care enough to put their patients first. They see the damage of PTSD. They tell the truth. I hope that truth is a good enough shield for them, but I fear that it will not be.

Telling the truth hasn't exactly helped me out much.

4. The VA Regional Offices and claims systems fail us because records at the time of the traumatic events are missing or incomplete.

Or said to be missing or incomplete.

The VA denies that a traumatic event took place. If no traumatic event took place, the PTSD can't be from an in-service event, and there is no need to order a comprehensive exam to get the professional medical opinion. Nor is there a need for the medical nexus opinion.

Why are records at the time of the traumatic event missing or incomplete? This can be attributed to several reasons. First, the military and the VA control the records, not the veteran. Sometimes records are lost or destroyed in all or in part. Often a veteran will remember seeking medical treatment, but the records are never officially found or produced by the VA.

Moreover, a person who has suffered a traumatic event is psychologically damaged (as well as physically damaged) at the time of the trauma. In many cases they are dissociative and amnesic. Their cognitive functioning is impaired. They are depressed, anxious, and sleep-deprived. This is called acute stress disorder.

People with acute stress disorder make different decisions and behave differently than people who function normally. Because we have acute stress disorder at the time of the trauma, the VA uses our trauma-induced decisions and reports to discredit the reality of our trauma, and denies its existence. Our very mental disorder becomes the basis upon which they deny our claims.

If we were capable of reporting and responding to a "traumatic" event as a non-traumatized or normal person would respond, is that proof that we were not traumatized? Please do not use my mental disorder as a reason or basis to deny that I have a compensable mental disorder. Be fair or change the rules.

5. The VA Regional Office and BVA fail us by asking female veterans reporting rape trauma questions about our contraceptive use at the time of the trauma. They love to find "evidence" that we were on oral contraceptives at the time of the trauma.

What does the use of oral contraceptives mean? It doesn't mean that a given veteran is, is not, is nor plans to be sexually active. Reasons for taking these contraceptives vary with the individual. In any case, if we thought we might become sexually active at some point, are we bad people to want to avoid an unplanned pregnancy? Does that mean that we planned to be traumatized?

Let's consider a more likely scenario, using myself as an example. Many young women suffer from heavy painful periods. By taking oral contraceptives, a woman can reduce her menstrual flow and reliance on sanitary products, and the number of days she will bleed.

She can therefore know exactly when her period will begin, and when it will end. Doesn't it seem that this is a pretty handy thing for a female soldier to know? I even packed a good supply of birth control pills from home so I wouldn't have to worry about whether I could obtain them from the Army doctors or not.

My point is there are a lot of different reasons for women to use oral contraceptives. My personal reason seems the most logical. Apparently, the VA thinks other female soldiers and I took them because we had the time and inclination for numerous casual sexual encounters. Personally, I did not have the time or the inclination for that; I was busy training to be a solider. I was serving the people of my country. I think all of us soldiers were busy being soldiers.

The real issue is, was there a trauma, instead of coming up with a fictitious reason to dislike a person enough to justify denying their claim. Don't assume the worst about me, and I'll try not assume the worst about you. Which means I won’t assume that you, Mr. or Ms. rating/hearing officer, have never been in the military, and don't have a clue what military life really involved during the time of my service.

6. The VA, and sometimes the mental health systems itself, fail us by believing that veterans seek help at VA treatment centers only to pursue compensation claims. Veterans seek help for the same reasons anyone else does. They have medical and/or mental health problems and need treatment. Most of these veterans live in poverty and have no, or inadequate, health insurance.

When they seek medical or mental health care outside of the VA system, that is a reflection of their satisfaction with the care they have received there. If they feel they have been misdiagnosed and not helped, or that their concerns are minimized they seek help elsewhere, just like you would.

7. The VA fails veterans by assuming that all claims are fraudulent, and are processing all claims on that basis. There is a strategy by the VA to slow the claims process down at all levels throughout the process: the initial filing, acknowledging communications from the veteran, and providing the veteran with confusing, inaccurate, and false or misleading information about their claim.

This backlog of claim cases is then used to further justify additional delays in processing the veterans claim. So the VA controls the sluggish speed of the claims process, with no consequences for doing so. Only the veteran has consequences.

All claims deserve to be handled in a reasonable timely manner. I am not asking that all claims be granted. I am asking that they be evaluated fairly, in a timely manner, and that consequences be built into the system to VA employees and the system itself so that the veteran does not suffer from this system with no opportunity or ability to be compensated.

At this time there is discussion about legislation to allow attorneys to represent veterans at the initial stage of the claims process. The Republicans are favoring this as a solution to the slow claims process! As though allowing attorneys, who are paid by the hour to handle VA claims, will speed up the process! What is needed are consequences to the VA employees for delaying and making errors in cases.

For example, in my own case, which has been ongoing for four years now, action was delayed for an entire year at one point because the VA decided that they had issued a "statement of the case" to me.

The statement of the case is the VA's initial summary of the facts of the case and the VA’s decision. A veteran must have a statement of the case before they can appeal a decision against them.

In fact, they had not done so. I was asked to prove to them that I had not received a “statement of the case.” According to them I had received one, and had not responded in time therefore my case was closed.

It was beyond my ability to prove non-receipt of this document. How would you go about proving that you never got something? Congressmen Sherrod Brown corresponded with the VA regional office on my behalf. As a result, I was sent a letter along with a statement of the case which stated that I had not previously been sent a statement of the case" and that this was the first one.

That's very nice. No apology. No consequences to the VA, only to me. This insanity caused a year's delay in my case. The date on which my appeal will be heard is determined by when I officially appeal , which was directly delayed by errors caused the VA, not me. But my case is delayed again, because of their delay. I am the one who pays the price. I wait longer. No consequences to the VA.

Many veterans give up their claims because the process is so demeaning and tiring. Those of use with mental disorders are the least equipped to deal with the additional stress of pursuing these claims, and we need the help.

We have real problems. We live in poverty. We need good VA mental health and medical care. We need financial help. That help was promised to us. Do the American people want their veterans to be treated this way?

Please help to change this system so that it operates more fairly, or please be honest and just tell us mentally disabled veterans to seek help elsewhere. Either answer is fine. I would just like to be treated honestly and fairly. I do not want to be traumatized anymore.

Next: part four, with other real cases.

where credit is due

The next time you pass a homeless man on the street, you might ask in which war he served. In the next several years, chances are good that he (and increasingly she) will say Iraq or Afghanistan.

That grim prediction is based on several facts:

One in three adult homeless males is a veteran and 45 percent of those suffer from mental illness, according to the National Coalition for Homeless Veterans.

A recent report in the New England Journal of Medicine, meanwhile, found that one in four veterans of Iraq and Afghanistan were diagnosed with some kind of mental health problem.

And those are just the ones who found their way to a VA hospital. Many don't. Returning veterans are either embarrassed, untrusting of government, frustrated by bureaucratic gridlock, or simply incapable of navigating the system.

This is an excerpt from an essay by Kathleen Parker. It's a good essay--read the whole thing. bram pointed it out to me and suggested that one of us put up a post about it.

bram had never heard of Kathleen Parker before, but I had. She is one of the stable of right-wing ideologues who write for Jewish World Review. Here's a link to her recent columns for that publication.

I bet I could read any five essays on that page at random and not find one single paragraph that I'd agree with. I know bram well enough to suspect the same would probably hold true for her as well.

Normally I wouldn't link to a column from someone like Parker, unless it would be to mock it. But I have to say it: she does seem to be one of the few right-wingers who actually gets it when it comes to understanding the mental health needs of veterans. She seems to realize that many soldiers come home with a full share of emotional baggage, and that caring for these men and women will require more federal funding than recent Congresses have been willing to subsidize.

Would that more of her right-wing compatriots be as able to view soldiers as more than just replaceable units churned out by the killbot factory. Maybe the tide really has turned with the recent election. Maybe people are starting to wake up to the damage that has been done to this country in recent years. I hope so.

I may never have occasion to write these words again: but thank you, Ms. Parker. Good work.

Veterans Day: part two

(This is part two of a series. The first part is here.)

On Memorial Day, 2002, I was finally able to symbolically march in a parade I had missed 28 years ago. I quietly followed the Memorial Day parade in Lodi, Ohio. My two sons walked with me. I shared with them my feelings about honoring our country, not because our country always does the right things in the world, but because the American people always want and work to do those right things. They want to protect freedom and dignity here and throughout the world.

And veterans are American citizens who go that extra step. They commit their bodies and souls to protect and to defend us all. They don’t just defending the people and the laws that they like. That would be easy. They don’t protect only their parents, their children, their cousins. They protect the people they don’t know. They even protected the people they don’t like. They even protect the people who hurt them, or cheat them out of money, or otherwise treat them unfairly. That's the commitment a soldier makes: to defend everything, and to protect everyone.

Then they come home. Being part of a military organization isn't an easy job. In some ways it's like being a parent. You're never really off duty, never get enough sleep, nerves fray, your mistakes can cost someone their life, and once you've made the commitment, you stay and do the best that you can. And there are some wonderful moments of camaraderie.

And there the similarity ends. Because unlike parenthood, your comrades are all adults, all under stress, and react in their own ways to that stress. And the purpose is different. The military exists to cause destruction and death, not nurturing and growth. The potential for ugliness in any military organization is quite high. Violence is expected. It’s a big part of the job.

The military is a machine programmed for violent intervention. Sometimes it sits and waits, and no orders come to engage in violence. The machine does not wait well. It wants action.

The machine operators—-the people in charge—-have the responsibility of keeping that machine ready, without letting it hurt itself. Sometimes they fail, and violence between soldiers occurs. People make mistakes, and that machine is hard to monitor. But when one American soldier hurts another American soldier, the damage can be incredibly painful.

I am a soldier who has felt that violence. The sense of betrayal and unreality was overwhelming. And I was hurt in a physically painful and deeply personal way. I was hurt as a soldier, as a woman, as a person. A fellow soldier overpowered me (made easier by my trust of his uniform), and raped me orally, vaginally, and anally.

The shock, the pain, the violence of that attack changed me forever. And I didn't even know I had changed because I hurt so badly in my whole being. I dissociated during the rape, which feels like parts of your brain don't communicate with other parts of your brain. If you think of the brain as a series of networked computers, mine became a roomful of stand-alone computers, unable to speak to each other.

To this day, I have to jump from one system to another to do different things. Life is inefficient and tiring. I can't recall events in a clear linear way. My whole system of memory has changed. For quite a long time, I didn't know it had changed, and when I did come to know it, I didn’t understand why it had happened. I was way too disconnected to figure it out on my own.

I have many problems that I don't understand and can't name.

What I have, I finally found, is something called PTSD: Post-Traumatic Stress Disorder. This is a chronic systemic disease, and can be terminal if undiagnosed and untreated. It’s systemic because it affects every part of a person's life: body, emotions, intellect, and soul. It's difficult to diagnose because it affects a person's cognitive functioning and their memory. PTSD is difficult to treat because no one fully understands it, and it is so very pervasive in, and damaging to, a person's life.

Symptoms of PTSD include:

1. Memory problems. Fragmented memories, often available as separate sensory memories. I may remember an event in a non-verbal sensory way, in terms of color, flashes of light, smoke, smells, shades of light and dark, tactile sensations, temperature, breeze. Any of these sensations can take me back to my trauma, leading to

2. Flashbacks. This is where I partially re-experience the event in my mind. I don't think I'm physically there, but my mind is. In my case if someone breathes on the side of my neck my mind takes me back to the scene of my rape, and I am mentally back on that floor. Flashbacks are painful and frightening, emotionally terrifying events. After a flashback, I am prone to

3. Dissociation. This is when I'm not sure where I am. I seem distant and confused. If I talk with you I will not remember our conversation later.

4. Nightmares. Sometimes of the trauma. These often involve sensory fragments incorporated into a new strange dream. Many times dreams are not remembered. I just wake up very alert and scared.

5. Interrupted sleep. Difficulty falling asleep. Difficulty staying asleep. Extreme startle reaction while sleeping in response to any noise or touch. This results in chronic sleep deprivation: no more than three to five hours of sleep each night, for the rest of the person's life.

6. Difficulty traveling. I get lost easily due to memory problems, dissociation, and flashbacks.

7. Difficulty forming close personal relationships, both due to trust and to the difficulty other people have with being friends with, or living with, someone with PTSD symptoms.

8. Difficulty holding a job. Due to symptoms, chronic fatigue from lack of sleep, anxiety, and memory problems.

9. Anxiety and panic attacks.

10. Depression. This is a result of trying to live with PTSD symptoms, difficulty in relationships (which we all crave), employment issues, and unresolved conflicts over the trauma (primarily the belief that there was some reason we were traumatized—like we weren't good enough).

11. Substance abuse. To relieve the depression and to dampen down the symptoms.

Mostly people with PTSD look fairly normal, but our lives are different. We are lonely, isolated, and confused. Life for us is very different from the way it was before the trauma or precipitating event, and very different than the way it would be if we didn't have this disease. Which is hard for us to imagine.

And many people look at us and blame us for being different, for having this disease, for not being pretty or handsome or normal anymore. But we didn't cause our disease. We live with it. It's chronic. Some of us are more damaged than others. Some of us take better care of ourselves than others. And the world hurts some of us repeatedly more than others.

One of the ways that we are hurt is by interacting with the Department of Veterans Affairs, which is staffed by a wide range of people. Some caring. Some indifferent. Some destructive.

Those of us veterans who remember the nation's promise to us seek help, not just for our medical problems, which are easy to see, but also for our emotional and spiritual problems. We were promised this help. We were promised this help whether we came home and you liked us, or didn't like us. We were promised this help because we promised to protect all of you whether we liked you or not. And we honored our promise to defend you. We understood that we were offering our whole beings, including our lives, to that cause.

We came home. We have problems. We ask for help. And the system is failing us. The American people need to know that the system is failing the veterans. You need to know so that you can decide whether you want to try to fix the system, so that it operates more fairly and honors its promises, or whether you want to just leave it the way it is.

Maybe you want to try to fix things. Maybe you don’t. But if you don’t, please don't lie to us. Be honest. If you don’t want to try to fix the system, have the decency to tell us that your intentions have changed, and you cannot or will not honor the promises that were made. Because as bleak as that would be, it’s still better than being lied to all the time.

Coming up next: part three.

Veterans Day: part one of a series

Note: this was originally written on June 9, 2002. I recently decided to revise it somewhat for this blog. Revisions, additions, comments, and updates are indicated by italics.

I recommend that anyone who has PTSD or who has been sexually assaulted be careful, or even to consider avoid reading this. Some of the content is graphic. Feel free to skip those parts to avoid triggering any symptoms of your own! And as always, your comments are welcome.

VETERANS, PTSD, AND THE VA TREATMENT AND COMPENSATION SYSTEM

PART ONE

by bram

About the author: I am a 46-year-old female veteran.

I am 50 years old now.

I joined the U.S. Army in 1974. That same year, while undergoing AIT training in Fort Dix, New Jersey, I was sexually assaulted by a male soldier. I developed hemorrhagic cystitis and was hospitalized for for 40 days with bacterial meningitis.

What is rape? Many people think of rape as “bad sex.” Consider the concept of bad driving. Bad driving can be looking at your radio, then realizing you are on the berm of the road, and correcting the wheels back onto the road. Or it can be a front-end collision with mangled bodies, broken glass, and twisted metal.

Both are instances of bad driving. One may have been preventable. Both may have been preventable. Who knows? But I guarantee you will have a much harder time recovering from the front-end collision (if you recover at all) than from driving off of the road.

My rape was a front-end collision. It wasn’t just non-consensual sex. It wasn’t just bad sex. It was a sexual attack that led to me bleeding so severe (not part of my period), that I was pissing and leaking blood. I had to wear a maxi pad constantly for days afterwards. The attack was so severe that most of the specific fragments of it didn’t resurface in my mind, and then in a jumbled mass, until I gave birth to children many years later.. The pain of childbirth, the bleeding and ripping of flesh, caused the fragmented memories of the rape to resurface from the jail cells my mind had placed them in. I was confused and frightened.

For years the assault was “bad sex” to me. That way I had some control. And control was what I most desperately wanted. Because without personal control, anything can happen to anybody at any time, and that notion was unbearable to me.

While I was in the hospital, after the rape, I was diagnosed by an Army psychiatrist with "transient situational personality disorder."

I wasn't told what my diagnosis was.

This is a fictitious diagnosis, one not listed in the DSM, that seems to mirror what is today known as acute stress disorder. Untreated, that disorder progressed to Post Traumatic Stress Disorder, or PTSD.

I was given a discharge from service but I was denied all benefits. I later asked for the record to be corrected, and ultimately received a 10% disability rating for residuals of meningitis.

I received a college education from a well-respected liberal arts college. I obtained a Bachelor of Arts degree in business administration, and then got my MBA. My GPA in graduate school was 4.0.

Despite my academic success, I have been unable to achieve adequate career, financial, or social adjustment. My life has been a series of failures. No one could ever be more disappointed by my life than I am.

In 1997, I needed medical treatment following the birth of my second son. I received treatment at the Brecksville VA hospital. Through that interventio,n I discovered that I have a mental disorder called PTSD, which I now consider to be a chronic, progressive, systemic disease. I am also diagnosed with migraines, and fibromyalgia, a muscle pain disease activated and aggravated by chronic lack of sleep.

Actually, that diagnosis was wrong, and four years later, after having a continuously high rheumatoid factor and being told I only needed more counseling, I was correctly diagnosed with rheumatoid arthritis, and given some medication for it!

An echocardiogram performed by the VA indicated that I also have pulmonary hypertension, which they have chosen not to treat. I believe that my deteriorating health is directly related to wear and tear of my PTSD symptoms on my body.

There is research linking PTSD (which changes neural pathways) with many health problems, primarily cardiac and auto-immune disorders.

I currently have an appeal to service-connect my PTSD before the Board of Veterans Appeals.

My claim was decided in my favor by the BVA in the fall of 2002, at a percentage just low enough to not warrant 100% compensation.

In the VA system, a disability is rated between 0 and 100%, in 10% increments. A claim to increase the percentage is pending.

I lost my BVA claim to increase my percentage, and my claim is now at the U.S. Court of Appeals.

I am sharing my story out of caring and wanting the world to be a better place. I hope that increased understanding can improve the treatment and lives of all of our veterans who suffer with this disorder. It is a very painful disease.

Click here to read part two.

Veterans Day: an introduction

Happy Veterans Day, I guess.

Despite all the lip service paid to our men and women in uniform, the current administration behaves as though the only good veteran is a dead veteran, to paraphrase an old saying (remember the Indians, ahem, native Americans?).

Why do I feel this way? Well, one day a year we “honor” living veterans. One day a year we honor dead veterans. But each and every day the nation, and that means all of us, ignores their medical and financial needs.

I hear so much about how everyone supports the troops, even if that speaker is against the war, but who supports those troops when they come home? You know, the people who may have survived the physical ordeal, perhaps with some body pieces missing, the ones whose brains were shaken in bomb attacks and who have psychological, neurological, and cognitive deficits? How about the ones with PTSD? Their numbers are growing daily. Who is helping them? Who cares?

The VA medical system is overburdened and underfinanced. Veterans who need care wait months to receive it, often being shuttled from one specialist to another, always waiting for appropriate treatment that they may never receive. Those with physical problems that aren’t easily diagnosable are often told that their problems are psychological, until their illness is so advanced that they may never recover, and their quality of life sucks. Those with psychological problems may be diagnosed correctly (PTSD), or may be misdiagnosed in an attempt to limit the financial compensation that they may be eligible to receive. Counseling, like medical care, is rationed. Many patients are seen by a counselor once a month or so, by a psychiatrist (for a medication check), once every three months or so. This isn't close to being adequate for the kinds of coping problems many veterans have.

But who cares? We live in a society where depersonalization is the norm. I’m pretty familiar with depersonalization--I have PTSD, and I don’t feel real to myself sometimes (okay, a lot of the time). Depersonalization is when someone doesn’t seem real. They don’t have blood, feelings, friends. They are them. In my case, I am them, and self-destructive behavior comes from that.

If you feel real to yourself, and the soldier doesn’t feel real to you, then it’s easy for you to hurt him or her, ignore him or her, pretend any of their problems are solely theirs and not your own. After all, many, if not most, of these soldiers are people from small towns, or impoverished areas of cities where their opportunities were so limited that any way out seemed like a step up, even joining the military.

But these soldiers and veterans are real people. I watch and read the news and I don’t hear the number of casualties being reported. I see faces. I see mangled bodies. I see blood on the ground and on the shredded trucks. I see someone’s mother crying and holding a picture her child painted for her in the third grade. I see a person who will never touch anyone again, or make love, or enjoy the feel of the sun on their face on the first day of spring when the birds are singing and the ground smells damp with life, not death.

When I read of the veterans returning home with injuries I realize that some are in hospitals, alone, receiving what medical care is available. They are struggling to regain some mastery over what is left of their bodies, their minds, their lives. The future they had planned or imagined is gone. The pain is constant, both physical and mental. And who cares?

The veterans that come home with psychological problems (PTSD), whether diagnosed or not, face a confusing and out-of-control future. One of the big problems is that the mentally ill (if I can refer to us as that), are expected to realize that we are mentally ill, and to seek help. Okay. We all see our own reality. What sort of reality does a person see who has just returned from a place where danger lurks everywhere and the smell of death is in the air? Where blood is a paint? Where someone may smile at you and then blow you up? Normal is whatever you live with on a daily basis. A person does not come back from this situation and suddenly think okay, the world is safe now.

Here's a news flash: it isn’t safe anyway. Some places may be safer than others. For many of us the solution is isolation. That’s safe. That makes sense. So the VA needs to make an outreach effort. The public needs to be aware of the need and to do their part.

Another problem is the number of veterans who live in poverty, who are homeless, who have needs they don’t even want to admit to.

In theory there is a compensation system for veterans with physical andor psychological problems. That system is unfair and burdensome, and many veterans give up or die before they can receive any help.

Over the next few days I will be sharing with you something that I wrote several years ago. It does not address specifically the needs of today’s new veterans, because it is very personal, and I am not a new veteran. What I hope to do is to put a face on a problem, to reduce the depersonalization.

My life is pretty screwed up. I have PTSD. I have pulmonary hypertension, I have asthma, and I have rheumatoid arthritis. The worst illness by far is the PTSD, and that’s what I want to share with you. I want to take you inside the PTSD. I want to show you how the compensation system works, and how it doesn't work.

Above all, please honor the veterans more than once or twice a year. That requires a little effort beyond simply slapping a metallic ribbon on your bumper and sticking a flag decal on your windshield, but it is worth it.

Try to see a face, not just a number.

Rumsfeld has gone

Yesterday we put up a post here linking to an Army Times editorial saying that Defense Secretary Donald Rumsfeld must go.

Today he's gone:

Defense Secretary Donald H. Rumsfeld, architect of an unpopular war in Iraq, intends to resign after six stormy years at the Pentagon, Republican officials said Wednesday.

Officials said Robert Gates, former head of the CIA, would replace Rumsfeld.

The development occurred one day after congressional elections that cost Republicans control of the House of Representatives, and possibly the Senate as well. Surveys of voters at polling places said opposition to the war was a significant contributor to the Democratic Party's victory.

Had we known that all it took was for the mighty jaded to weigh in on this issue to get this inept blustering jackass to resign, we'd have done so months ago.

Good riddance, Rummy. Don't let, door, ass, etc.

Rumsfeld must go

[U.S. Defense Secretary Donald] Rumsfeld has lost credibility with the uniformed leadership, with the troops, with Congress and with the public at large. His strategy has failed, and his ability to lead is compromised. And although the blame for our failures in Iraq rests with the secretary, it will be the troops who bear its brunt.

This is not about the midterm elections. Regardless of which party wins Nov. 7, the time has come, Mr. President, to face the hard bruising truth:

Donald Rumsfeld must go.

Harsh words! This must have been written by one of your typical Bush-bashing lefties, right?

Wrong.

war is over (if you say so)

It's got to be tough to be an Army recruiter these days. The people who shout the loudest about the need to go to war are the least likely to volunteer.

So how do you get people to enlist? Well, you could always lie your ass off:

An ABC News undercover investigation showed Army recruiters telling students that the war in Iraq was over, in an effort to get them to enlist.

ABC News and New York affiliate WABC equipped students with hidden video cameras before they visited 10 Army recruitment offices in New York, New Jersey and Connecticut.

"Nobody is going over to Iraq anymore?" one student asks a recruiter.

"No, we're bringing people back," he replies.

"We're not at war. War ended a long time ago," another recruiter says.

Despite the pressure to make quota, these tactics are reprehensible, and any recruiter who would lie like that ought to be held fully accountable for his actions.

Of course, such accountability should begin at the top, but that's not likely to happen with the kind of "leadership" we're getting from men like Bush and Rumsfeld.

lump-sum payment proposal rejected

Tom Philpott reports on military.com:

The Veterans’ Disability Benefits Commission has examined and rejected a proposal that the VA begin offering veterans with lower-rated disabilities a lump-sum payment instead of lifetime monthly compensation. The 13-member commission reached its decision unanimously last week at a public meeting in Washington D.C. It did so after being briefed on the pros and cons of lump-sum VA disability payments, and hearing arguments against the idea from veterans’ service organizations. . . .

Joseph V. Violante, legislative director for Disabled American Veterans, testified Oct. 19 against the lump-sum settlements, on behalf of 13 veterans’ groups and service associations. Later, in an interview, Violante said he was surprised to learn that commissioners, that same day, directed their staff to prepare a decision paper recommending rejection of all lump-sum options. . . .

Veterans should be relieved, said Violante. Those tempted by lump sums, he said, "would be giving up a lot of their benefit . . . and would face the possibility of not being able to re-open their claim should conditions worsen."

This decision is good news for veterans. If the lump-sum payment option were to be enacted, many veterans would lose the ability to reopen their claims and ask for increases in the percentage of their service-connected disability, and resulting increase in their monthly disability payments.

For those of you who are unfamiliar with this system, the VA rates claims on a percentage basis, from 0%, 10%, etc., up to 100%. You guessed it: initially many claims are rated at a very low percentage. Over a period of many years, the veteran may reopen their claim, or go through the appeals process to increase the percentage of disability, and thus the amount of compensation. Many disabilities are rated too low initially, and many disabilities become more severe with age. A lump-sum payment would leave veterans vulnerable as they aged, and unable to access compensation.

So, for whatever reason, the right outcome is in the works! A delightful change of pace from a system that is so adversarial to veterans in general.