Combat Veteran Eligibility: Enhanced Eligibility For VA Health Care Benefits

I know, I know. I'm a little late on breaking the news (2008, hello), I just found it and posted it. If anyone has any experience in filing for these benefits let me know in the comments.

Taken from the VA website:

On January 28, 2008, “Public Law 110-181” titled the “National Defense Authorization Act of 2008” was signed into law. Section 1707 amended Title 38, United States Code (U.S.C.), Section 1710(e)(3), extending the period of eligibility for health care for Veterans who served in a theater of combat operations after November 11, 1998, (commonly referred to as combat veterans or OEF/OIF Veterans or to the recently established Operation New Dawn Veterans).

Under the “Combat Veteran” authority, the Department of Veterans Affairs (VA) provides cost-free health care services and nursing home care for conditions possibly related to military service and enrollment in Priority Group 6, unless eligible for enrollment in a higher priority group to:

• Combat Veterans who were discharged or released from active service on or after January 28, 2003, are now eligible to enroll in the VA health care system for 5 years from the date of discharge or release. NOTE: The 5-year enrollment period applicable to these veterans begins on the discharge or separation date of the service member from active duty military service, or in the case of multiple call-ups, the most recent discharge date. Combat Veterans, while not required to disclose their income information, may do so to determine their eligibility for a higher priority status, beneficiary travel benefits, and exemption of co-pays for care unrelated to their military service.

Rules for Combat PTSD Change within the VA Today

Obama Chronicles writes,

In the weekly address, President Obama outlined how his administration is making it easier for veterans with Post Traumatic Stress Disorder to receive the benefits they need. These new changes in the Department of Veterans Affairs take effect today.

We Combat PTSD Veterans, had to ‘prove’ we were in combat, even though I was awarded the Combat Infantry Badge (CIB). I applied 7 times over 15 years before I was diagnosed and starting receiving care and treatment.

Round and Round the VA Merrygoround

I am doing the, "Hey not in my backyard" thing with the VA again. I go to one therapist in an attempt to be admitted to the PTSD program and they tell me, no, that I am depressed to go see another therapist. It took me 2 months to see this one, then I get another appointment, and then, they tell me to move on down the road. Now at the VA getting in to see a new therapist. So, now I have to wait to see another therapist and guess what? Yep, you guessed it, another two months, add this up, 5 freaking months.

I know that I am depressed AND I know that my PTSD is kickin. Treat PTSD in one clinic, depression in another.....this is madness! No wonder veterans do not come back to another appointment.

Wait, did I just go into a tangent? I was trying to say that I want to go through EMDR therapy, it might take me another 5 months to receive it, but THEY will not get me to turn away!! Thats all folks a little help here please!!

Our Veterans Mental Health System is Broke

The government system (DoD and VA) have become inundated with an ever increasing caseload of mentally ill combat soldiers and veterans. Compounding this problem, approximately 80% of military psychology positions have been filled, along with 80% of the VA positions. This does not reflect other mental health service practitioners.

I have an ongoing dialog with a therapist who just now received Tricare approval (after some much needed advice from a blogger that you might know...Yep, you guessed it, me), and she has taken a crash course in the combat flavor of PTSD. I gave her some direction and research when she was feeling overwhelmed in the beginning, as you can imagine one can when facing the horrors of killing and the pain this brings.

In Kentucky we have two major military bases with many soldiers who I know need help but cannot or will not seek help. Further widening the barriers to care, private practitioners do not have adequate integrative therapeutic skill sets based on the latest up to date research to engage this population, who in the past have been labeled as "treatment resistant." A misconceived attribution attached to combat PTSD (to be addressed in a follow up article).

Not only do we have this gap in services between the government and private sector, we do not have a treatment modality based on the most up to date research, and as if this was not enough of a hill to climb, we have unfilled mental health positions in the military and at the Veterans Administration.

Advocate for Soldiers and Veterans

My Prescription to Address Soldiers and Veterans Issues

• Revamp screening process for returning soldiers, the system as it stands detracts and dissuades soldiers from reporting traumatic stress and depression, thus impeding effective assessment. After a negative report of mental illness, the soldier will have a difficult time in receiving treatment after the fact. The question of "Do you have any psychological problems?", in contrast to the internal question of "Do you want to answer yes, or do you want to go home and see your family and friends?", does not fully appreciate and record the numbers of mentally wounded soldiers.
• Implement rigorous psychological training throughout the military from basic training and integrate into regular training at the company, squad and regimental levels on a continual basis. This will be the only way to break the stigma of psychological wounds. Additionally, it will increase the soldiers capability to recognize internal reactions and external signals from their battle buddies.
• Include a Clinical Social Worker in every Battalion to address psychological needs and counseling as they arise
• Double the Veterans Administration funding
• Replace every bureaucrat that has impeded veterans receiving benefits
• Hire thousands of clinical psych-workers
• Implement effective national treatment and reintegration programs, such as the Minnesota veterans program
• Develop initiatives to fund university programs to teach Combat Trauma Therapy (to aid hiring quotas)
• Significantly increase research monies for combat trauma based disorders, attach funding to universities that have Combat Trauma Therapy programs
• Adopt Substance Abuse and Mental Illness (SAMI) treatment modalities, treating both disorders as primary illnesses, across all VA treatment facilities and contract facilities
• Open long term treatment centers specializing in PTSD, if possible, one in every state
• Fix the VA disability process, in 2005 after 7 tries and 15 years I finally received a diagnosis, treatment and compensation, for which I should have been receiving continuously for 15 years. My mental illness was too severe to navigate the process. Only after spending 20 months in a treatment center was I able to complete the process. The bureaucracy is to complex and overwhelming for someone suffering from PTSD or other psychological injuries.
• Increase Concentration in area of Veteran Criminality research concentrating on connections and implications for individual, family and societal impacts
• Federally mandate Veterans Courts for every major municipal entity, such as Rochester and Buffalo NY, and Tulsa OK. Mandate to direct veterans in rural areas to such courts

Combat Veterans and Institutions: A Systems Analysis

Returning Combat Veterans (RCV), have a difficult time reintegrating back into society and life within their family. They deal with a myriad of symptoms combining to hinder the RCV from coping in the civilian world, while having constructive relationships with their family and friends. The lack of psychological education and training while in the military poorly prepares the soldier for the horrors of war and the negative effects on mental functioning. Further compounding the problems for the RCV upon their return they encounter limited services and a Veterans Administration (VA) system more in tune with economics and regulations then providing best outcomes. The scope of this paper explains these concerns as they relate to the competition between veterans seeking help and a system geared toward a macro structural functionalist model that concentrates on peripheral wide applications. A deeper apprehension and awareness has to come forward for our veterans to get the help they need.

The problem between bureaucracies, the combat veteran and their family receiving help lies with the systems application of dynamic systems theory to address problems that require a more interactive ideology such as the ecological systems approach. The main criticism of systems theory treats the person as a machine or something that can be “fixed” lies central to the VA’s approach (Robbins, S.P., Pranab, C., Canda, E. R., pps. 28-47). The models and programs stemming from government to redress RCV issues fail to take into account the magnitude of their problems that extend beyond the medical model and psychological paradigm. The attempt by the VA to apply a blanket policy of treatment on all veterans who face problems such as the affects of psychological trauma in combat has failed.

The military way of life provides strong attachments through a communal approach to every aspect of interactions between soldiers and their families, whether through a support network for the spouse of a soldier to help one another, or to the training of our troops. Developing and enveloping the individual perspectives while opening them to a cohesive togetherness usually not felt before enlisting in the armed services. Now add in a military conflagration and this level of interpersonal commitment and associations become welded to each other’s identity (Lee, 2008f). By educating the soldiers on how personal bonds can be broken by combat and the importance of redeveloping connections with significant others could lessen the mental shock upon returning home.

While many physical features of the RCV may have changed, the deleterious effects of Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD) leave nothing the same and completely alter the landscape of the mind. “Taking another's life in the name of freedom, patriotism and because of your job description profoundly changes the person.” (Lee, 2008a, para. 2) Their whole existence has been transformed by the experience of killing; the morality of war trumps the niceties of society and lends the RCV to a reflexive reactionary response to the environment. The enormous adaptive impositions caused by combat disposes of coping and social skills, personal values, cognitive development, definitions of boundaries, stress management, and appropriate responses to environmental stimuli. All of these issues combine to challenge the RCV’s reintegration back into society, “…the environment, which is physical and social…can either support or fail to support the adaptive achievements of autonomy, competence, identity formation, and relatedness to others” (Robbins, 35).

Value identifications have importance to the combat veteran with PTSD, as their value system has been compromised by the acts of killing and war. The values and morality of war greatly conflict with society’s norms and principles. When the combat veteran brings this survival perspective home with them it alienates them from everyone who has not experienced combat, war and or trauma. Combat changes and alters the soldier’s sense of importance and trivializes niceties that lubricate society’s interactions and exchanges. Without identifying what values the veteran or soldier deems important they will continue to operate from the old combat values set and wonder why people [fail to] understand them (Lee 2008c, para. 3).

Soldiers in combat develop a powerful attachment to one another; the strength of this symbiotic bonding overshadows all others, even family. First of all the degree of familiarity and closeness that extreme survival situations such as combat, brings people together to a height one has never experienced before. People have an instinctual need to feel a belonging such as in a herd where they feel safe. This “herdness” has supplanted all other attachments while people they once knew intimately have become foreign and strange. The family, friends and soldier feel this estrangement and all involved become unfamiliar and uncomfortable. Family and friends cannot understand what the RCV has been through, so the soldier or veteran seeks other survivors who do (Lee, 2008e).

The militaristic concentration on rituals of drilling and killing so that one becomes a more efficient “terminator” through automatic reflexive responses to survival, leads the veteran prone to using violent behavior in any given situation where boundaries have been crossed. The open system dynamics of “normal” interaction has become highly dysfunctional for the RCV who has lost their “goodness of fit” within their home environment. The breakdown of a unifying suprasystem interferes with the holistic dimensions of the veteran, increasing the separation and antagonizing the loss of identity that humans claim from associations within their communities. Without an understanding of boundary maintenance the RCV often develops a feeling of being attacked at home and in their community due to their inability to adapt to the fluidity of boundaries inherent with socialization.

Ehrenreich (2003) seeks to advance an understanding of “social traumas” where, …[i]n the context of physical devastation, massive social displacement, and ongoing violence, the hierarchy of need reasserts itself: concrete needs for, health care, housing, and jobs, the need for social reconstruction and reintegration, and the necessity of social reconciliation may dwarf individual emotional needs.

The identification and reinforcement of values, emotion identification, and anger management techniques along with stress management training would enable soldiers to realize better coping strategies when coming out of the combat zone. Further, interpersonal communication and social skills education along with boundaries identification would foster closer relationships with significant others (Lee, 2008d). Further on the topic of values and principles, these systems have a connection to feelings and emotions or the lack thereof with one who dissociates as most RCVs and complex-PTSD sufferers do. Emotions and feelings are the arbiters of values, principles, and morality; the ethical dilemmas that keep most people in check can get bypassed with a combat veteran’s lack of affect. A normal reaction with a non-traumatized brain would trigger an emotive response cascading into consideration of appropriate responses. The higher level processes of cognitive interaction delve into a consideration of choices and consequences, whereas the traumatized brain operates from the lower base of primitive survival systems and defensive mechanisms forgoing the thought of repercussions (Lee, 2008c).

The subsystem of a combat squad having experienced several fire fights develops a sense of oneness with each other; they have become an independent ecosystem; one organism through the forging process of fight or flight. Due to the nature of killing and survival their emotionality has become severed from their environment and channeled into the solidarity that soldiering brings. If one of them gets wounded or killed they all feel it through their connection of unity and common goal of survival (Lee 2008d). Bonding through blood and battle takes the soldier to a new level of raw humanism forged through survival and fight or flight defensive mechanisms. The psychology of killing alters the terrain of the mind disabling the rational machinery and enabling the ancient reflexive responsive unconscious (Lee, 2008f).

The focus on killing without contemplating consequences severs the RCVs ritual of connection to community, family, and wholeness resulting in deviant adaptations. Their formative connections have remained back in the field of combat and killing, where they left part of themselves with their buddies who have yet to come home while carrying the guilt of leaving them behind. They feel that egoistic “warrior archetype” connection with the military and the battle buddy who had their back in the combat zone. In this mind frame when the veteran comes home; they become lost in a world that no longer makes sense to them due to adaptive process of bypassing the five senses and emotional attachment to considerations of interactions. The hard wiring of the combat veterans mind acts as if their life depends on the ritualism of defensive hyper-vigilance and keeps the RCV stuck in a malposition (Lee, 2008b).

When combat takes away the soldier who has became the centerpiece of an intimate community it breaks down. Whether he has been buried or she has become a prisoner of her own mind; war fractures the body, mind, spirit and the community that once knew cohesion (Lee, 2008f). Some soldiers will long for that interconnectedness left in the field when they came home and reenlist or volunteer for another tour. Many soldiers find that their PTSD symptoms dissipate or vanish while back in the theater of combat, they have reentered the realm of survival, fight or flight and oneness with soldiering (Lee, 2008e).

The troops who do make it out of the theater of combat have been changed in body and mind. They have lost substantial parts of their mind, soul and community. Psychological trauma devastates the battle buddy, spouse, and children while splintering everything that once was the bedrock of the American Soldier (Lee, 2008f). In addition the military needs to teach mental health sensitivity training and PTSD awareness as a standard, in basic training and continuing throughout their careers thus giving mental injuries of war validity. Training in these areas would give our soldiers an extra set of tools and weapons in fighting the psychological effects of combat and war. Educating them before hand of what they may face upon going home would prepare them if they develop PTSD. Otherwise they will have gained the insights and ability to recognize when their fellow soldier suffers from PTSD (Lee, 2008d).

References
Ehrenreich, J. H., (2003). Understanding PTSD: forgetting trauma. Journal of Social Issues, 3 (1) 15-28.

Lee, S. (2008a, July 13). Forgive me. PTSD, a soldier’s perspective. Retrieved from http://ptsdasoldiersperspective.blogspot.com/2008/07/forgive-me.html

Lee, S (2008b, July 20). My first email response. PTSD, a soldier’s perspective. Retrieved from http://ptsdasoldiersperspective.blogspot.com/2008/07/my-first-e-mail-response.html

Lee, S. (2008c, August 22). Thoughts feelings and behavior. PTSD, a soldier’s perspective. Retrieved from http://ptsdasoldiersperspective.blogspot.com/2008/08/thoughts-eelings-and-actions.html

Lee, S. (2008d, September 5). Fully train our soldiers for the rigors of war. PTSD, a soldier’s perspective. Retrieved from http://ptsdasoldiersperspective.blogspot.com/2008/09/fully-train-our-soldiers-for-rigors-of.html

Lee, S. (2008e, September 6). Soldiers in combat develop powerful attachments to one another. PTSD, a soldier’s perspective. Retrieved from http://ptsdasoldiersperspective.blogspot.com/2008/09/soldiers-in-combat-develop-powerful.html

Lee, S. (2008f, September 14). Lower recruitment standards contributing to military suicide rates. PTSD, a soldier's perspective. Retrieved from http://ptsdasoldiersperspective.blogspot.com/2008/09/lower-recruitment-standards.html

Robbins, S. P., Pranab, C. and Canda, E. R. (2006). Contemporary human behavior theory: a critical perspective for social work. Boston: Pearson Education.

Mental Health Field Unprepared for Epidemic of PTSD

I received this email today and it touches on the topic of how unprepared our nation and mental health field is to handle the cases of PTSD we have right now. What will our veterans do when we have become inundated with the hundreds of thousands of combat vets seeking help in the next 20 years? Suicide rates have begun to climb on a continuous rate since the inception of the war. This trend will only increase in the next couple of decades, as of right now over 6,000 veterans kill themselves each year.

Email from a reader:

I will be reading your blog in detail. I am a counselor in [your nearest town], I have counseled 3 former soldiers, all with varying degrees of combat stress. I wish I could say that I have helped them. There is really no training information for civilian counselors that has satisfied me. The VA is little or no help to me, but I realize that I have to get more savvy about how it can help them. [The nearest base] is little or no help to civilian counselors. They didn’t even have a PTSD group on base until the 7th soldier killed himself in 2007 and received national attention b/c his widow insisted to national news that he was not helped appropriately. That was one who was credited as suicide. I know of a soldier who killed himself and the Army hushed it by giving his widow death benefits by listing it as a combat injury.

Anyway, I have applied for Tricare approval to become a provider and been denied on bogus grounds (last time they said there was no evidence that [my college] is an accredited institution – of course it is) twice despite the horrible mental health needs of the soldiers that any Joe Shomoe can read about online. I’ve appealed a third time. It all sickens me. However, as word spreads that I am open to helping and I have no military ties, they will come. AND they will pay out of their own pockets to get some relief. I want to be more prepared. Maybe you can help me to help them.

I’ll be in touch.

My response:

Thank you Joe (name changed) for your compassion towards veterans with PTSD. This insidious mental injury is all the rage in the news at this time, due to the perseverance of families with soldiers suffering from PTSD and the resulting suicides. I say all the rage because the media puts the face on this issue like things are being done to help, when in reality we are just beginning to touch on the topic and have little research on the complexities of PTSD or the resources to help our veterans. In addition we have insufficient training programs in our colleges and for practitioners already in the field. I will have to take an independent study course to be able to include trauma therapy geared toward PTSD at U of L, so I can be prepared to give our veterans the specialized care they need. We will be facing a mental health epidemic of proportions never seen before in the history of American Warfare. With the unprecedented levels of sustained combat and extended multiple tours our veterans will be facing the crippling effects of PTSD with their families as well as the public with generational consequences.

Thank you again, for your concern and commitment, I will do what I can to help you in your endeavors. I can only offer my experience as it relates to me and my life as I am not yet in the capacity of a therapist. I can answer your questions and give you insights as it pertains to my intuitions and knowledge that I have acquired.

I would like to put your email and my response in my blog as it covers and underscores the issue of how little prepared we are to handle the ensuing issue of PTSD.

A Beginning

I struggled with PTSD for 14 years before I received help for it. My experience with the Veteran's Administration (VA) bureaucracy discouraged me from getting the help that I needed. I attempted to get help 7 times within the VA system. The VA requires that you receive a diagnosis before treatment can begin. But they have you talk about the trauma that gave you the problems without the aid to help you through the triggered responses. It always sent me into a tail spin with no way around it, until I landed in a drug and alcohol treatment center after 14 years of insanity.

I started reading about PTSD to find out why I felt the way that I felt and did the things that i did. I started college along this time and started to have a catharsis, life started coming together in a way that it never had before.

As things progress in a positive manner I began to see how my life could help others and that's when I decided to go to school and become a therapist and specialize in PTSD and trauma therapy. I'm going for a masters in social work, that being the quickest way to attain my goals. I want to work at the VA and try and do some changes on the inside to help other soldiers come to terms with their illness. Then I plan to have my own practice and treat combat trauma in a long term treatment center from a holistic perspective, working on the complete person.